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.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Implementation of hospital-wide computer information system :a case study of this change process

This case study examines the impact of a computer information system as it was being implemented in one Ontario hospital. The attitudes of a cross section of the hospital staff acted as a barometer to measure their perceptions of the implementation process. With The Mississauga Hospital in the early stages of an extensive computer implementation project, the opportunity existed to identify staff attitudes about the computer system, overall knowledge and compare the findings with the literature. The goal of the study was to develop a greater base about the affective domain in the relationship between people and the computer system. Eight exploratory questions shaped the focus of the investigation. Data were collected from three sources: a survey questionnaire, focused interviews, and internal hospital documents. Both quantitative and qualitative data were analyzed. Instrumentation in the study consisted of a survey distributed at two points in time to randomly selected hospital employees who represented all staff levels.Other sources of data included hospital documents, and twenty-five focused interviews with staff who replied to both surveys. Leavitt's socio-technical system, with its four subsystems: task, structure, technology, and people was used to classify staff responses to the research questions. The study findings revealed that the majority of respondents felt positive about using the computer as part of their jobs. No apparent correlations were found between sex, age, or staff group and feelings about using the computer. Differences in attitudes, and attitude changes were found in potential relationship to the element of time. Another difference was found in staff group and perception of being involved in the decision making process. These findings and other evidence about the role of change agents in this change process help to emphasize that planning change is one thing, managing the transition is another.

National energy policies of the Federal Republic of Germany and Canada in the 1970s and 1980s: are economic and/or environmental concerns responsible for change?

The thesis presents a comparison of the national energy policies of the Federal Republic of Germany and Canada from 1973 until the late 1980s. The purpose of this paper is to analyze whether economic and/or environmental concerns were responsible for changes in the· West-German and Canadian national energy policies. Furthermore, the feasibility of implementing a soft energy path in West-Germany and Canada is examined. For better comprehension of the policy-making process and implemented changes in the national energy policies of the two states, the West-German and Canadian parliamentary systems and the political cultures were compared. For the analysis, several events with international impact were taken as guidelines. Furthermore, based on statistical data, the West-German and Canadian energy production and consumption were analyzed. With reference to these results the degree of the de facto changes in the national energy policies were analyzed. In addition, the thesis discusses the possibilities which a soft energy path offers to both national governments to renounce themselves from the dependencies on a few energy resources. The thesis reveals that changes in the West-German and Canadian national energy policies, in their energy production and consumption are correlated to various world events. In particular, governmental reponses security of energy supply by the two international oil crises of 1973 and 1979/1980 demonstrate that changes in the West-German and Canadian national energy policies were implemented in reaction to economic concerns than environmental ones. With the policies "away from oil" and "off oil", the West-German and Canadian government implemented the i i substitution of oil through various diverse energy supply resources. However, energy savings concepts and policies were initiated through the first oil crisis in 1973. The world recessions in 1975 and 1982 had no 'profound impacts on the agenda of West-German and Canadian energy policies. As a consequence of the stagnation or the negative growth of the world economic market, changes in their energy production and consumption can be perceived. However, the West-German and Canadian energy production and consumption intensified with the augmentation of the world economy. During the period of study, environmental concerns were taken into account in the energy policy agendas of the Federal Republic of Germany and Canada but they were not of primary concern. wi thin the decade of. the 1980s notably more environmental considerations were taken into account in the energy policies of the two states. The two nuclear reactor accidents in 1979 and 1986 sharpened to various degrees West-German and Canadian public discourse of present energy supply mix and attitude towards energy production and consumption. The statistical data reflects yet no changes in the energy policies in regard to the position of nuclear power. However, in the next several years possible changes can be observed through statistical data, because the planning, the construction and possible phase out of nuclear power requires several years. Finally, the thesis reveals that the implementation of a soft energy path requires profound changes in the consumer behaviour. As several studies indicate, a soft energy path is technological and economically feasible for the Federal Republic of Germany and Canada, its implementation remains to be a political decision.

Organizational change: implications of culture and leadership in the transformation to a total quality management paradigm

The study was undertaken to investigate organizational readiness for change to a total quality management (TQM) paradigm as the corporate-wide strategy within a long-term care facility. The focus of the study was on leadership values and organizational cultural characteristics that could either accelerate or impede the change process at The Public Hospital. structurally, the ~tudy included 'three distinct components. The first component examined the management philosophy outlined by Deming (1986) and his contemporary Juran (1989) in order to determine what leadership values best support the new Total Quality Management paradigm. Secondly, this information was compared to present leadership values at The Public Hospital with the purpose of identifying opportunities for improvement within the organization's current culture as the hospital moves toward the desired TQM culture. The final component, a roadmap, was developed to reflect the most appropriate direction for organizational change at The Public Hospital.

Patterns of faunal change at an upper Cambrian trilobite extinction event, Nolichucky Formation, Tennessee and Virginia

During the Upper Cambrian there were three mass extinctions, each of which eliminated at least half of the trilobite families living in North American shelf seas. The Nolichucky Formation preserves the record of one of these extinction events at the base of the Steptoean Stage. Sixty-six trilobite collections were made from five sections In Tennessee and Virginia. The lower Steptoean faunas are assigned to one low diversity, Aphelaspis-dominated biofacies, which can be recognized in several other parts of North America. In Tennessee, the underlying upper Marjuman strata contain two higher diversity biofacies, the Coosella-Glaphyraspis Biofacies and the Tricrepicephalus-Norwoodiid Biofacies. At least four different biofacies are present in other parts of North America: the Crepicephalus -Lonchocephalus Biofacies, the Kingstonia Biofacies, the Cedaria Biofacies, and the Uncaspis Biofacies. A new, species-based zonation for the Nolichucky Formation imcludes five zones, three of which are new. These zones are the Crepicephalus Zone, the Coosella perplexa Zone, the Aphelaspis buttsi Zone, the A. walcotti Zone and the A. tarda Zone. The Nolichucky Formation was deposited within a shallow shelf basin and consists largely of subtidal shales with stormgenerated carbonate interbeds. A relative deepening is recorded In the Nolichucky Formation near the extinction, and is indicated In some sections by the appearance of shale-rich, distal storm deposits above a carbonate-rich, more proximal storm deposit sequence. A comparable deepening-upward sequence occurs near the extinction in the Great Basin of southwestern United States and in central Texas, and this suggests a possible eustatic control. In other parts of North America, the extinction IS recorded In a variety of environmental settings that range from near-shore to slope. In shelf environments, there is a marked decrease in diversity, and a sharp reduction in biofacies differentiation. Although extinctions do take place in slope environments, there IS no net reduction in diversity because of the immigration of several new taxa.

Teachers' likes and dislikes as factors in educational change

Teachers at local elementary and secondary schools were invited to participate in a survey research study by completing a questionnaire containing 26 statements regarding educational issues (e.g., "I am satisfied with the quality of my interactions with students."). Teachers were asked to indicate whether they agreed, were neutral, or disagreed with each statement; and further, to make a suggestions for appropriate change; to indicate a level at which the change could be implemented (classroom, school, board, ministry, society); and to indicate to what extent they perceive they have influence on change in the area represented in the statement. The responses of 50 elementary and 50 secondary teachers were randomly chosen from among the completed questionnaires and the information was recorded for analysis. Results of frequency counts of responses showed teachers were generally satisfied with their experiences of the areas referred to in the statements. Seventy-two percent of the responses agreed with the statements; 15% of the responses indicated disagreement, and 13% of the responses were neutral. Cross-tabulations of the survey data with demographic information showed differences among the responses of female and male teachers; elementary and secondary teachers; and teachers grouped according to their total years of teaching experience.

The effectiveness of a goal-setting model on behavioural change

To evaluate the effectiveness of a goal-setting model on behavioural change, thirty nine adults between the ages of23 and 73 years who were in a weight loss program were assigned to one oftwo groups. One group was taught to change eating behaviour using a weight-reducing diet. The other group was taught to use a goal-setting model to change behaviour. Pretest and posttest surveys were completed by all participants, and a callback survey by theexperimentals. The PET Type Check and Kolb's Learning Style Inventory were administered to all participants. As well, five ofthe experimentals were interviewed. Results of qualitative analyses showed no significant difference between the two groups, but qualitative research suggested that experimentals were more likely to use the goal-setting model to make behavioural changes, and that being successful increased their self-efficacy.

Why do some adults change their minds about what is important in the visual arts? : a case study

This-~-case study used ethnographic-methodo-logy. --The research project was an introductory study of one adult's present and past experiences with the visual arts, exploring, in particular, the causes and processes that were related to the individual's changes of mind in order to develop an understanding of why that individual had changed her mind about what was significant in the visual arts. The individual who provided the data was a solid supporter of art galleries: female, middle-aged, graduate of university and college, married with two children, and living in an urban community. The data were collected from two informal conversational interviews and from a written description of one change experience selected by the participant. The individual had positive experiences with art during early childhood, in elementary and secondary school, during university, in avocational drawing and painting studio courses, and in aesthetic experiences. All of these experiences have had individual effects and, together, they have had a cumulative effect on the development of the participant's opinions and ideas about the visual arts. The experiences which had the most effect on the development of the individual's perspectives on the visual arts were handson studio, educational, and aesthetic experiences. Further research is suggested to investigate why some adults change their minds about the visual arts.

Postglacial water levels in the Great Lakes Region in relation to Holocene climate change : Thecamoebian and Palynological evidence /

Various lake phases have developed in the upper Great Lakes in response to isostatic adjustment and changes in water supply since the retreat of the Laurentide Ice Sheet. Georgian Bay experienced a lowstand that caused a basin wide unconformity approximately 7,500 years ago that cannot be explained by geological events. Thecamoebians are shelled protozoans abundant in freshwater environments and they are generally more sensitive to changing environmental conditions than the surrounding vegetation. Thecamoebians can be used to reconstruct the paleolimnology. The abundance of thecamoebians belonging to the genus Centropyxis, which are known to tolerate slightly brackish conditions (i.e. high concentrations of ions) records highly evaporative conditions in a closed basin. During the warmer interval (9000 to 700 yBP), the Centropyxis - dominated population diminishes and is replaced by an abundant and diverse Difflugia dominate population. Historical climate records from Tobermory and Midland, Ontario were correlated with the Lake Huron water level curve. The fossil pollen record and comparison with modem analogues allowed a paleo-water budget to be calculated for Georgian Bay. Transfer function analysis of fossil pollen data from Georgian Bay records cold, dry winters similar to modem day Minneapolis, Minnesota. Drier climates around this time are also recorded in bog environments in Southem Ontario - the drying of Lake Tonawanda and inception of paludification in Willoughby Bog, for instance, dates around 7,000 years ago. The dramatic impact of climate change on the water level in Georgian Bay underlines the importance of paleoclimatic research for predicting future environmental change in the Great Lakes.

Miss-understand-ing: design education in Ontario secondary schools : an exploration of the issues with stakeholders and recommendations for change /

For most people design is a mystery. The products of design are integrated into our daily lives to the point that design has become invisible to us. However. what is subsumed in design practice is a creative problem-solving process that is applicable as a teaching strategy as well as a method for teaching the subject of design. The purpose of this study was to inquire into the current classroom practice of Ontario Visual Arts and Technological Education teachers, understand the goals of Ontario government curriculum developers, and explore the position held by the professional design community on secondary school design education. Data for this study were collected from: (a) a textual analysis of 4 Ministry curriculum documents; (b) interviews with JO stakeholders; (c) unobtrusive observations and informal conversations conducted at 7 secondary school open house events; and (d) observation of 2 sessions of an AQ course for Design and Technology. The research design modeled the design process and was divided into 2 parts: a discovery or problem-finding phase and a discussion or problem-solving phase. The results showed that design is misunderstood and misused; it has become lost between visual arts and technology where neither program holds responsibility for its delivery; students mistake working on computers for design practice; and while there is a desire within the professional community to have a voice in secondary school design education. there is no forum for participation. The technology-driven paradigm shift taking place in society today calls for a new framework for tellching and practicing dcsign. Further research is required; howcvcr. in the meantime. secondary school educators might benefit from professional development and classroom support from the professional dcsign community.

The practical application of a meta-analysis of deinstitutionalization : adaptive behaviour outcomes and the piloting of a transitional questionnaire for adults with intellectual disabilities

This investigation examined the effects of de institutionalization on the adaptive behaviour and adjustment of adults with intellectual disabilities (ID). In study 1, a meta-analysis was conducted with 23 studies on deinstitutionalization adaptive behaviour outcomes. Deinstitutionalization was associated with modest improvements in adaptive behaviour however outcomes varied across adaptive behaviour domains and other substantive variables. Clinical and service implications of these results were explicated. Noting the trends from the meta-analysis, study 2 used this information in refining and piloting an Agency Transition Survey used to evaluate community transitions for persons with ID. Information derived from the survey was found to be valuable and adequate for the effective evaluation of transitional success. Potential applications of the survey and meta-analysis results were illustrated.

THE INFLUENCE OF LENGTH CHANGE SPEED AND DIRECTION ON DYNAMIC FUNCTION POTENTIATION IN FAST MOUSE MUSCLE

The purpose of this study was to test the hypothesis that the potentiation of dynamic function was dependent upon both length change speed and direction. Mouse EDL was cycled in vitro (25º C) about optimal length (Lo) with constant peak strain (± 2.5% Lo) at 1.5, 3.3 and 6.9 Hz before and after a conditioning stimulus. A single pulse was applied during shortening or lengthening and peak dynamic (concentric or eccentric) forces were assessed at Lo. Stimulation increased peak concentric force at all frequencies (range: 19 ± 1 to 30 ± 2%) but this increase was proportional to shortening speed, as were the related changes to concentric work/power (range: -15 ± 1 to 39 ± 1 %). In contrast, stimulation did not increase eccentric force, work or power at any frequency. Thus, results reveal a unique hysteresis like effect for the potentiation of dynamic output wherein concentric and eccentric forces increase and decrease, respectively, with work cycle frequency.

Notice of Change in Reparation Agent- Quebec 1 May 1822

A notice of change in reparation agent between Robert Morrogh and Thomas Douglas from Quebec to Daniel Shannon in Niagara.

Innovation and adaptation in the Ontario grape and wine industry: An integrated, transdisciplinary response to climate change

With scientific consensus supporting a 4oC increase in global mean temperature over the next century and increased frequency of severe weather events, adaptation to climate change is critical. Given the dynamic and complex nature of climate change, a transdisciplinary approach toward adaptation can create an environment that supports knowledge sharing and innovation, improving existing strategies and creating new ones. The Ontario wine industry provides a case study to illustrate the benefits of this approach. We describe the formation and work of the Ontario Grape and Wine Research Network within this context, and present some preliminary results to highlight the opportunities for innovation that will drive the successful adaption of the Ontario grape and wine industry.