835 resultados para Palliative Care, Palliative Approach, Undergraduate Education, Curriculum


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While there is sufficient evidence to suggest that physical activity is inversely related to lifestyle diseases, researchers are far from being certain that this evidence extends to children. Nevertheless, the school physical education curriculum has been targeted as an institutional agency that could have a significant impact on health during childhood and later during adulthood if individuals could be habituated to assume a physically active lifestyle. The purpose of this article is to examine the recontextualization of biomedical knowledge into an ideology of healthism in which health is conceived as a controllable certainty and used as a pedagogical construction to transform school physical education. Using a Foucauldian perspective, we explore how the atomized biomedical model of chemical and physical relationships is constructed, reproduced, and perpetuated to service and empower the discourse and the practices of researchers and scholars. In this process the sociological or cultural aspects of public health are marginalized or ignored. As a result of this examination, alternative approaches are proposed that engage the limitations of the biomedical model and openly consider the insights that are available from the social sciences regarding what participation in physical activity means to individuals.

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With the establishment of The New University Code in 1994, Taiwan's colleges and universities were mandated to shift physical education from a required course to an elective. The four-year colleges and universities are now responsible for either developing new physical education programs or removing existing programs from their curriculum. Planned change and curriculum leadership are considered in light of policy changes regarding required physical education programs enacted by the Ministry of Education. ^ This study compared the organizational structure and the curriculum of physical education at accredited colleges and universities in Taiwan. Chairpersons of physical education departments from 60 four-year colleges and universities were surveyed using a modified version of the Hensley's Basic Instruction Program (BIP) Questionnaire. Results were analyzed using analysis of variance (ANOVA) and crosstabs. The findings confirmed that physical education programs were effected by declining enrollment and administrative decisions to eliminate them. However, at the same time, chairpersons expressed strong support for the maintenance of the traditional physical education curriculum. ^

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Introduction: Current physical activity levels among children and youth are alarmingly low; a mere 7% of children and youth are meeting the Canadian Physical Activity Guidelines (Colley et al., 2011), which means that the vast majority of this population is at risk of developing major health problems in adulthood (Janssen & Leblanc, 2010). These high inactivity rates may be related to suboptimal experiences in sport and physical activity stemming from a lack of competence and confidence (Lubans, Morgan, Cliff, Barnett, & Okely, 2010). Developing a foundation of physical literacy can encourage and maintain lifelong physical activity, yet this does not always occur naturally as a part of human growth (Hardman, 2011). An ideal setting to foster the growth and development of physical literacy is physical education class. Physical education class can offer all children and youth an equal opportunity to learn and practice the skills needed to be active for life (Hardman, 2011). Elementary school teachers are responsible for delivering the physical education curriculum, and it is important to understand their will and capacity as the implementing agents of physical literacy development curriculum (McLaughlin, 1987). Purpose: The purpose of this study was to explore the physical literacy component of the 2015 Ontario Health and Physical Education curriculum policy through the eyes of key informants, and to explore the resources available for the implementation of this new policy. Methods: Qualitative interviews were conducted with seven key informants of the curriculum policy development, including two teachers. In tandem with the interviews, a resource inventory and curriculum review were conducted to assess the content and availability of physical literacy resources. All data were analyzed through the lens of Hogwood and Gunn’s (1984) 10 preconditions for policy implementation. Results: Participants discussed how implementation is affected by: accountability, external capacity, internal capacity, awareness and understanding of physical literacy, implementation expertise, and policy climate. Discussion: Participants voiced similar opinions on most issues, and the overall lack of attention given to physical education programs in schools will continue to be a major dilemma when trying to combat such high physical inactivity levels.

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The paradigm shift from traditional print literacy to the postmodern fragmentation, nonlinearity, and multimodality of writing for the Internet is realized in Gregory L. Ulmer’s electracy theory. Ulmer’s open invitation to continually invent the theory has resulted in the proliferation of relays, or weak models, by electracy advocates for understanding and applying the theory. Most relays, however, remain theoretical rather than practical for the writing classroom, and electracy instruction remains rare, potentially hindering the theory’s development. In this dissertation, I address the gap in electracy praxis by adapting, developing, and remixing relays for a functional electracy curriculum with first-year writing students in the Virginia Community College System as the target audience. I review existing electracy relays, pedagogical applications, and assessment practices – Ulmer’s and those of electracy advocates – before introducing my own relays, which take the form of modules. My proposed relay modules are designed for adaptability with the goals of introducing digital natives to the logic of new media and guiding instructors to possible implementations of electracy. Each module contains a justification, core competencies and learning outcomes, optional readings, an assignment with supplemental exercises, and assessment criteria. My Playlist, Transduction, and (Sim)ulation relays follow sound backward curricular design principles and emphasize core hallmarks of electracy as juxtaposed alongside literacy. This dissertation encourages the instruction of new media in Ulmer’s postmodern apparatus in which student invention via the articulation of fragments from various semiotic modes stems from and results in new methodologies for and understandings of digital communication.

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General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

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Breast cancer is a public health issue in numerous countries. Multidisciplinary collaboration is required for patient care, research, and also education of future physicians. This paper uses Kern's framework for curriculum design to demonstrate how a breast diseases module for undergraduate medical students created in 1993 evolved over 15 years. The main outcomes of program refinements were better integrated course content, the development of electronic course documents, and implementation of computer-aided small group learning. A main future challenge is to further develop efficient instructional strategies in line with well-defined learning needs for undergraduate students.

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This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 +/- A 8 years, with a mean of 14 +/- A 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

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Purpose. To conduct a controlled trial of traditional and problem-based learning (PBL) methods of teaching epidemiology. Method. All second-year medical students (n = 136) at The University of Western Australia Medical School were offered the chance to participate in a randomized controlled trial of teaching methods fur an epidemiology course. Students who consented to participate (n = 80) were randomly assigned to either a PBL or a traditional course. Students who did not consent or did not return the consent form (n = 56) were assigned to the traditional course, Students in both streams took identical quizzes and exams. These scores, a collection of semi-quantitative feedback from all students, and a qualitative analysis of interviews with a convenience sample of six students from each stream were compared. Results. There was no significant difference in performances on quizzes or exams between PBL and traditional students. Students using PBL reported a stronger grasp of epidemiologic principles, enjoyed working with a group, and, at the end of the course, were more enthusiastic about epidemiology and its professional relevance to them than were students in the traditional course. PBL students worked more steadily during the semester but spent only marginally more time on the epidemiology course overall. Interviews corroborated these findings. Non-consenting students were older (p < 0.02) and more likely to come from non-English-speaking backgrounds (p < 0.005). Conclusions. PBL provides an academically equivalent but personally far richer learning experience. The adoption of PBL approaches to medical education makes it important to study whether PBL presents particular challenges for students whose first language is not the language of instruction.

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The focus of the study is to understand curriculum innovation from the perspective of Tanzanian teacher educators. It is argued that the deterioration of quality of education in schools is partly to be attributed to the way in which teachers are educated. Curriculum innovation is considered as an essential strategy for bringing about improvement in teacher education. Therefore, in 2000 a new curriculum was introduced; however, right from the inception the curriculum was criticised by teacher educators. The overall aim of the study is to investigate teacher educators’ conceptions of curriculum innovation. In the theoretical framework the main focus is on discussion about different curriculum approaches for teacher education and innovation. In order to achieve the aim of the study, a phenomenographic approach is employed. This approach is used in order to identify similarities and variation in educators’ conceptions of curriculum innovation. The empirical basis of the study consists of interviews with thirty teacher educators working in eight teachers’ colleges situated in various parts of Tanzania. The findings, in brief, reveal variation in teacher educators’ conceptions of the dominant domains of innovation. Two broad conceptions of teaching with six aspects are identified. Conceptions of educational studies are presented in four broad categories of description with four aspects. Similarly, in methodology subjects two conceptions are described with four aspects. On the integration of subject matter studies and subject methods, two broad conceptions are presented with six aspects. Conceptions of textbook prescription policy are characterised in two broad categories of description with four aspects. With the use of modules two broad conceptions are identified with six aspects. In addition, the study identifies four broad conceptions of future curriculum approaches with eight aspects. Looking across the categories of description, the results indicate that educators cope with innovation individually. Three character types of teacher educators are presented: loyal, creative and critical. Furthermore, four types of phenomena suggesting critical areas about teacher educators’ conceptions of innovation are described: educators’ prior educational background, technical factors, student teachers’ factors and shifting from teaching to learning. On the whole, educators express a number of frame factors in the process of change towards the aim of curriculum innovation. This indicates that the new curriculum (2000) is not implemented as intended by curriculum developers. Constraints to the implementation are presented and discussed in detail. From these findings, two models of educators’ stance towards curriculum innovation are presented and can be used as a framework for planning successful curriculum innovations and analysing practice in teachers’ colleges.

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This study \Alas initiated in response to the Junior Division Review (1985) publ ished by the Ministry of Education for the Province of Ontario. Curriculum integration is an element used within the educational paradigm designed by the Ontario Ministry of Education. It is a term frequent1y verbal ized b>' educators in this province, but because of 1 imi ted resource support regarding this methodology, it was open to broad interpretation resulting in an extreme v ar i at i on i nit simp 1 eme n tat i on • I n de ed, the Min i s try intimated that it was not occurring to any significant degree across the province. The objective of this thes is was· to define integration in the junior classroom and de-:.ign a meas.ur·ement in-:.tr-ument which would in turn high 1 i gh t indicators of curriculum integration. The :.tudy made a prel iminary, field-based survey of educa tiona 1 professionals in order to generate a relevant description of integrated curr-iculum programm i ng as def i ned in the j un i or classroom. The description was a compilation of views expressed by a random selection of teachers, consultants, supervisory officers and principals. The survey revea 1 ed a much more comprehens i ve vi et·<,l of the attributes of integrated programming than tradition would dictate and resulted in a functional definition tha t was broader than past prac t ices. Based on the information generated by this survey, an instrument ou t 1 in i ng program cr iter i a of was devised. an integrated junior cla~·sroom Th i s measuremen t i nstrumen t , designed for all levels of educators, was named uThe Han~.son I nstrumen t for the Measuremen t of Program Integrat ion in the Jun i or Cl assroom". It refl ected five categories intrinsic to the me thodol ogy of integration: Teacher Behaviour, Student Behaviour, Classroom Layout, Cl as~·r oom Environment and Progr amm i ng. Each category and the items therein were successfully tested in val idi ty and rel iabi 1 i ty checKs. Interestingly, the individual class was found to be the major variable programming in in the measuremen t the j un i or d i vis i on • of The integrated instrument demonstrated potential not onl)' a~· an initial measure of the degree of integrated curriculum, but as a guide to strategies to implement such a methodology.

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Il y a quelques décennies, l’émergence du discours de la promotion de la santé infléchissait un nouveau tournant à la santé publique, orientant sa pratique vers l’action communautaire, participative et intersectorielle. Parallèlement, au Québec, la réforme du système de santé de 2004 réorganisait le niveau de gouverne locale à travers la création des centres de santé et de services sociaux (CSSS). Ceux-ci doivent articuler les secteurs des soins et de la santé publique à travers un continuum de services qui va de la promotion de la santé aux soins palliatifs. Ces changements ont des implications majeures pour les acteurs de la santé et de la santé publique, qui doivent composer avec de nouveaux rôles professionnels et de nouvelles stratégies d’action. Le développement professionnel est considéré comme un levier potentiel pour soutenir ces changements. En 2009, une équipe de la Direction de la santé publique de l’Agence de santé et des services sociaux de Montréal concevait un programme de développement professionnel appelé le Laboratoire de promotion de la santé. Ce programme mise sur une approche d’apprentissage de groupe pour permettre aux professionnels des CSSS de développer de nouvelles compétences, une pratique réflexive ainsi que de nouvelles pratiques de promotion de la santé. Basée sur une méthodologie générale qualitative et une approche d’évaluation collaborative, cette thèse utilise plusieurs stratégies d’investigation afin d’évaluer le Laboratoire de promotion de la santé sous trois angles, qui renvoient à sa conceptualisation, à son implantation et à ses effets. Plus spécifiquement, elle vise à : (1) examiner la plausibilité de la théorie d’intervention du programme; (2) décrire et comprendre les processus d’apprentissage d’équipe ainsi que les facteurs qui les influencent; et (3) explorer, du point de vue des participants, les effets réflexifs du Laboratoire. Afin de répondre à ces objectifs, la thèse mobilise diverses perspectives théoriques liées à l’apprentissage individuel, d’équipe et organisationnel. Les résultats des analyses démontrent que : (1) malgré quelques améliorations possibles, le modèle du programme est généralement bien conçu pour parvenir aux résultats visés; (2) l’implantation de ce modèle dans deux sites a donné lieu à des processus d’apprentissage d’équipe différents, bien que conditionnés par des facteurs communs liés aux participants, à l’équipe, au contexte organisationnel et à l’implantation du programme; (3) tel que visé, les participants des deux sites ont développé de la réflexivité vis-à-vis leur pratique et leur rôle professionnel – cette réflexivité adoptant une fonction formative ou critique en regard de l’expérience professionnelle. Ces résultats soulignent le potentiel que représente l’évaluation de la théorie d’intervention pour améliorer la conceptualisation d’un programme de développement professionnel, ainsi que l’intérêt et la pertinence d’évaluer les processus d’apprentissage au niveau de l’équipe dans le cadre d’une approche collective de développement professionnel. De plus, ils appuient l’importance de l’apprentissage réflexif pour l’amélioration des pratiques et l’engagement social des professionnels. En ce sens, ils proposent différentes avenues qui ont le potentiel de consolider les capacités de la main-d’œuvre de santé publique et d’influer conséquemment sur son efficacité à améliorer la santé des collectivités dans le prochain siècle.

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Rapport de stage présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil en soins infirmiers