A combination of strokes works well to relieve muscle tension. Try gentle chops with the edge of your hands or tapping with fingers or cupped palms. Put fingertip pressure on muscle knots. Knead across muscles, and try long, light, gliding strokes. You can apply these strokes to any part of the body that falls easily within your reach. For a short session like this, try focusing on your neck and head:
To gain a deeper understanding of the influence of the nursing work environment on patient experiences, we conducted four focus groups. The purpose was to elicit ideas, thoughts and perceptions from nurses  about patient experiences and how nurses can improve those experiences. We recruited participants by purposeful sampling, using the following criteria:
The organisations we recruited are participating in a Dutch programme called Excellent Care. The programme is based on the eight essentials of magnetism and focuses on creating a dynamic, inspiring and innovative nursing work environment in order to improve the quality of care. We asked the programme director of each organisation to recruit nurses for the focus groups. A total of 26 registered nurses participated. Each focus group consisted of 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care, respectively. The nurses described their perceptions and views with respect to their own areas of expertise.
The sample consisted of 26 registered nurses (6 male and 20 female nurses). The mean age of the participants and the mean length of nursing experience varied per focus group, as shown in Table 2 below.
Participants in all four focus groups stated that the scope of practice for which they are accountable influences patient experiences. The scope of practice, according to them, means that nurses can control their own work related to patient care and can make independent decisions about patient outcomes based on clinical judgements. Participants therefore believe it is essential to monitor and measure outcomes, as long as the monitoring is directly related to patient care. However, participants indicated that they did not have insight into care results obtained from assessments.
According to participants, the focus of nurses is the provision of patient-centred care. They define this as nursing care that is focussed on patient needs and preferences and is intended to increase patient self-management and encourage improved health and recovery.
Participants stated that organisation policy is focused on the efficient and effective deployment of people and resources. They mentioned the transfer of tasks to less well qualified nurses in order to work as efficiently as possible and to achieve higher productivity. In their view, care is more and more standardised. At the same time, they noted that care has become increasingly complex. According to them, patients are generally older and have multiple age-related comorbidities. The participants experience an increasing workload and work-associated pressure.
The other sub-question concerned mechanisms by which these elements lead to better patient experiences. By analysing the data it became clear that nurses operate in a complex healthcare context. These different views control the manner in which nurses can practise their profession. We noticed that nurses are confronted with organisation policies that are focussed on cost-efficiency, transparency and accountability goals. According to participants, this has led to a more productive care system. It also became clear that nurses flourish within a patient-centred care system. Such a system supports individual patients in their need to make decisions and participate in their own care. This means that organisations should facilitate a culture where nurses can professionally support patients by practising high-quality nursing care .
It could be argued that the dominance of cost-effective policy and transparency determines the manner in which nurses can practise their profession and that this influences patient experiences of care. Ancarani  showed that patient satisfaction was negatively associated with management-controlled wards that are under pressure to produce. Open, collaborative, innovative wards and wards that are focused on the welfare and involvement of nurses and that provide supervisory support and training were positively associated with patient satisfaction. This confirms that the environment in which nurses operate influences patient experiences of the quality of care. This corresponds with the findings of our research, in which participants stated that the dominance of policies focussed on cost-effectiveness and transparency lead to more pressure to produce and a high administrative workload. The participants feel that they have insufficient autonomy to influence this policy.
This research revealed several factors that nurses find inhibiting when it comes to improving patient experiences of the quality of nursing care. Current nursing policy is heavily focussed on cost-effectiveness and transparency for external accountability, which creates a high administrative workload and pressure to increase productivity. However, despite all the registrations that take place for external accountability, the participating nurses stated that they do not monitor care results to improve their own practice. They felt they insufficient autonomy to influence this. They believe it is important to reflect upon and discuss nursing issues related to the quality of patient care, including patient experiences.
The authors should like to thank all the nurses who participated in the focus groups. We also want to thank the programme directors who helped to recruit the participants and who facilitated the interviews by providing an interview room. This paper represents independent research that was not funded by a grant.
RK participated in the design of the study, conducted the focus groups and analyses, and drafted the manuscript. BdB participated in the data collection (two focus groups) and revised the manuscript. DD participated in formulating the research questions, designing the study, and collecting and analysing the data (two focus groups), and helped to draft the manuscript. ALF participated in the design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.
Write it down. Put your specific goal in writing. Then write it down again. And again. Research shows that writing down a goal is part of the mental process of committing to it. Write your goal down every day to keep you focused and remind you how much you want it.
In other cases, you might want to isolate a subject in the frame with a shallow depth of field. This is a great way to focus on something in particular without needing a close-up or extreme close-up.
The trouble with the split diopter is that is produces shots that are "impossible." In other words, our eyes can't create their own split focus image, it's unnatural. So, when we see it in a film, you run the risk of pulling the audience out of the movie.
A user needs analysis was undertaken to inform the content, design, and structure of the CALD Assist app. Two components were undertaken as part of the user needs analysis: (1) a review into the languages required to be part of app and (2) focus groups conducted to elicit information from allied health end users on their current practices and modes of assessment .
Recruitment of user needs focus group participants was achieved through the managers of allied health discipline. Each identified staff member was invited by email. A total of 19 staff members participated.
The feasibility evaluation included clinician and patient participant groups. All focus group participants were invited and agreed to participate in the baseline data collection stage of the evaluation. Additionally, all allied health staff working on wards where the CALD Assist app was introduced were invited to participate in the live trial. Candidate clinical participants were contacted via an invitation email that included a copy of the information sheet and consent form. Clinician training was conducted by the principal investigator (PI) at designated allied health discipline staff meetings. A total of 58 clinician participants were recruited to the trial, including the 19 participants who also consented for the focus groups and baseline data collection. As opportunity to participate was dependent on a need for the app on trial wards during the trial period; not all clinicians were able to take part.
As a follow-up exercise, participants were asked to identify phrases suitable for their app-enabled assessments. These were provided to the researchers in the week following the focus groups. The phrase lists supplied during and after the focus groups were aggregated, refined, and classified in relevant subgroups by the project team before being circulated to participants and colleagues for discussion and approval.
We hope that by providing evidence in the design and evaluation of CALD Assist that we have addressed these gaps and will instill confidence in allied health clinicians in the use of the app as part of their care delivery. We look forward to comparing the patient experience with CALD Assist to other apps in the market in future studies. CALD Assist is available for download to iPads via the Apple App Store. 2b1af7f3a8