Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

Ethical space in a secondary school: a case study /

Discourse in the provincial education system that includes Aboriginal peoples is a convoluted one-sided affair. This has contributed to the limited academic success for Aboriginal secondary students in the provincial school system. The Office of the Auditor General (2004) announced a 27-28 year gap in Academic success compared to non- Aboriginal students (p. I). Both Aboriginal and non-Aboriginal stakeholders are fiiistrated and confused with the lack of support for long-term solutions to address academic success for Aboriginal students. The boundaries in education that exist between the dominant society of Canada and Aboriginal peoples in education are hindering the development of ethical space in which to negotiate and apply "concrete arguments and concepts" (Ermine, 2000, p. 140) for 'best' solutions across the cultural divide. Recent literature suggests a gap in knowledge to address this cultural divide. This study reveals racism is still prevalent and the problem lies in the fallacy of Euro-Western pedagogical beliefs. There is a need to design ethical space that will assist transformation of cross-relations in education for inclusion of Aboriginal voices and content. I submit that ethical space involves physical and abstract space. This report is a qualitative, exploratory, and single case study of one northern Ontario secondary school attended by First Nations and Metis peoples who comprise 35% of the school population. Twenty-six stakeholders volunteered to participate in six interviews. The volunteers in this study are Aboriginal and non-Aboriginal. Aboriginal peoples are firom two First Nations, and Metis peoples. It is an Aboriginal designed and delivered study that a) describes an Aboriginally-designed research method to gather data across cultural divides in a secondary school, b) reviews Tri-Council Policy Section 6 (TCPS) regarding 'good practices' in ethical research involving Aboriginal peoples, and c) summarizes stakeholder perspectives of the 'best educational environment' for one secondary school.

Aboriginal women in education : Honouring our experiences a vision of access to and success within the university

This thesis explores Aboriginal women's access to and success within universities through an examination of Aboriginal women's educational narratives, along with input from key service providers from both the Aboriginal and non-Aboriginal community. Implemented through the Wildfire Research Method, participants engaged in a consensusbased vision of accessible education that honours the spiritual, emotional, intellectual, and physical elements necessary for the success of Aboriginal women in university. This study positions Aboriginal women as agents of social change by allowing them to define their own needs and offer viable solutions to those needs. Further, it connects service providers from the many disconnected sectors that implicate Aboriginal women's education access. The realities of Aboriginal women are contextualized through historical, sociocultural, and political analyses, revealing the need for a decolonizing educational approach. This fosters a shift away from a deficit model toward a cultural and linguistic assets based approach that emphasizes the need for strong cultural identity formation. Participants revealed academic, cultural, and linguistic barriers and offered clear educational specifications for responsive and culturally relevant programming that will assist Aboriginal women in developing and maintaining strong cultural identities. Findings reveal the need for curriculum that focuses on decolonizing and reclaiming Aboriginal women's identities, and program outcomes that encourage balance between two worldviews-traditional and academic-through the application of cultural traditions to modern contexts, along with programming that responds to the immediate needs of Aboriginal women such as childcare, housing, and funding, and provide an opportunity for universities and educators to engage in responsive and culturally grounded educational approaches.

The Perceptions of Kinesiologists of Ethics and Professionalism as Established by the College of Kinesiologists of Ontario

As of April 1, 2013 kinesiology became a regulated health profession in Ontario. With its own governing body, the College of Kinesiologists of Ontario (CKO), there are new ethical and professional standards to which kinesiologists must adhere. The purpose of this study is to investigate kinesiologists’ thoughts and perceptions regarding the CKO’s Practice Standards, Guidelines and Code of Ethics, and their level of ethical knowledge and training. Eleven semi-structured interviews were carried out with kinesiologists. Interview data was analyzed through the development of general themes. Findings revealed that kinesiologists are confident of their ethical decision making skills but are in need of more ethical and professional education and training in order to become respected healthcare professionals in the healthcare community and in the eyes of the public. Furthermore, there were key areas identified in need of improvement regarding the quality of the Practice Standards, Guidelines and Code of Ethics. Additional findings, implications and recommendations for future research were also discussed.

Anticipated Guilt and Ethical Consumption: The Moderating Role of Consumers’ Socially Responsible Consumption Behaviour

Recent research in the marketing literature has indicated that, while consumers’ interests in ethical products are growing, demand for such products still remains weak. Previous research has indicated that anticipated guilt can have a positive effect on ethical consumption. Thus, the objective of the current study is to investigate the moderating role of consumers’ socially responsible consumption behaviour (SRCB) on the relationship between anticipated guilt and ethical consumption. Specifically, the current study hypothesizes that, when viewing a guilt ad, high (vs. low) SRCB individuals will generate higher, ethical purchase intentions, willingness to pay an ethical premium, and attitudes toward an ethical brand. The findings from the two experimental studies indicate that, when viewing a guilt ad for an ethical product, high SRCB individuals are willing to pay a higher ethical premium and generate more favourable brand attitudes than low SRCB individuals. However, when viewing a non-guilt ad, high SRCB individuals did not differ from low SRCB individuals in their willingness to pay an ethical premium or brand attitudes. Further, consumers’ socially conscious self-identity was explored as a mediator of these effects. By understanding the moderating role that SRCB plays in the relationship between anticipated guilt and ethical consumption, this paper intends to assist marketers in understanding for which consumers a guilt appeal is an appropriate strategy in marketing ethical products.