Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

Giving voice to lifelong learning in professional nursing practice

The purpose of this phenomenological study was to uncover the meaning of lifelong learning to nurses in an Academic Health Care setting. Six female pediatric nurses were interviewed and audiotaped in response to 2 main questions of interpretation and engagement in lifelong learning with respect to their nursing practice. Four additional probing questions elicited responses of further qualities and characteristics of the meaning of lifelong learning. The emergent themes uncovered the characteristics and nature of the journey of lifelong learning. The themes evolved into parallel characteristics developing into the concepts of personal empowerment and occupational authorship. The personal empowerment concept involved processes whereby the participants overcame or removed barriers to engage in personal lifelong learning. Participants utilized personal power and internal motivators to sustain their engagement in lifelong learning. The occupational authorship concept involved participants controlling their exploration into lifelong learning through collaboration and recognition of occupational demands to be met as a professional. The remaining themes revealed a seasoning journey. This journey entailed a process of mastery through the themes of engagement discord, discovery pilgrimage, transforming, and maturation. The engagement in this journey resulted in their lifelong learning to becoming more intuitive and a part oftheir being. The overall theme uncovered from the journeys was one of a vocation described as a call to thinking critically of nursing practice. The participants responded to lifelong learning as a call to be a good nurse by using critical thinking through reflection, transformative and constructionist learning processes. This study gave voice to the meaning of lifelong learning in their nursing practice as interpreted by -ao the nurse participants.

Shop-floor narratives : how six workers and a researcher describe learning activities

I am a part-time graduate student who works in industry. This study is my narrative about how six workers and I describe shop-floor learning activities, that is learning activities that occur where work is done, outside a classroom. Because this study is narrative inquiry, you wilileam about me, the narrator, more than you would in a more conventional study. This is a common approach in narrative inquiry and it is important because my intentions shape the way that I tell these six workers' stories. I developed a typology of learning activities by synthesizing various theoretical frameworks. This typology categorizes shop-floor learning activities into five types: onthe- job training, participative learning, educational advertising, incidental learning, and self-directed learning. Although learning can occur in each of these activities in isolation, it is often comprised of a mixture of these activities. The literature review contains a number of cases that have been developed from situations described in the literature. These cases are here to make the similarities and differences between the types of learning activities that they represent more understandable to the reader and to ground the typology in practice as well as in theory. The findings are presented as reader's theatre, a dramatic presentation of these workers' narratives. The workers tell us that learning involves "being shown," and if this is not done properly they "learn the hard way." I found that many of their best case lean1ing activities involved on-the-job training, participative learning, incidentalleaming, and self-directed learning. Worst case examples were typically lacking in properly designed and delivered participative learning activities and to a lesser degree lacking carefully planned and delivered on-the-job training activities. Included are two reflective chapters that describe two cases: Learning "Engels" (English), and Learning to Write. In these chapters you will read about how I came to see that my own shop-floor learning-learning to write this thesis-could be enhanced through participative learning activities. I came to see my thesis supervisor as not only my instructor who directed and judged my learning activities, but also as a more experienced researcher who was there to participate in this process with me and to help me begin to enter the research community. Shop-floor learning involves learners and educators participating in multistranded learning activities, which require an organizational factor of careful planning and delivery. As with learning activities, which can be multi-stranded, so too, there can be multiple orientations to learning on the shop floor. In our stories, you will see that these six workers and I didn't exhibit just one orientation to learning in our stories. Our stories demonstrate that we could be behaviorist and cognitivist and humanist and social learners and constructivist in our orientation to learning. Our stories show that learning is complex and involves multiple strands, orientations, and factors. Our stories show that learning narratives capture the essence of learning-the learners, the educators, the learning activities, the organizational factors, and the learning orientations. Learning narratives can help learners and educators make sense of shop-floor learning.

The examination of assumptions in clinical nursing practice

This was a study designed to identify and explore the assumptions that Registered Nurses have about their current nursing role and practice. A qualitative case study approach was used to gather descriptive data. Thirteen study participants completed the indicators of critical thinking exercise and participated in a group session in which they identified positive and negative critical incidents in their clinical practice. The analysis of the anecdotes that were generated from the critical incident exercises revealed ten assumptions held by the Registered Nurses about their nursing practice. The ten assumptions were reflected back to the study participants to determine their level of agreement with each assumption. The ten assumptions were supported by the majority of the respondents. The Registered Nurses in this study appraised themselves affirmatively on eight out of nine indicators of critical thinking.

Understanding the portfolio in the secondary school classroom

Four secondary school teachers were involved in this case study. Individual interviews, group reflective sessions, and participant portfolios were transcribed verbatim and analyzed. The use of the portfolio in the secondary school classroom was then discussed in relation to emergent themes. These themes included teacher attitude, portfolio structure, portfolio purpose, challenges, effect, and professional development. Teachers were able to individualize the portfolio structure to meet both program and students' needs. The portfolio structure enabled both teachers and students to assume control over the learning process. The portfolio informed teachers about their teaching. This, in tum, challenged them to reflect on their teaching practices and enabled them to redesign curriculum implementation. A collaborative professional development structure fostered a learning environment that enabled teachers to experience success, despite the challenges that they inevitably encountered. These findings were related to contemporary literature. Finally, implications for theory and practice related to portfolio use in the secondary school classroom and professional development for secondary school teachers were considered.

Verbal ability, previous practice and load on short-term memory as determiners of differences in a complex learning task: an experimental study

Traditional psychometric theory and practice classify people according to broad ability dimensions but do not examine how these mental processes occur. Hunt and Lansman (1975) proposed a 'distributed memory' model of cognitive processes with emphasis on how to describe individual differences based on the assumption that each individual possesses the same components. It is in the quality of these components ~hat individual differences arise. Carroll (1974) expands Hunt's model to include a production system (after Newell and Simon, 1973) and a response system. He developed a framework of factor analytic (FA) factors for : the purpose of describing how individual differences may arise from them. This scheme is to be used in the analysis of psychometric tes ts . Recent advances in the field of information processing are examined and include. 1) Hunt's development of differences between subjects designated as high or low verbal , 2) Miller's pursuit of the magic number seven, plus or minus two, 3) Ferguson's examination of transfer and abilities and, 4) Brown's discoveries concerning strategy teaching and retardates . In order to examine possible sources of individual differences arising from cognitive tasks, traditional psychometric tests were searched for a suitable perceptual task which could be varied slightly and administered to gauge learning effects produced by controlling independent variables. It also had to be suitable for analysis using Carroll's f ramework . The Coding Task (a symbol substitution test) found i n the Performance Scale of the WISe was chosen. Two experiments were devised to test the following hypotheses. 1) High verbals should be able to complete significantly more items on the Symbol Substitution Task than low verbals (Hunt, Lansman, 1975). 2) Having previous practice on a task, where strategies involved in the task may be identified, increases the amount of output on a similar task (Carroll, 1974). J) There should be a sUbstantial decrease in the amount of output as the load on STM is increased (Miller, 1956) . 4) Repeated measures should produce an increase in output over trials and where individual differences in previously acquired abilities are involved, these should differentiate individuals over trials (Ferguson, 1956). S) Teaching slow learners a rehearsal strategy would improve their learning such that their learning would resemble that of normals on the ,:same task. (Brown, 1974). In the first experiment 60 subjects were d.ivided·into high and low verbal, further divided randomly into a practice group and nonpractice group. Five subjects in each group were assigned randomly to work on a five, seven and nine digit code throughout the experiment. The practice group was given three trials of two minutes each on the practice code (designed to eliminate transfer effects due to symbol similarity) and then three trials of two minutes each on the actual SST task . The nonpractice group was given three trials of two minutes each on the same actual SST task . Results were analyzed using a four-way analysis of variance . In the second experiment 18 slow learners were divided randomly into two groups. one group receiving a planned strategy practioe, the other receiving random practice. Both groups worked on the actual code to be used later in the actual task. Within each group subjects were randomly assigned to work on a five, seven or nine digit code throughout. Both practice and actual tests consisted on three trials of two minutes each. Results were analyzed using a three-way analysis of variance . It was found in t he first experiment that 1) high or low verbal ability by itself did not produce significantly different results. However, when in interaction with the other independent variables, a difference in performance was noted . 2) The previous practice variable was significant over all segments of the experiment. Those who received previo.us practice were able to score significantly higher than those without it. J) Increasing the size of the load on STM severely restricts performance. 4) The effect of repeated trials proved to be beneficial. Generally, gains were made on each successive trial within each group. S) In the second experiment, slow learners who were allowed to practice randomly performed better on the actual task than subjeots who were taught the code by means of a planned strategy. Upon analysis using the Carroll scheme, individual differences were noted in the ability to develop strategies of storing, searching and retrieving items from STM, and in adopting necessary rehearsals for retention in STM. While these strategies may benef it some it was found that for others they may be harmful . Temporal aspects and perceptual speed were also found to be sources of variance within individuals . Generally it was found that the largest single factor i nfluencing learning on this task was the repeated measures . What e~ables gains to be made, varies with individuals . There are environmental factors, specific abilities, strategy development, previous learning, amount of load on STM , perceptual and temporal parameters which influence learning and these have serious implications for educational programs .

Letting go : a self-study utilizing critical literacy as method in improving my practice /

This is a Self-study about my role as a teacher, driven by the question: "How do I improve my practice?" (Whitehead, 1989)? In this study, I explored the discomfort that I had with the way that I had been teaching. Specifically, I worked to uncover the reasons behind my obsessive (mis)management of my students. I wrote of how I came to give my Self permission for this critique: how I came to know that all knowledge is a construction, and that my practice, too, is a construction. I grounded this journey within my experiences. I constructed these experiences in narrative fomi in order to reach a greater understanding of how I came to be the teacher I initially was. I explored metaphors that impacted my practice, re-constructed them, and saw more clearly the assumptions and influences that have guided my teaching. I centred my inquiry into my teaching within an Action Reflection methodology, bon-owing Jack Whitehead's (1989) term to describe my version of Action Research. I relied upon the embedded cyclical pattern of Action Reflection to understand my teaching Self: beginning from a critical moment, reflecting upon it, and then taking appropriate action, and continuing in this way, working to improve my practice. To understand these critical moments, I developed a personal definition of critical literacy. I then tumed this definition inward. In treating my practice as a textual production, I applied critical literacy as a framework in coming to know and understand the construction that is my teaching. I grounded my thesis journey within my Self, positioning my study within my experiences of being a grade 1 teacher struggling to teach critical literacy. I then repositioned my journey to that of a grade 1 teacher struggling to use critical literacy to improve my practice. This journey, then, is about the transition from critical literacyit as-subject to critical literacy-as-instmctional-method in improving my practice. I joumeyed inwards, using a critical moment to build new understandings, leading me to the next critical moment, and continued in this cyclical way. I worked in this meandering yet deliberate way to reach a new place in my teaching: one that is more inclusive of all the voices in my room. I concluded my journey with a beginning: a beginning of re-visioning my practice. In telling the stories of my journey, of my teaching, of my experiences, I changed into the teacher that I am more comfortable with. I've come to the frightening conclusion that I am the decisive element in the classroom. It's my personal approach that creates the climate. It's my daily mood that makes the weather As a teacher, I possess a tremendous power to make a person's life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humour, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a person humanized or de-humanized. (Ginott, as cited in Buscaglia, 2002, p. 22)

Inclusive teaching practice in the Jewish day school: general studies teachers' experiences /

Little research has been done on inclusive education in the context of the Jewish day school general studies classroom. This qualitative case study research examines the inclusive teaching experiences of 2 general studies teachers in their respective grade 4 classrooms in 2 traditionally structured dual curriculum Jewish day schools. Data analysis of qualitative open-ended interviews, classroom observations, postobservation discxissions, and school and formal curriculum documents yielded understandings about the participants' inclusive practice and the challenges of the traditional Jewish day school structure. Eight themes that emerged related to understandings and questions about time limitations, an emphasis on efficiency, the day school structure, inclusion models, the need for increased teacher collaboration, and tension between curriculum-as-plan and curriculum-as-lived. Discussion of the findings suggests the need for further research in inclusion and integrated curriculimi in order to better understand possible restructuring of the traditional Jewish day school fi-om the time efficiency constrained dual curriculiun structure to a more flexible structure conducive of a meaningful and dynamic lived curriculum.

Produced subjectivities and productive subjects : locating the potential of the self-reflective blog

Blogging software has popularly been used as a mode of writing about everyday life to interact with others. This thesis examines the political potentials that are opened up by self-reflective blogging. The self-reflective blog is a synergy of self-reflective practices and computer-mediated communication. A genealogy of the history of computer-mediated communication and various public self-reflective practices is conducted to uncover affect as the utility of various economies of subject production. Efforts made to blog-like the efforts made to interact online in other CMCs-are positioned as a kind of affective labor. Adapting Hardt and Negri's (2005) theorization of the multitude, whereby affective labor-the production of social relationshipsis a kind ofbiopolitical production, affect will be determined as a kind ofbiopolitical power that exists in everyday life.