Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

A study of dual cultures in dyadic relations

Elderly caregiving, a fact of life for millions of Americans, has gained significance with the increase in the elderly population. Over 25 million family caregivers in the US, most of whom are women rearing their own children, care for severely ill or disabled family members. The increased flow of women into the labor force has caused this traditional role to be entrusted to hired caregivers, mainly home health aides. ^ This case study describes and explains the dyadic experiences of elderly Jewish clients and their Jamaican home health aides in a mixed-culture environment. The inquiry was conducted with a purposive sample of four dyads, their case manager, and the placement officer, all of whom were selected through a home care agency in Fort Lauderdale, Florida. Strategies of data collection including non-participant observation, interviews, document analysis, and researcher's journals. Data from verbatim transcription of interviews and field notes were coded, sorted into emic categories, and reduced as linkages were identified via cross-case comparison. Three major themes—mixed-culture experiences, relationship building and maintenance, and agency role perceptions—emerged from the interpretative analysis of the data. ^ Assertions from these findings include that dyads have established a range of relationships to meet their personal needs, expectations, and desires in these goal-driven relationships. Relationally, they have reached interactional synchrony with some achieving the ideal family-type bond. Cultural difference is but one of the many contextual variables in the home care environment, which has its own cultural norms and expectations. Conflicts transcend cultural difference and seemed more a factor of individual relational disposition. ^

Social funds as a strategy for poverty reduction in Jamaica: An exploratory study

This study explored the relationship between social fund projects and poverty reduction in selected communities in Jamaica. The Caribbean nation's social fund projects aim to reduce “public” poverty by rehabilitating and expanding social and economic infrastructure, improving social services, and strengthening organizations at the community level. Research questions addressed the characteristics of poverty-focused social fund projects; the nexus between poverty reduction and three key concepts suggested by the literature— community (citizen) participation, social capital, and empowerment; and the impact of the projects on poverty. ^ In this qualitative study, data were collected and triangulated by means of in-depth, semi-structured interviews, supplemented by key informant data; non-participant observation; and document reviews. Thirty-four respondents were interviewed individually at eight rural and urban sites over a period of four consecutive months, and 10 key informants provided supplementary data. Open, axial, and selective coding was used for data reduction and analysis as part of the grounded theory method, which included constant comparative analysis. The codes generated a set of themes and a substantive-formal theory. Findings were crosschecked with interview respondents and key informants and validated by means of an audit trail. ^ The results have revealed that the approach to poverty reduction in social fund-supported communities is a process of development-focused collaboration among various stakeholders. The process encompasses four stages: (1) identifying problems and priorities, (2) motivating and mobilizing, (3) working together, and (4) creating an enabling environment. The underlying stakeholder involvement theory posits that collaboration increases the productivity of resources and creates the conditions for community-driven development. In addition, the study has found that social fund projects are largely community-based, collaborative, and highly participatory in their implementation, as well as prescription-driven, results-oriented, and leadership-dependent. Further, social capital formation across communities was found to be limited, and in general, the projects have been enabling rather than empowering. The projects have not reduced poverty per se; however, they have been instrumental in improving conditions that were concomitants of poverty. ^

O atendimento do enfermeiro aos acidentados de trânsito terrestre

Considered the disease of the 20th century, the trauma is still the main cause of mortality in the age group of one to forty-four years old in World, and among several possible etiologies, the terrestrial transit accident has a strong impact on these statistics. The operational essentiality of nurses in the organization and integration of this scenario of care to the terrestrial transit casualties and the recognition that the moments after the trauma are decisive in the victim's prognosis, justify this study. Thus, it was sought to evaluate the nurses´care to casualties of land transit in this crucial process in a public hospital in urgent and emergency reference. This is an normative evaluative study with qualitative approach, carried out at the Hospital Monsenhor Walfredo Gurgel, located in the municipality of Natal/RN. Data collection occurred in May 2014, with approval of the Ethics Committee in Research (CAAE 27971114.9.0000.5537). The target population of the study were the nurses who work in Politrauma area of the hospital, following the inclusion criteria: agree to be part of the study voluntarily and act in the mentioned area and, as exclusion: allocated professionals in other areas (eventually acting in the area) and professionals on vacation and/or medical license. A semi-structured interview and non-participant observation was held to obtain data submitted subsequently to the technique of Content Analysis based on Bardin. The lack of specific training for trauma care was identified, whose severity can be mitigated with proper and skilled care. Therefore, the urgent need of the nurses' training for qualification of care to the victims of traffic accidents on land was evidenced

Integração e interdisciplinaridade no processo ensino/aprendizagem de projeto: o curso de Arquitetura e Urbanismo da Universidade Potiguar de Mossoró-RN

Training in Architecture and Urbanism with its general characteristic involves, in its nature, knowledge of various areas (technology, theory, history, representation, and design), being the space of design conception that place where the synthesis of this knowledge is reflected more clearly. We believe that the integrated work in the architectural curriculum can provide an overview of the project, thus contributing to better training of the architect. This research aims to reflect on the role of integration and interdisciplinary in teaching architectural design. This theme has been work recurrently by critics in the teaching area of project and events of the area as the seminars of the Projetar, highlighted by several authors to search integration as an essential pedagogical approach to design education. The work aims to contribute to reflection and awareness of those involved on the importance of integration in the architectural course of project processes. For this, we analyzed the potential and limits of this process in Architecture and Urbanism Course (CAU) at the Universidade Potiguar (UNP) Mossoró, which has the integration and interdisciplinary recorded since the Pedagogical Project of the Course. This analysis will be performed by observing the development of “interdisciplinary work” in the fifth term during the first half of 2014.1. This research concerns an exploratory qualitative study that aims to investigate specific issues on the teaching/learning architecture project and the integration in architecture courses, following a non-participant observation in architectural design classes in the fifth term of CAU/UnP/ Mossoró, and analysis of final products, which would be the work of the last unit of the semester, called “Interdisciplinary work”. Questionnaires for the teachers who participated in the process has been apply via email and analyzed. Reflection supports several other already carried out to identify the difficulties inherent in applying these principles satisfactorily. Noting, however, that interdisciplinarity, in fact, it goes beyond integration and is even more difficult to achieve. In addition to an educational project that incorporates these principles, such as the course of Architecture and Urbanism of the UNP-Mossoró, full adhesion it is necessary by the faculty and students of this teaching philosophy.

Integração e interdisciplinaridade no processo ensino/aprendizagem de projeto: o curso de Arquitetura e Urbanismo da Universidade Potiguar de Mossoró-RN

Training in Architecture and Urbanism with its general characteristic involves, in its nature, knowledge of various areas (technology, theory, history, representation, and design), being the space of design conception that place where the synthesis of this knowledge is reflected more clearly. We believe that the integrated work in the architectural curriculum can provide an overview of the project, thus contributing to better training of the architect. This research aims to reflect on the role of integration and interdisciplinary in teaching architectural design. This theme has been work recurrently by critics in the teaching area of project and events of the area as the seminars of the Projetar, highlighted by several authors to search integration as an essential pedagogical approach to design education. The work aims to contribute to reflection and awareness of those involved on the importance of integration in the architectural course of project processes. For this, we analyzed the potential and limits of this process in Architecture and Urbanism Course (CAU) at the Universidade Potiguar (UNP) Mossoró, which has the integration and interdisciplinary recorded since the Pedagogical Project of the Course. This analysis will be performed by observing the development of “interdisciplinary work” in the fifth term during the first half of 2014.1. This research concerns an exploratory qualitative study that aims to investigate specific issues on the teaching/learning architecture project and the integration in architecture courses, following a non-participant observation in architectural design classes in the fifth term of CAU/UnP/ Mossoró, and analysis of final products, which would be the work of the last unit of the semester, called “Interdisciplinary work”. Questionnaires for the teachers who participated in the process has been apply via email and analyzed. Reflection supports several other already carried out to identify the difficulties inherent in applying these principles satisfactorily. Noting, however, that interdisciplinarity, in fact, it goes beyond integration and is even more difficult to achieve. In addition to an educational project that incorporates these principles, such as the course of Architecture and Urbanism of the UNP-Mossoró, full adhesion it is necessary by the faculty and students of this teaching philosophy.

Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Neutralność płci w szwedzkiej polityce edukacyjnej

The Author discusses the concept of gender neutrality in the context of the Swedish education system. The article is based on critical analyses of the international press discourse, studies of Nordic scholars and on a small-scale empirical study carried out in Stockholm in the autumn of 2014. The study involved non participant observation, interviews with academics associated with the subject matter, interviews with head teachers of schools and nurseries in Stockholm and a number of openquestion, questionnaires completed by teachers and students enrolled in specialist teaching courses at Stockholm University at the time of the study. This triangulation of qualitative techniques allowed the building of an in-depth understanding of what gender neutrality means in educational practice.

A dança de salão no processo de composição coreográfica em Jomar Mesquita

Esta dissertação apresenta como objetivos conhecer e descrever o processo de composição coreográfica de Jomar Mesquita, onde a transposição da Dança de Salão do seu contexto genuíno e social para o contexto cênico constitui a dimensão estruturante do processo criativo. A obra de Jomar Mesquita pode ser vista principalmente através das apresentações da Mimulus Companhia de Dança (MCD), a qual ele dirige, por isso a pesquisadora foi a Belo Horizonte/Minas Gerais – Brasil, onde a companhia funciona, realizar a pesquisa de campo. Esta pesquisa apresenta-se como um estudo de caso cuja metodologia é de natureza qualitativa. Foram usados como instrumentos desta pesquisa a observação não-participante da rotina diária do estabelecimento onde funcionam a Mimulus Companhia de Dança, a Mimulus Escola de Dança e a Associação Cultural Mimulus; entrevistas semiestruturadas a integrantes da Mimulus Companhia de Dança e dois funcionários da Mimulus Escola de Dança; questionários a alunos da Mimulus Escola de Dança; e fontes documentais acerca da Mimulus Companhia de Dança. Esta pesquisa demonstrou que o processo de composição coreográfica em Jomar Mesquita caracteriza-se principalmente pelas desconstruções dos passos e figuras padronizados da Dança de Salão, assim como das representações e conceitos incutidos nessa dança. Caracteriza-se ainda pela participação dos bailarinos tanto nos processos vivenciados pela MCD, quanto nos processos vivenciados em outras companhias de dança.

A utilização das aplicações digitais «Peak & Neuronation» no envelhecimento ativo : um estudo de caso na USALBI

Trabalho de Projeto apresentado à Escola Superior de Educação do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gerontologia Social.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

Appropriation of technology in "non-western" societies: an approximation to the case of Bulgaria

The principal focus of the PhD thesis lies in the Social Software area and the appropriation of technology in "non-Western" societies taking the example of Bulgaria. The term "non-Western" is used to explain places considered technologically underdeveloped. The aims have been to capture how Bulgarian users creatively interpret and appropriate Internet identifying the sociocultural, political and subjective conditions in which that appropriation occurs, to identify emerging practices based on the interpretation and use of Internet and the impact they had on society and what conditions could influence the technological interpretation and the meaning these practices had for both users and social configuration of Internet as media in Bulgaria. An ethnographic approach has been used simultaneously in different online and offline contexts. On the one hand, this study is based on exploration of the Bulgarian Internet Space through online participant observation in forums and websites reviews and on the other hand, on semi-structured interviews with different types of users of the virtual platforms found, made both face to face and online and finally online participant observation at the same platforms. It is based on some contributions of the ethnographic work of Christine Hine in virtual environments and the notions of time and space of Barbara Czarniawska contextualized in the modern form of organization that occurs in a network of multiple and fragmented contexts across many movements.

Measures of observation impact in non-Gaussian data assimilation

ABSTRACT Non-Gaussian/non-linear data assimilation is becoming an increasingly important area of research in the Geosciences as the resolution and non-linearity of models are increased and more and more non-linear observation operators are being used. In this study, we look at the effect of relaxing the assumption of a Gaussian prior on the impact of observations within the data assimilation system. Three different measures of observation impact are studied: the sensitivity of the posterior mean to the observations, mutual information and relative entropy. The sensitivity of the posterior mean is derived analytically when the prior is modelled by a simplified Gaussian mixture and the observation errors are Gaussian. It is found that the sensitivity is a strong function of the value of the observation and proportional to the posterior variance. Similarly, relative entropy is found to be a strong function of the value of the observation. However, the errors in estimating these two measures using a Gaussian approximation to the prior can differ significantly. This hampers conclusions about the effect of the non-Gaussian prior on observation impact. Mutual information does not depend on the value of the observation and is seen to be close to its Gaussian approximation. These findings are illustrated with the particle filter applied to the Lorenz ’63 system. This article is concluded with a discussion of the appropriateness of these measures of observation impact for different situations.

Non-challenging education and teacher control as factors for marginalization of students in diverse settings

This article discusses teachers’ attitudes towards immigrant students in poor settings and the effect these attitudes have on organization of education on classroom level. It draws on results from two ethnographic studies where some primary school classes in Sweden were followed with participant observation and interviews as main research methods. The article focuses on classroom activities and teachers’ attitudes towards immigrant students and students with low socio-economic status. In the article is argued for the importance of presenting students in poor settings with demanding tasks and challenging education. In these cases, intellectually undemanding tasks in combination with little room for students’ own initiatives resulted in low enthusiasm among students regarding schoolwork and accordingly low learning, while classroom work that demanded active involvement by students in combination with high level of students’ influence on what took place in classrooms resulted in high level of students’ engagement and high outcome.

Isolated Islands? Memory of the Holocaust in Formal and Non-Formal Education. The Case Study of Post-Communist Poland

Existing studies revealed several conflicts around the memory of the Holocaust in Poland: between understanding the need to teach about the Holocaust and indifference toward anti-Jewish graffiti; a conflict around the perception of Polish help to Jews; and the competing images of Polish and Jewish suffering during World War II. Those conflicts will be addressed in the paper as reflecting educational gaps in the Polish education system (lack of bad memory). This paper will look at the consciousness of young Poles, in terms of attitudes toward Jews, the Holocaust and memory of the Holocaust. The data presented are the preliminary results of the author’s longitudinal study „Attitudes of Young Poles toward the Jews and the Holocaust”. Quantitative and qualitative studies include field studies and participant observation of educational projects in Tykocin, Treblinka, Warsaw, Lublin, Bodzentyn and Kielce. The paper will present some components of the development of education about the Holocaust in Poland. There is a need to evaluate the attempt to bring back the memory of Jewish neighbours in some of the states of Central and Eastern Europe, a process with an ongoing effort to renovate monuments, destroyed cemeteries and synagogues. The number and scope of such initiatives in Poland indicate that civic institutions and individuals are intensifying their efforts to teach their fellow citizens about the Holocaust, however their impact should be assessed in detail.