Evaluating the impact of decision making during construction on transport project outcome

Decisions made during the project construction phase may bear considerable impacts on the success of transport projects and undermine the ex-ante project evaluation. An innovative and holistic approach has been taken to assess and address this issue by (a) examining the decision process and procedure during project construction, through a field survey, (b) assessing the impact of decisions made during construction on respective transport project and, finally, (c) developing a quality monitoring framework model which links decisions made during the project implementation (construction) phase with the ex-ante and ex-post project evaluations. The framework model is proposed as a guiding and support tool for decision makers.     

Red balloon: approaching dreams as self-narratives

In this article, dreams are seen as stories within a self-narrative. Dream stories, like all other stories, are told in an effort to make sense of experiences. Here, dream content is linked to current concerns, some aspects of which are not given voice in waking. Dreams depict restricting themes but also openings in self-narratives. Several examples are provided of how dreams can be linked to early, middle, and late therapy phases associated with recognizing, challenging, revising, and maintaining a revising stance. It is further suggested that dream stories can be used to trace, facilitate, and evaluate the process of reconstructing self-narratives. Finally, a number of therapeutic interventions are briefly presented to facilitate the work of narrative-informed family therapists working with individuals, families, and groups.     

A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

BackgroundImplementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging.AimTo identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation.MethodSeven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis.FindingsThree overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.ConclusionsHealth care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.     

Space,place and the midwife: Exploring the relationship between the birth environment,neurobiology and midwifery practice

BackgroundResearch indicates that midwives and their practice are influenced by space and place and that midwives practice differently in different places. It is possible that one mechanism through which space and place influence midwifery practice is via neurobiological responses such as the production and release of oxytocin, which can be triggered by experiences and perceptions of the physical environment.AimTo articulate the significance of space and place to midwifery and explore the relationship between the birth environment, neurobiology and midwifery practice.DiscussionQuality midwifery care requires the facilitation of trusting social relationships and the provision of emotionally sensitive care to childbearing women. The neuropeptide oxytocin plays a critical role in human social and emotional behaviour by increasing trust, reducing stress and heightening empathy, reciprocity and generosity.Principle conclusionThrough its role as a trigger for oxytocin release, the birth environment may play a direct role in the provision of quality midwifery care.