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.

Anomalous carbonate preservation in the abyssal North Pacific, ODP sites 882 and 1179: planktonic foraminiferal analysis, climate change and palaeogeomagnetism /

Thesis (M.Sc.)--Brock University, 2004.

Analysis of the late correspondence between our administration and Great Britain & France, with an attempt to show what are the real causes of the failure of the negotiation.

Ten pieces originally published in the Columbian Centinel. A later edition with imprint New York, Printed for E. Sargeant, 1809, contains two additional pieces.

Supplement to the late analysis of the public correspondence between our Cabinet and those of France and G. Britain /

Caption title.

Drama in education : deconstructing the role of movement in text

The purpose of this study was to conduct a comparative textual analysis on the role of movement in 3 texts in Drama in Education in Canada. As the subject is holistic and encourages creative, active participation, movement was expected to appear, even inadvertently, in both theory and practice. It was hoped that guidelines for the use of movement within Drama in Education would emerge from the texts and that these guidelines would serve as models for others to use. A total of 26 Drama in Education experts in Canada were each asked to list the 10 most important texts in the field. Those who answered were assigned numbers and charted according to age, gender, and geography. An objective colleague helped narrow the group to 16 participants. A frequency count was used, assigning 10 points to the first text on each list, and descending to 1 point for the tenth text listed. Based on the highest number of points calculated, the 5 most frequently used texts were identified. These were compared to ascertain the widest representation ofthe authors' geographic location and gender, as well as differences in theory and practice. The final selection included 3 texts that represented differing approaches in their presentation and discussion of Drama in Education theories and practices. Analysis involved applying 5 levels of commitment to determine if,how, why, when, and with what results movement was explicitly or implicitly addressed in the 3 texts. Analysis resulted in several unexpected surprises around each of the 3 texts. The study also provided suggestions for extending and clarifying the role of movement in teaching and learning in general, as well as for Drama in Education in particular.

An analysis of the systemic aspects of rights training for people with intellectual disabilities

Individuals with intellectual disabilities (ID) as a group have been subject to abuse. Individuals with ID need to be made aware of their rights. The 3Rs: Rights, Respect and Responsibility Human Rights Project is promoting rights awareness in individuals with ID, their caregivers and family members. To be effeCtive, abuse prevention must include support from the whole organization and its processes. This research evaluated the impact of the 3Rs initiative on the organization. It focused particularly on descriptions of organizational change perceived by full-time staff and managers in response to the initiation of the 3Rs Project. Behavioural interviews were conducted and a thematic analysis was used to describe changes in the organizational culture and behavioural mechanisms maintaining these changes. Systemic barriers to change were also explored. The results indicate that the Association is effectively implementing and supporting the rights-based philosophy.

Family attitudes toward the deinstitutionalization of individuals with developmental disabilities in Ontario : a quality of life analysis

The deinstitutionalization of individuals with developmental disabilities to community-based residential services is a pervasive international trend. Although controversial, the remaining three institutions in Ontario were closed in March of 2009. Since these closures, there has been limited research on the effects of deinstitutionalization. The following retrospective study evaluated family perceptions of the impact of deinstitutionalization on the quality of life of fifty-five former residents one year post-closure utilizing a survey design and conceptual quality of life framework. The methods used to analyze the survey results included descriptive statistical analyses and thematic analyses. Overall, the results suggest that most family members are satisfied with community placement and supports, and report an improved quality of life for their family member with a developmental disability. These findings were consistent with previously published studies demonstrating the short-term and long-term benefits of community living for most individuals with developmental disabilities and their families.

The development of a Flanders Interaction Analysis style instrument for use in educational computer mediated communication research

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 E38 D56 1992

Rotational analysis of the 5 1 0 6 1 0 band of formyl chloride

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 C54 L434 1989

The vocation of responsibility : a conceptual analysis of a modern idea

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 P55 N48 2004

Factors Contributing to Reading Performance: An In-Depth Analysis of the “Boy Crisis”

This research used a quantitative study approach to investigate the “boy crisis” in Canada. Boy crisis advocates suggest that boys are being surpassed by girls on reading assessments and promote strategies to assist male students. A feminist framework was used in this study that allowed for an investigation and discussion of the factors that mediate between gender and success at reading comprehension, interpretation, and response to text without ignoring female students. Reading scores and questionnaire data compiled by the Pan-Canadian Assessment Program were used in this research, specifically the PCAP-13 2007 assessment of approximately 30,000 13-year-old students from all Canadian provinces and Yukon Territory (CMEC, 2008). Approximately 20,000 participants wrote the reading assessment, while 30,000 students completed the questionnaire responses. Predictor variables were tested using parametric tests such as independent samples t-test, one-way ANOVA, chi-square analysis, and Pearson r. Findings from this study indicate that although boys scored lower than girls on the PCAP-13 2007 reading assessment, factors were found to influence the reading scores of both male and female students to varying degrees. Socioeconomic status, perceptions of the reading material used in language arts classrooms, reading preference, reading interest, parental involvement, parental encouragement for reading, and self-efficacy were all found to affect the reading performance of boys and girls. Relationships between variables were also found and are discussed in this research. The analysis presented in this study allows parents, educators, and policy makers to begin to critically examine and re-evaluate boy crisis literature and offers suggestions on how to improve reading performance for all students of all socioeconomic backgrounds.

Youth, Global Citizenship and Help: A Critical Rhetorical Analysis of Free The Children

Since 1995 Free The Children (FTC) has grown to be one of the largest and most recognized youth-focused and youth-led non-governmental organizations (NGOs) in Canada. FTC has distinguished itself by developing slick marketing campaigns, promising youth that they will become agents of change who can make a significant contribution towards eradicating poverty and promoting global social justice. The organization has utilized the Internet, creating an engaging and dynamic web page used to promote its development initiatives and celebrate the altruistic actions of its young participants. FTC uses a variety of strategies including text, video and images to persuade the viewer to engage with and elicit support for the organization. FTC attracts viewers by highlighting the successes of its overseas initiatives and the contributions made by young Northern volunteers in the global South. The organization also uses celebrity ambassadors, and cultural events such as We Day to raise its profile. Using a critical rhetorical analysis, this thesis interrogates FTC’s online promotional materials, exploring how the organization uses rhetorical strategies to persuade young people to take an interest in social justice activities. More specifically, an examination of FTC web-based promotional materials identifies and problematizes the organization’s rhetorical emphasis on youth empowerment, global citizenship and direct forms of helping the global South. This thesis argues that FTC does not direct adequate attention to fostering critical awareness among it participants. Further, the organization fails to provide its online participants with the appropriate tools or opportunities to critically engage with the structural issues related to global inequities. This thesis also examines how the organization uses rhetoric that promotes simplistic, feel-good projects that avoid exposing young people to an analysis of global social injustices.