Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Notice of Change in Reparation Agent- Quebec 1 May 1822

A notice of change in reparation agent between Robert Morrogh and Thomas Douglas from Quebec to Daniel Shannon in Niagara.

Evaluating the Outcomes of a Peer-Mentoring Program for Transitioning Postsecondary Students

A peer-mentoring program was initiated in 2003 for students in an introductory biology course at a university in Ontario, Canada. Students could attend up to 5 peer-mentoring sessions during the 12-week fall semester. Quantitative-survey, participation, and academic data spanning 5 years were reviewed for the purpose of evaluating the program. An objectives-oriented approach was used to determine if the program was meeting its goals to improve students' introductory biology grades, facilitate transitioning experiences, and encourage students to pursue studies in biology. Data analysis revealed characteristics of participants and showed that students who participated in the program felt that it was a valuable experience. Students attending 3 or more sessions performed significantly better in their introductory biology courses than those attending fewer sessions. There were no indications that the peer-mentoring program had any impact on students' perceptions of transitioning to university or on their program selection preferences. Recommendations are made to improve the peer-mentoring program to better align its components and objectives.

Learning and Experiential Outcomes of Face-to-Face Versus Online Communications Courses

Higher education is rapidly trending toward the implementation of online (OL) courses and a blended facilitation style that incorporates both OL and face-to-face (FTF) classes. Though previous studies have explored the benefits and pitfalls of OL and blended learning formats from institutional, teacher, and student perspectives, scant research has examined learning outcomes for OL and FTF courses sharing identical content. This study used an explanatory mixed methods design—including pre- and post-test assessments, a questionnaire, and interviews—to explore similarities and differences in participant and teacher perceptions and outcomes (gain scores and final grades) of OL versus traditional FTF Communications courses, and to examine effects of students’ age and gender on learning preference and performance. Data collection occurred over a 4-month period and involved 183 student and 2 professor participants. The study used an SPSS program for data analysis and created a Microsoft Excel document to record themes derived from the questionnaire and interviews. Quantitative findings suggest there are no significant differences in gain scores, final grades, or other learning outcomes when comparing OL and FTF versions of identical Communications courses; however, qualitative findings indicate differences between facilitation styles based on student and professor perception. The study sheds light on student and faculty perceptions of facilitation styles and suggests areas for potential improvements in FTF- and OL-facilitated courses. The study ultimately recommends that students and faculty should have options when it comes to preferred delivery of course material.

A detailed assessment of adverse perioperative outcomes of the elderly treated with radical cystectomy for bladder cancer

Objectifs: Les données provenant des centres de soins tertiaires suggèrent que le taux de mortalité péri-opératoire (MPO) après cystectomie notés pour les patients âgés (septuagénaires et octogénaires) n’excède pas celle des patients plus jeunes. Toutefois, les données provenant de la communauté démontrent un phénomène inverse. Spécifiquement, la MPO est plus élevés chez les ainés. Dans cette thèse nous allons présenter une réévaluation contemporaine du taux de MPO après cystectomie. Méthodes: Entre 1988 et 2006, 12722 cystectomies radicales pour le carcinome urothéliale de la vessie ont été enregistrées dans la banque de données SEER. Le taux de MPO a été évalué dans les analyses de régression logistique univariées et multivariées à 90 jours après cystectomie radicale. Les covariables incluaient: le sexe, l’ethnie, l’année de chirurgie, la région d’origine du patient ainsi que le grade et le stade de la tumeur. Résultats: Parmi tous les patients, 4480 étaient des septuagénaires (35.2%) et 1439 étaient des octogénaires (11.3%). Le taux de MPO à 90 jours était de 4% pour la cohorte entière vs. 2% pour les patients moins de 69 ans vs. 5.4% pour les septuagénaires vs. 9.2% pour les octogénaires. Dans les analyses de régression logistiques multivariées, les septuagénaires (OR=2.80; <0.001) et les octogénaires (OR=5.02; <0.001) avaient reçu un taux de MPO plus augmenté que les patients moins de 70 ans après une cystectomie radicale. Conclusion: Cette analyse épidémiologique basée sur les donnés le plus contemporaines démontre que l’âge avancée représente un facteur de risque pour un taux de MPO plus élevé.

Influence of Weapon Types on the Patterns and Outcomes of Violent Encounters

Rapport de stage présenté à l'école de Criminologie de la Faculté des arts et sciences en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en criminologie option analyse criminologique

Comparative costs and outcomes of traumatic brain injury from biking accidents with or without helmet use

Contexte: Évaluer les déterminants de maladies évitables et leurs coûts est nécessaire dans le contexte d’assurance maladie universelle. Le moment d’évaluer les impacts des traumatismes crâniocérébraux (TCC) survenus lors d’accidents de vélo est idéal vu la popularité récente du cyclisme au Québec. Objectifs: Comparer les caractéristiques démographiques et médicales, ainsi que les coûts sociétaux qu’engendrent les TCC de cyclistes portant ou non un casque. Méthodologie: Étude rétrospective de 128 cyclistes avec TCC admis à l’Hôpital Général de Montréal entre 2007 et 2011. Les variables indépendantes sont sociodémographiques, cliniques et le port du casque. Les variables dépendantes sont la durée de séjour, l’échelle GOS-E, l’échelle ISS, l’orientation au congé, les décès et les coûts à la société. Résultats: Le groupe portant un casque était plus vieux, plus éduqué, retraité et marié; au niveau médical, ils avaient des TCCs moins sévères à l’imagerie, des hospitalisations aux soins intensifs plus courtes et moins de neurochirurgies. Les coûts médians à la société pour les TCC isolés de cyclistes avec casque étaient significativement moindres. Conclusion: Dans cette étude, le port du casque semblait prévenir certaines complications des TCC et permettait de faire économiser de l’argent à l’état. Le port de casque est recommandé.

Evidence versus ideology in education policy : the recent history of initial teacher education in England and Wales and the implications for educational researchers as agents of change.

Resumen del autor. Este art??culo pertenece al monogr??fico 'John Elliott: su pensamiento y su influencia'

The impact of education and host language skills on the labor market outcomes of immigrants in Spain. 'El impacto de la educación y las habilidades en lengua española en los resultados de la inserción laboral de los inmigrantes en España'.

Resumen basado en el de la publicación

A century of change, 1900-2000. 'Un siglo de cambio, 1900-2000'.

Forma parte de una serie que explica a los niños la vida cotidiana de la gente, los lugares y acontecimientos de las islas británicas, desde los primeros pobladores hasta la actualidad y, que, también analiza los grandes momentos de cambios sociales, descubrimientos e invenciones. Este libro comienza con el inicio del siglo XX y la muerte de la reina Victoria, en 1901 y termina al empezar el nuevo siglo y el nuevo milenio. En este siglo se han producido grandes avances tecnológicos, la revolución en las comunicaciones y el movimiento por la igualdad de la mujer en la sociedad.

Heuristic techniques for the analysis of variability as a dynamic aspect of change. 'Técnicas heurísticas para analizar la variabilidad como un aspecto dinámico de cambio'.

Monográfico con el título: 'Los mecanismos del cambio cognitivo'. Resumen basado en el de la publicación

The outcomes of a survey regarding the socialization of CID's alumni

This paper examines the results of a survey undertaken of CID alumni to determine how they are managing socially in a hearing world.