A teoria de Callista Roy, a nanda-i e o cuidado ao paciente prostatectomizado

Trata-se de um estudo descritivo de caso clínico, com abordagem qualitativa, o qual possui como objetivo estabelecer relações entre os diagnósticos de enfermagem da NANDA-I e os problemas de adaptação segundo o Modelo Teórico de Roy em um paciente prostatectomizado. A coleta de dados ocorreu em um hospital universitário localizado na cidade de Natal-RN, no mês de janeiro de 2011, por meio de um roteiro de entrevista e exame físico. Os diagnósticos que apresentaram relações entre a NANDA-I e o Modelo de Roy foram: dor, ansiedade, constipação, sono, atividade, volume de líquido e infecção. Conclui-se que grande parte dos problemas adaptativos segundo o Modelo de Roy, manifestados pelos pacientes no pós-operatório de prostatectomia, possuem semelhança com os diagnósticos da NANDA-I

Programa de aquisição de alimentos (2003-2010): avaliação da implementação pela CONAB no Rio Grande do Norte

This thesis aimed to evaluate the implementation of the Food Acquisition Program(PAA) through CONAB RN in the period of 2003-2010 with the perception of all agents involved in the implementation of the government program.For the methodological trajectory it was adopted a descriptive bibliographical and documentary approach with triangular qualitative and quantitative, also called evaluative research.The theoretical model was supported by the authors Draibe (2001), Aguilar and Ander-Egg (1994) and Silva(2001), among others, that focused on family farming and evaluation of implementation of public policy having as a category of analysis the size implementation of policy and the latter divided into 10 theoretical dimensions.The universe consisted of three groups: the first were the managers and technicians from CONAB(RN and Brasilia), totaling 15 subjects. The second group was of associations/cooperatives that participated in the programin 2010, totaling a sample in each access of 15 representatives. The third group of subjects totaled with 309 representatives of governmental and non-governmental organizations that received donations of food for the same period. Semi-structured interviews and forms were adopted as instruments of data collection.The data were processed qualitatively by the analysis of content (interviews and documents) and quantitatively by means of statistical tests that allowed inferences and adoption of frequencies. Among the key find ingests that the program is not standing as a structure supported by planning. The interests of the performers do not necessarily converge with the objectives of the Food Acquisition Program (PAA). A shockof goals was identified (within the same program) when comparingthe financial agent (Ministry of Rural Development and of Social Development and Fight Against Hunger Ministry r) and the executor, CONAB/RN. Within the assessed dimensions, the most fragileis the sub-managerial decision-making and Organizational Environment and internal assessment, still deserves attention the sizeof logistical and operational Subsystem, as this also proved weak.The focusin the quest toexpand thequantificationof the resultsof theFood Acquisition Program (PAA)by CONAB/RN does forget a quality management focused on what really should be:the compliance with the institutional objectives of the government program.Finally, the perspective for the traded implementation should be re-examined because excessive discretion by managers along with technical staff has characterized there al role of the Food Acquisition Program (PAA) as public policy. We conclude that the implementation model, which apparently aggregates values to the benefitted citizens, has weakened the context of work on family farms having the management model of the implementation process be reviewed by the Federal Government and point too ther paths, which have as a guide line the emancipation and developmentof the field or in the field andat the same time enables the reduction of nutritional deficiency of beneficiaries in a balanced and coherent way

The physical classroom environment : roles, conceptions, and preferences

The problem addressed in this thesis is that a considerable proportion of students around the world attend school in inadequate facilities, which is detrimental for the students’ learning outcome. The overall objective in this thesis is to develop a methodology, with a novel approach to involve teachers, to generate a valuable basis for decisions regarding design and improvement of physical school environment, based on the expressed needs for a specific school, municipality, or district as well as evidence from existing research. Three studies have been conducted to fulfil the objective: (1) a systematic literature review and development of a theoretical model for analysing the role of the physical environment in schools; (2) semi structured interviews with teachers to get their conceptions of the physical school environment; (3) a stated preference study with experimental design as an online survey. Wordings from the transcripts from the interview study were used when designing the survey form. The aim of the stated preference study was to examine the usability of the method when applied in this new context of physical school environment. The result is the methodology with a mixed method chain where the first step involves a broad investigation of the specific circumstances and conceptions for the specific school, municipality, or district. The second step is to use the developed theoretical model and results from the literature study to analyse the results from the first step and transform them in to a format that fits the design of a stated preference study. The final step is a refined version of the procedure of the performed stated preference study.

Supply Chain Adaptation of Finnish Companies in Chinese Institutional Environment

Within the last few decades of operations and supply chain management, the field has seen the rise of so called best practices, methods that will help supply chains obtain their business goals and gain a competitive edge. These methods were thought to be universal. This however is not always the case, as the surrounding business environment could have a significant impact on what will be effective in gaining competitive edge. Contingency theory states that the success of a supply chain is determined by both internal capabilities, as well as external context aligning. This creates a strategic fit, which is a major determinant of success. In order for supply chains to reach this strategic fit, they must adapt. As China has seen rapid growth and over the last few decades become one of the major economies of the world, Western companies have tried to establish themselves there, only to find that the Chinese market is extremely difficult to operate in. The aim of this thesis was to investigate from contingency theory perspective, what are the institutional factors that affect supply chain management of Finnish companies operating in China, and how do Finnish companies adapt their supply chains to better fit the Chinese institutional environment. A theoretical model was created for this thesis, in which supply chains possess resources, which can be combined in a meaningful manner to create capabilities. Both resources and capabilities are affected by the surrounding institutional environment, which forces supply chains to adapt in order to find a better strategic fit. A total of six Finnish managers from three large and three small companies operating in China were interviewed. The results indicated that the Chinese business environment is significantly different, than that of Finland or Western countries in general. Three institutional factors were identified: Confucian though, fast-paced business environment, and managing labor force. These three institutional factors made the relationship and delivery capabilities particularly important, as well as human resources, reputation, physical resources and technological resources. In conclusion, it was discovered that the Chinese institutional environment is heavily affected by Confucian thought, as well as the rapid market growth. These are the two most important institutional factors that shape the Chinese market. If supply chains wish to be successful in China, adaptation regarding these two institutional factors should yield good results.

Validation of the self-regulated online learning questionnaire

Abstract The number of students engaged in Massive Open Online Courses (MOOCs) is increasing rapidly. Due to the autonomy of students in this type of education, students in MOOCs are required to regulate their learning to a greater extent than students in traditional, face-to-face education. However, there is no questionnaire available suited for this online context that measures all aspects of self-regulated learning (SRL). In this study, such a questionnaire is developed based on existing SRL questionnaires. This is the self-regulated online learning ques- tionnaire. Exploratory factor analysis (EFA) on the first dataset led to a set of scales differing from those theoretically defined beforehand. Confirmatory factor analysis (CFA) was conducted on a second dataset to compare the fit of the theoretical model and the exploratively obtained model. The exploratively obtained model provided much better fit to the data than the theoretical model. All models under investigation provided better fit when excluding the task strategies scale and when merging the scales measuring metacognitive activities. From the results of the EFA and the CFA it can be concluded that further development of the questionnaire is necessary.

Fatores que influenciam a aceitação de práticas avançadas de gestão de segurança da informação: um estudo com gestores públicos estaduais no Brasil

This study examines the factors that influence public managers in the adoption of advanced practices related to Information Security Management. This research used, as the basis of assertions, Security Standard ISO 27001:2005 and theoretical model based on TAM (Technology Acceptance Model) from Venkatesh and Davis (2000). The method adopted was field research of national scope with participation of eighty public administrators from states of Brazil, all of them managers and planners of state governments. The approach was quantitative and research methods were descriptive statistics, factor analysis and multiple linear regression for data analysis. The survey results showed correlation between the constructs of the TAM model (ease of use, perceptions of value, attitude and intention to use) and agreement with the assertions made in accordance with ISO 27001, showing that these factors influence the managers in adoption of such practices. On the other independent variables of the model (organizational profile, demographic profile and managers behavior) no significant correlation was identified with the assertions of the same standard, witch means the need for expansion researches using such constructs. It is hoped that this study may contribute positively to the progress on discussions about Information Security Management, Adoption of Safety Standards and Technology Acceptance Model

Gestão colegiada da cadeia produtiva da cajucultura: o papel do comitê gestor no Rio Grande do Norte à luz do desenvolvimento regional sustentável

The theme of this dissertation is the collegiate management in the cashew cultivation s productive chain by the reading of the Managerial Committee s role in accordance with Sustainable Regional Development. The research had as aim to reveal the way as Managerial Committee s members of cashew cultivation s productive chain interpret the economic, social and environmental dimensions to the sustainability of entrepreneurships, using as interpretative base Sachs (2004) theoretical model. The theoretical reference is based in precepts of Solidarity Economy as a strategy to the Sustainable Regional Development. To reach this aim was done a case study, based in analysis of contents and semi-structured interviews with the solidarities economic entrepreneurships that integrate the Committee and with the group of Entities of Support and Fomentation responsible for formulating and conducting actions in favour of development of the chain. The research permitted to conclude that the economic, mainly, and social dimension, secondly, to super-impose the environmental dimension. The actions in favour of the chain are yet restricted and with low effectiveness when interpreted, in an integrated way, by a side, by the informers of this research and, by another side, in accordance with precepts of sustainable development

Evaluating a School Community Linked Physical Activity Intervention Programme: a Multi-level Analysis.

Previous research has highlighted the importance of positive physical activity (PA) behaviors during childhood to promote sustained active lifestyles throughout the lifespan (Telama et al. 2005; 2014). It is in this context that the role of schools and teachers in facilitating PA education is promoted. Research suggests that teachers play an important role in the attitudes of children towards PA (Figley 1985) and schools may be an efficient vehicle for PA provision and promotion (McGinnis, Kanner and DeGraw, 1991; Wechsler, Deveraux, Davis and Collins, 2000). Yet despite consensus that schools represent an ideal setting from which to ‘reach’ young people (Department of Health and Human Services, UK, 2012) there remains conceptual (e.g. multi-component intervention) and methodological (e.g. duration, intensity, family involvement) ambiguity regarding the mechanisms of change claimed by PA intervention programmes. This may, in part, contribute to research findings that suggest that PA interventions have had limited impact on children’s overall activity levels and thereby limited impact in reducing children’s metabolic health (Metcalf, Henley & Wilkin, 2012). A marked criticism of the health promotion field has been the focus on behavioural change while failing to acknowledge the impact of context in influencing health outcomes (Golden & Earp, 2011). For years, the trans-theoretical model of behaviour change has been ‘the dominant model for health behaviour change’ (Armitage, 2009); this model focusses primarily on the individual and the psychology of the change process. Arguably, this model is limited by the individual’s decision-making ability and degree of self-efficacy in order to achieve sustained behavioural change and does not take account of external factors that may hinder their ability to realise change. Similar to the trans-theoretical model, socio-ecological models identify the individual at the focal point of change but also emphasises the importance of connecting multiple impacting variables, in particular, the connections between the social environment, the physical environment and public policy in facilitating behavioural change (REF). In this research, a social-ecological framework was used to connect the ways a PA intervention programme had an impact (or not) on participants, and to make explicit the foundational features of the programme that facilitated positive change. In this study, we examined the evaluation of a multi-agency approach to a PA intervention programme which aimed to increase physical activity, and awareness of the importance of physical activity to key stage 2 (age 7-12) pupils in three UK primary schools. The agencies involved were the local health authority, a community based charitable organisation, a local health administrative agency, and the city school district. In examining the impact of the intervention, we adopted a process evaluation model in order to better understand the mechanisms and context that facilitated change. Therefore, the aim of this evaluation was to describe the provision, process and impact of the intervention by 1) assessing changes in physical activity levels 2) assessing changes in the student’s attitudes towards physical activity, 3) examining student’s perceptions of the child size fitness equipment in school and their likelihood of using the equipment outside of school and 4) exploring staff perceptions, specifically the challenges and benefits, of facilitating equipment based exercise sessions in the school environment. Methodology, Methods, Research Instruments or Sources Used Evaluation of the intervention was designed as a matched-control study and was undertaken over a seven-month period. The school-based intervention involved 3 intervention schools (n =436; 224 boys) and one control school (n=123; 70 boys) in a low socioeconomic and multicultural urban setting. The PA intervention was separated into two phases: a motivation DVD and 10 days of circuit based exercise sessions (Phase 1) followed by a maintenance phase (Phase 2) that incorporated a PA reward program and the use of specialist kid’s gym equipment located at each school for a period of 4 wk. Outcome measures were measured at baseline (January) and endpoint (July; end of academic school year) using reliable and valid self-report measures. The children’s attitudes towards PA were assessed using the Children’s Attitudes towards Physical Activity (CATPA) questionnaire. The Physical Activity Questionnaire for Children (PAQ-C), a 7-day recall questionnaire, was used to assess PA levels over a school week. A standardised test battery (Fitnessgram®) was used to assess cardiovascular fitness, body composition, muscular strength and endurance, and flexibility. After the 4 wk period, similar kid’s equipment was available for general access at local community facilities. The control school did not receive any of the interventions. All physical fitness tests and PA questionnaires were administered and collected prior to the start of the intervention (January) and following the intervention period (July) by an independent evaluation team. Evaluation testing took place at the individual schools over 2-3 consecutive days (depending on the number of children to be tested at the school). Staff (n=19) and student perceptions (n = 436) of the child sized fitness equipment were assessed via questionnaires post-intervention. Students completed a questionnaire to assess enjoyment, usage, ease of use and equipment assess and usage in the community. A questionnaire assessed staff perceptions on the delivery of the exercise sessions, classroom engagement and student perceptions. Conclusions, Expected Outcomes or Findings Findings showed that both the intervention (16.4%) and control groups increased their PAQ-C score by post-intervention (p < 0.05); with the intervention (17.8%) and control (21.3%) boys showing the greatest increase in physical activity levels. At post-intervention, there was a 5.5% decline in the intervention girls’ attitudes toward PA in the aesthetic subdomains (p = 0.009); whereas the control boys had an increase in positive attitudes in the health domain (p = 0.003). No significant differences in attitudes towards physical activity were observed in any other domain for either group at post-intervention (p > 0.05). The results of the equipment questionnaire, 96% of the children stated they enjoyed using the equipment and would like to use the equipment again in the future; however at post-intervention only 27% reported using the equipment outside of school in the last 7 days. Students identified the ski walker (34%) and cycle (32%) as their favorite pieces of equipment; with the single joint exercises such as leg extension and bicep/tricep machine (<3%) as their least favorite. Key themes from staff were that the equipment sessions were enjoyable, a novel activity, children felt very grown-up, and the activity was linked to a real fitness experience. They also expressed the need for more support to deliver the sessions and more time required for each session. Findings from this study suggest that a more integrated approach within the various agencies is required, particularly more support to increase teachers pedagogical content knowledge in physical activity instruction which is age appropriate. Future recommendations for successful implementation include sufficient time period for all students to access and engage with the equipment; increased access and marketing of facilities to parents within the local community, and professional teacher support strategies to facilitate the exercise sessions.

Estudo do consumo energético associado ao processo de cozedura na indústria cerâmica

O presente trabalho realizou-se no âmbito do Projeto Galp 20-2020 implementado na empresa Sanindusa, em parceira com a Universidade de Aveiro. Como principal objetivo pretendia-se estudar o consumo de energia durante o processo de cozedura das peças cerâmicas com o intuito de avaliar a viabilidade da substituição do refratário existente na empresa. Uma vez que esta medida implicaria um tempo de retorno do investimento demasiado elevado, optou-se por estudar o consumo de energia associado a uma placa horizontal, de massa unitária, de qualquer tipo de material refratário. Para tal, foi desenvolvido um Modelo Teórico capaz de calcular o calor absorvido por uma placa de refratário ao longo de todo o percurso dentro do Forno Túnel 2, existente na empresa e utilizado no processo de produção das peças cerâmicas. Através deste estudo foi possível concluir que o Modelo Teórico é bastante útil na medida em que permite a criação de vários cenários, através da alteração de diversas variáveis, permitindo conhecer qual o impacto de cada uma no consumo de energia neste equipamento. Como trabalho futuro propõe-se o desenvolvimento do Modelo Teórico apresentado para o estudo da transferência de calor bidimensional. Esta melhoria permitiria analisar o consumo de energia associado a diferentes formas de material refratário utilizado no processo de cozedura de peças cerâmicas (o que não é possível quando se aplica o conceito de transferência de calor unidimensional).

A satisfação e a intenção de continuidade de uso em servços de e-learning:validação empírica de um modelo aplicado no serviço público

The present study aims to investigate the constructs of Technological Readiness Index (TRI) and the Expectancy Disconfirmation Theory (EDT) as determinants of satisfaction and continuance intention use in e-learning services. Is proposed a theoretical model that seeks to measure the phenomenon suited to the needs of public organizations that offer distance learning course with the use of virtual platforms for employees. The research was conducted from a quantitative analytical approach, via online survey in a sample of 343 employees of 2 public organizations in RN who have had e-learning experience. The strategy of data analysis used multivariate analysis techniques, including structural equation modeling (SEM), operationalized by AMOS© software. The results showed that quality, quality disconfirmation, value and value disconfirmation positively impact on satisfaction, as well as disconfirmation usability, innovativeness and optimism. Likewise, satisfaction proved to be decisive for the purpose of continuance intention use. In addition, technological readiness and performance are strongly related. Based on the structural model found by the study, public organizations can implement e-learning services for employees focusing on improving learning and improving skills practiced in the organizational environment

Computer simulations of soft particles in flow

Understanding the dynamics of blood cells is a crucial element to discover biological mechanisms, to develop new efficient drugs, design sophisticated microfluidic devices, for diagnostics. In this work, we focus on the dynamics of red blood cells in microvascular flow. Microvascular blood flow resistance has a strong impact on cardiovascular function and tissue perfusion. The flow resistance in microcirculation is governed by flow behavior of blood through a complex network of vessels, where the distribution of red blood cells across vessel cross-sections may be significantly distorted at vessel bifurcations and junctions. We investigate the development of blood flow and its resistance starting from a dispersed configuration of red blood cells in simulations for different hematocrits, flow rates, vessel diameters, and aggregation interactions between red blood cells. Initially dispersed red blood cells migrate toward the vessel center leading to the formation of a cell-free layer near the wall and to a decrease of the flow resistance. The development of cell-free layer appears to be nearly universal when scaled with a characteristic shear rate of the flow, which allows an estimation of the length of a vessel required for full flow development, $l_c \approx 25D$, with vessel diameter $D$. Thus, the potential effect of red blood cell dispersion at vessel bifurcations and junctions on the flow resistance may be significant in vessels which are shorter or comparable to the length $l_c$. The presence of aggregation interactions between red blood cells lead in general to a reduction of blood flow resistance. The development of the cell-free layer thickness looks similar for both cases with and without aggregation interactions. Although, attractive interactions result in a larger cell-free layer plateau values. However, because the aggregation forces are short-ranged at high enough shear rates ($\bar{\dot{\gamma}} \gtrsim 50~\text{s}^{-1}$) aggregation of red blood cells does not bring a significant change to the blood flow properties. Also, we develop a simple theoretical model which is able to describe the converged cell-free-layer thickness with respect to flow rate assuming steady-state flow. The model is based on the balance between a lift force on red blood cells due to cell-wall hydrodynamic interactions and shear-induced effective pressure due to cell-cell interactions in flow. We expect that these results can also be used to better understand the flow behavior of other suspensions of deformable particles such as vesicles, capsules, and cells. Finally, we investigate segregation phenomena in blood as a two-component suspension under Poiseuille flow, consisting of red blood cells and target cells. The spatial distribution of particles in blood flow is very important. For example, in case of nanoparticle drug delivery, the particles need to come closer to microvessel walls, in order to adhere and bring the drug to a target position within the microvasculature. Here we consider that segregation can be described as a competition between shear-induced diffusion and the lift force that pushes every soft particle in a flow away from the wall. In order to investigate the segregation, on one hand, we have 2D DPD simulations of red blood cells and target cell of different sizes, on the other hand the Fokker-Planck equation for steady state. For the equation we measure force profile, particle distribution and diffusion constant across the channel. We compare simulation results with those from the Fokker-Planck equation and find a very good correspondence between the two approaches. Moreover, we investigate the diffusion behavior of target particles for different hematocrit values and shear rates. Our simulation results indicate that diffusion constant increases with increasing hematocrit and depends linearly on shear rate. The third part of the study describes development of a simulation model of complex vascular geometries. The development of the model is important to reproduce vascular systems of small pieces of tissues which might be gotten from MRI or microscope images. The simulation model of the complex vascular systems might be divided into three parts: modeling the geometry, developing in- and outflow boundary conditions, and simulation domain decomposition for an efficient computation. We have found that for the in- and outflow boundary conditions it is better to use the SDPD fluid than DPD one because of the density fluctuations along the channel of the latter. During the flow in a straight channel, it is difficult to control the density of the DPD fluid. However, the SDPD fluid has not that shortcoming even in more complex channels with many branches and in- and outflows because the force acting on particles is calculated also depending on the local density of the fluid.

Investigating routes toward atomic layer deposition of silicon carbide: Ab initio screening of potential silicon and carbon precursors

Silicon carbide (SiC) is a promising material for electronics due to its hardness, and ability to carry high currents and high operating temperature. SiC films are currently deposited using chemical vapor deposition (CVD) at high temperatures 1500–1600 °C. However, there is a need to deposit SiC-based films on the surface of high aspect ratio features at low temperatures. One of the most precise thin film deposition techniques on high-aspect-ratio surfaces that operates at low temperatures is atomic layer deposition (ALD). However, there are currently no known methods for ALD of SiC. Herein, the authors present a first-principles thermodynamic analysis so as to screen different precursor combinations for SiC thin films. The authors do this by calculating the Gibbs energy ΔGΔG of the reaction using density functional theory and including the effects of pressure and temperature. This theoretical model was validated for existing chemical reactions in CVD of SiC at 1000 °C. The precursors disilane (Si2H6), silane (SiH4), or monochlorosilane (SiH3Cl) with ethyne (C2H2), carbontetrachloride (CCl4), or trichloromethane (CHCl3) were predicted to be the most promising for ALD of SiC at 400 °C.

Conceptualising cosmopolitanism and entrepreneurship through the lens of the three-dimensional theory of power

Purpose – The paper aims to conceptualise cosmopolitanism drivers from the third-level power perspective by drawing on Lukes’ (1974; 2005) theory of power. In addition, the paper aims to investigate the relationship between entrepreneurs’ cosmopolitan dispositions and habitus, i.e. a pattern of an individual’s demeanour, as understood by Bourdieu. Design/methodology/approach – This conceptual paper makes use of Bourdieu’s framework (habitus) by extending it to the urban cosmopolitan environment and linking habitus to the three-dimensional theory of power and, importantly, to the power’s third dimension – preference-shaping. Findings – Once cosmopolitanism is embedded in the urban area’s values, this creates multiple endless rounds of mutual influence (by power holders onto entrepreneurs via political and business elites, and by entrepreneurs onto power holders via the same channels), with mutual benefit. Therefore, mutually beneficial influence that transpires in continuous support of a cosmopolitan city’s environment may be viewed as one of the factors that enhances cosmopolitan cities’ resilience to changes in macroeconomic conditions. Originality/value – The paper offers a theoretical model that enriches the understanding of the power-cosmopolitanism-entrepreneurship link, by emphasising the preference-shaping capacity of power, which leads to the embedment of cosmopolitanism in societal values. As a value shared by political and business elites, cosmopolitanism is also actively promoted by entrepreneurs through their disposition and habitus. This ensures not only their willing compliance with power and the environment, but also their enhancement of favourable business conditions. Entrepreneurs depart from mere acquiescence (to power and its explicit dominance), and instead practice their cosmopolitan influence by active preference-shaping.

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protocol

Adolescents - defined as young people between 10 and 19 years of age1 - are, in general, a relatively healthy segment of the population.2 However, the developmental changes that take place during adolescence may affect their subsequent risk for diseases and for a variety of health-related behaviors. In fact, early onset of preventable health problems (e.g. obesity, malnutrition, STDs) and the engagement in health risk behaviors (e.g., sedentary life style, excessive alcohol consumption, unprotected sex) during adolescence, are likely to put them at greater risk for physical and mental health problems at a later stage in life. Moreover, health related problems and health risk behaviors may disrupt adolescents' physical and cognitive development and therefore may affect their ability to think and act in relation to decisions about their health in the future.1 In summary, health-related behaviors in adolescence, apart from their influence on the continuum of "health-disease", they also have the potential to influence future behaviors. In fact, several studies have shown that past behaviors are good predictors of future behaviors .3,4 Thus, promoting healthy practices during adolescence and taking measures to better protect young people from health risks are essential for the prevention of health problems in adulthood.5 According to the World Health Organization, the main problems affecting young people include mental health problems (such as behavioral disorders, eating disorders, suicide, anxiety or depression), the use of substances (illegal substances, alcohol and tobacco), interpersonal violence, nutrition (a proper nutrition consists of healthy eating habits and physical exercise), unintentional injuries (which are a leading cause of death and disability among young people, with road traffic injuries accounting for about 700 deaths per day), sexual and reproductive health (for example, risky sexual behaviors, early pregnancy and childbirth) and HIV (resulting from sexual transmission and drug injection).5,6 On the other hand, the number of children and youth with chronic health conditions has increased dramatically in the past four decades7 as larger numbers of chronically ill children survive beyond the age of 10.8 Despite the lack of data on adolescents' health making it difficult to determine the prevalence of chronic illnesses in this age group9, it is known that one in ten adolescents suffers from a chronic condition worldwide.10 In fact, national population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months.8 The most prevalent chronic illness among adolescents is asthma and the one with the highest incidence is diabetes mellitus, particularly type II.9 Traditionally, healthcare professionals have been mainly investing in health education activities, through the transmission of knowledge with a view to creating habits, customs and behaviors, and promoting healthy lifestyles. However, empowering people does not only consist of giving them the right information11 , i.e. good information is not enough to cause people to make changes.12 The motivation or desire to change unhealthy behaviors and habits depends on many factors, namely intrinsic motivation, control over personal decisions, self-confidence and perception of effectiveness, personal ambivalence, and individualized assistance.12 Many professionals assume that supplying knowledge is sufficient for behavioral changes; however, even very good advice often fails to generate behavioral change. After all, people continue to engage in unhealthy behaviors despite clearly knowing what they should do and how to change. "What is lacking is the motivation to apply that knowledge".13, p.1233 In fact, behavioral change is a complex phenomenon with multiple determinants that also includes motivational variables. It is associated with ambivalent processes expressed in the dilemma between keeping the current status and moving on to new ways of acting. For example, telling adolescents that if they keep on engaging in a certain behavior, they are increasing the risk of developing a long-term condition such as cardiovascular disease, stroke or diabetes is rarely enough to trigger the desired behavioral change; people are more likely to change when they believe that the change is really effective and that they are able to implement it.12 Therefore, it is essential to provide specific training for "healthcare professionals to master motivational techniques, avoid confrontation with the users, and facilitate behavioral changes".14 In this context, motivating patients to make behavioral changes is also an important nursing task where change in lifestyle is a major element of patients' treatment and preventive interventions.15 One of the nurse's goals is to help improve a patient's health or help them to manage existing health conditions. Once nurses are in a position where they have to focus on accomplishing tasks and telling patients what needs to be accomplished16, the role of the nurse is expanding even more into the use of motivational strategies.17 MI is bringing nurses back to therapeutic communication and moving them closer to successful health promotion and disease management, by promoting behavior change and empowering their patients. As the nursing profession evolves, MI is seen as a challenge and the basis of nurse's interactions with individuals, families and communities.16, 17 In the same way, MI may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects regarding problems, clarification of doubts, and development of skills.18 In fact, MI may be particularly applicable in work with adolescents because of their specific developmental stage. Adolescents attempt to establish their own autonomy and identity while struggling with social interactions and moral issues, which leads to ambivalence.19 Consistent with the developmental challenges during adolescence, "MI explicitly honors autonomy, people's right and irrevocable ability to decide about their own behavior"20 while allowing the person to explore possibilities for change of risky or maladaptive behaviours.19 MI can be defined as a directive, client-centred counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style of interpersonal relationship.21 It is a set of strategies and techniques widely used in clinical practice based on the transtheoretical model of change. The Stages of Change model describes five stages of readiness—precontemplation, contemplation, preparation, action, and maintenance—and provides a framework for understanding behavior change.22 The MI has been widely tested and applied in different areas, such as modification of addictive behaviors, interventions with offenders in the context of justice, eating disorders, promotion of therapeutic adherence among chronic patients, promotion of learning in school settings or intervention with adolescents at risk.18,23 In general, clinical practice has been adopting the perspective of motivation as something relatively immutable, i.e., the adolescent is either motivated for change/treatment and, in these conditions, the professional's role is to help him/her, or the adolescent is not motivated and then change/treatment is not feasible. Alternatively the theoretical model underlying the MI technique postulates that the individual's adherence to change/treatment depends on his/her motivation, which can change throughout the therapeutic intervention. As several studies found positive results for effects of MI24-26 and its use by health professionals is encouraged23,27 nurses may play an important role in patients' process of change. As nurses have a crucial role in clinical contexts, they can facilitate the process of ending risk behaviors and/or adopting positive health behaviors through some motivational techniques, namely with adolescents. A considerable number of systematic reviews about MI already exist pointing to some benefits of its use in the treatment of a broad range of behavioral problems and diseases.13,28,29 Some of the current reviews focus on examining the effectiveness of MI for adolescents with diverse health risks/problems 30-32. However, to date there are no reviews that present and assess the evidence for the use of nurse-led MI in adolescents. Therefore, we have little knowledge of what works for whom (which adolescent subpopulation) under what circumstances (in which setting, for what problem) in relation to motivational interviewing by nurses. There is a clear need for scoping or mapping the use of MI by nurses with adolescents to identify evidence gaps and to inform opportunities for future development in nursing practice. On the other hand, information regarding nurse-led implemented and evaluated interventions, techniques and/or strategies used, contexts of application and adolescents subpopulation groups is dispersed in the literature33-36 which impedes the formulation of precise questions about the effectiveness of those interventions conducted by nurses and therefore the realization of a systematic review. In other words, it is known that different kind of motivational interventions have been implemented in different contexts by nurses, however does not exist a map about all the motivational techniques and/or strategies used. Furthermore the literature does not clarify which is the role of nurses at cross professional motivational intervention implemented programs and finally the outcomes and evaluation of interventions are unclear. Thus, the practical implication of this mapping will be clarifying all these aspects. Without this clarification is not possible to proceed to the realization of a systematic review about the effectiveness of the use of motivational interviews by nurses to promote health behaviors in adolescents, in a particular context and/or health risk behavior; or regarding the effectiveness of certain technique and/or strategy of MI. Consequently, there are important questions about the nature of the evidence in this area that need to be answered before formulating a precise question of effectiveness. This scoping review aims to respond to these questions. An initial search of the JBI Database of Systematic Reviews & Implementation Reports, Cochrane Database of Systematic Reviews, , Database of promoting health effectiveness reviews (DoPHER), The Campbell Library, Medline and CINAHL, has revealed that currently there is no Scoping Review (published or in progress) on the subject. In this context, this scoping review will examine and map the published and unpublished research around the use of MI by nurses implemented and evaluated to promote health behaviors in adolescents; to establish its current extent, range and nature and identify its feasibility, outcomes and gaps in the evidence defining research priorities in this field. This scoping review will be informed by the JBI methodology37 that suggests a five stage methodological framework for conducting scoping reviews which includes: identifying the research question, searching for relevant studies, selecting studies, charting data, collating, summarizing and reporting the results.

Musikalisches Involviertsein als Modell kultureller Teilhabe und Teilnahme

In recent years, the concept of cultural participation has become very popular both in the scientific context as well as in the political discourse. Despite that, a sound definition of the construct allowing for solid empirical data collection and analysis is still missing. While this is a major obstacle for researchers, society and political decision makers ask for evidence-based knowledge concerning the effects and benefits of cultural education and assistant measures. Based on Amartya Sen’s “Capability Approach” and on a broad conception of culture, the authors try to fill this gap and propose a theoretical model of “musical involvement” to describe cultural participation in music. (DIPF/Orig.)