Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

County condemnation manual : manual of practice and procedure for the acquisition of real property through the exercise of the power of eminent domain, 1995

This manual contains a summary of acquisition policy and makes recommendations to implement law and policy.

From the Members' Perspective: Participants' Perception of the Moderator Role in Educator Communities of Practice

Thesis (Ph.D.)--University of Washington, 2016-08

The relationship between personal cognition, social context, and knowledge sharing in global communities of practice

The purpose of this study was to identify the structural pathways of personal cognition and social context as they influence knowledge sharing behaviors in communities of practice. Based on the existing literature, ten hypotheses and a conceptual model built on the basis of the social cognitive theory were developed regarding the interrelationships of the five constructs: self-efficacy for knowledge sharing, outcome expectations, sense of community, leadership of a community, and knowledge sharing. The data were collected through an online questionnaire from the employees who have participated in communities of practice in a Fortune 100 corporation. A total of 438 usable questionnaires were collected. Overall, three analyses were conducted in order to prove the given hypotheses: (a) hypothesized measurement model fit, (b) relational and influential associations among the constructs, and (c) structural equation model analysis (SEM). In addition, open-ended responses were analyzed. The results presented that (a) hypothesized measurement models were valid and reliable, (b) personal cognitive factors, self-efficacy and outcome expectations for knowledge sharing, were found to be significant predictors of community members’ sense of community and knowledge sharing behaviors, (c) sense of community had the most significant impact on the knowledge sharing, (d) as the perceived social context, sense of community mediated the effects of personal cognition on knowledge sharing behaviors, and (e) personal cognition and social context jointly contributed to knowledge sharing. In brief, all of the hypotheses were positively supported. A conclusive summary is provided along with contributive discussion. Implications and contributions to HRD researchers and practitioners are discussed, and recommendations are provided.

DnaG interacts with a linker region that joins the N- and C-domains of DnaB and induces the formation of 3-fold symmetric rings

Loading of the replicative ring helicase onto the origin of replication (oriC) is the final outcome of a well coordinated series of events that collectively constitute a primosomal cascade. Once the ring helicase is loaded, it recruits the primase and signals the switch to the polymerization mode. The transient nature of the helicase-primase (DnaB-DnaG) interaction in the Escherichia coli system has hindered our efforts to elucidate its structure and function. Taking advantage of the stable DnaB-DnaG complex in Bacillus stearothermophilus, we have reviewed conflicting mutagenic data from other bacterial systems and shown that DnaG interacts with the flexible linker that connects the N- and C-terminal domains of DnaB. Furthermore, atomic force microscopy (AFM) imaging experiments show that binding of the primase to the helicase induces predominantly a 3-fold symmetric morphology to the hexameric ring. Overall, three DnaG molecules appear to interact with the hexameric ring helicase but a small number of complexes with two and even one DnaG molecule bound to DnaB were also detected. The structural/functional significance of these data is discussed and a speculative structural model for this complex is suggested.

Communities of practice as professional and organizational development strategy in local public health organizations in Québec, Canada : an evaluation model

Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health.

Virtual knowledge brokering : describing the roles and strategies used by knowledge brokers in a pediatric physiotherapy virtual community of practice

Introduction: Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions. Methods: A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment. Results: We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time. Discussion: This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.

Competency Standards and Educational Requirements for Specialist Breast Nurses in Australia

There is substantial evidence that Specialist Breast Nurses (SBNs) make an important contribution to improved outcomes for women with breast cancer, by providing information and support and promoting continuity of care. However, a recent study has identified significant variation in how the role functions across individual nurses and settings, which is likely to contribute to varied outcomes for women with breast cancer. The project reported in this paper illustrates how a set of competency standards for SBNs were developed by the National Breast Cancer Centre. The competency standards were developed through a review of published literature and consultation with key stakeholders. The resulting SBN Competency Standards reflect the core domains and elements of SBN practice seen as integral to achieving optimal outcomes for women with breast cancer. This project identifies the SBN as a registered nurse who applies advanced knowledge of the health needs, preferences and circumstances of women with breast cancer to optimise the individual's health and well-being at various phases across the continuum of care, including diagnosis, treatment, rehabilitation, follow-up and palliative care. The five core domains of practice identified are: Supportive care; Collaborative care; Coordinated care; Information provision and education; and Clinical leadership. A variety of education programs are currently available for nurses who wish to learn about breast cancer nursing. The majority of stakeholders consulted in this project agreed that a Graduate Diploma level of education is required at minimum in order for an SBN to develop the minimum level of competence required to perform the role. The evidence supports the view that as an advanced role, nurses practising as SBNs require high-quality programs of sufficient depth and scope to achieve the required level of competence

Domain 4: The Education Function.

This chapter examines the role of the advanced nurse practitioner (ANP) within the domains of practice identified by the Royal College of Nursing (2002) as the teaching and coaching function. (Note that this is referred to by the NMC as the education function. It approaches the analysis against the backdrop of three policy documents: The Expert Patient: a new approach to chronic disease management for the 21st century(DoH 2001), Choosing Health: making healthy choices easier (DoH 2004), Our health, our care, our say (DoH 2006). It draws into the frame the experiences of ANP students as they work with patients, clients and carers, with the intention of enabling health and managing illness. It uses examples from a range of everyday practice setting to illustrate the inherent challenges of the teaching and coaching function of the ANP, at the same time as recognising its significance if patients, clients and carers are to be enabled to make choices that might optimize their well-being. Before this, however, some statistics are presented to focus thinking on why education is an invaluable component of advanced nursing practice.

Développement, mise à l’essai et évaluation qualitative d’une intervention infirmière dyadique auprès de couples âgés vivant avec la maladie de Parkinson au stade modéré

Au Québec, près de 25 000 personnes, principalement des aînés, sont touchées par la maladie de Parkinson (MP), la majorité étant soignée par leur conjoint. Au stade modéré, la MP altère la santé et la qualité de vie de ces couples. Ce stade est propice à la mise en place d’interventions dyadiques, car les couples expérimentent des pertes croissantes, nécessitant plusieurs ajustements. Néanmoins, aucune étude n’avait encore examiné leurs besoins d’intervention lors de cette transition et peu d’interventions pour les soutenir ont fait l’objet d’études évaluatives. Avec comme cadre de référence la théorie de l’expérience de transition de Meleis et al. (2000) et l’approche systémique de Wright et Leahey (2009), cette étude visait à développer, mettre à l’essai et évaluer une intervention auprès de couples âgés vivant avec la MP au stade modéré. À cette fin, un devis qualitatif et une approche participative ont été privilégiés. L’élaboration et l’évaluation de l’intervention s’appuient sur le cadre méthodologique d’Intervention Mapping de Bartholomew et al. (2006) et sur les écrits de Miles et Huberman (2003). L’étude s’est déroulée dans une clinique ambulatoire spécialisée dans la MP. Dix couples et quatre intervenants ont collaboré à la conceptualisation de l’intervention. Trois nouveaux couples en ont fait l’expérimentation et l’évaluation. L’intervention dyadique compte sept rencontres de 90 minutes, aux deux semaines. Les principaux thèmes, les méthodes et les stratégies d’intervention sont basés sur les besoins et les objectifs des dyades ainsi que sur des théories et des écrits empiriques. L’intervention est orientée vers les préoccupations des dyades, la promotion de la santé, la résolution de problèmes, l’accès aux ressources, la communication et l’ajustement des rôles. Les résultats de l’étude ont montré la faisabilité, l’acceptabilité et l’utilité de l’intervention. Les principales améliorations notées par les dyades sont l’adoption de comportements de santé, la recherche de solutions ajustées aux situations rencontrées et profitables aux deux partenaires, la capacité de faire appel à des services et l’accroissement des sentiments de maîtrise, de soutien mutuel, de plaisir et d’espoir. Cette étude fournit des pistes aux infirmières, engagées dans différents champs de pratique, pour développer et évaluer des interventions dyadiques écologiquement et théoriquement fondées.