935 resultados para nurse practitioner


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Over the past two decades there has been a remarkable expansion in the use of executive coaching as an executive development technique. The increasing prominence of executive coaching has been attributed to the emergence of new organisational cultures and the subtler competencies needed by executives in these faster moving organisations. The widespread popularity of executive coaching has been based largely on anecdotal feedback regarding its effectiveness. The small body of empirical research has been growing but conclusive outcomes are rare. The prominent question for those with the business imperative to implement executive coaching has been what are the ingredients of the process that engender an effective outcome? This investigation has focused on the factors of executive coaching that contribute to effectiveness. A qualitative methodology facilitated an in-depth study of the experiences of the participants of executive coaching with the perceptions of both executives and coaches being sought. Semi-structured interviews and a focus group provided rich, thick descriptions and together with a process of inductive analysis produced findings that confidently identify the key factors that contribute to coaching effectiveness. Six major themes were identified, each comprising a collection of meanings. These themes have been labelled Executive Engagement, Preliminary Assessment and Feedback, Coaching Process, Coach.s Contribution, Trusting Relationship and Support from the Organisation. One theme, Coaching Process, comprises three significant sub-themes, namely, Encouragement and Emotional Support, Challenge and Reflection and Enhancing Executive Performance. The findings of this study add value to the field by identifying factors contributing to coaching effectiveness, and providing for the coaching practitioner a basis for enhancing their practice of executive coaching to better meet the needs of executives and their organisations.

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David Held is the Graham Wallace Chair in Political Science, and co-director of LSE Global Governance, at the London School of Economics. He is the author of many works, such as Cosmopolitanism: Ideals and Realities (2010); The Cosmopolitanism Reader (2010), with Garrett Brown; Globalisation/AntiGlobalisation (2007), Models of Democracy (2006), Global Covenant (2004) and Global Transformations: Politics, Economics and Culture (1999). Professor Held is also the co-founder, alongside Lord Professor Anthony Giddens, of Polity Press. Professor Held is widely known for his work concerning cosmopolitan theory, democracy, and social, political and economic global improvement. His Global Policy Journal endeavours to marry academic developments with practitioner realities, and contributes to the understanding and improvement of our governing systems.

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In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

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Many people with severe mental illness (SMI) such as schizophrenia, whose psychotic symptoms are effectively managed, continue to experience significant functional problems. This chapter argues that low intensity (LI) cognitive behaviour therapy (CBT; e.g. for depression, anxiety, or other issues) is applicable to these clients, and that LI CBT can be consistent with long-term case management. However, adjustments to LI CBT strategies are often necessary and boundaries between LI CBT and high intensity (HI) CBT (with more extensive practitioner contact and complexity) may become blurred. Our focus is on LI CBT's self-management emphasis, its restricted content and segment length, and potential use after limited training. In addition to exploring these issues, it draws on the authors' Collaborative Recovery (CR; Oades et al. 2005) and 'Start Over and Survive' programs (Kavanagh et al. 2004) as examples. ----- ----- Evidence for the effectiveness of LI CBT with severe mental illness is often embedded within multicomponent programs. For example, goal setting and therapeutic homework are common components of such programs, but they can also be used as discrete LI CBT interventions. A review of 40 randomised controlled trials involving recipients with schizophrenia or other sever mental illnesses has identified key components of illness management programs (Mueser et al. 2002). However, it is relatively rare for specific components of these complex interventions to be assessed in isolation. Given these constraints, the evidence for specific LI CBT interventions with severe mental ilnness is relatively limited.

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Research methodology in the discipline of Art & Design has been a topic for much debate in the academic community. The result of such avid and ongoing discussion appears to be a disciplinary obsession with research methodologies and a culture of adopting and adapting existing methodologies from more established disciplines. This has eventuated as a means of coping with academic criticism and as an attempt to elevate Art & Design to a ‘real academic status’. Whilst this adoption has had some effect in tempering the opinion of Art & Design research from more ‘serious’ academics the practice may be concealing a deeper problem for this discipline. Namely, that knowledge transfer within creative practice, particularly in fashion textiles design practice, is largely tacit in nature and not best suited to dissemination through traditional means of academic writing and publication. ----- ----- There is an opportunity to shift the academic debate away from appropriate (or inappropriate) use of methodologies and theories to demonstrate the existence (or absence) of rigor in creative practice research. In particular, the changing paradigms for the definitions of research to support new models for research quality assessment (such as the RAE in the United Kingdom and ERA in Australia) require a re-examination of the traditions of academic writing and publication in relation to this form of research. It is now appropriate to test the limits of tacit knowledge. It has been almost half a century since Michael Polanyi wrote “we know more than we can tell” (Polanyi, 1967 p.4) at a time when the only means of ‘telling’ was through academic writing and publishing in hardcopy format. ----- ----- This paper examines the academic debate surrounding research methodologies for fashion textiles design through auto-ethnographic case study and object analysis. The author argues that, while this debate is interesting, the focus should be to ask: are there more effective ways for creative practitioner researchers to disseminate their research? The aim of this research is to examine the possibilities of developing different, more effective methods of ‘telling’ to support the transfer of tacit knowledge inherent in the discipline of Fashion Textiles Design.

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Since 2005, Business Process Management (BPM) has been one of the top 10 issues for CIO’s. However, while there is a general awareness what BPM is and what it relates to, one needs to ask ‘does everyone have the same understanding of the BPM phenomenon? And if not, is there a pattern to these conceptions and how do the ways of conceptualizing BPM differ?’ This paper presents the practitioner conceptions of BPM using a phenomenographic approach to detect variations in the BPM conceptions emphasised. 26 interviews were conducted with BPM practitioners with various scopes of work (namely program management, project management and execution levels) in this qualitative research. Distinct variations in how BPM is conceptualized among BPM practitioners are revealed, showing that emphasis is put depending on their scope of work either towards value generation, improvement or managing processes. This is of particular relevance to the Information Systems and BPM community in order to align the rigorous work done to date by the research community with the current understanding of BPM in the practitioner community.

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BACKGROUND. Physical symptoms are common in pregnancy and are predominantly associated with normal physiological changes. These symptoms have a social and economic cost, leading to absenteeism from work and additional medical interventions. There is currently no simple method for identifying common pregnancy related problems in the antenatal period. A validated tool, for use by pregnancy care providers would be useful. AIM: The aim of the project was to develop and validate a Pregnancy Symptoms Inventory for use by healthcare professionals (HCPs). METHODS: A list of symptoms was generated via expert consultation with midwives and obstetrician gynaecologists. Focus groups were conducted with pregnant women in their first, second or third trimester. The inventory was then tested for face validity and piloted for readability and comprehension. For test-re-test reliability, it was administered to the same women 2 to 3 days apart. Finally, outpatient midwives trialled the inventory for 1 month and rated its usefulness on a 10cm visual analogue scale (VAS). The number of referrals to other health care professionals was recorded during this month. RESULTS: Expert consultation and focus group discussions led to the generation of a 41-item inventory. Following face validity and readability testing, several items were modified. Individual item test re-test reliability was between .51 to 1 with the majority (34 items) scoring .0.70. During the testing phase, 211 surveys were collected in the 1 month trial. Tiredness (45.5%), poor sleep (27.5%) back pain (19.5%) and nausea (12.6%) were experienced often. Among the women surveyed, 16.2% claimed to sometimes or often be incontinent. Referrals to the incontinence nurse increased > 8 fold during the study period. The median rating by midwives of the ‘usefulness’ of the inventory was 8.4 (range 0.9 to 10). CONCLUSIONS: The Pregnancy Symptoms Inventory (PSI) was well accepted by women in the 1 month trial and may be a useful tool for pregnancy care providers and aids clinicians in early detection and subsequent treatment of symptoms. It shows promise for use in the research community for assessing the impact of lifestyle intervention in pregnancy.

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The focus of this study is on curriculum change within a School of Nursing in Taiwan where there is a growing demand for educational reform in order to meet the new accreditation standards and demands of the Taiwan Nursing Accreditation Council (TNAC). The aim of this study was to transform the Psychiatric Nursing curriculum in ways that are empowering, generative and sustainable. This study introduced Action Research as a vehicle to bring about curriculum transformation. I conceptualised a framework to guide the transformation process based on the notions of learner-centredness, conceptual change, pedagogical knowledge, reflection, collaboration, reculturing and empowerment. The Action Plan was developed in accordance with the conceptual framework, and was developed in five steps through which team members explored and became aware of our conceptions of teaching and learning, and then planned and implemented actions to change our curriculum, and examined and reflected on the curriculum transformation. The study demonstrated the value of working collaboratively to solve educational problems. This study also suggested that experiential knowledge, when shared and integrated with theoretical knowledge, can constructively contribute to all aspects of curriculum transformation. This study further supported the value of including clinical facilitators in the development and transformation of curricula. It confirmed that academics and clinical facilitators can work together to create new learning for students. This study is significant for both practical and political reasons. Its practical significance lies in its direct utility to the learners and teachers who were involved in the study. The political significance lies in the potential of the study to lead to further changes or improvements in other, similar contexts. The study is limited in that any interpretations cannot be generalised to other contexts. However, what emerged adds to the body of knowledge in such a way that it would constitute the basis for better informed educational practice.

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The authors draw on some powerful practitioner research they have been associated with recently to nvision ways in which a national curriculum might redress the inequities experienced by Australia's most disadvantaged young people.

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In a recent journal article, Luke Jaaniste and I identified an emergent model of exegesis. From a content analysis of submitted exegeses within a local archive, we identified an approach that is quite different from the traditional thesis, but is also distinct from previously identified forms of exegesis, which Milech and Schilo have described as a ‘context model’ (which assumes the voice of academic objectivity and provides an historical or theoretical context for the creative practice) and a ‘commentary’ model’ (which takes the form of a first person reflection on the challenges, insights and achievements of the practice). The model we identified combines these dichotomous forms and assumes a dual orientation–looking outwards to the established field of research, exemplars and theories, and inwards to the methodologies, processes and outcomes of the practice. We went on to argue that this ‘connective’ exegesis offers clear benefits to the researcher in connecting the practice to an established field while allowing the researcher to demonstrate how the methods have led to outcomes that advance the field in some way. And, while it helps the candidate to articulate objective claims for research innovation, it enables them to retain a voiced, personal relationship with their practice. However, it also poses considerable complexities and challenges in the writing. It requires a reconciliation of multi-perspectival subject positions: the disinterested perspective and academic objectivity of an observer/ethnographer/analyst/theorist at times and the invested perspective of the practitioner/ producer at others. The author must also contend with a range of writing styles, speech genres and voices: from the formal, polemical voice of the theorist to the personal, questioning and sometimes emotive voice of reflexivity. Moreover, the connective exegesis requires the researcher to synthesize various perspectives, subject positions, writing styles, and voices into a unified and coherent text. In this paper I consider strategies for writing a hybrid, connective exegesis. I first ground the discussion on polyvocality and alternate textual structures through reference to recent discussions in philosophy and critical theory, and point to examples of emergent approaches to texts and practices in related fields. I then return to the collection of archived exegeses to investigate the strategies that postgraduate candidates have adopted to resolve the problems that arise from a polyvocal, connective exegesis.

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Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%)compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three faceto- face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac- Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program.

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Mentoring has been identified as a valuable learning activity for beginners and more experienced personnel across a range of professions. For example, education, nursing, medicine, law, accounting , and public administration are among those professions that have utilised mentoring programs as a way of socialising and developing the skills and competencies of new professionals. The definition of mentoring used in this paper comes from Hansford, Tennent, and Ehrich (2002, 2003) that describes mentoring as a process whereby a more experienced practitioner works with, supports, guides and provides professional development to a less experienced practitioner. Mentoring, then, is often used to develop novice or less experienced professionals at two important phases in their career: (i) during their initial university training; and (ii) after graduation from university. For example, within the field experience components of many university degrees in education, nursing, medicine, social work, and other human service programs, students are assigned workplace mentors who assist them in transferring important skills and knowledge learned at university into practical setting. For concentrated periods of time during their degree, pre-service teachers, pre-service nurses and medical students work in the field alongside a workplace mentor.

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Many initiatives to improve Business processes are emerging. The essential roles and contributions of Business Analyst (BA) and Business Process Management (BPM) professionals to such initiatives have been recognized in literature and practice. The roles and responsibilities of a BA or BPM practitioner typically require different skill-sets; however these differences are often vague. This vagueness creates much confusion in practice and academia. While both the BA and BPM communities have made attempts to describe their domains through capability defining empirical research and developments of Bodies of knowledge, there has not yet been any attempt to identify the commonality of skills required and points of uniqueness between the two professions. This study aims to address this gap and presents the findings of a detailed content mapping exercise (using NVivo as a qualitative data analysis tool) of the International Institution of Business Analysis (IIBA®) Guide to the Business Analysis Body of Knowledge (BABOK® Guide) against core BPM competency and capability frameworks.

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Statement: Jams, Jelly Beans and the Fruits of Passion Let us search, instead, for an epistemology of practice implicit in the artistic, intuitive processes which some practitioners do bring to situations of uncertainty, instability, uniqueness, and value conflict. (Schön 1983, p40) Game On was born out of the idea of creative community; finding, networking, supporting and inspiring the people behind the face of an industry, those in the mist of the machine and those intending to join. We understood this moment to be a pivotal opportunity to nurture a new emerging form of game making, in an era of change, where the old industry models were proving to be unsustainable. As soon as we started putting people into a room under pressure, to make something in 48hrs, a whole pile of evolutionary creative responses emerged. People refashioned their craft in a moment of intense creativity that demanded different ways of working, an adaptive approach to the craft of making games – small – fast – indie. An event like the 48hrs forces participants’ attention on the process as much as the outcome. As one game industry professional taking part in a challenge for the first time observed: there are three paths in the genesis from idea to finished work: the path that focuses on mechanics; the path that focuses on team structure and roles and the path that focuses on the idea, the spirit – and the more successful teams need to put the spirit of the work first and foremost. The spirit drives the adaptation, it becomes improvisation. As Schön says: “Improvisation consists on varying, combining and recombining a set of figures within the schema which bounds and gives coherence to the performance.” (1983, p55). This improvisational approach is all about those making the games: the people and the principles of their creative process. This documentation evidences the intensity of their passion, determination and the shit that they are prepared to put themselves through to achieve their goal – to win a cup full of jellybeans and make a working game in 48hrs. 48hr is a project where, on all levels, analogue meets digital. This concept was further explored through the documentation process. This set of four videos were created by Cameron Owen on the fly during the challenge using both the iphone video camera and editing software in order to be available with immediacy and allow the event audience to share the experience - and perhaps to give some insights into the creative process exposed by the 48 hour challenge. ____________________________ Schön, D. A. 1983, The Reflective Practitioner: How Professionals Think in Action, Basic Books, New York

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Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.