Development, implementation and evaluation of a clinical research engagement and leadership capacity building program in a large Australian health care service

BACKGROUND: Health professionals need to be integrated more effectively in clinical research to ensure that research addresses clinical needs and provides practical solutions at the coal face of care. In light of limited evidence on how best to achieve this, evaluation of strategies to introduce, adapt and sustain evidence-based practices across different populations and settings is required. This project aims to address this gap through the co-design, development, implementation, evaluation, refinement and ultimately scale-up of a clinical research engagement and leadership capacity building program in a clinical setting with little to no co-ordinated approach to clinical research engagement and education.

METHODS/DESIGN: The protocol is based on principles of research capacity building and on a six-step framework, which have previously led to successful implementation and long-term sustainability. A mixed methods study design will be used. Methods will include: (1) a review of the literature about strategies that engage health professionals in research through capacity building and/or education in research methods; (2) a review of existing local research education and support elements; (3) a needs assessment in the local clinical setting, including an online cross-sectional survey and semi-structured interviews; (4) co-design and development of an educational and support program; (5) implementation of the program in the clinical environment; and (6) pre- and post-implementation evaluation and ultimately program scale-up. The evaluation focuses on research activity and knowledge, attitudes and preferences about clinical research, evidence-based practice and leadership and post implementation, about their satisfaction with the program. The investigators will evaluate the feasibility and effect of the program according to capacity building measures and will revise where appropriate prior to scale-up.

DISCUSSION: It is anticipated that this clinical research engagement and leadership capacity building program will enable and enhance clinically relevant research to be led and conducted by health professionals in the health setting. This approach will also encourage identification of areas of clinical uncertainty and need that can be addressed through clinical research within the health setting.

A survey to evaluate the implementation of a national clinical assessment form

Purpose: The Australian Universities Radiation Therapy Student Clinical Assessment Form (AURTSCAF) was designed to assess the clinical skills of radiation therapy (RT) students from the six universities that offer entry level RT programs. Given the AURTSCAF has now been in use for over two years, the Radiation Therapy Program Coordinators (RTPC) group initiated a post implementation evaluation survey. This formed the final phase of the AURTSCAF project and was funded by the Radiation Oncology Division of the Department of Health and Ageing. Methods: A cross-sectional designed survey using purposive sampling was distributed via email to all RT clinical sites. The survey asked questions about the requirements of a pass grade for students at different stages of their program, and the addition of a new category of assessment related to fitness to practise. Response types included both forced choice closed ended responses and open ended responses. There was also a section for open comments about the AURTSCAF. Results: There were 100 responses (55%) from clinicians who had utilised the assessment form over the previous 12 month period. Responses highlighted several positives with regard to the utility and implementation of the form. Comments regarding areas for improvement with the standardisation of the grading of students and consensus for the addition of a new domain in fitness for practise have informed the recommended changes proposed for 2012. Conclusion: This evaluation has provided a representative sample of the views of clinicians involved in assessing students on clinical placement. Recommendations include the addition of the sixth domain of assessment: Fitness for practise, the addition of descriptors and prompts for this domain in the user guide, the addition of a consensus statement about the use of the rating scale and dissemination of the proposed changes nationally.

Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study

Objective: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. Methods: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. Results: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. Conclusion: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. Implications: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

Methods for exploring implementation variation and local context within a cluster tandomised community intervention trial

Insignificant or modest findings in intervention trials may be attributable to poorly designed or theorised interventions, poorly implemented interventions, or inadequate evaluation methods. The pre-existing context may also account for the effects observed. A combination of qualitative and quantitative methods is outlined that will permit the determination of how context level factors might modify intervention effectiveness, within a cluster randomised community intervention trial to promote the health of mothers with new babies. The methods include written and oral narratives, key informant interviews, impact logs, and inter-organisational network analyses. Context level factors, which may affect intervention uptake, success, and sustainability are the density of inter-organisational ties within communities at the start of the intervention, the centrality of the primary care agencies expected to take a lead with the intervention, the extent of context-level adaptation of the intervention, and the amount of local resources contributed by the participating agencies. Investigation of how intervention effects are modified by context is a new methodological frontier in community intervention trial research.

Assessing the Implementation of a Secondary Plan Using a Conformance-Based GIS Method: A Pilot Project in Winnipeg, Manitoba

This case study evaluates the implementation of a secondary land use plan in Winnipeg, MB. The area selected for this case study is the Northeast Neighbourhood located in Waverley West; the development of this neighbourhood was guided by the Northeast Neighbourhood Area Structure Plan (NNASP). This case study evaluates the implementation of the NNASP through a conformance analysis which answers the following research questions: 1) Does the developed land use pattern in the NNASP area conform to what was planned; and 2) Does the implementation of the NNASP conform to the goals, objectives, policies, and intent of the plan? The implementation of the NNASP was evaluated against 62 evaluation criteria which were generated based on the policies of the NNASP. Using this method, the development of the Northeast Neighbourhood is effectively evaluated against the requirements of the NNASP. This conformity test utilized threefold approach including GIS analysis, a site visit, and document analysis.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

Two Thai teachers' perceptions of cooperative learning

Over the past decade, the need for educational reform in Thailand has become increasingly apparent. The strong tradition of teacher-directed instruction has been the major teaching and learning style in Thai education. Recent policy changes have focused on expanding education opportunities, the implementation of compulsory education and also on more student-centered pedagogies (Carter, 2006). A suggested way of bringing about the changes necessary to improve the standard of education in primary schools and retention rates is to incorporate cooperative learning into Thai primary school classrooms. The action research in this study proceeded in four stages. There were pre-implementation interviews of teachers, teacher preparation, implementation of program, and post-implementation evaluation. This study focused on the two Thai teachers' perceptions about the benefits of cooperative learning and the roles of the teachers in cooperative learning classroom. The study found that the two teachers had constructed different levels of perceptions about the benefits of cooperative learning and the roles of the teacher. These findings indicated that Thai teachers who are relatively inexperienced, lacking in confidence and with little or no experience with group work strategies such as peer tutoring need alternative, less intense professional development programs conducted over a period of a semester than the professional development program implemented in this study. In addition to being conducted over a longer period of time, the findings also indicate that alternative teacher professional programs need to provide additional workshops to improve their understanding of cooperative learning and the teachers' roles.

Advancing Nursing Practice in Pain Management

This book showcases the development and evaluation of innovative examples of pain management initiatives by advanced practitioners. It considers each service development or community initiative both in terms of advanced practice nursing and pain management. There is a wide range of examples of innovation in pain management included - from the introduction of ketamine use in one trust, to wider issues around meeting the needs of pain management in the community. The book considers issues including use of research, education and interprofessional working in the advanced practitioner role. Each chapter looks at development of the service, challenges of implementation, evaluation of the service's success and justifying the importance of the advanced nurse in the service's achievements.

Programa Escola Ativa: educação do campo e trabalho docente

O Programa Escola Ativa (PEA) foi implementado no Brasil a partir de 1997 no marco de um convênio com o Banco Mundial, com o objetivo de melhorar o rendimento de alunos de classes multisseriadas rurais. O PEA tem seu foco na formação de professores e na melhoria da infra-estrutura das escolas, e propõe amplas mudanças na organização do trabalho docente, constituindo-se na único programa voltado especificamente para as classes multisseriadas no Brasil. Seu histórico é marcado pela coexistência com movimentos sociais que sintetizam e defendem novos princípios para a educação do meio rural alinhados com os seus próprios interesses e configurando-os em um novo conceito: Educação do Campo. Estes princípios devieram em 2002 em Referências para uma política nacional de educação do campo e passaram a orientar, em tese, a reformulação e redirecionamento do PEA. O objetivo desta pesquisa é analisar as mudanças no trabalho docente a partir da introdução do Programa Escola Ativa nas escolas multisseriadas rurais. Três frentes de análise foram abertas: uma análise macro, relativa ao contexto histórico da formulação do Programa e início de sua implantação no Brasil; uma análise meso, relativa aos processos de apropriação e resistência de diferentes grupos de interesse; e uma análise micro, relativa às mudanças no trabalho docente no campo a partir da implementação do Programa, considerando os sentidos que adquire o mesmo para o professor, a partir das novas prescrições e condições engendradas. Ao reconstituir o percurso do PEA, da origem à universalização, buscou-se identificar o papel do professor que atua nas escolas aderentes ao PEA e o papel dos movimentos sociais, ao proporem uma política nacional de educação do campo. Inicialmente, realizou-se uma análise macro dos contextos do desenvolvimento e da implementação do PEA, por meio de revisão da literatura. Observou-se uma retórica modernizadora e uma racionalidade tecnocrática que impunha-se de cima para baixo orientando as políticas, em matéria de autonomia e profissionalização dos docentes. No nível meso, por meio de entrevistas, pesquisa participante e análise documental buscou-se mapear pontos convergentes e divergentes na interlocução da coordenação do PEA com os movimentos sociais que discutem a educação do campo no Brasil. Detectou-se um considerável acúmulo de informações construídas de maneira coletiva e utilizadas pelo movimento crítico de maneira isolada dos articuladores das políticas públicas. No nível micro, foram utilizadas técnicas em que o grupo foi meio e estratégia de abordagem das trabalhadoras e de análise reflexiva dos conteúdos evocados. As técnicas foram utilizadas durante um seminário, com a participação de todas as professoras das Escolas Ativas de um município de Goiás. Observou-se que, da perspectiva das professoras, houve melhora das condições materiais para o exercício da profissão docente a partir do PEA. Contudo, esta foi insuficiente para garantir condições adequadas para todos os professores e alunos e uma ampliação da autonomia do professor, que está condicionada a uma intensificação do trabalho e extensão da jornada. Observou-se ainda o caráter vertical da relação com a coordenadora municipal do Programa. Conclui-se que o Programa Escola Ativa possui um traço de verticalismo forte no modo como é implementado, nas esferas macro, meso e micro, que abarca todo o processo de formulação, implantação, avaliação e universalização e reflete na sua dificuldade de incorporar produções críticas e análises coletivas para além do nível do discurso

Sistema integrado para empresas de construcción en Cusco

Actualmente las empresas requieren estrategias innovadoras, que permitan gestionar de forma integral, optimizando los recursos y maximizando los resultados. Siendo el objetivo del presente trabajo de investigación, diseñar un instrumento de gestión integral (gestión de la calidad, ambiental, seguridad y salud ocupacional) para el sector construcción en Cusco. Se realizó un análisis actual de la actividad de construcción, se planteó a diferencia de otras propuestas, el diseño que inicia con el diagnóstico, planificación, organización, ejecución, supervisión y optimización del sistema integral. Los resultados están expresados en el diagnóstico de los 3 sistemas, información clave, para el planteamiento y propuesta de las etapas posteriores; estructurando el planteamiento de los subprogramas basados en el diagnóstico integral, para finalmente determinar los lineamientos estratégicos, de implementación, evaluación y verificación del sistema, teniendo en cuenta la norma ISO 9001: 2008, ISO 14001:2004 y OSHAS 18001:2007; así como la legislación vigente para el Perú.

Unraveling EU Policies: the ““Common Basic Principles”” and the ““European Integration Fund”” as a technology of government

this paper is about EU “soft policies” on immigrant integration. It analyzes the “Common Basic Principles” (CBPs) and the “European Integration Fund” (EIF), two devices that have been recently established within this framework. It adopts the theoretical perspective of the “anthropology of policy” and “governmentality studies”. It shows the context of birth of the aforementioned devices, as well as their functioning and the assessment done by the actors implied in the elaboration/implementation/evaluation of the related policies. It is based both on documentary research as well as direct observation and interviews done to the actors implied. It concludes that the PBC and the EIF should be considered as a “technology of government”, that strives to align the conduct of the actors with the governmental aims, as well as it produces specific practices and knowledge. It also underlines an intrinsic feature of many policies: their “congenital failure”, since they are (often) disputed and resignified by situated actors, who are embedded in asymmetrical power relations.

Knowledge and attitudes of Registered Nurses toward pain /

This research provided relevant data to support pain research literature that finds nurses do not have the knowledge base that they require to sufficiently provide effective pain management. The data demonstrated that nurses have mixed attitudes toward pain. These two findings have been observed in the literature for more than 20 years, but were important results for the hospitals and the nurses involved in the study. The purposes of this study were to identify the level of knowledge and attitudes in a sample of nurses fi-om the surgical and medical units in three hospitals, and determine whether a difference between these two groups existed. The institutional resources to support pain relief practices provided by each hospital were also documented. Data were collected using a convenience sample from the medical and surgical units of three hospitals. Ofthe 1 13 nurses who volunteered to participate, 78 worked in surgical units and 35 worked in medical units. Demographic data were collected about the participants. The established instruments used to obtain data about knowledge and attitude included: (a) Nurses Knowledge of Pain Issues Survey, (b)Attitude to Pain Control Scale, and (c) Andrew and Robert Vignette. Data collected were quantitative along with two open-ended questions for a rich, qualitative section. Inadequate knowledge and outdated attitudes were very evident in the responses. Data from the open-ended questions described how nurses assessed pain and the most conmion problems caring for patients in pain. Nursing practice implications for these hospitals involve initiating a process to develop an educational pain program for nurses throughout the hospital. Utilizing findings from other studies, the program should have an interdisciplinary approach to the planning, implementation, evaluation, and ongoing support. This study supports the belief that inadequate pain management has been attributed to many factors, most importantly to a lack of knowledge. Pain is a costly, unnecessary complication for the patient as well as the hospital. It follows then, that it is in the best interest of all involved to implement an educational pain program in order to influence practice.

Évaluation de l'implantation d'un programme de prévention des maux de dos chez le personnel soignant des centres hospitaliers du Québec

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Analyse d’implantation du programme de prévention de la transmission du VIH de la mère à l’enfant au Bénin

Problématique : Implanté en 2004 au Bénin, le programme national de prévention de la transmission du VIH de la mère à l’enfant (PTME) semble globalement bien implanté. Toutefois une enquête, en 2005, révèle certaines difficultés, particulièrement au niveau de la couverture du programme: seulement 70 à 75 % des femmes enceintes vues en consultations prénatales ont été dépistées et 33 % des 1150 femmes dépistées séropositives ont accouché suivant le protocole de PTME. En outre, d’un site à un autre, on relève une grande variation dans la couverture en termes de dépistage et de suivi des femmes enceintes infectées. Cette faiblesse dans la couverture nous a amené à questionner le contexte organisationnel dans lequel le programme est implanté. Objectif : L’objectif général de cette thèse est d’analyser l'implantation de la PTME au Bénin. Le premier objectif spécifique consiste à identifier et comprendre les enjeux reliés à la façon de rejoindre les femmes enceintes dans le cadre du dépistage. Le second consiste à comprendre le contexte d’implantation et son influence sur la mise en œuvre de la PTME. Méthodologie : Cette recherche évaluative s’appuie sur une étude de cas. Six maternités ont été sélectionnées avec le souhait de représenter les différents contextes d’organisation des services. Les données ont été collectées par observation non participante, entrevues semi-dirigées (n=41) réalisées avec des prestataires de services, analyse documentaire des rapports d’activités des maternités et par questionnaires administrés aux femmes enceintes en consultations prénatales (n=371). Résultats : Le premier article a permis d'apprécier le caractère libre et éclairé du consentement au dépistage. Une majorité des femmes enceintes, suivies dans les centres privés, ont été dépistées sans être effectivement informées de la PTME alors que les femmes fréquentant les autres maternités connaissent mieux les composantes de la PTME. Le caractère volontaire du consentement des femmes est généralement respecté sur tous les sites. Le deuxième article porte sur l'analyse de la qualité du conseil pré-test. Seulement 54% des femmes enceintes ont participé à un conseil en groupe et 80% à un conseil individuel. Dans les centres où sont dispensées des séances d'information de groupe, la qualité est meilleure que dans les centres qui dispensent un conseil individuel exclusif. Le troisième article analyse l'influence du contexte d'implantation sur la mise en œuvre du programme. Parmi les facteurs qui contribuent favorablement à la mise en œuvre on relève la proximité d’un centre de référence et la coordination des activités de PTME dans une zone géographique, la responsabilisation du prestataire dédié à la PTME, la supervision formative régulière accompagnée de séances de discussion collective et l’implication des médiatrices dans la recherche active des perdues de vues. A l’opposé, la responsabilisation des médiatrices pour la réalisation du conseil individuel et du dépistage ne favorise pas une bonne mise en œuvre de la PTME. Conclusion : Nos résultats montrent qu'il est possible de jouer sur l'organisation des services de santé dans le cadre du programme du PTME pour améliorer la façon dont le programme est implanté tant dans les centres privés que publics, sans que cela ne représente un ajout net de ressources. C'est le cas de l’amélioration de la qualité du conseil et du dépistage, de l’implantation du processus interne d’apprentissage organisationnel et de la coordination des services.