Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

Inclusão no ensino superior: modelos de atuação e contributos dos serviços de apoio em Portugal

A inclusão de estudantes com deficiência na Universidade tem desafiado as instituições a responderem às demandas de acesso e permanência específicas destes estudantes. Neste artigo analisaremos como estão organizadas as iniciativas institucionais de inclusão, tomando como objeto os serviços de apoio na universidade e os desafios explicitados pelos responsáveis dos setores. Participaram do estudo três responsáveis técnicas pelos serviços de inclusão em três universidades portuguesas. Os dados foram recolhidos por meio de entrevista semiestruturada e analisados numa abordagem exploratória. Os resultados apontam para o desafio de proporcionar, para além das condições de acesso, a qualificação das condições de permanência que possam resultar em experiências exitosas dos estudantes, ampliando a oportunidades de obter autonomia e sucesso académico. A partir da discussão, apresentaremos considerações que podem constituir indicadores de intervenção e, ainda, temas para investigações futuras que possam contribuir para práticas mais adequadas de atendimento a esse grupo de estudantes.

Home Accident Prevention Strategy

The overall aim of the strategy is “To reduce the number of accidental deaths and injuries in the home.” OBJECTIVES OF THE STRATEGY The key objectives are: • to reduce home accidents, particularly in those most at risk; • to raise awareness of the causes of home accidents and promote effective preventative measures to reduce such accidents; • to promote and facilitate effective training, skills and knowledge in home accident prevention across all relevant organisations, groups and individuals. These objectives will be met through integrated and effective approaches including: • education and information programmes to promote home safety, and promote a change in public behaviour towards home accident prevention; and • the use of evidence based practice, models of good practice, and by evaluating home accident prevention initiatives. OUTCOMES If successful, implementation of this strategy will lead to a reduction in the number of home accidents and contribute to the outcome “reduction in preventable deaths and diseases and improvement in wellbeing” set out in the Northern Ireland Priorities and Budget 2004-2006.

Reducing the Risk: A Strategic Approach - The Report of the Task Force on Sudden Cardiac Death

The Minister for Health and Children established the Task Force on Sudden Cardiac Death (SCD) in the Autumn of 2004, with the following terms of reference:1) Define SCD and describe its incidence and underlying causes in Ireland.2) Advise on the detection and assessment of those at high risk of SCD and their relatives.3) Advise on the systematic assessment of those engaged in sports and exercise for risk of SCD.4) Advise on maximizing access to basic life support (BLS) and automated external defibrillators (AEDs) and on:- appropriate levels of training in BLS and use of AEDs, and on the maintenance of that training- priority individuals and priority groups for such training- geographic areas and functional locations of greatest need- best practice models of first responder scheme and public access defibrillation, and- integration of such training services.5) Advise on the establishment and maintenance of surveillance systems, including a registry of SCD and information systems to monitor risk assessment, and training and equipment programmes.6) Advise and make recommendations on other priority issues relevant to SCD in Ireland.7) Outline a plan for implementation and advise on monitoring the implementation of recommendations made in the Task Force’s report. In undertaking its work the Task Force was mindful of national health policy, relevant national strategies and of the recently reformed structures for health service delivery in Ireland. Read the Report (PDF, 1.66mb)

06003-002 Upper Catfish Creek Watershed Final Report

Upper Catfish Creek is located in a 9,300-acre watershed that flows through two significant natural resources, Swiss Valley Park and Swiss Valley Nature Preserves, one of the largest nature preserves in the Midwest. According to DNR’s 2002 305(d) report, that portion of the creek within the park and preserve is classified as a Class B(CW) cold water stream of which a portion has naturally reproducing trout (one of only 30 in the state of Iowa with this capability). Urban sprawl is a real threat to the Upper Catfish Creek Watershed. Currently, 10% of the watershed is residential, but 27% is zoned residential or commercial. The watershed is near Dubuque city limits but the jurisdiction is in the county. Differing criteria for land development between city and county jurisdictions further entices developers to build in outlying areas. County leaders agree there is more that needs to be done and will work with municipalities on uniformity of regulations and follow-up measures. We propose to set up key urban conservation practice models that will address storm water runoff and water quality which can be learned about and viewed by city and county officials, engineers, developers, etc. This would be part of a larger initiative including an educational campaign, inter-jurisdictional planning, the development of a land use GIS database, and agricultural conservation practices. The successes coming out of and learned about this watershed will serve as a model to spread county-wide.

Le vieillissement au travail chez les infirmières et le personnel soignant d’expérience auprès de personnes en perte d’autonomie : activités professionnelles et cadres bureaucratiques en transformation

Cette thèse cherche à comprendre comment les transformations bureaucratiques influencent l’activité professionnelle des infirmières et du personnel soignant d’expérience dans le domaine des soins aux personnes âgées en perte d’autonomie depuis les années 90 au Québec. Elle s’inscrit dans une profonde remise en question de l’État-providence, de sa régulation hiérarchique, de son rapport avec le marché privé, et particulièrement des agences privées de placement du personnel. Prenant en compte le déploiement inégal des changements imposés de façon top down et promus par des considérations économiques visant une plus grande « performance » des services publics, plus près du milieu de vie de la personne, notre démarche tient aussi compte de la dimension relationnelle propre au travail infirmier, qui s’illustre par des formes différenciées tenant compte des modèles de pratique préconisés. Notre démarche s’attarde finalement aux rapports entre l’activité professionnelle et la prise de la retraite. À travers l’exploration du nouveau rôle attendu de l’infirmière, dont les habiletés de « chef » ou de « gestion d’équipe de travail » sont sollicitées à titre d’« intervenante pivot » ou de « gestionnaire de cas », et de la place importante qu’occupe la notion de compétences relationnelles dans la prescription de nouvelles modalités des services, plus près des besoins spécifiques de la personne, les données empiriques se présentent sous la forme d’un tableau hétérogène qui montre que ce ne sont pas toutes les infirmières qui souscrivent à ce type de pratique professionnelle. Leur âge, expérience et trajectoire professionnelle, le poste occupé ou encore le milieu de pratique influenceront le rapport entre leurs activités professionnelles et le cadre bureaucratique en transformation. La base empirique de la recherche est constituée d’une collecte de données réalisée entre janvier 2003 et juillet 2006 et qui comprend 9 entrevues exploratoires, 7 entrevues semi-dirigées auprès de retraité-e-s, infirmières, infirmières auxiliaires, 17 réunions incluant majoritairement des membres de la direction d’établissements, ainsi que des syndicats, 21 observations directes avec des infirmières, infirmières auxiliaires, préposées aux bénéficiaires et auxiliaires familiales et sociales, la passation de 112 questionnaires auprès de ces différentes catégories professionnelles, et 7 entrevues semi-dirigées complémentaires, réparties dans 4 établissements différents, sur deux territoires. Quatre grands constats ressortent de notre matériel empirique. Premièrement, la dimension relationnelle au sein des activités professionnelles du personnel soignant d’expérience ainsi que sa perception en ce qui concerne les compétences et l’âge présentent des formes contrastées, voire opposées. Si certains membres du personnel soignant estiment que les interactions professionnelles se sont considérablement réduites à la suite des transformations des dernières années et que la compétence n’est pas reliée à l’âge des professionnelles, les observations directes indiquent, au contraire, un rapport étroit entre ces deux derniers éléments qui s’illustre à travers de riches relations interpersonnelles. Les données quantitatives montrent, quant à elles, qu’une écrasante majorité de répondantes estiment que les compétences associées à leurs fonctions sont reconnues par l’organisation (89,3%), probablement sous l’angle de la conformité aux descriptions de travail, et qu’elles bénéficient d’une marge d’autonomie dans leur travail (83%). Deuxièmement, des résultats s’opposent également en ce qui concerne l’influence du cadre bureaucratique sur les « capacités » ou l’« intérêt » des infirmières d’expérience à maintenir un lien à l’emploi à la date d’éligibilité à la retraite. La majorité des répondantes s’estiment « incapables » de conserver un tel lien alors qu’une minorité d’entre elles exprime un intérêt face au nouveau rôle souhaité chez l’infirmière. Quantitativement, la prise de la retraite à bas âge est toutefois marquante, surtout pour celles qui occupent une fonction et possèdent une rémunération élevée (ex. cadres). Troisièmement, des contrastes apparaissent aussi en ce qui concerne les formes que prennent les rivalités entre les infirmières d’expérience et d’autres catégories professionnelles ainsi que dans les rapports intergénérationnels. Même si les trois quarts (76,2%) des répondantes d’expérience estiment que la répartition du travail devrait être le fruit d’une discussion entre elles et les plus jeunes, et non une imposition de la direction, près de la totalité (92,6%) veulent garder leurs acquis sociaux même si elles savent que la prochaine génération de travailleuses n’aura pas les mêmes avantages. Leur rapport face aux professionnelles d’agences privées de placement est également paradoxal. Huit répondantes sur dix (78,6%) perçoivent le fait que l’établissement recourt aux agences de placement contribue à alourdir leur travail, alors qu’une partie envisage de poursuivre leur activité professionnelle après leur date d’éligibilité à la retraite, par l’intermédiaire de ces mêmes agences. Finalement, il ressort de ce portrait hétérogène que la confrontation des changements du cadre bureaucratique sur l’activité professionnelle se manifestera différemment selon la vision paradigmatique qu’aura le personnel soignant de sa pratique. Les résultats quantitatifs et qualitatifs soulignent que ce paradigme sera influencé par trois dimensions : le territoire de pratique, le type d’établissement de services et l’unité spécifique de travail. Le style de gestion (traditionnel ou intégrateur) influencera également l’impact de ces changements. L’analyse et l’interprétation de l’influence différenciée des transformations bureaucratiques sur l’activité professionnelle s’illustrent par la manifestation de rapports plus conflictuels avec les autorités administrative et professionnelle, ainsi que dans les relations interprofessionnelles. Ces conflits ont émergé lors du passage d’un cadre bureaucratique historiquement construit sur un modèle médical (cure) qui considère la personne comme un « malade chronique » et associé à un style de gestion traditionnel, voire autoritaire, surtout dans certains CHSLD, à une approche « milieu de vie » privilégiant un modèle d’accompagnement (care) favorisant des services associés aux besoins spécifiques de la personne en perte d’autonomie, à titre de « partenaire actif ». Le style de gestion intégrateur de ce dernier modèle rapproche les domaines administratif et de soins de santé, approche que nous retrouvons davantage, mais non exclusivement, dans le cadre de soins à domicile. Une des conclusions majeures de cette thèse est la possibilité d’« enrichir les qualifications de base » (Le Boterf, 2005) des professionnelles lorsque le cadre bureaucratique et le style de gestion institués tendent vers un modèle care/intégrateur, ce qui constitue une forme de « compromis social » (Oiry, 2004). La « surutilisation » des effectifs (O’Brian-Pallas et al., 2005) qui en résulte peut expliquer, en partie, l’incontournable force d’attraction vers la retraite, dès la date d’admissibilité, du personnel soignant, quitte à ce qu’il poursuive ensuite ses activités professionnelles, selon des exigences personnelles, par le biais d’agences privées de placement. Les « fissures » (Laville, 2005) de la frontière entre les services publics et ceux du marché privé ne peuvent alors que s’accentuer, surtout lorsqu’on constate que le cinquième des effectifs, soit 14, 000 infirmières de 55 ans et plus, est potentiellement admissible à la retraite dès maintenant (OIIQ, 2008a).

Stratégies à privilégier pour permettre aux infirmières et infirmiers de déployer pleinement leur étendue de pratique.

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option administration des services infirmiers

Risk of Agricultural Practices and Habitat Change to Farmland Birds

Many common bird species have declined as a result of agricultural intensification and this could be mitigated by organic farming. We paired sites for habitat and geographical location on organic and nonorganic farms in Ontario, Canada to test a priori predictions of effects on birds overall, 9 guilds and 22 species in relation to candidate models for farming practices (13 variables), local habitat features (12 variables), or habitat features that influence susceptibility to predation. We found that: (1) Overall bird abundance, but not richness, was significantly (p < 0.05) higher on organic sites (mean 43.1 individuals per site) than nonorganic sites (35.8 individuals per site). Significantly more species of birds were observed for five guilds, including primary grassland birds, on organic vs. nonorganic sites. No guild had higher richness or abundance on nonorganic farms; (2) Farming practice models were the best (ΔAIC < 4) for abundance of birds overall, primary grassland bird richness, sallier aerial insectivore richness and abundance, and abundance of ground nesters; (3) Habitat models were the best for overall richness, Neotropical migrant abundance, richness and abundance of Ontario-USA-Mexico (short-distance) migrants and resident richness; (4) Predation models were the best for richness of secondary grassland birds and ground feeders; (5) A combination of variables from the model types were best for richness or abundance overall, 13 of 18 guilds (richness and abundance) and 16 of 22 species analyzed. Five of 10 farming practice variables (including herbicide use, organic farm type) and 9 of 13 habitat variables (including hedgerow length, proportion of hay) were significant in best models. Risk modeling indicated that herbicide use could decrease primary grassland birds by one species (35% decline from 3.4 to 2.3 species) per site. Organic farming could benefit species of conservation concern by 49% (an increase from 7.6 to 11.4 grassland birds). An addition of 63 m of hedgerow could increase abundance and richness of short distance migrants by 50% (3.0 to 4.8 and 1.3 to 2.0, respectively). Increasing the proportion of hay on nonorganic farms to 50% could increase abundance of primary grassland bird by 40% (6.7 to 9.4). Our results provide support for alternative farmland designs and agricultural management systems that could enhance select bird species in farmland.

A alfabetização sob o olhar de uma educadora de EJA: entre o como e o por quê

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Learning Environments in Design Studio Culture

The paper reports on a study of design studio culture from a student perspective. Learning in design studio culture has been theorised variously as a signature pedagogy emulating professional practice models, as a community of practice and as a form of problem-based learning, all largely based on the study of teaching events in studio. The focus of this research has extended beyond formally recognized activities to encompass the student’s experience of their social and community networks, working places and study set-ups, to examine how these have contributed to studio culture and how there have been supported by studio teaching. Semi-structured interviews with final year undergraduate students of architecture formed the basis of the study using an interpretivist approach informed by Actor-network theory, with studio culture featured as the focal actor, enrolling students and engaging with other actors, together constituting an actor-network of studio culture. The other actors included social community patterns and activities; the numerous working spaces (including but not limited to the studio space itself); the equipment, tools of trade and material pre-requisites for working; the portfolio enrolling the other actors to produce work for it; and the various formal and informal events associated with the course itself. Studio culture is a highly charged social arena: The question is how, and in particular, which aspects of it support learning? Theoretical models of situated learning and communities of practice models have informed the analysis, with Bourdieu’s theory of practice, and his interrelated concepts of habitus, field and capital providing a means of relating individually acquired habits and modes of working to social contexts. Bourdieu’s model of habitus involves the externalisation through the social realm of habits and knowledge previously internalised. It is therefore a useful model for considering whole individual learning activities; shared repertoires and practices located in the social realm. The social milieu of the studio provides a scene for the exercise and display of ‘practicing’ and the accumulation of a form of ‘practicing-capital’. This capital is a property of the social milieu rather than the space, so working or practicing in the company of others (in space and through social media) becomes a more valued aspect of studio than space or facilities alone. This practicing-capital involves the acquisition of a habitus of studio culture, with the transformation of physical practices or habits into social dispositions, acquiring social capital (driving the social milieu) and cultural capital (practicing-knowledge) in the process. The research drew on students’ experiences, and their practicing ‘getting a feel for the game’ by exploring the limits or boundaries of the field of studio culture. The research demonstrated that a notional studio community was in effect a social context for supporting learning; a range of settings to explore and test out newly internalised knowledge, demonstrate or display ideas, modes of thinking and practicing. The study presents a nuanced interpretation of how students relate to a studio culture that involves a notional community, and a developing habitus within a field of practicing that extends beyond teaching scenarios.

Physiotherapy practice in the private sector: organizational characteristics and models.

BACKGROUND: Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. METHODS: This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. RESULTS: Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. CONCLUSIONS: The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

Markov models of aging: theory and practice

We review and structure some of the mathematical and statistical models that have been developed over the past half century to grapple with theoretical and experimental questions about the stochastic development of aging over the life course. We suggest that the mathematical models are in large part addressing the problem of partitioning the randomness in aging: How does aging vary between individuals, and within an individual over the lifecourse? How much of the variation is inherently related to some qualities of the individual, and how much is entirely random? How much of the randomness is cumulative, and how much is merely short-term flutter? We propose that recent lines of statistical inquiry in survival analysis could usefully grapple with these questions, all the more so if they were more explicitly linked to the relevant mathematical and biological models of aging. To this end, we describe points of contact among the various lines of mathematical and statistical research. We suggest some directions for future work, including the exploration of information-theoretic measures for evaluating components of stochastic models as the basis for analyzing experiments and anchoring theoretical discussions of aging.