Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

The will to write: Students' and teachers' perceptions of writing

This study investigated the perceptions of writing among secondary and post-secondary students and their teachers. The focus was on students' writing philosophy and influences, perceptions of the writing process, and perceptions of student writing skills, high stakes assessment tests, and writing across the curriculum. ^ An ethnographic case study was used to investigate the perceptions of writing among ten students and their English teachers in two high schools, a community college, and a university. To establish balance and ethnic plurality, seven females and three males representing the four large ethnic groups in South Florida—African American, Haitian American, European American and Latino—participated. During one four-month term, data from written samples of students' writing, formal and informal interviews, a student focus group, field notes, classroom observations, and a “think-aloud” protocol were collected. ^ Four themes emerged. First, Florida's writing assessment test has a negative influence on students' perceptions of writing. Students' motivation and attitudes as well as their confidence in their abilities were affected by practice and preparation in “recital writing.” Second, writing is a vehicle of social and personal transformation. Students believed that writing is a mean to connect to others and to create change in schools and communities. Third, students lacked the ability to connect writing, thinking and learning. Although students and teachers agree with statements about this connection, students failed to see the relevance of thinking and learning through writing in current or future courses, or in their future careers. Finally, writing context, teachers, schools, peers and gender influenced writing perceptions. Students believed that their writing philosophy, writing process, and perceptions of writing in academia and in the workplace are connected to these five factors. ^ The effect of the Florida writing test pervades students' and teachers' writing perceptions, making a stronger case for writing across the curriculum than previous research. Writing should help students see knowledge as interrelated, honor students' interests and values, and build relationships between and among students, schools and communities. In designing and implementing methods that support and sustain student writing, teachers should provide students with multiple opportunities to expand knowledge, learning, and connection through writing. ^

Teachers' perceptions of the national board certification process: Developing a sense of professionalism

This study describes and explains the experiences and perceptions of six public school teachers who had undergone the National Board for Professional Teaching Standards national certification process as a vehicle for promoting a teacher's sense of professionalism. Of these six participants, two achieved National Board certification, two did not achieve National Board certification, and two are awaiting results of their certification status. The study took place over a period of eleven months and focused on the participants' perceptions regarding the National Board certification process as it affected their sense of (a) efficacy and (b) professionalism. Data for this collective case study were gathered from interviews, portfolios and videotapes, and artifacts. Using case analysis, this study's participants' responses gathered through the interview process were examined. ^ The findings indicated that participants had concerns about the National Board certification process in the following areas: process, sense of efficacy, and sense of professionalism. All participants reported the process to be overwhelmingly demanding. Analysis of the data also reveals that those who were successful in achieving National Board certification had a greater sense of efficacy than those who did not. A disappointing finding was that the National Board process impacting participants' sense of professionalism could not be sustained; however, the participants in this study suggested the process was a step towards providing opportunities for collaboration, collegiality, and reflective practice. This study raises the question as to whether or not the espoused purposes of National Board certification are achieved via the certification process. ^

An analysis of student and instructor perceptions of students' writing skills at the university level

This study examined university students' writing skills as perceived by university students and their English instructors. The goal of the study was to provide English instructors with objective, quantified information about writing perceptions from both the students' and instructors' viewpoints. ^ A survey instrument was developed based on a survey instrument created by Newkirk, Cameron, and Selfe (1977) to identify instructors' perceived knowledge of student writing skills. The present study used a descriptive statistical design. It examined five writing skill areas: attitude, content, grammar and mechanics, literary considerations, and the writing process through a questionnaire completed by a convenience sample of summer and fall admitted freshmen who were enrolled in Essay Writing and Freshman Composition courses and English Department instructors at a large South Florida public university. ^ The study consisted of five phases. The first phase was modifying of the Newkirk, Cameron, and Selfe (1977) questionnaire. Two versions of the revised survey were developed - one for instructors and one for students. The second phase was pilot testing the questionnaire for evaluation of administration and scoring. The third phase was administering the questionnaire to 1,280 students and 48 instructors. The fourth phase was analyzing the data. The study found a significant difference in the perceptions of students and instructors in all areas of writing skills examined by the survey. Responses to 29 of 30 questions showed that students felt they had better attitudes toward writing and better writing skills than instructors thought. ^ The final phase was developing recommendations for practice. Based on findings and theory and empirical evidence drawn from the fields of adult education and composition research, learner-centered, self-directed curriculum guidelines are offered. ^ By objectively quantifying student and instructor perceptions of students' writing skills, this study contributes to a growing body of literature that: (a) encourages instructors to acknowledge the perception disparities between instructors and students; (b) gives instructors a better understanding of how to communicate with students; and (c) recommends the development of new curriculum, placement tests, and courses that meet the needs of students and enables English instructors to provide meaningful instruction. ^

The perceptions of best mentoring practices in an early literacy intervention project: A case study of nine coaches

There is significant national evidence the language development of four year-olds is a critical area for later school success (Brooks-Gunn, Fuligni, & Berlin, 2003; Cunningham, & Stanovich, 1998). This study originated as part of Literacy Intervention X (LIX), a larger national study conducted to examine the effectiveness of early literacy curricula implemented in subsidized childcare centers. The professional development of childcare center providers is key to improving the quality of subsidized care. In exploring the mentoring practices of nine LIX literacy coaches, the researcher investigated the perceptions of what best mentoring practices facilitated the implementation of literacy curricula by childcare providers. A qualitative case study was conducted using a combination of participant observer notes, document analysis, and focus group semi-structured interviews. The researcher is a participant observer, one of the nine Literacy Coaches. The best mentoring practices from the perspective of the literacy coaches are related to building relationships including trust, mutual respect, support, empathy, and encouragement with the childcare providers, the center directors, and with fellow literacy coaches. Clear, constant, and consistent communication with the childcare providers was a vital mentoring practice in building a relationship between the literacy coach and childcare provider. Another best mentoring practice in building a relationship with the childcare provider was the perceptions of the literacy coaches as co-learners in the mentoring process. The best mentoring practices highlighted in this study exemplified the kind of effective professional development that builds on the strengths of the childcare providers and does not disrupt the childcare centers or the services provided by the subsidized childcare programs that meet the needs of children and families. The experience of these nine literacy coaches, including their perceptions of effective mentoring practices, along with lesson learned about relationships, mentoring team structures, and general project design sheds light on the challenge of mentoring subsidized childcare providers in future literacy intervention projects.

A mixed method study of organizational culture dimensions of community college faculty library use and perceptions

Because past research has shown faculty as the driving force affecting student academic library use, librarians have tried for decades to engage classroom faculty in library activities. Nevertheless, a low rate of library use by faculty on behalf of their students persists. This study investigated the organizational culture dimensions affecting library faculty demand at a community college. The study employed a sequential quantitative-qualitative research design. A random sample of full-time faculty at a large urban community college responded to a 46-item survey. The survey data showed strong espoused support (84%) for the use of library-based materials but a much lower incidence of putting this construct into practice (46%). Interviews were conducted with 11 full-time faculty from two academic groups, English-Humanities and Engineering-Math-Science. These groups were selected because the survey data resulted in statistically significant differences between the groups pertaining to several key variables. These variables concerned the professors' perceptions of the importance of library research in their discipline, the amount of time spent on the course textbook during a term, the frequency of conversations about the library in the academic department, and the professors' ratings of the librarians' skill in instruction related to the academic discipline. All interviewees described the student culture as the predominant organizational culture at Major College. Although most interview subjects held to high information literacy standards in their courses, others were less convinced these could be realistically practiced, based on a perception of students' poor academic skills, lack of time for students to complete assignments due to their commuter and family responsibilities, and the need to focus on textbook content. Recommended future research would involve investigation of methods to bridge the gap between high espoused value toward information literacy and implementation of information-literate coursework.

Human resource development professionals' perceptions about the Academy of Human Resource Development Standards on Ethics and Integrity

Professional standards of ethics proclaim the core values of a profession, describe expected professional duties and responsibilities, and provide a framework for ethical practice and ethical decision-making. The purpose of this mixed, quantitative and qualitative, survey study was to examine HRD professionals' perceptions about the AHRD Standards on Ethics and Integrity, how HRD professionals used the Standards for research and decision-making, and the extent to which the Standards provided guidance for ethical decision-making. Through an on-line survey instrument, 182 members of AHRD were surveyed. The open-ended questions were analyzed using thematic analysis to expand on, inform, and support the quantitative findings. The close-ended questions were analyzed with frequency distributions, descriptive statistics, cross tabulations, and Spearman rank correlations. The results showed a significant relationship between (a) years of AHRD membership and level of familiarity with the Standards, (b) years of AHRD membership and use of the Standards for research, and (c) level of familiarity with the Standards and use of the Standards for research. There were no significant differences among scholars, scholar practitioners, practitioners, and students regarding their perceptions about the Standards. The results showed that the Standards were not well known or widely used. Nevertheless, the results indicated overall positive perceptions about the Standards. Seventy percent agreed that the Standards provided an appropriate set of ethical principles and reflected respondents' own standards of conduct. Seventy-eight percent believed that the Standards were important for defining HRD as a profession and 54% believed they were important for developing a sense of belonging to the HRD profession. Fifty-one percent believed the Standards should be enforceable and 61% agreed members should sign the membership application form showing willingness to adhere to the Standards. Seventy-seven percent based work-related ethical decisions on personal beliefs of right and wrong and 56% on established professional values and rules of right and wrong. The findings imply that if the professional standards of ethics are to influence the profession, they should be widely publicized and discussed among members, they should have some binding power, and their use should be encouraged.

Organizational culture, organizational climate, and collaborative capacity for planning

The objective of this study was to investigate the relationship of organizational culture and organizational climate on participant perceptions of collaborative capacity for planning, within the context of the Florida School Readiness Coalitions (FSRCs). Three hypotheses were proposed for study: First, that organizational culture would be correlated to organizational climate; second, that organizational culture would be correlated to collaborative capacity for planning; and the third that organizational climate would be correlated to collaborative capacity for planning. ^ A cross-sectional survey research design was used to obtain data from participants in 25 Florida School Readiness Coalitions. Pearson product-moment correlations were used to examine the association between the dependent variable, collaborative capacity for planning, and the independent variables, organizational culture and climate. Bivariate analyses revealed a significant level of association for five culture indicators to collaborative capacity for planning: motivation, interpersonal, service, supportive and individualistic indicators, and four climate indicators: cooperation, job satisfaction, organizational commitment, and role clarity. Findings suggest (a) a constructive culture and positive climate were present within the FSRCs during the period of study and (b) participants perceived that the collaborative capacity for planning existed. Hierarchical multiple regression, controlling for effects of participant demographics, were used to examine the degree to which organizational culture and climate predict collaborative capacity. The culture indicators, supportive and individualistic, and the climate indicator job satisfaction accounted for 46% of the variance in collaborative capacity for planning. No other indicators of the independent variables demonstrated significance. The findings suggests that (a) culture and climate should be studied together, (b) culture and climate are two constructs that may provide knowledge about the way community groups work together, and (c) the collaborative capacity of groups planning services such as the FSRCs may benefit through consideration of how culture and climate affect service planners' relationships, communication, and ability to achieve a mission or goal. Culture and climate may offer social workers new information about internal factors affecting the collaborative process. Further investigation of these constructs with other types of groups is warranted. ^

Computational evaluation of wind loads on low- and highrise buildings

Buildings and other infrastructures located in the coastal regions of the US have a higher level of wind vulnerability. Reducing the increasing property losses and causalities associated with severe windstorms has been the central research focus of the wind engineering community. The present wind engineering toolbox consists of building codes and standards, laboratory experiments, and field measurements. The American Society of Civil Engineers (ASCE) 7 standard provides wind loads only for buildings with common shapes. For complex cases it refers to physical modeling. Although this option can be economically viable for large projects, it is not cost-effective for low-rise residential houses. To circumvent these limitations, a numerical approach based on the techniques of Computational Fluid Dynamics (CFD) has been developed. The recent advance in computing technology and significant developments in turbulence modeling is making numerical evaluation of wind effects a more affordable approach. The present study targeted those cases that are not addressed by the standards. These include wind loads on complex roofs for low-rise buildings, aerodynamics of tall buildings, and effects of complex surrounding buildings. Among all the turbulence models investigated, the large eddy simulation (LES) model performed the best in predicting wind loads. The application of a spatially evolving time-dependent wind velocity field with the relevant turbulence structures at the inlet boundaries was found to be essential. All the results were compared and validated with experimental data. The study also revealed CFD's unique flow visualization and aerodynamic data generation capabilities along with a better understanding of the complex three-dimensional aerodynamics of wind-structure interactions. With the proper modeling that realistically represents the actual turbulent atmospheric boundary layer flow, CFD can offer an economical alternative to the existing wind engineering tools. CFD's easy accessibility is expected to transform the practice of structural design for wind, resulting in more wind-resilient and sustainable systems by encouraging optimal aerodynamic and sustainable structural/building design. Thus, this method will help ensure public safety and reduce economic losses due to wind perils.

Perceptions of character education in a Seventh-day Adventist school

Character education has been viewed by many educators as having significant historical, academic, and social value. Many stakeholders in education argue for character development as a curricular experience. While understanding the degree to which character education is of worth to stakeholders of institutions is important, understanding students, teachers, and administrators perspectives from their lived experiences is likewise significant. The purpose of this phenomenological study was to gain a deeper understanding of character education within a Biblical framework environment by examining the lived experiences of students, administrators, and teachers of a Seventh-day Adventist School. Phenomenology describes individuals' daily experiences of phenomena, the manner in which these experiences are structured, and focuses analysis on the perspectives of the persons having the experience (Moustakas, 1994). This inquiry was undertaken to answer the question: What are the perceptions of students, teachers, and an administrator toward character education in a Seventh-day Adventist school setting? Ten participants (seven students and three adults) formed the homogeneous purposive sample, and the major data collection tool was semi-structured interviews (Patton, 1990; Seidman, 2006). Three 90-minute open-ended interviews were conducted with each of the participants. Data analysis included a three-phase process of description, reduction and interpretation. The findings from this study revealed that participants perceived that their involvement in the school's character education program decreased the tendency to violence, improved their conduct and ethical sensibility, enhanced their ability to engage in decision-making concerning social relationships and their impact on others, brought to their attention the emerging global awareness of moral deficiency, and fostered incremental progress from practice and recognition of vices to their acquisition of virtues. The findings, therefore, provide a model for teaching character education from a Seventh-day Adventist perspective. The model is also relevant for non-Seventh day Adventists who aspire to teach character education as a means to improving social and moral conditions in schools.

Perceptions of the Beach Users: A Case Study of the Coastal Areas of North Cyprus Towards Establishment of a "Carrying Capacity"

Within the main elements of economic sustainability, socio-cultural sustainability, and environmental sustainability, the criteria of 'carrying capacity’ have ben emphasized through residents’ perception analysis to explore practical methods towards the application and implementation of such criteria. As data analysis revealed, the main tourist resources in the case of North Cyprus –the coast and the beach- have a certain capacity to sustain the impact and pressure of tourism. Despite the significance of the indigenous environment and with respect to the residents’ perception of optimum carrying capacity levels, this issue has not been given a due consideration. This has resulted in a process of coastal development which bypasses any measure ore application of a standard to harmonize the degree of physical development and the capacity of the beach. The main objective of this paper is to establish the concept of ‘carrying capacity’ as the means to achieve the reconciliation of environmental impacts with tourism development. The study concludes that, if carrying capacity measurement and its implementation are not incorporated into the planning decision as a clear policy, there will be grave negative consequences for those resources attracting visitors.

Research-to-Practice (R2P) Tools for Improving Safety in Nighttime Highway Construction Work Zones

The safety of workers in nighttime roadway work zones has become a major concern for state transportation agencies due to the increase in the number of work zone fatalities. During the last decade, several studies have focused on the improvement of safety in nighttime roadway work zones; but the element that is still missing is a set of tools for translating the research results into practice. This paper discusses: 1) the importance of translating the research results related to the safety of workers and safety planning of nighttime work zones into practice, and 2) examples of tools that can be used for translating the results of such studies into practice. A tool that can propose safety recommendations in nighttime work zones and a web-based safety training tool for workers are presented in this paper. The tools were created as a component of a five-year research study on the assessment of the safety of nighttime roadway construction. The objectives of both tools are explained as well as their functionalities (i.e., what the tools can do for the users); their components (e.g., knowledge base, database, and interfaces); and their structures (i.e., how the components of the tools are organized to meet the objectives). Evaluations by the proposed users of each tool are also presented.

Curricular perceptions of adult education at National Chun -Chin University, Chia -Yi, Taiwan

This research was conducted in Chia-Yi, Taiwan to study the needs of adult education participants to determine the factors necessary to provide direction for the development of university adult education curriculum and supportive government educational policies. Factors researched were characteristics of the adult learner, theories of adult learning, demands of adult education, and implications of university adult education as the theoretical foundation for the development of specific curriculum development efforts. The study investigated adult learning needs and their relationship with demographic variable. Analyzing the needs of adult education participant and the relative factors through a survey resulted in recommendations for the development of adult education program plans, content of curriculum, and teaching. Research questions were analyzed using descriptive statistics, frequencies, chi square, one-way analysis of variance (ANOVA), and post hoc analysis. ^ The study showed that most participants in these adult education activities were under forty, middle class, of above average educational levels, and either living or working in the city. People who were older, of lesser social and economic positions, with lower educational standards, and living/working in the country, did not participate as much in adult education opportunities. Recommendations included that in the planning or setting up of adult education activities, attention be given to all the possible barriers or problems that are likely to occur in people's participation, e.g., motivation, interests, content of courses, teaching methods, willingness of participation, qualification of teachers, time, funds, locations, and so on. It is suggested that the resolution of these problems can significantly increase the participation of adult education. ^

A qualitative study of selected fourth -grade teachers' perceptions of the Sunshine State Standards

Despite a history of grappling with educational standards, never before has the federal government attempted to establish explicit national standards for what American children should learn in school. Recently, U.S. educators have developed voluntary national content standards, or explicit expectations of what students should know and be able to do. Not surprisingly, this major curriculum reform has provoked considerable debate. Today, teachers face difficult challenges working towards the implementation of standards. The objective of this study was to describe and explain the perceptions of a selected team of fourth-grade teachers regarding the language arts component of their state's Sunshine State Standards (SSS). The exploratory questions that guided this qualitative study were: (a) How are the SSS perceived by these fourth-grade teachers? (b) In what ways do the SSS affect teachers' self-perceptions? and, (c) To what extent and how do the SSS affect the participants' professional classroom behavior? ^ Direct observations, interviews, analysis of relevant documents and the researcher's critical reflective journal served as the methods of inquiry employed in this qualitative study. Bandura's Teacher Self-Efficacy Scale was used as a tool to help categorize the data specifically related to self-perception. ^ Analysis of the data suggests that participants perceived the SSS as a useful guideline as they taught. The SSS were a decisive factor in teachers' planning. They were the actual guide lines used by teachers to plan their lessons. However, participants did not believe the SSS were attainable by all students or were fair to students with special needs. They also believed there was not sufficient time allocated for the effective implementation of the SSS. This lack of time created pressure among some of the participants and others even felt disempowered regarding the curriculum and the instructional focus implemented during the test preparation time. The SSS negatively affected the participants when they felt constraints during this time, which led to their inability to carry out important activities in their classrooms. Thus, the SSS directly affected the participants' behavior in their classrooms. ^

Personal autonomy in discharge planning decision -making in mentally alert hospitalized elderly individuals: The social workers' perspective

This study was conducted to understand (a) hospital social workers' perspectives about patients' personal autonomy and self-determination, (b) their experiences, and (c) their beliefs and behaviors. The study used the maximum variation sampling strategy to select hospitals and hospital social work respondents. Individual interviews were conducted with 31 medical/surgical and mental health hospital social workers who worked in 13 hospitals. The data suggest the following four points. First, the hospital setting as an outside influence as it relates to illness and safety, and its four categories, mentally alert patients, family members, health care professionals, and social work respondents, seems to enhance or diminish patients' autonomy in discharge planning decision making. Second, respondents report they believe patients must be safe both inside and outside the hospital. In theory, respondents support autonomy and self-determination, respect patients' wishes, and believe patients are the decision makers. However, in practice, respondents respect autonomy and self-determination to a point. Third, a model, The Patient's Decision in Discharge Planning: A Continuum, is presented where a safe discharge plan is at one end of a continuum, while an unsafe discharge plan is at the other end. Respondents respect personal autonomy and the patient's self-determination to a point. This point is likely to be located in a gray area where the patient's decision crosses from one end of the continuum to the other. When patients decide on an unsafe discharge plan, workers' interventions range from autonomy to paternalism. And fourth, the hospital setting as an outside influence may not offer the best opportunity for patients to make decisions (a) because of beliefs family members and health care professionals hold about the value of patient self-determination, and (b) because patients may not feel free to make decisions in an environment where they are surrounded by family members, health care professionals, and social work respondents who have power and who think they know best. Workers need to continue to educate elderly patients about their right to self-determination in the hospital setting. ^