Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma

BACKGROUND: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. OBJECTIVE: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. METHODS: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. RESULTS: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. CONCLUSIONS: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

A case study: Perceptions of the induction process of intern principals in Broward County Public Schools

The case study is a qualitative study of the perceptions of a purposeful sample of intern principal participants in Broward County Public School's 2001-2003 principal leadership induction program through survey, interview and document analysis of their experiences concerning their success or failure in achieving the position of principal. The study focused on constructs of professional and organizational socialization and instructional leadership that research suggests are vital and integrated components of the effective development of aspiring instructional leaders. ^ The findings revealed that purposeful mentoring, a variety of site placement, hands on practical experiences, in addition to the quality of experience measured by the number of years prior experience are positively reported to affect the degrees of success perceived by intern principals. The study validated the interrelatedness of the three constructs professional and organizational socialization and instructional leadership as components that are realized in the development process through formal and informal characteristics of socialization. The data gathered would be of benefit to principal leadership program designers to assist in their understanding of participants' successes and failures that influence individual needs based on their experience as perceived by this group. ^ Implications for further study are the need for better understanding of leadership development, continued reinforcement of best practices such as mentoring, site shadowing and coaching, clarification of the administrator's role, data analysis, curriculum implementation and student achievement. Organizations need to implement a common set of expectations, reasoning, attitudes, and understanding of purpose that guide behaviors. Recommendations are to design leadership induction programs to meet individual strengths and weaknesses not a one-size-fits-all program including a constructive and prescriptive two-way feedback system, select and assign mentors based on their expertise and candidate needs, varied site placements, develop skills to build collaborative relationships, and a standards based monitoring and assessment system to document program mastery and completion. ^

Perceptions of the Induction Process of Intern Principals in a Large Urban School District

This study presents perceptions of principals in a leadership induction program in a large urban school district in the southeastern United States. Qualitative research procedures were used to document experiences of principals. Theoretical constructs guiding the study were professional socialization, organizational socialization, and instructional leadership.

Women at work: Nurse and intern talk to patient, coronary-intensive care unit, Douglas County Hospital, Alexandria, Minnesota

Inscription: Verso: Women at work: miscellaneous occupations.

Utveckling av lojalitetsprogram - individanpassade erbjudanden : Marknadsföring genom CRM-strategier

Den ökade konkurrenssituationen mellan företag är ett resultat på att handeln har globaliserats. Konsumenter är idag mer medvetna om vad företag har att erbjuda, och det är lätt att välja alternativa företag om ett specifikt företag inte lever upp till konsumentens förväntningar. Detta ställer krav på att företag ständigt måste arbeta med och utveckla sina strategier för att skapa konkurrensfördelar. Idag arbetar många företag med lojalitetsprogram som är ett typexempel på en CRM-strategi. CRM-strategier och lojalitetsprogram syftar till att göra konsumenten mer lojal, för att möjliggöra att konsumenten skall välja att göra återupprepande och mer frekventa köp. Lojalitetsprogrammen måste dock uppdateras och förändras, för att ständigt kunna vara konkurrenskraftiga. Företag arbetar därmed för att skapa ett mervärde, det vill säga erbjuda en servicelösning som är utöver vad konsumenten förväntar sig att få från företag. Kundlojalitet kan utvecklas genom att företag skapar långsiktiga relationer med konsumenterna, och en relation mellan parterna kan utvecklas genom att företag lyssnar på konsumenterna, för att få reda på dess behov och önskemål. Forskning indikerar att individanpassade erbjudanden kan bidra till att konsumenterna än mer tenderar att bli lojala, detta eftersom individanpassade erbjudanden är erbjudanden som baseras på konsumentens unika köpbeteende, vilket möjliggör för träffsäkerhet och relevans. Syftet med denna studie är att mäta konsumenters efterfrågan på individanpassade erbjudanden, för att undersöka om konsumenterna faktiskt efterfrågar och kommer ta till sig dessa erbjudanden. Frågeställningarna är; på vilket sätt kan efterfrågan på individanpassade erbjudanden bidra till ett företags konkurrensfördelar samt på vilket sätt skiljer sig efterfrågan på individanpassade erbjudanden beroende på butikernas geografiska placering. Studien är baserad på en kvantitativ surveyundersökning riktad till konsumenter, med en kvalitativ semi-strukturerad intervju för att erhålla viktig information vid utformandet av frågeformuläret. Resultatet för studien visade att konsumenter värdesätter att få individanpassade erbjudanden, och att dessa erbjudanden kan bidra till ett företags konkurrensfördelar eftersom erbjudandena möjliggör att servicekvaliteten kan öka vilket innebär att dessa erbjudanden kan upplevas ha ett mervärde. I denna studie återfanns dock inte några skillnader på efterfrågan av individanpassade erbjudanden beroende på butikernas geografiska placering.

Intern kontroll: En fallstudie på Trafikverket

Internal control is something that’s grown more important for enterprises to keep in mind. The community is increasingly affected by the IT-development which demands a bigger degree of security. Enterprises needs to make sure that their systems are up to date and secure enough to keep it safe from unauthorized to take part of sensitive information. Internal control can exist in a major part of the work. If an enterprise have a goal for no harm or serious injury at work, internal control is necessary to reach that goal. The purpose for this essay is to examine how five different departments of Trafikverket practices internal control. How internal control is described. How the guidance from the managements is described and how it reaches the rest of the enterprise. This will lead to a proposal of improvement of the internal control at Trafikverket. We focus our frame of reference on the COSO-model and its five components. The components included in the COSO-model are control environment, risk valuation, control activities, information and communication and monitoring. The essay is a case-study of Trafikverket. We have chosen a qualitative method and interviewed five respondents from the different departments on Trafikverket. The respondents we interviewed works with internal control in their everyday work or have a god insight in the subject. We used a semi structured interview guide with questions based on the COSO framework. The results from our study shows that it exist big variations between how the departments work with internal control. It emerged that there are new guidelines for how the work should be done. This makes it necessary with education to implement the new ways to work. How the departments use the COSO-model varies. Some of them have incorporated the model in their new ways to work others have never heard of it. The conclusion of our study shows that the COSO-model and it´s components contribute to a functioning internal control. Implementing the components is important and the most important feature to good internal control is the corporate management. Education within the enterprise is the most effective way to inform the staff about the model and to implement it.

Teacher leadership : interns crossing to the domain of higher professional learning with mentors?

Over the last two decades, the notion of teacher leadership has emerged as a key concept in both the teaching and leadership literature. While researchers have not reached consensus regarding a definition, there has been some agreement that teacher leadership can operate at both a formal and informal level in schools and that it includes leadership of an instructional, organisational and professional development nature (York-Barr & Duke, 2004). Teacher leadership is a construct that tends not to be applied to pre-service teachers as interns, but is more often connected with the professional role of mentors who collaborate with them as they make the transition to being a beginning teacher. We argue that teacher leadership should be recognised as a professional and career goal during this formative learning phase and that interns should be expected to overtly demonstrate signs, albeit early ones, of leadership in instruction and other professional areas of development. The aim of this paper is to explore the extent to which teacher education interns at one university in Queensland reported on activities that may be deemed to be ‘teacher leadership.’ The research approach used in this study was an examination of 145 reflective reports written in 2008 by final Bachelor of Education (primary) pre-service teachers. These reports recorded the pre-service teachers’ perceptions of their professional learning with a school-based mentor in response to four outcomes of internship that were scaffolded by their mentor or initiated by them. These outcomes formed the bases of our research questions into the professional learning of the interns and included, ‘increased knowledge and capacity to teach within the total world of work as a teacher;’ ‘to work autonomously and interdependently’; to make ‘growth in critical reflectivity’, and the ‘ability to initiate professional development with the mentoring process’. Using the approaches of the constant comparative method of Strauss and Corbin (1998) key categories of experiences emerged. These categories were then identified as belonging to main meta-category labelled as ‘teacher leadership.’ Our research findings revealed that five dimensions of teacher leadership – effective practice in schools; school curriculum work; professional development of colleagues; parent and community involvement; and contributions to the profession – were evident in the written reports by interns. Not surprisingly, the mentor/intern relationship was the main vehicle for enabling the intern to learn about teaching and leadership. The paper concludes with some key implications for developers of preservice education programmes regarding the need for teacher leadership to be part of the discourse of these programmes.

Making the transition from pharmacy student to pharmacist: Australian interns' perceptions of professional identity formation

Objectives The experience of transitioning from university to practice influences professional identity formation. It is unclear how this transitioning experience influences pharmacy interns' professional identities. This study aims to examine pharmacy interns' perceptions of their transition from university to the workplace and the influence this had on their pharmacist identities. Methods A qualitative approach using in-depth interviews was adopted for this study. Fifteen interns (community and hospital) from one school of pharmacy in Australia were interviewed. Questions were asked about the nature of their current intern role, their university experiences, how they saw themselves as pharmacists and their perceptions of the transition to practice. Key findings The interns interviewed entered the workplace valuing patient-focused aspects of practice and contributing to patient care. The nature of work meant there were limited opportunities to enact these aspects of their professional identities. The interns were challenged by interactions with patients and doctors, and experienced difficulties reconciling this with their university-derived professional identities. Also, the interns lacked the confidence and strategies to overcome these challenges. Some were exploring alternative ways of being pharmacists. Conclusions This paper argues that graduates' experience of the transition to practice was challenging. This was due to nascent professional identities formed in university and a lack of workplace experiences enabling patient-centred practices. The interns' formation of professional identities was highly responsive to the context of work. To facilitate the development of Australian patient-centred pharmacy practice, supporting professional identity formation should be a focus within pharmacy education.

Finnish and Austrian Wood Markets in a Changing Environment

At present the operating environment of sawmills in Europe is changing and there are uncertainties related in raw material supply in many countries. The changes in the operating environment of roundwood markets and the effects followed by these changes have brought up several interesting issues from the viewpoint of research. Lately new factors have been influencing the roundwood markets, such as increasing interest towards wood-based energy and implementation of new energy policies as well as changes in wood trade flows that affect the domestic markets in many countries. This Master’s thesis studies the adaptation ability of Finnish roundwood markets in a changing operating environment, aiming to produce an up-to-date analysis considering new development trends. The study concentrates on the roundwood markets from the viewpoint of sawmill industry since the industry is dependent on the functioning of the markets and sawmills are highly affected by the changes on the roundwood markets. To facilitate international comparison, the study is implemented by comparing Finnish and Austrian roundwood markets and analysing changes happening in the two countries. Finland and Austria share rather similar characteristics in the roundwood market structures, forest resources and forest ownership as well as production of roundwood and sawnwood. In addition they both are big exporters of forest industry products. In this study changes in the operating environment of sawmill industry both in Finland as well as in Austria are compared to each other aiming to recognise the main similarities and differences between the countries. In addition both development possibilities as well as challenges followed by the changes are discussed. The aim of the study is to define the main challenges and possibilities confronted by the actors on the markets and also to find new perspectives to approach these. The study is implemented as a qualitative study. The theoretical framework of the study describes the operating environment of wood markets from the viewpoint of the sawmill industry and represents the effects of supply and demand on the wood markets. The primary research material of the study was gathered by interviewing high level experts of forestry and sawmill industry in both Finland and Austria. The aim was to receive as extensive country specific viewpoint from the markets as possible, hence interviewees represented different parties of the markets. After creating country-specific profiles based on the theoretical framework a cross-country comparison was implemented. As a consequence the main similarities and differences in the operating environment and on the roundwood markets of Finland and Austria were recognized. In addition the main challenges and possibilites were identified. The results of the study offer a wide analysis regarding the main similarities and differences of the wood markets of Finland and Austria and their operating environments as well as concerning challenges and possibilities faced on the markets.

Kuluttajien verkko-ostamisen vaiheet ja kuluttajien kokema riski verkkokaupassa

Tutkielmassa on tarkasteltu kuluttajien internetin käyttöä, verkko-ostamisen vaiheita sekä niihin liittyviä riskejä. Lisäksi teoriaosuudessa on esitelty verkkomarkkinoinnin vaikutusmahdollisuuksia kuluttajien verkko-ostamiseen. Empiirisessä osuudessa tutkittiin kuluttajien internetin käyttöä, verkko-ostamista ja siihen liittyviä riskejä sekä selvitettiin suhtautumista maksunvälityspalveluihin. Tutkimus toteutettiin survey-tutkimuksena. Aineisto kerättiin internet-pohjaisella kyselylomakkeella, joka sijoitettiin kahdelle Checkout™maksunvälityspalvelua käyttävälle verkkosivustolle. Kyselyyn saatiin yhteensä 133 vastausta. Lisäksi tutkimukseen kerättiin aineistoa Checkout™palvelun kautta. Aineiston avulla pystyttiin tutkimaan verkkokauppojen myynnin jakautumista eri viikonpäivien Ja kellonaikojen mukaan. Tuloksista oli havaittavissa selvästi, että verkko-ostaminen painottuu myöhäiseen iltaan niin välitettyjen maksujen lukumäärän kuin euromäärienkin mukaan. Kyselyyn vastanneet olivat internetin aktiivikäyttäjiä eli käyttivät internetiä päivittäin. Kaikilla vastaajilla oli lisäksi kotona käytössään vähintään yksi tietokone. Vastaajien demografioita tarkasteltaessa nuorten, alle 25-vuotiaiden, määrä oli selvästi suurin. Vastaajissa oli enemmän miehiä kuin naisia. Vastaajien aktiivinen internetin käyttö ei tutkimuksen mukaan tehnyt heistä verkkokauppojen aktiivikäyttäjiä. Kyselyyn vastanneet kuluttajat tiedostivat selkeästi verkko-ostamiseen liittyvät riskit ja pyrkivät valitsemaan ostopaikakseen verkkokauppoja, joissa kokivat riskit pienimmiksi. Verkko-ostamisen yleistymistä rajoittavat kalliit postikulut, tuotetietojen puutteellisuus sekä erityisesti ulkomaalaisten verkkokauppojen epäluotettavuus. Myös tasoerot kauppojen välillä rajaavat kuluttajien verkko-ostamisen mahdollisuuksia.

Organizing (with) Thirdness. A Dialogic Understanding of Bicultural Interactions in Organizations

This conceptual paper examines bicultural interactions in organizations as they are experienced by the involved individuals. Notions from Bakhtinian dialogism are used in order to conceptualize the sensemaking opportunities provided by the encounter with a cultural otherness. It is argued that in such bicultural situations, because of the lack of intimate understanding of the other culture, the third element in the dialogic relation - ‘thirdness’, i.e. the relation itself, without which there would be no sensemaking potential - may be lacking as a result of the distorting combination of projected similarity and stereotyping, added to certain counterproductive organizational dynamics. Therefore, it is suggested that, to make the bicultural work interaction the rewarding relation it could be, thirdness should be coordinated by management in a way that can transcend the spontaneous negative dynamics of the confrontational situation. If management was to fail to organize (with) thirdness appropriately, bringing in a third party could be a possible alternative in order to initiate the necessary mutual understanding that should eventually lead to a fruitful work interaction.

Finnish-French Fundamental Cultural Antagonisms in Organising

Seeking to challenge the belief that within-West cultural differences should be seen as insignificant in organisations, this paper seeks to demonstrate how two given Western European ‘organising cultures’ (i.e. Finnish culture and French culture, as they are expressed in the process of organising) can contrast, if not conflict, with each other. Further, it aims to help the reader realise what kinds of fundamental ‘cultural antagonisms’ these contrasting organising behaviours may come from, to help her/him understand ‘the other culture’ better, and thus allow for a first step towards an improvement of Finnish-French intercultural interactions in organisational contexts. After shortly introducing what should be understood here as ‘cultural antagonisms’, the paper addresses four fundamental Finnish-French antagonisms, regarding the vision of the organisation (‘functionalist vs. personalist’), the relative importance of ‘consensus vs. dissensus’, the typical trade-off between reliability and flexibility, and the striking differences in communication, respectively. These four fundamental antagonisms are found to be closely interrelated and integrated, serving as explanation, justification and legitimisation for each other. That does not mean, however, that differences, however striking they may be, should merely be a threat to co-operation: some implications introduced at the end of the paper suggest that, provided people are aware of them, cultural antagonisms can also be seen as opportunities for a more fruitful work interaction.

Service Experience in an Innovation Context

Service researchers and practitioners have repeatedly claimed that customer service experiences are essential to all businesses. Therefore comprehension of how service experience is characterised in research is an essential element for its further development through research. The importance of greater in-depth understanding of the phenomenon of service experience has been acknowledged by several researchers, such as Carú and Cova and Vargo and Lusch. Furthermore, Service-Dominant (S-D) logic has integrated service experience to value by emphasising in its foundational premises that value is phenomenologically (experientially) determined. The present study analyses how the concept of service experience has been characterised in previous research. As such, it puts forward three ways to characterise it in relation to that research: 1) phenomenological service experience relates to the value discussion in S-D logic and interpretative consumer research, 2) process-based service experience relates to understanding service as a process, and 3) outcome-based service experience relates to understanding service experience as one element in models linking a number of variables or attributes to various outcomes. Focusing on the phenomenological service experience, the theoretical purpose of the study is to characterise service experience based on the phenomenological approach. In order to do so, an additional methodological purpose was formulated: to find a suitable methodology for analysing service experience based on the phenomenological approach. The study relates phenomenology to a philosophical Husserlian and social constructionist tradition studying phenomena as they appear in our experience in a social context. The study introduces Event-Based Narrative Inquiry Technique (EBNIT), which combines critical events with narratives and metaphors. EBNIT enabled the analysis of lived and imaginary service experiences as expressed in individual narratives. The study presents findings of eight case studies within service innovation of Web 2.0, mobile service, location aware service and public service in the municipal sector. Customers’ and service managers’ stories about their lived private and working lifeworld were the foundation for their ideal service experiences. In general, the thesis finds that service experiences are (1) subjective, (2) context-specific, (3) cumulative, (4) partially socially constructed, (5) both lived and imaginary, (6) temporally multiple-dimensional, and (7) iteratively related to perceived value. In addition to customer service experience, the thesis brings empirical evidence of managerial service experience of front-line managers experiencing the service they manage and develop in their working lifeworld. The study contributes to S-D logic, service innovation and service marketing and management in general by characterising service experience based on the phenomenological approach and integrating it to the value discussion. Additionally, the study offers a methodological approach for further exploration of service experiences. The study discusses managerial implications in conjunction with the case studies and discusses them in relation to service innovation.

Hur den aktiva kunden konstruerar budskap - Ett synsätt inom relationskommunikation

Den här avhandlingen erbjuder ett nytt perspektiv på marknadskommunikation. Det nya är ett starkt kundfokus, där kunden är en aktiv medpart i kommunikationsprocessen. I det traditionella kommunikationsperspektivet har man sett kunden som ett objekt som blir utsatt för företagets olika åtgärder. Där har det varit företaget som stått för integreringen av de olika budskapen. I det här arbetet står kunden för integrationen och har därmed möjligheten att lägga till budskap eller lämna bort någonting väsentligt. I och med perspektivskiftet kan man upptäcka nya fenomen i kommunikation som inte tidigare beaktats i tillräcklig utsträckning. Eftersom det är kunden som står för den aktiva konstruktionen av budskap, kan kundens uppfattning vara en annan än den som företagen avsett. Kundens uppfattning kan beskrivas med hjälp av begreppen tydlig, otydlig och tyst kommunikation. Inom ramen för tyst kommunikation utvecklas ett nytt begrepp – passiv kommunikation – som kan öppna möjligheter för företag att minska på den aktiva kommunikationen med sina kunder. Även källorna till den här kommunikationen kan variera. Dylika källor kan lokaliseras till relation, händelse eller konsekvens. Dessa fenomen har sammanställts i en modell som kallas relationskommunikationsarenan. Kundernas uppfattningar varierar beroende på om det är fråga om relationskommunikation eller annan kommunikation. Dessa uppfattningar är strukturerade i två olika dimensioner: en tids- och en kontextdimension. Tidsdimensionen består av historiska och framtidsrelaterade faktorer och kontextdimensionen är en situationsdimension som består av interna, personliga faktorer och av externa faktorer i omgivningen. I relations-kommunikation förekommer faktorer från alla dimensioner. Modellen för denna struktur kallas den dynamiska kommunikationsmodellen. I avhandlingen utvecklas även en metod – kommunikationstopografi – med vars hjälp olika uppfattningar kan visualiseras på ett åskådligt sätt. Med topografierna kan olika budskap som annonser analyseras och tydliga, otydliga samt tysta budskap separeras. På motsvarande sätt kan även olika grupper av personer som uppfattar budskap på ett visst sätt särskiljas. Både budskap och personer analyseras här. Förekomsten av relationskommunikation kan i en del fall påvisas. Med kommunikationstopografi kan man visa hur den aktiva kunden konstruerar, lägger till eller lämnar bort budskap.