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AIMS/QUESTIONS: To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision. DESIGN: Scoping review of peer-reviewed research and grey literature. DATA SOURCES: CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature. REVIEW METHODS: PRISMA-ScR guidelines were used during the literature review process. Eighty-seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework. RESULTS: Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required. CONCLUSION: Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as 'barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions. IMPACT: This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory

Introduction: Advanced cancer (AC) is increasingly an indication for home parenteral nutrition (HPN) but an area with possible variation in practice between geographical locations. The aims of this study are to explore the views and experiences of international multi-disciplinary teams to determine opinions and practices. Methods: An online questionnaire was developed with members of the Home Artificial Nutrition and Chronic Intestinal Failure interest group of the European Society for Clinical Nutrition and Metabolism (ESPEN) and distributed to colleagues involved in managing patients with AC on HPN. Results: A total of 220 responses were included from 5 continents including 36 countries, with 90% of all responses from Europe. Predicted survival was a key factor influencing the decision to commence HPN for most respondents 152/220 (75%), with the majority of participants reporting that patients should have a predicted survival of ≥3 months if considered for HPN (≥3 months: n = 124, 56% vs. <3 months: n = 47, 21%, p < 0.001). However, most respondents were not confident about predicting overall survival in more than 50% of cases (confident n = 40, 23% vs not confident n = 135, 77%, p < 0.001). Barriers to utilising HPN in AC included colleagues’ objections (n = 91, 46%), lack of local expertise (n = 55, 28%) and funding restrictions (n = 34, 17%). Conclusions: Significant consensus was observed regarding AC as indication for HPN, while areas of variation exist. Survival prognostication is often used as an indication for commencing HPN in people with AC, although the majority of respondents were not confident in prognosticating, suggesting better clinical prognostication tools will be of assistance. Further studies are also required to better understand the obstacles faced by clinical teams to commencing HPN that may explain variations in clinical practice between countries, as well as adressing variation in funding.

Background: The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change. Methods: A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis. Results: Barriers and facilitators were analysed according the COM-B domains. “Capability” factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff “motivation” included skilled facilitation of training, trainees’ desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). “Opportunity” factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential. Conclusions: A wide range of fac

Background: Up to 80% of care home residents have dementia. Ensuring this workforce is appropriately trained is of international concern. Research indicates variable impact of training on a range of resident and staff outcomes. Little is still known about the most effective approaches to the design, delivery and implementation of dementia training. This study aimed to investigate the features and contextual factors associated with an effective approach to care home staff training on dementia. Methods: An embedded, collective case study was undertaken in three care home provider organisations who had responded to a national training audit. Data collected included individual or small group interviews with training leads, facilitators, staff attending training, managers, residents and their relatives. Observations of care practice were undertaken using Dementia Care Mapping. Training delivery was observed and training materials audited. A within case analysis of each site, followed by cross case analysis using convergence coding was undertaken. Results: All sites provided bespoke, tailored training, delivered largely using face-to-face, interactive methods, which staff and managers indicated were valuable and effective. Self-study booklets and on-line learning where were used, were poorly completed and disliked by staff. Training was said to improve empathy, knowledge about the lived experience of dementia and the importance of considering and meeting individual needs. Opportunities to continually reflect on learning and support to implement training in practice were valued and felt to be an essential component of good training. Practice developments as a result of training included improved communication, increased activity, less task-focussed care and increased resident well-being. However, observations indicated positive well-being and engagement was not a consistent experience across all residents in all sites. Barriers to training attendance and implementation wer

The increasing proliferation of Mixed Methods Research (MMR) as an approach to nursing inquiry reflects a pragmatic ‘needs-based’ approach to explore complex social phenomena, which is capable of supporting a deeper understanding of the phenomenon of interest. Combining and interpreting data from the qualitative and quantitative research strands through processes of integration, draws upon the strengths of both paradigms and is considered a desirable outcome which enhances the value of MMR (Fetters et al 2013). However, selecting a MMR approach is not a natural or easy methodological choice, with the challenge of integrating qualitative and quantitative data in MMR subject to long-standing and extensive discourse. Epistemological concerns regarding the compatibility of paradigms, alongside discussion of integration strategies to develop meta-inferences (integrative findings from MMR), and whether data integration is the only possible outcome of MMR, shape the nature of the debate. Reviews of MMR studies reveal discrepancies between principles for integration and what happens in practice, with commentators noting that implementing integration is often limited, under-theorised and difficult to achieve (Fetters et al 2013, Kuckartz 2017, Uprichard & Dawney 2019). This paper critically explores integration principles and practice in MMR, supported with data drawn from a sequential embedded MM study investigating assessment decisions of undergraduate student competence in practice. With integration extending beyond any one individual method, and concerned with interaction, whether coherent or divergent, and synthesis of data across paradigms, this paper will present the stages of an integration strategy, and the underpinning integration principles. The product of integration, through ‘side by side’ integration displays (Kuckartz 2017) will also be outlined. The paper illustrates how findings from integrative synthesis and theorisation can provide impactful explanations f

Background: Up to 80% of care home residents have dementia. Ensuring this workforce is appropriately trained is of international concern. Research indicates variable impact of training on a range of resident and staff outcomes. Little is still known about the most effective approaches to the design, delivery and implementation of dementia training. This study aimed to investigate the features and contextual factors associated with an effective approach to care home staff training on dementia. Methods: An embedded, collective case study was undertaken in three care home provider organisations who had responded to a national training audit. Data collected included individual or small group interviews with training leads, facilitators, staff attending training, managers, residents and their relatives. Observations of care practice were undertaken using Dementia Care Mapping. Training delivery was observed and training materials audited. A within case analysis of each site, followed by cross case analysis using convergence coding was undertaken. Results: All sites provided bespoke, tailored training, delivered largely using face-to-face, interactive methods, which staff and managers indicated were valuable and effective. Self-study booklets and on-line learning where were used, were poorly completed and disliked by staff. Training was said to improve empathy, knowledge about the lived experience of dementia and the importance of considering and meeting individual needs. Opportunities to continually reflect on learning and support to implement training in practice were valued and felt to be an essential component of good training. Practice developments as a result of training included improved communication, increased activity, less task-focussed care and increased resident well-being. However, observations indicated positive well-being and engagement was not a consistent experience across all residents in all sites. Barriers to training attendance and implementation wer

The increasing proliferation of Mixed Methods Research (MMR) as an approach to nursing inquiry reflects a pragmatic ‘needs-based’ approach to explore complex social phenomena, which is capable of supporting a deeper understanding of the phenomenon of interest. Combining and interpreting data from the qualitative and quantitative research strands through processes of integration, draws upon the strengths of both paradigms and is considered a desirable outcome which enhances the value of MMR (Fetters et al 2013). However, selecting a MMR approach is not a natural or easy methodological choice, with the challenge of integrating qualitative and quantitative data in MMR subject to long-standing and extensive discourse. Epistemological concerns regarding the compatibility of paradigms, alongside discussion of integration strategies to develop meta-inferences (integrative findings from MMR), and whether data integration is the only possible outcome of MMR, shape the nature of the debate. Reviews of MMR studies reveal discrepancies between principles for integration and what happens in practice, with commentators noting that implementing integration is often limited, under-theorised and difficult to achieve (Fetters et al 2013, Kuckartz 2017, Uprichard & Dawney 2019). This paper critically explores integration principles and practice in MMR, supported with data drawn from a sequential embedded MM study investigating assessment decisions of undergraduate student competence in practice. With integration extending beyond any one individual method, and concerned with interaction, whether coherent or divergent, and synthesis of data across paradigms, this paper will present the stages of an integration strategy, and the underpinning integration principles. The product of integration, through ‘side by side’ integration displays (Kuckartz 2017) will also be outlined. The paper illustrates how findings from integrative synthesis and theorisation can provide impactful explanations f

DietAdvice is an Australian self-administered dietary assessment website initially developed in 2003- 2005. The website allows patients to enter their dietary information and dieticians to remotely access and interpret the data. DietAdvice is presently being updated with new Australian food composition data. This study aims to describe the update process for moving from 1995 to 2006 food composition data. The database for the website was developed using grouped food data from the NUTTAB 1995 database. All food groups were cross-matched with the food from the NUTTAB 2006 database using the food ID codes. Rules were applied to determine the suitability of the food for inclusion in the database. New, ungrouped foods were considered individually and added to existing groups or grouped together as new groups. Foods within each group were statistically weighted to determine the nutrient profile for each group. The NUTTAB 1995 data was used to develop 19, 103 and 422 first, second and third level groups, respectively. From the NUTTAB 2006 data, an additional 623 foods needed to be individually considered. The final database contained 23, 123 and 430 first, second and third level groups, respectively. Ensuring the most recent food composition data is incorporated into the database of the website will maximise the accuracy of the dietary advice provided by the dieticians.

DietAdvice is an Australian self-administered dietary assessment website initially developed in 2003- 2005. The website allows patients to enter their dietary information and dieticians to remotely access and interpret the data. DietAdvice is presently being updated with new Australian food composition data. This study aims to describe the update process for moving from 1995 to 2006 food composition data. The database for the website was developed using grouped food data from the NUTTAB 1995 database. All food groups were cross-matched with the food from the NUTTAB 2006 database using the food ID codes. Rules were applied to determine the suitability of the food for inclusion in the database. New, ungrouped foods were considered individually and added to existing groups or grouped together as new groups. Foods within each group were statistically weighted to determine the nutrient profile for each group. The NUTTAB 1995 data was used to develop 19, 103 and 422 first, second and third level groups, respectively. From the NUTTAB 2006 data, an additional 623 foods needed to be individually considered. The final database contained 23, 123 and 430 first, second and third level groups, respectively. Ensuring the most recent food composition data is incorporated into the database of the website will maximise the accuracy of the dietary advice provided by the dieticians.

To develop a set of food groups for use in a self-administered, computer-assisted diet history interview for use in Australia by combining foods into groups so as to minimize database error in the macronutrient values for the groups. The program needs to appropriately balance the level of detail used with the load on respondents and errors associated with categorization of foods into groups.

To develop a set of food groups for use in a self-administered, computer-assisted diet history interview for use in Australia by combining foods into groups so as to minimize database error in the macronutrient values for the groups. The program needs to appropriately balance the level of detail used with the load on respondents and errors associated with categorization of foods into groups.

DietAdvice is an Australian self-administered dietary assessment website initially developed in 2003- 2005. The website allows patients to enter their dietary information and dieticians to remotely access and interpret the data. DietAdvice is presently being updated with new Australian food composition data. This study aims to describe the update process for moving from 1995 to 2006 food composition data. The database for the website was developed using grouped food data from the NUTTAB 1995 database. All food groups were cross-matched with the food from the NUTTAB 2006 database using the food ID codes. Rules were applied to determine the suitability of the food for inclusion in the database. New, ungrouped foods were considered individually and added to existing groups or grouped together as new groups. Foods within each group were statistically weighted to determine the nutrient profile for each group. The NUTTAB 1995 data was used to develop 19, 103 and 422 first, second and third level groups, respectively. From the NUTTAB 2006 data, an additional 623 foods needed to be individually considered. The final database contained 23, 123 and 430 first, second and third level groups, respectively. Ensuring the most recent food composition data is incorporated into the database of the website will maximise the accuracy of the dietary advice provided by the dieticians.

DietAdvice is an Australian self-administered dietary assessment website initially developed in 2003- 2005. The website allows patients to enter their dietary information and dieticians to remotely access and interpret the data. DietAdvice is presently being updated with new Australian food composition data. This study aims to describe the update process for moving from 1995 to 2006 food composition data. The database for the website was developed using grouped food data from the NUTTAB 1995 database. All food groups were cross-matched with the food from the NUTTAB 2006 database using the food ID codes. Rules were applied to determine the suitability of the food for inclusion in the database. New, ungrouped foods were considered individually and added to existing groups or grouped together as new groups. Foods within each group were statistically weighted to determine the nutrient profile for each group. The NUTTAB 1995 data was used to develop 19, 103 and 422 first, second and third level groups, respectively. From the NUTTAB 2006 data, an additional 623 foods needed to be individually considered. The final database contained 23, 123 and 430 first, second and third level groups, respectively. Ensuring the most recent food composition data is incorporated into the database of the website will maximise the accuracy of the dietary advice provided by the dieticians.

To develop a set of food groups for use in a self-administered, computer-assisted diet history interview for use in Australia by combining foods into groups so as to minimize database error in the macronutrient values for the groups. The program needs to appropriately balance the level of detail used with the load on respondents and errors associated with categorization of foods into groups.

The recently funded Spatial Environmental Epidemiology in New South Wales (SEE NSW) project aims to use routinely collected data in NSW Australia to investigate risk factors for various chronic diseases. In this paper, we present a case study focused on the relationship between social disadvantage and ischemic heart disease to highlight some of the methodological challenges that are likely to arise. © 2005 Springer Science+Business Media, Inc.

The recently funded Spatial Environmental Epidemiology in New South Wales (SEE NSW) project aims to use routinely collected data in NSW Australia to investigate risk factors for various chronic diseases. In this paper, we present a case study focused on the relationship between social disadvantage and ischemic heart disease to highlight some of the methodological challenges that are likely to arise. © 2005 Springer Science+Business Media, Inc.

Agrin triggers signaling mechanisms of high temporal and spatial specificity to achieve phosphorylation, clustering, and stabilization of postsynaptic acetylcholine receptors (AChRs). Agrin transiently activates the kinase MuSK; MuSK activation has largely vanished when AChR clusters appear. Thus, a tyrosine kinase cascade acts downstream from MuSK, as illustrated by the agrin-evoked long-lasting activation of Src family kinases (SFKs) and their requirement for AChR cluster stabilization. We have investigated this cascade and report that pharmacological inhibition of SFKs reduces early but not later agrin-induced phosphorylation of MuSK and AChRs, while inhibition of Abl kinases reduces late phosphorylation. Interestingly, SFK inhibition applied selectively during agrin-induced AChR cluster formation caused rapid cluster dispersal later upon agrin withdrawal. We also report that a single 5-min agrin pulse, followed by extensive washing, triggered long-lasting MuSK and AChR phosphorylation and efficient AChR clustering. Following the pulse, MuSK phosphorylation increased and, beyond a certain level, caused maximal clustering. These data reveal novel temporal aspects of tyrosine kinase action in agrin signaling. First, during AChR cluster formation, SFKs initiate early phosphorylation and an AChR stabilization program that acts much later. Second, a kinase mechanism rapidly activated by agrin acts thereafter autonomously in agrin's absence to further increase MuSK phosphorylation and cluster AChRs.

Mice deficient in src and fyn or src and yes move and breathe poorly and die perinatally, consistent with defects in neuromuscular function. Src and Fyn are associated with acetylcholine receptors (AChRs) in muscle cells, and Src and Yes can act downstream of ErbB2, suggesting roles for Src family kinases in signaling pathways regulating neuromuscular synapse formation. We studied neuromuscular synapses in src(-/-); fyn(-/-) and src(-/-); yes(-/-) mutant mice and found that muscle development, motor axon pathfinding, clustering of postsynaptic proteins, and synapse-specific transcription are normal in these double mutants, showing that these pairs of kinases are not required for early steps in synapse formation. We generated muscle cell lines lacking src and fyn and found that neural agrin and laminin-1 induced normal clustering of AChRs and that agrin induced normal tyrosine phosphorylation of the AChR beta subunit in the absence of Src and Fyn. Another Src family member, most likely Yes, was associated with AChRs and phosphorylated by agrin in myotubes lacking Src and Fyn, indicating that Yes may compensate for the loss of Src and Fyn. Nevertheless, PP1 and PP2, inhibitors of Src-class kinases, did not inhibit agrin signaling, suggesting that Src class kinase activity is dispensable for agrin-induced clustering and tyrosine phosphorylation of AChRs. AChR clusters, however, were less stable in myotubes lacking Src and Fyn but not in PP1- or PP2-treated wild-type cells. These data show that the stabilization of agrin-induced AChR clusters requires Src and Fyn and suggest that the adaptor activities, rather than the kinase activities, of these kinases are essential for this stabilization.

The correlation between toughness, microstructure, and interface form was examined for nickel-molybdenum composites (Vf 0.08 and 0.20) in the diffusion-bonded condition and following elevated-temperature exposure. Instrumented Charpy tests were conducted on subsize specimens notched perpendicular to the direction of reinforcement. By testing above (ambient) and below the ductile to brittle transition temperature (DBTT) of the wire reinforcement, a direct comparison of impact response of ductile matrix-ductile fiber and ductile matrix-brittle fiber systems was possible. Composites exhibited a high level of toughness for all combinations of Vf, exposure history, and impact temperature; Charpy values were in the range 28-36 ft.lbs. (39-48.7J) and 10-19 ft.lbs. (13.5-25.7J) for Vf levels of 0.08 and 0.20, respectively. For each combination of test temperature and composite structure, increasing the level of reinforcement lowered toughness. Wire necking occurred at both Vf levels in the as-fabricated condition at room temperature. Pull-out was restricted to the lower volume fraction composites. Multiple fiber fracturing was a characteristic feature of low-temperature impact testing. Impact energy for the ductile matrix-brittle fiber condition can be predicted from the Cooper-Kelley model if an effective flow-stress is used for the matrix to accommodate work-hardening. A micromechanical model was developed for the ductile fiber condition which allowed for prediction of impact energy from tensile behavior of the constituents, and which accounted for the change in toughness associated with interface intermetallic compounds. (Author)

The tensile behavior of Ni-Mo and Nichrome-W filamentary composites (V sub f < or = 0.2) has been examined with particular reference to the effect of prolonged exposure at temperatures up to 1473 K. Composites were tested above and below the DBTT of the wire reinforcement to give a direct comparison of ductile matrix-ductile fiber and ductile matrix-brittle fiber behavior. Data were analyzed in terms of micromechanical models of composite deformation. For ductile fiber reinforcement, the rule of mixtures analysis of composite tensile strength must allow for a reduction in V sub f fue to interface reaction, and for a decrease in the fracture strain of the composite compared to the as-fabricated condition. With brittle reinforcement, following elevated temperature exposure, composite tensile strength was lower than that of the matrix material; fiber-matrix reaction induces notch sensitivity in the fibers and alters constituent properties such that the fiber content required for reinforcement is raised to a level above that existing in the nickel or nichrome matrix. The nature and extent of the interface-reaction products were characterized and the effectiveness of diffusion barrier coatings of Y203 appraised. (Author)