Living with diabetes: quality of care and quality of life

Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients" opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients" quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.

Use and perception of urban green spaces in Barcelona

Background: Although the mechanisms are not well understood yet, evidence exists of the benefits of urban green spaces for human health. As a consequence, one of the concerns of public health interventions must be to promote the use of urban green spaces within cities. Aims: This study aims to explore the citizens’ purposes of use of urban green spaces as well as the elements related to the characteristics of these places that condition their use. Methods: In-depth interviews were conducted with non-hospitalised people living in different areas of Barcelona, with different socioeconomic status and different residential distance to urban green spaces (n = 20). Thematic content analysis of the qualitative data was performed. Results: Physical pursuits and attention restoration were identified as prominent purposes of use of urban green spaces. The natural features of urban green spaces were identified as the most relevant determiners for the use of these places. Conclusions: To promote the use of urban green spaces, qualitative findings from this study suggest that purpose-built places should be provided. Moreover, natural features of urban green spaces must be particularly taken into account when designing and maintaining them.

The third transformation of Japan: An institutional narrative on agglomeration economies in abenomics

Objective of the study The aim of this study is to understand the institutional implications in Abenomics in a spatial context, the contemporary economic reform taking place in Japan, which is to finally end over two decades of economic malaise. For theoretical perspective of choice, this study explores a synthesis of institutionalism as the main approach, complemented by economies of agglomeration in spatial economics, or New Economic Geography (NEG). The outcomes include a narrative with implications for future research, as well as possible future implications for the economy of Japan, itself. The narrative seeks to depict the dialogue between public discourse and governmental communication in order to create a picture of how this phenomenon is being socially constructed. This is done by studying the official communications by the Cabinet along with public media commentary on respective topics. The reform is studied with reference to historical socio-cultural, economic evolution of Japan, which in turn, is explored through a literature review. This is to assess the unique institutional characteristics of Japan pertinent to reform. Research method This is a social and exploratory qualitative study – an institutional narrative case study. The methodological approach was kept practical: in addition to literature review, a narrative, thematic content analysis with structural emphasis was used to construct the contemporary narrative based on the Cabinet communication. This was combined with practical analytic tools borrowed from critical discourse analysis, which were utilized to assess the implicit intertextual agenda within sources. Findings What appears to characterize the discourse is status quo bias that comes in multiple forms. The bias is also coded in the institutions surrounding the reform, wherein stakeholders have vested interests in protecting the current state of affairs. This correlates with uncertainty avoidance characteristic to Japan. Japan heeds the international criticism to deregulate on a rhetorical level, but consistent with history, the Cabinet solutions appear increasingly bureaucratic. Hence, the imposed western information-age paradigm of liberal cluster agglomeration seems ill-suited to Japan which lacks risk takers and a felicitous entrepreneur culture. The Japanese, however, possess vast innovative potential ascribed to some institutional practices and traits, but restrained by others. The derived conclusion is to study the successful intrapreneur cases in Japanese institutional setting as a potential benchmark for Japan specific cluster agglomeration, and a solution to its structural problems impeding growth.

Supporting employer branding by inbound marketing in Russia

The objective of this study is to understand how employer branding can be strategically supported by inbound marketing in Russia. Furthermore, the aim is to examine the special features of inbound marketing in Russia, as well as to learn what the most useful inbound marketing channels are in the Russian context. The theoretical background of this study is built from employer branding and inbound marketing literature. Inbound marketing is currently lacking a profound research on the topic and thus, this study contributes to the inbound marketing literature as well. The empirical data of this research is collected via three qualitative expert field interviews. The interviews were conducted between January and February 2014. Furthermore, a thematic content analysis was used in the process of analyzing the research results. Both the employer branding and inbound marketing are growing their importance in Russia. The results of this study suggest that a combination of employer branding and inbound marketing can bring companies competitive advantage over others in the Russian market. It is, however, crucial to first understand the peculiarities of the inbound marketing in Russia before taking it to the employer branding context. This study provides a framework for inbound marketing tools in Russia. The proposed framework takes into careful consideration the cultural factors affecting the selection of the inbound marketing tools in Russia. Furthermore, the results of this study suggest how inbound marketing could be successfully combined with employer branding in Russia in order to strengthen the employer brands in the Russian market. However, these results are mainly applicable in the Russian context. Therefore, additional research is needed in order to understand the relationship between the employer branding and inbound marketing in other cultural settings or in particular fields of business.

Representations of cultural encounters in the global business press – The importance of cross-cultural competence

This qualitative study has started from the interest to examine how the reality of crosscultural encounters is presented in the global business press. The research paper emphasizes different ways to classify culture and cross-cultural competency, both from the point of view of individuals and organizations. The analysis consists of public discourses, where cross-cultural realities are created through different persons, stories and contexts For data collection, a comprehensive database search was performed and 10 articles from the widely known worldwide business magazine The Financial Times were chosen as the data for the study paper. For the functions of addressing the research study questions, Thematic Content Analysis (TCA) and also Discourse Analysis (DA) are utilized, added with the continuous comparison method of grounded theory in the formation of the data.The academic references consist of literary works and articles presenting relevant concepts, creating a cross-cultural framework, and it is designed to assist the reader in the navigation through the topics of culture and cross-cultural competency. The repertoires were formed from the data and following, the first repertoire is contrast difference between home and target culture that the individual was able to discern. As a consequence of the first repertoire, the companies then offer cultural training to their employees to prepare them to situations of increasing levels of cultural variation. The third repertoire is increased awareness of other cultures, which is conveyed as a result of cultural training and contextual work experience. The fourth repertoire is globalization as an international business environment, where the people in the articles perform their job functions. It is stated in the conclusions that the representations emphasize Western values and personal traits in leadership.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

L'intervention psychosociale dans le sport pour développer des habiletés de vie chez des jeunes à risque de délinquance

Implanté en 1999 dans le quartier Centre-Sud à Montréal, le programme d'intervention psychosociale « Bien dans mes baskets » (BdmB) utilise le basketball comme outil pour entrer en contact avec des jeunes à risque de délinquance. Ce programme se distingue par le fait que ses entraîneurs-travailleurs-sociaux (ETS) interviennent tant dans le développement d'habiletés de vie que d’habiletés sportives. La présente étude vise à comprendre comment les expériences vécues au sein de BdmB ont pu contribuer au développement d’habiletés de vie chez les adolescents qui ont participé au programme lorsqu’ils étaient à l’école secondaire. Une méthodologie rétrospective qualitative a été utilisée pour cette étude. Des entretiens semi-dirigés ont été effectués auprès de 14 anciens athlètes-étudiants (AÉ) masculins qui ont participé à BdmB pendant leurs études secondaires. Le verbatim des entretiens enregistrés a été transcrit afin de procéder à une analyse de contenu par thématique. Les résultats suggèrent que quatre principaux facteurs semblent contribuer au développement d’habiletés de vie chez certains participants : le modelage de l’ETS a permis aux AÉ de reproduire les comportements de leur entraîneur; le développement d’un sentiment d’attachement entre les joueurs a engendré la création d’un nouveau réseau social dans lequel les AÉ ont pu trouver du soutien social; une culture d’équipe influencée par la philosophie de BdmB semble avoir été intériorisée par les joueurs; et BdmB a agi dans certains cas comme facteur de protection contre des influences externes négatives. Les résultats suggèrent que le sport collectif combiné à des interventions psychosociales favoriserait le développement d’habiletés de vie.

Développement, mise à l'essai et évaluation d'une intervention de pratique réflexive avec des infirmières oeuvrant auprès de personnes âgées hospitalisées

Cette recherche visait à développer, mettre à l’essai et évaluer les effets d’une intervention de pratique réflexive (IPR) avec des infirmières œuvrant auprès d’aînés hospitalisés. Fondée sur la théorie du Human Caring de Watson (1979) et sur le modèle de réflexion structurée de Johns (2006), l’étude a été réalisée au moyen d’un devis mixte. Le développement et la mise à l’essai de l’IPR ont été réalisés au moyen d’une approche qualitative de type recherche-action. L’évaluation de l’intervention a été effectuée à l’aide d’une approche qualitative et d’une approche quantitative de type quasi-expérimental avec groupe de comparaison (GC). Au terme de l’IPR, les infirmières étaient invitées à décrire les retombées perçues de cette intervention, soit les habiletés et les savoirs infirmiers développés suite à une pratique réflexive (PR), ainsi que leur perception de la PR comme moyen d’amélioration de leur pratique professionnelle. De plus, comparativement à un GC, trois hypothèses étaient formulées : les infirmières du groupe expérimental (GE) ayant bénéficié d’une IPR amélioreraient significativement leurs attitudes et leurs connaissances à l’égard des aînés; identifieraient davantage d’interventions infirmières adaptées à la clientèle âgée hospitalisée, et obtiendraient un niveau de réflexion supérieur. L’étude a été effectuée auprès de 43 infirmières (GE = 22; GC = 21) travaillant dans un centre hospitalier universitaire. L’IPR s’est déroulée sur une période de 22 semaines. Elle comprenait huit ateliers thématiques d’une durée de 75 minutes chacun, dispensés aux trois semaines, combinés à des lectures et à des exercices individuels. L’IPR portait sur trois thèmes centraux du séjour hospitalier des aînés : la médication, la mobilisation et la planification du congé. Des données qualitatives et quantitatives ont été colligées par le biais de questionnaires ouverts (vignettes, écrit réflexif) et standardisés (Kogan’s Attitudes Toward Old People Scale, Palmore’s Facts on Aging Quiz) pré et post intervention pour les deux groupes. Les infirmières du GE ont également complété un questionnaire sur l’expérience de la PR et certaines d’entre elles ont participé à des groupes de discussion focalisée. Une analyse de contenu thématique, selon l’approche de Miles et Huberman (2003), a été réalisée sur les données qualitatives, alors que des tests de classement de Wilcoxon ont été effectués sur les données quantitatives. Les résultats soulignent que les infirmières ont développé différentes habiletés nécessaires à une PR telles que l’introspection, l’ouverture aux autres et l’analyse critique. Les participantes reconnaissent que l’IPR leur a notamment permis de développer des savoirs empirique, éthique, esthétique, personnel et émancipatoire. De plus, elles perçoivent que l’IPR est un moyen d’amélioration de la pratique professionnelle puisqu’elle peut, entre autres, contrer la routinisation des soins. Par ailleurs, comparativement au GC, les infirmières du GE ont amélioré significativement leurs attitudes et leurs connaissances à l’égard des aînés. Cependant, aucune différence significative entre le GE et le GC n’a été révélée suite à l’IPR quant au nombre d’interventions adaptées aux situations vécues par les aînés hospitalisés et au niveau de réflexion atteint. Les hypothèses de recherche ont ainsi été partiellement soutenues. Cette étude démontre le potentiel d’une IPR comme approche de développement professionnel novateur qui valorise l’expérience des infirmières, tout en leur permettant de modifier positivement leurs attitudes à l’égard des aînés et d’ajuster leurs connaissances aux besoins de cette clientèle hautement fragile et vulnérable.

Los mecanismos de influencia en el liderazgo : un estudio de caso organizacional

Esta investigación busca aportar a la literatura sobre las tácticas de influencia en el liderazgo. Surge como una aplicación, a un caso específico, del proyecto de investigación “Los mecanismos de influencia en la relación de liderazgo”, dirigido por el profesor Juan Javier Saavedra Mayorga e inscrito en la línea de Liderazgo del Grupo de Investigación en Perdurabilidad Empresarial (GIPE) de la Escuela de Administración de la Universidad del Rosario. La investigación busca identificar y analizar las tácticas que utiliza un líder en particular (la señora Yolanda Sánchez, Directora de Mercadeo y Servicio al Cliente de una Cámara de Comercio colombiana) para ejercer influencia en sus colaboradores, así como la reacción de estos últimos ante las tácticas de influencia que son ejercidas sobre ellos. El trabajo parte de una revisión teórica sobre los conceptos de poder e influencia en el liderazgo, y sobre las reacciones que los mecanismos de influencia pueden generar en los colaboradores para, posteriormente, desarrollar el estudio empírico. La estrategia metodológica empleada es el estudio de caso. La técnica de recolección de información es la entrevista semi estructurada, y el método de análisis de información, el análisis de contenido temático. Como resultado del análisis de la información, se encontró que las principales tácticas de influencia utilizadas por la líder estudiada son Persuasión Racional, Intercambio – Negociación, Apelación Inspiracional, Presión, Colaboración, Amistad, Modulación, Apelación a la capacidad Individual, Involucramiento grupal, Aceptación y Pedir el favor. Estas tácticas provocan en los colaboradores principalmente una reacción de Conformidad y, en menor medida, de resistencia. El trabajo hace un análisis de la forma como ella utiliza dichas tácticas de influencia con sus colaboradores, y describe los efectos que ello tiene en el trabajo cotidiano de la organización.

The influence of age and gender on food choice: a focus group exploration

With 25% of the UK population predicted to be obese by 2010, the costs to individuals and society are set to rise. Due to the extra economic and social pressures obesity causes, there is an increasing need to understand what motivates and prevents consumers from eating a healthy diet so as to be able to tailor policy interventions to specific groups in society. In so doing, it is important to explore potential variations in attitudes, motivation and behaviour as a function of age and gender. Both demographic factors are easily distinguished within society and a future intervention study which targets either, or both, of these would likely be both feasible and cost-effective for policy makers. As part of a preliminary study, six focus groups (total n = 43) were conducted at the University of Reading in November 2006, with groups segmented on the basis of age and gender. In order to gather more sensitive information, participants were also asked to fill out a short anonymous questionnaire before each focus group began, relating to healthy eating, alcohol consumption and body dissatisfaction. Making use of thematic content analysis, results suggested that most participants were aware of the type of foods that contribute to a healthy diet and the importance of achieving a healthy balance within a diet. However, they believed that healthy eating messages were often conflicting, and were uncertain about where to find information on the topic. Participants believed that the family has an important role in educating children about eating habits. Despite these similarities, there were a number of key differences among the groups in terms of their reasons for making food choices. Older participants (60+ years old) were more likely to make food choices based on health considerations. Participants between the ages of 18–30 were less concerned with this link, and instead focused on issues of food preparation and knowledge, prices and time. Younger female participants said they had more energy when they ate healthier diets; however, very often their food choices related to concern with their appearance. Older female participants also expressed this concern within the questionnaire, rather than in the group discussions. Overall, these results suggest that consumer motivations for healthy eating are diverse and that this must be considered by government, retailers and food producers.

Contraceptive methods with male participation: a perspective of Brazilian couples

Objective: To assess the perspectives of couples who requested vasectomy in a public health service on the use of male participation contraceptive methods available in Brazil: male condoms, natural family planning/calendar, coitus interruptus and vasectomy. Methods: A qualitative study with semi-structured interviews was held with 20 couples who had requested vasectomy at the Human Reproduction Unit of the Universidade Estadual de Campinas, Brazil. Data analysis was carried out through thematic content analysis. Findings: The couples did not, in general, know any effective contraceptive options for use by men and/or participating in their use, except for vasectomy. The few methods with male participation that they knew of were perceived to interfere in spontaneity and in pleasure of intercourse. Men accepted that condom use in extra-conjugal relations offered them protection from sexually transmitted diseases; that their wives might also participate in extra-marital relationships was not considered. Discussion: The few contraceptive options with male participation lead to difficulty in sharing responsibilities between men and women. On the basis of perceived gender roles, women took the responsibility for contraception until the moment when the situation became untenable, and they faced the unavoidable necessity of sterilization. Conclusion: Specific actions are necessary for men to achieve integral participation in relation to reproductive sexual health. These include education and discussions on gender roles, leading to greater awareness in men of the realities of sexual and reproductive health.

Prevenção de úlceras por pressão segundo a perspectiva do enfermeiro intensivista

Analisar a atuação dos enfermeiros de unidade de terapia intensiva na prevenção da úlcera por pressão. Método: trata-se de estudo descritivo desenvolvido com 13 enfermeiros da unidade de terapia intensiva do Hospital Universitário Onofre Lopes (HUOL), em Natal-RN. Foi aplicado um questionário, submetido à análise de conteúdo temática. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Norte (UFRN), sob o CAAE n. 0240.0.051.000-10. Resultados: os enfermeiros reportaram a realização da mudança de decúbito, a avaliação de risco, a discussão com os colegas sobre as medidas adotadas, a higiene e hidratação da pele do paciente através de uso de ácidos graxos essenciais e hidratante corporal, o cuidado com a disposição dos lençóis, de forma a evitar dobras, a utilização de colchão de ar e a aplicação de placas de hidrocoloide nas proeminências ósseas. Conclusão: a prática da prevenção das úlceras por pressão aplicada pelos enfermeiros da unidade de terapia intensiva ocorre sem padronização dos cuidados

Aceitação e uso de ambiente virtual de aprendizagem no contexto de um curso de capacitação para servidores públicos

This study aimed to examine how students perceives the factors that may influence them to attend a training course offered in the distance virtual learning environment (VLE) of the National School of Public Administration (ENAP). Thus, as theoretical basis it was used the Unified Theory of Acceptance and Use of Technology (UTAUT), the result of an integration of eight previous models which aimed to explain the same phenomenon (acceptance/use of information technology). The research approach was a quantitative and qualitative. To achieve the study objectives were made five semi-structured interviews and an online questionnaire (websurvey) in a valid sample of 101 public employees scattered throughout the country. The technique used to the analysis of quantitative data was the structural equation modeling (SEM), by the method of Partial Least Square Path Modeling (PLS-PM). To qualitative data was the thematic content analysis. Among the results, it was found that, in the context of public service, the degree whose the individual believes that the use of an AVA will help its performance at work (performance expectancy) is a factor to its intended use and also influence its use. Among the results, it was found that the belief which the public employee has in the use of a VLE as a way to improve the performance of his work (performance expectation) was determinant for its intended use that, in turn, influenced their use. It was confirmed that, under the voluntary use of technology, the general opinion of the student s social circle (social influence) has no effect on their intention to use the VLE. The effort expectancy and facilitating conditions were not directly related to the intended use and use, respectively. However, emerged from the students speeches that the opinions of their coworkers, the ease of manipulate the VLE, the flexibility of time and place of the distance learning program and the presence of a tutor are important to their intentions to do a distance learning program. With the results, it is expected that the managers of the distance learning program of ENAP turn their efforts to reduce the impact of the causes of non-use by those unwilling to adopt voluntarily the e-learning, and enhance the potentialities of distance learning for those who are already users

Violência institucional no âmbito da saúde reprodutiva : a percepção de mulheres usuárias do SUS, na cidade de Natal/RN

Institutional violence ranges from the most widespread lack of access to the poor quality of services provided. It includes abuses committed by virtue of the unequal power between patients and professionals within institutions. The aim of this study was to analyze the perception of women with regard to this type of violence, in the services offered at a reproductive health facility belonging to the National Health System (SUS) in Natal, Brazil. Interdisciplinary perspective is important, in that it provides interaction and complementarity between various disciplines, favoring, in an integrated way, a thematic approach in research activities, teaching and extension, involving professionals, students and researchers in medicine, social services, psychology, nursing, anthropology and physical therapy. A quantitative/qualitative approach was used, involving a sample of 401 women, as part of a transversal observational study. In the qualitative stage, which consisted of participatory observation and semi-structured interviews, we used an intentional sample of 10 individuals. The data were analyzed using logistic regression techniques, correspondence analysis and categorical thematic content analysis, showing that the 2 questions that investigated directly the perception of institutional violence obtained affirmative response frequencies of 28.2% and 31.8%, respectively. In regard to data collected in a field diary related to participatory observation, the main complaints referred to the health providerpatient relation, translated into dissatisfaction with the interpersonal relationship and with the resolution of the specific demand that required care. From content analysis, we classified 4 categories: Access; Information; Health professionalpatient relation; and Respect/dignity. We identified 6 subcategories: Impossibility of choice; Repressed demand; Communication difficulty; Asymmetric interpersonal relations; Privacy/confidentiality; Disrespect. We concluded, therefore, that the data presented show that in the reproductive health care programs, there are indicators of institutional violence. However, it is difficult to approach this phenomenon, mainly because of the power relations involved in the patient-health care provider interaction, resulting from unawareness that determinate situations violate sexual and reproductive rights. This can be explained by sociostructural questions that reveal marked inequalities, ratified by issues related to violation of the rights of National Health System (SUS) patients

A Humanização e a Formação Médica na Perspectiva dos Estudantes de Medicina da Universidade Federal do Rio Grande do Norte

The aim of this study is to understand the perception of medical students at the Federal University of Rio Grande do Norte (UFRN) about humanization in the context of their medical formation, using a qualitative approach. The focus group and participant observation techniques were used, involving a multidisciplinary team composed of professionals from the areas of anthropology and psychology, as well as professors from the medical course, who studied two groups of nine students in their final year. The data were analyzed using the categorical thematic content analysis technique, from which emerged three categories: student/patient relationship, teaching/learning and student/professor relationship. The first allows us to identify that student-patient contact is an essential experience for adopting a more humanized view of the disease process. The second category shows that unqualified professors in the pedagogic practices inherent to the teaching profession and the theory the practical dichotomy hinder the autonomous and holistic formation of knowledge. Similarly, the lack of practices outside the academic environment and the absence of multiprofessional stimulation interfere in the construction of an integral view of the individual. From the third category, the student/professor relationship, emerge two opposing subcategories (professor model and assymetric relationships), which reflect the importance of the professor`s ethical humanist position, as opposed to an authoritarian attitude, to form the professional attitude of the student. The results point important aspects of the medical formation that may open a discussion about humanization, in the context of new national curricular guidelines