Étude multicentrique des facteurs influençant l’adoption d’un dossier clinique informatisé hospitalier par des infirmières

À l’instar de plusieurs systèmes de santé, les centres hospitaliers québécois ont amorcé l’informatisation du dossier patient sous forme papier pour la transition vers un dossier clinique informatisé (DCI). Ce changement complexe s’est parfois traduit par des répercussions sur les pratiques de soins, la sécurité et la qualité des soins offerts. L’adoption de la part des utilisateurs de technologies de l’information (TI) est considérée comme un facteur critique de succès pour la réalisation de bénéfices suite au passage à un DCI. Cette étude transversale multicentrique avait pour objectifs d’examiner des facteurs explicatifs de l’adoption, de l’utilisation réelle d’un DCI, de la satisfaction des infirmières et de comparer les résultats au regard du sexe, de l’âge, de l’expérience des infirmières et des stades de déploiement du DCI. Un modèle théorique s’appuyant sur la Théorie unifiée de l’adoption et de l’utilisation de la technologie a été développé et testé auprès d’un échantillon comptant 616 infirmières utilisant un DCI hospitalier dans quatre milieux de soins différents. Plus particulièrement, l’étude a testé 20 hypothèses de recherche s’intéressant aux relations entre huit construits tels la compatibilité du DCI, le sentiment d’auto-efficacité des infirmières, les attentes liées à la performance, celles qui sont liées aux efforts à déployer pour adopter le DCI, l'influence sociale dans l’environnement de travail, les conditions facilitatrices mises de l’avant pour soutenir le changement et ce, relativement à l’utilisation réelle du DCI et la satisfaction des infirmières. Au terme des analyses de modélisation par équations structurelles, 13 hypothèses de recherche ont été confirmées. Les résultats tendent à démontrer qu’un DCI répondant aux attentes des infirmières quant à l’amélioration de leur performance et des efforts à déployer, la présence de conditions facilitatrices dans l’environnement de travail et un DCI compatible avec leur style de travail, leurs pratiques courantes et leurs valeurs sont les facteurs les plus déterminants pour influencer positivement l’utilisation du DCI et leur satisfaction. Les facteurs modélisés ont permis d’expliquer 50,2 % de la variance des attentes liées à la performance, 52,9 % des attentes liées aux efforts, 33,6 % de l’utilisation réelle du DCI et 54,9 % de la satisfaction des infirmières. La forte concordance du modèle testé avec les données de l’échantillon a notamment mis en lumière l’influence des attentes liées à la performance sur l’utilisation réelle du DCI (r = 0,55 p = 0,006) et sur la satisfaction des infirmières (r = 0,27 p = 0,010), des conditions facilitatrices sur les attentes liées aux efforts (r = 0,45 p = 0,009), de la compatibilité du DCI sur les attentes liées à la performance (r = 0,39 p = 0,002) et sur celles qui sont liées aux efforts (r = 0,28 p = 0,009). Les nombreuses hypothèses retenues ont permis de dégager l’importance des effets de médiation captés par le construit des attentes liées à la performance et celui des attentes liées aux efforts requis pour utiliser le DCI. Les comparaisons fondées sur l’âge, l’expérience et le sexe des répondants n’ont décelé aucune différence statistiquement significative quant à l’adoption, l’utilisation réelle du DCI et la satisfaction des infirmières. Par contre, celles qui sont fondées sur les quatre stades de déploiement du DCI ont révélé des différences significatives quant aux relations modélisées. Les résultats indiquent que plus le stade de déploiement du DCI progresse, plus on observe une intensification de certaines relations clés du modèle et une plus forte explication de la variance de la satisfaction des infirmières qui utilisent le DCI. De plus, certains résultats de l’étude divergent des données empiriques produites dans une perspective prédictive de l’adoption des TI. La présente étude tend à démontrer l’applicabilité des modèles et des théories de l’adoption des TI auprès d’infirmières œuvrant en centre hospitalier. Les résultats indiquent qu’un DCI répondant aux attentes liées à la performance des infirmières est le facteur le plus déterminant pour influencer positivement l’utilisation réelle du DCI et leur satisfaction. Pour la gestion du changement, l’étude a relevé des facteurs explicatifs de l’adoption et de l’utilisation d’un DCI. La modélisation a aussi mis en lumière les interrelations qui évoluent en fonction de stades de déploiement différents d’un DCI. Ces résultats pourront orienter les décideurs et les agents de changement quant aux mesures à déployer pour optimiser les bénéfices d’une infostructure entièrement électronique dans les systèmes de santé.

Evaluation of effectiveness of the project ‘Caring caregivers of persons in disability situation’. Bogotá - second semester of 2007

The present paper presents the results of a transversal descriptive study which intended to estimate the contribution of the project “Caring for those who take care of people with disabilities” in the areas of: strength of personal and group competences, self care, life project, dexterity in the care process of people with disabilities, and communitarian auto management; that was implemented in 20 urban areas with caregivers of the city of Bogota in the year 2007. The study allowed the nresearches to acknowledge the little change perception that caregivers had in terms of self care, however, the caregivers perceived change in the four areas, although this were not statistically significant in comparison with the general population. There were only significant changes in the communitarian auto management area in 30% of the population. As a result, it is proposed that more extensive, continuous, and sustainable processes are implemented and that this process arises from contention spaces which can be created with the caregivers, from which they can be motivated to participate in other ´processes of collective and individual changes. Also there’s a need to rely on facilitators (professionals and change agents) who have stronger competences on the how to be and the how to interact competences, because there’s a need to manage the psychosocial components in this group of people. Also, we must make organizational processes and the social networks stronger, this is: collective actions are required, because disability is a social fact, and so, the individual issues are just a moment in the process of inclusion of the person with disability, his family and caregiver.

Resiliencia y variables socio demográficas: implicaciones en la dirección de organizaciones

En el ámbito organizacional es necesario interiorizar y aplicar conceptos que generen herramientas que hagan posible el adecuado funcionamiento de las empresas a efectos de mejorar los resultados en términos económicos. Es importante entender las circunstancias que rodean al mundo y así mismo la manera en la que este funciona, ya que cada vez se ve influenciado por culturas y rasgos que difieren según el espacio geográfico en el que se desarrolle la actividad. Por este motivo es importante identificar personas que influencien positivamente a las organizaciones y sean agentes de cambio que desarrollen planes y estrategias que sean comunes a los objetivos de la organización orientando todos sus esfuerzos a la consecución de metas que la misma se proponga. En las empresas es claro que pueden presentarse problemas que encierren cualquier ámbito, como el personal, empresarial o familiar, lo cual a su vez puede generar desmotivación y falta de ánimo entre quienes desarrollen el rol de líder haciendo que sus responsabilidades no se cumplan a cabalidad. Sin embargo, estos deben tener la capacidad de anteponerse ante este tipo de adversidades de manera profesional con el fin de equilibrar sus emociones y superar el obstáculo de manera satisfactoria, sin pensar en resultados negativos y siendo un ejemplo para sus seguidores; dicha capacidad hoy en día se denomina resiliencia. Por esta razón, a lo largo de este trabajo se realizará una revisión teórica que tendrá como objeto identificar los aspectos generales del concepto de resiliencia y de igual forma encontrar la importancia de este estudio dentro del ámbito organizacional. Así mismo, se analizará la relación existente entre la resiliencia y las variables socio-demográficas: edad, nivel de estudios, estrato económico y género. Dicho análisis se hará posible con la ayuda de estudios realizados a nivel latinoamericano en países como: México, Perú y Colombia.

Dealing and discovering a new organizational culture within a very traditional university

La Universidad del Rosario es una de las universidades más antiguas de Colombia, fundada en 1653 y, desde entonces, caracterizada como una universidad tradicional. Existe al interior de la Universidad una Facultades ha desarrollado fuertemente un cambio cultural transformando la naturaleza y desempeño de la Universidad. Esta investigación explora este cambio utilizando un modelo que estudia la cultura como una realidad compleja. El resultado de este trabajo es interesante desde el punto de vista teórica dado que es un ejemplo de “cambio de los agentes” en como una institución antigua y tradicional en términos académicos puede transformarse y cómo puede estudiarse dicho caso.

Do inspections of schools influence head teachers’ leadership?

This paper seeks to describe and discuss the impact of inspections of schools in Sweden. It outlines the political context, based on New Public Management (NPM) theory, according to what role the Schools Inspectorate is supposed to play in order to govern and control. Attention is also devoted, referring an on-going case study, to how inspections influence head teachers and their leadership in their everyday work.   Reports from the Schools inspectorate are public. This forces both politicians and head teachers to take measures. In this case, the head teachers perceived that the inspection reports confirmed what they already knew, but it also gave them an alibi and a tool to push their teachers to take part in everyday school development work. During the first year after the inspection the head teachers mainly strived to adjust formal deficiencies in local steering documents. However, some of the deviations reported from the Schools inspectorate are regarding pedagogical problems that are complicated and difficult to handle. As interventions in many cases will show up much later the results are, for example as increased goal fulfilment, in this case, still an open question. Nevertheless, it seems obvious that the Schools Inspectorate must be seen as a result of the governing philosophy that denotes New Public Management NPM).

Jornalismo e meio ambiente: a contribuição dos meios de comunicação e o conceito de sustentabilidade

This article is a reflection about the contribution the social communication media can provide to the public debate about the environmental concerns. The Agenda XXI and several other UN documents call to the need to inform and educate the society. On the other hand, the Communication theories always have in common the imperative of the emitter to be understood by the recipient, in such a way that they can become change agents and not only observers. The first step is, therefore, to study the environmental question, adequately focus the theme and convey clarification. It is not what happened, for instance, with some technical concepts from the area, in particular sustainability, that came about in the 70 s to guide public policies at the service of the life preservation and specially, future and today, utilized even as a parameter of preservation of profit and advantage resulting from exploitation of nature.Key-Words Theory of Communication - Environmental Sustainability MCM

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Beyond Bullying: Transforming the Culture of Peer Abuse

Bullying needs to be understood and positioned as a form of child abuse – peer abuse. For too many people, bullying is a benign term. This article will include information collected from a wide-range of researchers and discussions with over 50,000 students that I have facilitated during the past twenty years. The content will focus on new morbidities related to bullying such as depression and suicide, obesity, eating disorders, food allergies, juvenile diabetes, truancy, and substance and alcohol abuse. Making a cultural change in our society will require identified Change Agents, along with recommendations for collaboration, policies, projects and legislation.

Sistemática de transformação: desenvolvimento teórico para o alinhamento entre estratégia e cultura organizacional nos projetos de Lean

Desde o final do Século XX e início do Século XXI, estudos analisam a elevada taxa de insucesso ou insatisfação com os Programas de Lean. Esta taxa tem se demonstrado demasiadamente elevada, variando entre 66% e 90%. Como efeito deste insucesso, tem-se o desperdício de tempo, dinheiro, recursos e, talvez o pior, tem-se a propagação do medo nos agentes de mudança em empreitar novas iniciativas de mudança. Estudos apontam a falta de alinhamento de tais projetos com a Cultura Organizacional como uma das questões fundamentais deste insucesso. Partindo desta temática de pesquisa, este ensaio teórico pode ser caracterizado como uma abordagem qualitativa de análise do problema, de natureza básica de pesquisa buscando gerar conhecimentos novos e úteis às organizações, sem aplicação prática prevista neste primeiro estágio de pesquisa. A fonte de evidências para sustentar o modelo proposto foi revisão dos estudos de caso encontrados na literatura, sendo utilizadas tanto uma Revisão Bibliográfica Sistemática (RBS) quanto Exploratória, de tal maneira a buscar o \"estado da arte\" no campo de estudo. A Fundamentação Teórica do trabalho é baseada na literatura de quatro grandes campos de estudo: (i) Estratégia, (ii) Lean, (iii) Cultura Organizacional e (iv) Gestão de Mudanças. A RBS tem foco nas interseções destes grandes campos, agregando 190 trabalhos internacionais. Por sua vez, a Revisão Exploratória traz algumas das principais referências dos três campos de estudo, como: Edgar Schein, John Kotter, Kim Cameron, Robert Quinn, David Mann, dentre outros. Desta maneira, este trabalho estudou a influência da cultura organizacional nos projetos de transformação e, a partir da ruptura com a teoria atual, construiu e propôs uma sistemática teórica, intitulada de \"Sistemática de Transformação\" (ou simplesmente \"Sistemática T\"), a qual propõe o alinhamento entre três dimensões: Estratégia, Projeto de Transformação e Cultura Organizacional. Fazendo uso desta sistemática, é esperado que os agentes de mudança consigam ter um planejamento mais eficaz do processo de diagnóstico, avaliação e gestão da cultura organizacional alinhado à Estratégia e também ao Projeto de Transformação da organização, com ênfase nos Programas de Lean. A proposição e uso desta sistemática pode favorecer tanto a discussão acadêmica na área de Gestão de Operações sobre o tema, quanto fornecer subsídios para aplicações práticas mais eficazes.

Projeto – sustentabilidade e matemática

A disciplina matemática e o tema sustentabilidade podem ser muito bem trabalhados pelos docentes da área de exatas. Pois, saber quantificar, calcular e associar o consumo e o impacto ambiental através de dados numéricos é uma possibilidade que pode ser desenvolvida em sala de aula. Saber interpretar e construir gráficos de colunas são outras competências e habilidades presentes na ciência da matemática. Compreender conceitos, estratégias e situações matemáticas numéricas para aplicá-los a situações diversas no contexto das ciências, da tecnologia e da atividade cotidiana se faz necessário. E também, reconhecer, pela leitura de textos apropriados, a importância da Matemática na elaboração de proposta de intervenção solidária na realidade. Dessa forma, conhecer o ambiente em que vivemos, verificar a influência do homem na Natureza e quais ações deverão ser tomadas pensando nas futuras gerações é um despertar para o consumo consciente. O que acarreta como possibilidade o retorno à natureza de recursos utilizados de maneira correta. Conhecer uma conta de luz detalhada, aprender a calcular o consumo mensal de Kwh e diminuir o consumo de energia elétrica através da mudança de hábitos são exemplos cotidianos em que a matemática se faz presente. Relacionar a matemática ao estudo do meio ambiente proporciona através dos números mensurar os prejuízos e projetar soluções, torna a aprendizagem construtiva, podendo se constituir num comportamento cotidiano ou numa ação educativa para formar uma consciência ecológica dentro de indicadores reais. A aprendizagem se torna significativa quando relacionada ao cotidiano do aluno no sentido de mostrar o meio ambiente a que estão inseridos para que possam ser agentes transformadores, através da mudança de hábitos e principalmente desenvolvendo suas habilidades matemáticas. Sendo assim, o processo de ensino aprendizagem matemática-meio ambiente é realizado no sentido de oportunizar o conhecimento do mundo e domínio da natureza, com base nas linguagens matemáticas, criando-se condições de melhorar a capacidade de agir na sociedade, assumindo ações permanentes concentradas em um desenvolvimento sustentável para a continuidade da vida na Terra. Nesse diapasão, é possível desenvolver trabalhos pedagógicos “na trilha da matemática: do raciocínio ao meio-ambiente”. A resolução de situações problemas e assuntos referentes ao meio ambiente fazem com que os alunos tomem os cuidados necessários para com o meio ambiente, aos recursos por ele oferecidos e as consequências das ações errôneas causadas pelo homem.

Saúde e outros : natalidade e fertilidade nos estudantes universitários

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

"Ignorance was bliss, now I'm ignorant and that is far more difficult":transdisciplinary learning and reflexivity in responsible management education

Purpose – The collapse of world economic systems brought the interconnectedness between business and global events sharply into focus. As Starkey points out: “leading business schools need to overcome their fascination with a particular form of finance and economics […] to broaden their intellectual horizons […] (and to) look at the lessons of history and other disciplines”. The purpose of this paper is to provide evidence from three years of research on the Aston MBA suggesting that an emphasis on developing capabilities within a far broader, connected and reflexive business curriculum is what business students and practitioners now recognise as an essential way forward for responsible management education. Design/methodology/approach – This research paper examines the reflective accounts of 300 MBA students undertaking a transdisciplinary Business Ethics, Responsibility and Sustainability core module. Findings – As Klein argues, transdisciplinarity is simultaneously an attitude and a form of action. The student reflections provide powerful discourses of individual learning and report a range of outcomes from finding “the vocabulary or the confidence” to raise issues to acting as “change agents” in the workplace. Originality/value – As responsibility and sustainability requires learners, researchers and educators to engage with real world complexity, uncertainty and risk, conventional disciplinary study, especially within business, often proves inadequate and partial. This paper demonstrates that creative and exploratory frames need to be developed to facilitate the development of more connected knowledge – informed by multiple stakeholders, able to contribute heterogeneous skills, perspectives and expertise.

The green campus is also a virtual one

This paper analyses the role of education for sustainability as enabling future sustainability practitioners to become key change agents and leaders. It is important that generic skills and understandings are married to a capability to lead beyond one's disciplinary or professional authority. 'Academic' education for future (and current) sustainability professionals should focus on transdisciplinary learning and research, new media affordances and distributed learning. This raises important questions about the nature of experiential learning and the meaning of 'living sustainability'. With reference to various developments in e-learning, including the European Union's aim to establish a virtual campus for a sustainable Europe, this paper argues that the digital environment is an integral part of our lifeworld connecting people to place, with each other and to possibilities for creative transdisciplinary inquiry. The role of new media in education for sustainability is rarely discussed, is under theorised and its potential largely ignored. © 2010 Inderscience Enterprises Ltd.

Institutional contradiction and management control innovation:a field study of total quality management practices in a privatised telecommunications company

The purpose of this paper is to theorise the changes surrounding the introduction of a management control innovation, total quality management (TQM) techniques, within Telecom Fiji Limited. Using institutional theory and drawing on empirical evidence from multiple sources including interviews, discussions and documents, the paper explicates the institutionalization of these TQM practices. The focus of the paper is the micro-processes and practice changes around TQM implementation, rather than the influence of the macro-level structures that are often linked with institutional theory. The change agents used Quality Action Teams and the National Quality Council to introduce new TQM routines. The present study extends the scope of institutional analysis by explaining how institutional contradictions impact to create and make space for institutional entrepreneurs, who in turn, modify existing routines or introduce new routines in fluid organizational environments which also exhibit evidence of resistance.