The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

The Dynamic Process of Development through Sport

This article presents a global vision for sport through a new framework that incorporates the elements necessary for a developmentally sound approach to youth sport involvement. This framework proposes that youth sport involvement includes three basic elements: (1) taking part in activities (what), while creating relationships with others (who), in a specific setting (where). When these three elements positively interact, it creates a context that, when repeated on a regular basis, leads to changes in the personal assets of the participants. Changes in individuals’ personal assets, such as Competence, Confidence, Connection, and Character (4 C’s), have long been associated with positive sport experiences, which in turn lead to long-term outcomes, including continued sport Participation, higher levels of Performance in sport, and Personal development through sport (3 P’s). Research linking the three basic elements of youth sport (activities, relationships, and settings) to positive changes in personal assets (4 C’s) and long-term outcomes (3 P’s) are discussed and the Personal Assets Framework is presented

Using modeling as a co-design approach in the planning process of new care environments

Current research shows a relationship between healthcare architecture and patient-related Outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modelling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience. An explorative and qualitative design was used to describe participants’ experiences of participating in the group modelling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analysed by qualitative content analysis. Two themes were formed, representing the experiences in the group modeling process: ‘Partaking in the G-M created knowledge and empowerment’and ‘Partaking in the G-M was different from what was expected and required time and skills’. The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

Exploring associations between violent discipline and aggressive behavior in children ages 4-5 in The Republic of Nicaragua: A secondary data analysis of the 2011 Demographic and Health Survey

Thesis (Master's)--University of Washington, 2016-06

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114). RESULTS: There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use. CONCLUSIONS: Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. TRIAL REGISTRATION: Clinicaltrials.gov NCT01827995.

Europeanization in VET policy as a process of reshaping the educational space

The EU represents a transforming educational space, where national and supranational boundaries in educational governance are becoming blurred. The EU has become an important actor in educational governance and an important arena for policy learning and transfer. This paper explores how the process of reshaping the educational space manifests itself in the process of the Europeanization of VET policy in the case of Estonia. In Estonia, this process was followed by the growth of executive VET institutions and has developed from rather uncritical initial policy transfer to more active learning from the EU, although conformism can still be seen in cases of the introduction of standardizing policy tools. (DIPF/Orig.)

TIMESCAPES: an architectural process of memory and adaptation

What if the architectural process of making could incorporate time? All designers who impact the physical environment- consciously and unconsciously are gatekeepers of the past, commentators of the present, and speculators of the future. This project proposes the creation of architecture and adaptive public space that looks to historical memories, foster present day cultural formation, and new alternative visions for the city of the future. The thesis asks what it means to design for stasis and change in a variety of scales- urban, architectural, and detail and arrives at a speculated new neighborhood, institutional buildings, and landscape. Central to this project is the idea of the architect as archeologist, anthropologist, and artist. The project focuses on a rapidly changing part of the city of Fort Worth, Texas and assigns a multipurpose institutional buildings and public space as a method of investigation. The thesis hopes to further architectural discourse about into the role of architecture in the preservation of memory, adaptive potential of public spaces, and the role of time in architecture.

Ledroit Park, A Portrait In Black And White: A Study Of Historic Districts, Social Change, And The Process Of Neighborhood Placemaking

This research examines the process of placemaking in LeDroit Park, a residential Washington, DC, neighborhood with a historic district at its core. Unpacking the entwined physical and social evolution of the small community within the context of the Nation’s Capital, this analysis provides insight into the role of urban design and development as well as historic designation on shaping collective identity. Initially planned and designed in 1873 as a gated suburb just beyond the formal L’Enfant-designed city boundary, LeDroit Park was intended as a retreat for middle and upper-class European Americans from the growing density and social diversity of the city. With a mixture of large romantic revival mansions and smaller frame cottages set on grassy plots evocative of an idealized rural village, the physical design was intentionally inwardly-focused. This feeling of refuge was underscored with a physical fence that surrounded the development, intended to prevent African Americans from nearby Howard University and the surrounding neighborhood, from using the community’s private streets to access the City of Washington. Within two decades of its founding, LeDroit Park was incorporated into the District of Columbia, the surrounding fence was demolished, and the neighborhood was racially integrated. Due to increasingly stringent segregation laws and customs in the city, this period of integration lasted less than twenty years, and LeDroit Park developed into an elite African American enclave, using the urban design as a bulwark against the indignities of a segregated city. Throughout the 20th century housing infill and construction increased density, yet the neighborhood never lost the feeling of security derived from the neighborhood plan. Highlighting the architecture and street design, neighbors successfully received historic district designation in 1974 in order to halt campus expansion. After a stalemate that lasted two decades, the neighborhood began another period of transformation, both racial and socio-economic, catalyzed by a multi-pronged investment program led by Howard University. Through interviews with long-term and new community members, this investigation asserts that the 140-year development history, including recent physical interventions, is integral to placemaking, shaping the material character as well as the social identity of residents.

Marketing in SMEs: the sales process of SMEs on the food and drink industry.

There would appear to be varied approaches to the sales process practiced by SMEs in how they go about locating target customers, interfacing with prospects and new customers, presenting the benefits and features of their products and services, closing sales deals and building relationships, and an understanding of what the buyers needs are in the seller-buyer process. Recent research has revealed that while entrepreneurs and small business owners rely upon networking as an important source of sales, they lack marketing competencies, including personal selling skills and knowledge of what is involved in the sales process to close sales deals and build relationships. Small companies and start-ups with innovative products and services often find it difficult to persuade potential buyers of the merits of their offerings because, while the products and services may be excellent, they have not sufficiently well-developed selling skills necessary to persuade their target customers.

Technology strategies in the process of student retention and efficiency of academic management

This article discusses the application of Information and Communication Technologies and strategies for best practices in order to capture and maintain faculty students' attention. It is based on a case study of ten years, using a complete information system. This system, in addition to be considered an ERP, to support the activities of academic management, also has a strong component of SRM that provides support to academic and administrative activities. It describes the extent to which the presented system facilitates the interaction and communication between members of the academic community, using the Internet, with services available on the Web complementing them with email, SMS and CTI. Through a perception, backed by empirical analysis and results of investigations, it demonstrates how this type of practice may raise the level of satisfaction of the community. In particular, it is possible to combat failure at school, avoid that students leave their course before its completion and also that they recommend them to potential students. In addition, such a strategy also allows strong economies in the management of the institution, increasing its value. As future work, we present the new phase of the project towards implementation of Business Intelligence to optimize the management process, making it proactive. The technological vision that guides new developments to a construction based on Web services and procedural languages is also presented.