The complexity in the implementation process of empowerment-based chronic kidney care: a case study

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

Partner relationship in couples living with atrial fibrillation

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses. The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics. Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care. In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

Annual report 1979

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1980

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1981

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1983

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1984

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1986

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1987

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1988

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1989

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

Annual report 1994

This report contains a brief discussion of the boards and commissions within this department, caseload statistics from each level of court, and concludes with personnel and other financial information gathered from the Judicial Survey of the offices of Clerk of Court, Probate Judge, Master-In-Equity, Public Defender, Magistrate and Municipal Judge.

O sistema integrado de gestão de recursos humanos de uma empresa de tecnologias de informação

O presente trabalho final de mestrado pretende realizar uma análise crítica acerca do estágio curricular desenvolvido no Departamento de Recursos Humanos de uma empresa ligada ao setor das Tecnologias de Informação. Este relatório procura, através da identificação e descrição de métodos e estratégias implementadas pela empresa, que têm como finalidade potencializar o capital humano da organização, estabelecer uma relação entre os diferentes processos de Gestão de Recursos Humanos, interligando-os. Funcionando como um sistema integrado, pretende-se descrever as atividades realizadas no processo de recrutamento e seleção, de acolhimento e integração, de gestão administrativa/contratual, de gestão de desempenho e de formação e desenvolvimento profissional. Em suma, importa salientar que apesar de os processos de Gestão de Recursos Humanos da companhia terem procedimentos devidamente identificados, existe necessidade de promover práticas de melhorias no que concerne ao controlo interno dos mesmos; Abstract: The Integrated Human Resource Management of an Information Technology company This final work of master aims to realize a critical analysis about the internship developed in the Human Resources Department of Information Technology company. This report seeks, through the identification and description of methods and strategies implemented by the company, which are intended to enhance the human capital of the organization, establish a relationship between the different Human Resource Management processes, connecting them. Functioning as an integrated system, is intended to describe the activities in the process of recruitment and selection, reception and integration, administrative/contract management, performance management and training and professional development. In short, it should be noted that although Human Resource Management processes of the company have properly identified procedures, there is need to promote improved practices with regard to internal monitoring.

Relatório da prática de ensino supervisionada na Escola Secundária Gabriel Pereira, agrupamento de escolas n,º 4 de Évora EB 2,3 conde de Vilalva e EB1 Jardim de Infância do Bacelo

Este trabalho tem por base o relato de um ano lectivo 2009/201O de Prática de Ensino Supervisionada (PES) para a especialidade do grau de Mestre em Ensino de Educação Física nos Ensinos Básico e Secundário, leccionado na Universidade de Évora e contribui para a avaliação do mesmo. O estágio foi realizado no agrupamento de Escolas n° 4 de Évora - EB 2,3 Conde de Vilalva; EB1 Jardim de Infância e Escola Secundária Gabriel Pereira, abrangendo os três ciclos de aprendizagem dando assim cumprimento à exigência curricular. Relata de forma sucinta a preparação científica, pedagógica e didáctica desde o conhecimento do currículo, do conteúdo e dos alunos. Desenvolve de forma fundamentada a planificação, condução de aulas e avaliação das aprendizagens. Faz uma análise das actividades desenvolvidas como professor de uma disciplina e como participante activo na escola e na comunidade escolar. Tenta fundamentar as estratégias, metodologias e decisões tomadas. Por último, realiza uma análise da prática de ensino. O que foi constatado nesta pequena experiência foi uma prática mais consciente e um respeito maior, por nós mesmo, enquanto profissional da educação, e pelos alunos, enquanto sujeitos activos no processo de ensino/aprendizagem. ABSTRACT: This work is based on the report of an academic year 2009/2010 Supervised Teaching Practice (PES) for the specialty Master's degree in Teaching Physical Education in Primary and Secondary Schools, taught at the University of Évora and contribute to the evaluation the same. The group stage was held at school n8 4 EB 2,3 Conde Vilalva e Kindergarten and Secondary school Gabriel Pereira, covering the three cycles of learning thus fulfilling the curricular requirement. Reports briefly the scientific training and didactic knowledge from the curriculum the content and pupils. Develop and informed opinion to planning, conducting classes and learning assessment. Makes and analyses of the activities as a teacher of a discipline and as an active participant in school and school community. Try the strategies, methodologies and decisions. Finally makes an analysis of teaching practice. What was found on this little experiment was a more conscious practice and a greater respect for ourselves as professional education, and students as active participants in the teaching /learning.

Realidade da olimpíada colegial do estado de São Paulo (OCESP) em relação ao discurso presente na educação física acerca da competição escolar : estudo da região leste de Campinas

Universidade Estadual de Campinas . Faculdade de Educação Física