The journey towards comprehensive school health within an aboriginal community

The purpose of this research is to describe the journey towards Comprehensive School Health at two Aboriginal elementary schools. An advocate and a healthy schools committee were identified at both schools and were responsible for developing initiatives to create a healthy school community. A case study was used to gather an in-depth understanding of Comprehensive School Health for the two schools involved. As a researcher, I functioned within the role of a participantobserver, as I was actively involved in the programs and initiatives completed in both schools. The research process included: the pilot study, ethics clearance and distribution of letters of invitation and consent forms. Data collection included 16 semi-structured, guided interviews with principals, teachers, and stupents. Participant observations included sites of the gymnasium, classroom, playgrounds, school environments, bulletin boards as well as artifact analysis of decuments such as school newsletters, physical education schedules and school handbooks. The interviews were transcribed and coded using an inductive approach which involves finding patterns, themes and categories from the data (patton, 2002). Research questions guided the findings as physical activity, physical education, nutrition and transportation were discussed. Themes developed t~rough coding were teacherstudent interactions, cultural traditions, time constraints and professional development and were discussed using a Comprehensive School Health framework.

The Effectiveness of Learning Portfolios: A Study of Quality Assurance Programs of Selected Health Regulatory Colleges in Ontario

Health regulatory colleges promote quality practice and continued competence through Quality Assurance (QA) programs. For many colleges, a QA program includes the use of portfolios that incorporate self-directed learning. The purpose of this study was to determine some of the issues surrounding the effectiveness of QA portfolio programs. The literature review revealed that portfolios are valuable tools, but gaps in knowledge include a comparative analysis of QA programs and the perspective of regulatory college administrators. Data were collected through interviews with 6 administrators and a review of 14 portfolio models described on college websites. The results from the two data sources were applied to Robert Stake's responsive evaluation framework to identify issues related to the portfolio's effectiveness (Stake, 1967). The learning components of portfolios were analyzed through the humanist and constructivist lenses. All 14 portfolio models were found to have 3 main components: self-diagnosis, learning plan and activities, and self-evaluation. However, differences were uncovered in learners' autonomy in selecting learning activities, methods of portfolio evaluation, and the relationship between the portfolio and other QA components. The results revealed a dual philosophy of learning in portfolio models and an apparent contradiction between the needs of the individual learner and the organization. Paths for future research include the tenuous relationship between competence and learning, and the impact of technical approaches on selfdirected learning initiatives. A key recommendation is to acknowledge the unique identity of each profession so that health regulatory colleges can address legislative demands and learner needs.

Greener Golf Operations: A Comparative Case Study of Ontario Golf Courses Engaged in Environmental Sustainability Initiatives

This research explored environmental sustainability (ES) initiatives at five top-ranked Ontario golf courses that were members of the Audubon Cooperative Sanctuary Program for Golf (ACSP). Research Questions: (1) How are golf courses adapting to safeguard the natural environment? (2) Why or why not are golf courses moving to ES? and (3) What are the arising barriers to ES in golf and how can they be overcome; what role does communication play? Overall, the research was framed with an adaptation of the dimensions of convergence by Houlihan (2012), including the motives, inputs, implementation, momentum, and impact. Additionally, impression management and message framing constructs were utilized to address the issue of communicating ES initiatives. Data collection involved in-depth interviews, observations, and unobtrusive document collection. Environmental aspects of the examination were guided by the Canadian Standards Association (CSA) Requirements and Guidance for Organizers of Sustainable Events and Sustainable Sport and Event Toolkit (SSET).

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.