Collegial Support and Community with Trust in Swedish and Danish dentistry.

PubMed

Berthelsen, Hanne; Söderfeldt, Björn; Harris, Rebecca; Pejtersen, Jan Hyld; Bergström, Kamilla; Hjalmers, Karin; Ordell, Sven

2011-11-01

The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers.

PubMed

Kristman, Vicki L; Shaw, William S; Reguly, Paula; Williams-Whitt, Kelly; Soklaridis, Sophie; Loisel, Patrick

2017-03-01

Purpose Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors' support for temporary job accommodations for LBP injured workers. Methods Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors' support for accommodations. Results A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21 % of the variance in supervisors' support for temporary job accommodations. Considerate leadership style (β = 0.261; 95 % CI 0.212, 0.310), workplace disability management policies and practices (β = 0.243; 95 % CI 0.188, 0.298), and supervisor autonomy for designing and providing workplace accommodations (β = 0.156; 95 % CI 0.071, 0.241) had the largest effect on supervisor support for accommodations. Conclusion Factors predicting supervisors' likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes.

Internal and External Factors Affecting Teachers' Adoption of Formative Assessment to Support Learning

ERIC Educational Resources Information Center

Izci, Kemal

2016-01-01

Assessment forms an important part of instruction. Assessment that aims to support learning is known as formative assessment and it contributes student's learning gain and motivation. However, teachers rarely use assessment formatively to aid their students' learning. Thus reviewing the factors that limit or support teachers' practices of…

Internal and External Factors Affecting Teachers' Adoption of Formative Assessment to Support Learning

ERIC Educational Resources Information Center

Izci, Kemal

2016-01-01

Assessment forms an important part of instruction. Assessment that aims to support learning is known as formative assessment and it contributes student's learning gain and motivation. However, teachers rarely use assessment formatively to aid their students' learning. Thus, reviewing the factors that limit or support teachers' practices of…

Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

NASA Astrophysics Data System (ADS)

Wetzel, Angela Payne

Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize this gap in best practices and subsequently to promote instrument development research that is more consistent through the peer-review process.

The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study.

PubMed

Untas, Aurélie; Thumma, Jyothi; Rascle, Nicole; Rayner, Hugh; Mapes, Donna; Lopes, Antonio A; Fukuhara, Shunichi; Akizawa, Tadao; Morgenstern, Hal; Robinson, Bruce M; Pisoni, Ronald L; Combe, Christian

2011-01-01

This study aimed to investigate the influence of social support and other psychosocial factors on mortality, adherence to medical care recommendations, and physical quality of life among hemodialysis patients. Data on 32,332 hemodialysis patients enrolled in the Dialysis Outcomes and Practice Patterns Study (1996 to 2008) in 12 countries were analyzed. Social support and other psychosocial factors related to ESRD and its treatment were measured by patient self-reports of health interference with social activities, isolation, feeling like a burden, and support from family and dialysis staff. Cox regression and logistic regression were used to examine associations of baseline social support and other psychosocial factors with all-cause mortality and with other measured outcomes at baseline, adjusting for potential confounders. Mortality was higher among patients reporting that their health interfered with social activities, were isolated, felt like a burden, and were dissatisfied with family support. Poorer family support and several psychosocial measures also were associated with lower adherence to the prescribed hemodialysis length and the recommended weight gain between sessions. Some international differences were observed. Poorer self-reported social support and other psychosocial factors were associated with poor physical quality of life. Poorer social support and other psychosocial factors are associated with higher mortality risk, lower adherence to medical care, and poorer physical quality of life in hemodialysis patients. More research is needed to assess whether interventions to improve social support and other psychosocial factors will lengthen survival and enhance quality of life.

Supports and Concerns for Teacher Professional Growth During the Implementation of a Science Curriculum Innovation

NASA Astrophysics Data System (ADS)

Peers, Cheryl (Shelley) E.; Diezmann, Carmel M.; Watters, James J.

2003-02-01

Internationally, considerable reform in science education is occurring which promotes constructivist philosophies and advocates constructivist-inspired pedagogical strategies that are new to many teachers. This paper reports on the supporting factors necessary for teacher professional growth and the issues of concern that were evident during one primary teacher''s successful implementation of a unit of work based on a draft of a new state-wide science syllabus which proposes such approaches. One researcher (CEP) provided guidance during the writing and implementation of the unit through professional development workshops complemented by ongoing collegial support. The analysis of the teacher''s practice reveals that professional growth required a willingness of the teacher to engage with change and modify his professional practice. The support factors for teacher growth consisted of an appropriate program of professional development, teacher understanding of the elements of the curriculum innovation, and successful experiences in implementing new approaches. In contrast, the issues of concern were: the adequacy of support for planning including the time required to understand the innovation and make changes to teaching practice; science equipment; teacher knowledge; classroom management strategies; and ways to cope with change. Understanding of these support factors and issues of concern is vital for the successful implementation of science curriculum innovations.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention.

PubMed

Spence Laschinger, Heather K; Zhu, Junhong; Read, Emily

2016-07-01

To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments. © 2016 John Wiley & Sons Ltd.

From Checklists to Heuristics: Designing MOOCs to Support Teacher Learning

ERIC Educational Resources Information Center

Brennan, Karen; Blum-Smith, Sarah; Yurkofsky, Maxwell M.

2018-01-01

Background: Although much is known from educational research about factors that support K-12 teacher professional learning, it has been an ongoing challenge to incorporate these factors into practice in new contexts and environments. We argue that these factors are too often treated like a checklist of discrete elements, either present or not,…

Are person-related and socio-structural factors associated with nurses' self-management support behavior? A correlational study.

PubMed

Duprez, Veerle; Beeckman, Dimitri; Verhaeghe, Sofie; Van Hecke, Ann

2018-02-01

To explore nurses' self-perceived behavior of supporting patients' self-management, and its association with person-related and socio-structural factors. Correlational study in a sample of nurses from nine general hospitals, three community healthcare organizations, and six private community practices. Nurses with >50% of their patients living with a chronic condition were eligible to participate. Data were collected at two time-points. Self-management support behavior was measured by the SEPSS-36 instrument. The person-related and socio-structural associated factors were derived from behavioral theories and measured by validated questionnaires. Nurses (N=477) scored overall low on self-management support behavior. Nurses lacked mainly competencies in collaborative goalsetting, shared decision making and organizing follow-up. Factors predicting nurses' behavior in supporting patients' self-management were self-efficacy, priority, perceived supervisor support and training in self-management support. This model explained 51.7% of the variance in nurses' behavior. To date, nurses do not optimally fulfil their role in supporting patients' self-management. Self-management support is practiced from a narrow medical point of view and primarily consists of informing patients, which is the lowest level of patient participation. It is essential to better prepare and support nurses - and by extend all healthcare professionals - for the challenges of supporting patients' self-management. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient distress and emotional disclosure: a study of Chinese cancer patients.

PubMed

Wei, Dong; Tian, Yan; Gao, Hui; Peng, Jingjing; Tan, Yong; Li, Yan

2013-06-01

The study was conducted to extend research on the reluctance for emotional disclosure to Chinese patients with a variety of types of cancer. A quantitative survey was conducted among 400 cancer patients in China. Statistical analysis revealed that among four confirmed factors on reluctance for emotional disclosure to physicians, no perceived need scored highest, followed by unwillingness to bother, no practical use, and fear of negative impact. Patient distress was negatively associated with no perceived need and no practical use. Patients with low family support scored significantly lower in all factors except fear of negative impact. Education and income affected the factor of no perceived need. Those patients having limited family support and limited education indicated a higher need for emotional support from their physicians and were more likely to open up to them. Cultural traits should be integrated into supportive cancer care research.

Variables Associated with Enhanced Sustainability of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

McIntosh, Kent; Kim, Jerin; Mercer, Sterett H.; Strickland-Cohen, M. Kathleen; Horner, Robert H.

2015-01-01

Practice sustainability is important to ensure that students have continued access to evidence-based practices. In this study, respondents from a national sample of 860 schools at varying stages of implementing school-wide positive behavioral interventions and supports (SWPBIS) were administered a research-validated measure of factors predicting…

Influential Factors for Knowledge Creation Practices of CTE Teachers: Mutual Impact of Perceived School Support, Transformational Leadership, and Work Engagement

ERIC Educational Resources Information Center

Song, Ji Hoon; Bae, Sang Hoon; Park, Sunyoung; Kim, Hye Kyoung

2013-01-01

This study examined the structural relationships among perceived school support, transformational leadership, teachers' work engagement, and teachers' knowledge creation practices. It also investigated the mediating effects of transformational leadership and work engagement in explaining the association between perceived school support…

Practical Considerations When Supporting Transitions for Pupils with Speech, Language and Communication Needs

ERIC Educational Resources Information Center

Perfitt, Ruth

2013-01-01

This article investigates the impact of transitions upon pupils aged 11-14 with speech, language and communication needs, including specific language impairment and autism. The aim is to identify stress factors, examine whether these affect any subgroups in particular and suggest practical strategies to support pupils through transitions. Stress…

Building a Socially Supportive Environment. ERIC-IRCD Urban Disadvantaged Series, Number 16.

ERIC Educational Resources Information Center

Gordon, Edmund W.

This paper examines the conflicts between and the inequities inherent in practically all present day social systems and suggests strategies for building a socially supportive environment. The study focuses on the practical implications of the nature-nurture controversy and contends that greater attention must be given to extrinsic factors in…

Factors related to nursing students' readiness to enter working life - A scoping literature review.

PubMed

Järvinen, Tiina; Eklöf, Niina; Salminen, Leena

2018-03-01

The aim of this scoping literature review was to identify the factors related to nursing students' readiness to enter working life. The literature search was carried out in autumn 2017 in PubMed and CINAHL databases. The studies selected for this review (n = 17) were analyzed thematically with inductive content analysis. Four subthemes that were combined into two main factors related to nursing students' readiness to enter working life were found. The main factors found were 1) educational factors and 2) personal factors. Educational factors consisted of professional competence and clinical practice, while personal factors consisted of nursing students' background and feelings. Some nursing students tend to feel insecure about entering working life as a newly graduated nurse. This literature review also supports the importance of clinical practice periods in nursing education and for readiness for working life. Nurse education needs to ensure clinical practice periods which support nursing students' professional growth. Further research is needed on how the factors related to nursing students' readiness to enter working life correlate with each other. Particularly, the association between competence, readiness and positive feelings towards graduation needs further investigation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Organisational support for evidence-based practice: occupational therapists perceptions.

PubMed

Bennett, Sally; Allen, Shelley; Caldwell, Elizabeth; Whitehead, Mary; Turpin, Merrill; Fleming, Jennifer; Cox, Ruth

2016-02-01

Barriers to the use of evidence-based practice extend beyond the individual clinician and often include organisational barriers. Adoption of systematic organisational support for evidence-based practice in health care is integral to its use. This study aimed to explore the perceptions of occupational therapy staff regarding the influence of organisational initiatives to support evidence-based practice on workplace culture and clinical practice. This study used semi-structured interviews with 30 occupational therapists working in a major metropolitan hospital in Brisbane, Australia regarding their perceptions of organisational initiatives designed to support evidence-based practice. Four themes emerged from the data: (i) firmly embedding a culture valuing research and EBP, (ii) aligning professional identity with the Research and Evidence in Practice model, (iii) experiences of change: pride, confidence and pressure and (iv) making evidence-based changes to clinical practices. Organisational initiatives for evidence-based practice were perceived as influencing the culture of the workplace, therapists' sense of identity as clinicians, and as contributing to changes in clinical practice. It is therefore important to consider organisational factors when attempting to increase the use of evidence in practice. © 2016 Occupational Therapy Australia.

A qualitative exploration of the factors influencing the job satisfaction and career development of physiotherapists in private practice.

PubMed

Davies, J M; Edgar, S; Debenham, J

2016-09-01

The aim of this study was to investigate factors contributing to job satisfaction at different career stages, among private practice physiotherapists in Australia. Qualitative case study design utilising focus groups. Sixteen participants allocated to 3 focus groups: new graduates (n = 6), post graduates (n = 5) and practice owners (n = 5). Focus groups were transcribed verbatim and a thematic analysis was undertaken to determine themes and subthemes from each focus group. The key themes identified within each focus group included the role of peer support and mentoring, professional development, professional relationships, new graduate employment issues and career pathways within private practice. In particular, issues surrounding the new graduate experience in private practice were explored, with all groups noting lack of support and financial pressures were of concern. Findings demonstrated that new graduates are underprepared to work in private practice and modifications to the delivery of peer support, mentoring and professional development is required. Key recommendations include physiotherapy undergraduate program reform to reflect industry requirements in private practice, an increase in private practice clinical placement numbers, as well as streamlining the physiotherapy profession to improve career development pathways. Copyright © 2016 Elsevier Ltd. All rights reserved.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

Conceptualising Teacher Practice and Pupil Group Learning through Developmental Stages and Integration Factors

ERIC Educational Resources Information Center

Saito, Eisuke; Atencio, Matthew

2014-01-01

This article proposes four key developmental stages and various underpinning factors pertaining to the practices of setting up and supporting group learning in the classroom setting. The discussion is mostly explained conceptually, with some compelling examples from the field. The authors subsequently advise that three elements of…

The Common Factors Model: Implications for Transtheoretical Clinical Social Work Practice

ERIC Educational Resources Information Center

Cameron, Mark; Keenan, Elizabeth King

2010-01-01

Direct practice social workers today are challenged to address the requirements of the complex array of professional, organizational, institutional, and regulatory demands placed on them in the broader socioeconomic context of fewer resources and diminished public support for social welfare services in the United States. The common factors model…

Development and Validation of a Short Form of the Alabama Parenting Questionnaire

ERIC Educational Resources Information Center

Elgar, Frank J.; Waschbusch, Daniel A.; Dadds, Mark R.; Sigvaldason, Nadine

2007-01-01

Brief assessments of parenting practices can provide important information about the development of disruptive behavior disorders in children. We examined the factor structure of a widely used assessment of parenting practices, the Alabama Parenting Questionnaire, and produced a 9-item short scale around its three supported factors: Positive…

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Introducing the Postsecondary Instructional Practices Survey (PIPS): A Concise, Interdisciplinary, and Easy-to-Score Survey

PubMed Central

Walter, Emily M.; Henderson, Charles R.; Beach, Andrea L.; Williams, Cody T.

2016-01-01

Researchers, administrators, and policy makers need valid and reliable information about teaching practices. The Postsecondary Instructional Practices Survey (PIPS) is designed to measure the instructional practices of postsecondary instructors from any discipline. The PIPS has 24 instructional practice statements and nine demographic questions. Users calculate PIPS scores by an intuitive proportion-based scoring convention. Factor analyses from 72 departments at four institutions (N = 891) support a 2- or 5-factor solution for the PIPS; both models include all 24 instructional practice items and have good model fit statistics. Factors in the 2-factor model include (a) instructor-centered practices, nine items; and (b) student-centered practices, 13 items. Factors in the 5-factor model include (a) student–student interactions, six items; (b) content delivery, four items; (c) formative assessment, five items; (d) student-content engagement, five items; and (e) summative assessment, four items. In this article, we describe our development and validation processes, provide scoring conventions and outputs for results, and describe wider applications of the instrument. PMID:27810868

e-Learning competency for practice nurses: an evaluation report.

PubMed

Heartfield, Marie; Morello, Andrea; Harris, Melanie; Lawn, Sharon; Pols, Vincenza; Stapleton, Carolyn; Battersby, Malcolm

2013-01-01

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

Maternity staff perspectives regarding resource demands of breastfeeding supportive practices in accordance with the Baby-Friendly Hospital Initiative accreditation: a Q methodology approach.

PubMed

Huang, Chiu-Mieh; Hung, Wei-Shu; Lai, Jung-Nien; Kao, Yu-Hsiu; Wang, Ching-Ling; Guo, Jong-Long

2016-06-01

To explore the resource demands of implementing the Baby-Friendly Hospital Initiative among maternity staff. Implementing the Baby-Friendly Hospital Initiative is the most recognized global strategy for ensuring that hospital routines support breastfeeding. The maternity services of Baby-Friendly Hospital Initiative accredited hospitals are evaluated according to the Ten Steps to Successful Breastfeeding. Q methodology was applied to investigate the perspectives of 60 maternity staff in Northern Taiwan. Data were collected from May - December 2014. An online Q-sort platform was designed for the participants to perform sorting. The Q-sorts were subjected to factor analysis by using PQ Method software. Factors were extracted using principal component analysis with a varimax rotation. A combination of eigenvalues and a scree plot were employed to determine the number of retained factors. Four factors retained in the final model accounted for 56% of the total variance: (1) emphasis on implementing an institutional policy; (2) emphasis on providing supportive practices for breastfeeding mothers; (3) emphasis on establishing continual breastfeeding support; and (4) emphasis on managing breastfeeding supportive practices concerning a designated time period. The participants that were associated with Factors 1 and 3 emphasized the necessity of allocating resources to Steps 1, 2 and 10 of the Ten Steps. The participants associated with Factors 2 and 4 emphasized allocating resources to Steps 2-5 and 7. This study revealed the various perspectives of maternity staff regarding the resource demands of implementing the Baby-Friendly Hospital Initiative. These perspectives may serve as a reference for decision-makers in prioritizing resource allocation. © 2016 John Wiley & Sons Ltd.

Mothers Who Formula Feed: Their Practices, Support Needs and Factors Influencing Their Infant Feeding Decision

ERIC Educational Resources Information Center

Tarrant, Roslyn C.; Sheridan-Pereira, Margaret; McCarthy, Roberta A.; Younger, Katherine M.; Kearney, John M.

2013-01-01

The majority of mothers in Ireland provide formula milk to their infants during the initial weeks postpartum; however, data are lacking on their formula feeding practices and support needs. This prospective Dublin-based observational study, which included 450 eligible mother-term infant pairs recruited and followed up to six months postpartum,…

Promoting Evidence-Based Practices: The Adoption of a Prevention Support System in Community Settings

ERIC Educational Resources Information Center

Hunter, Sarah B.; Paddock, Susan M.; Ebener, Patricia; Burkhart, A. K.; Chinman, Matthew

2009-01-01

Prevention support systems (PSSs) are designed to help communities implement evidence-based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)[R] among staff in two community coalitions with varying levels…

User-centered design to improve clinical decision support in primary care.

PubMed

Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

2017-08-01

A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance improvement" was the only user-centered design practice significantly associated with perceived utility of clinical decision support, b=.47 (p<.001). This association was present in hospital-based clinics, b=.34 (p<.05), but was stronger at community-based clinics, b=.61 (p<.001). Our findings are highly supportive of the practice of analyzing the impact of clinical decision support on performance metrics. This was the most common user-centered design practice in our study, and was the practice associated with higher perceived utility of clinical decision support. This practice may be particularly helpful at community-based clinics, which are typically less connected to VA medical center resources. Published by Elsevier B.V.

Preschool Teachers’ Language and Literacy Practices with Dual Language Learners

PubMed Central

Sawyer, Brook E.; Hammer, Carol Scheffner; Cycyk, Lauren M.; López, Lisa; Blair, Clancy; Sandilos, Lia; Komaroff, Eugene

2016-01-01

The purposes of this study were to (a) examine the degree to which teachers used linguistically responsive practices to support the language and literacy development of Spanish-speaking Dual Language Learners (DLL) and (b) to investigate the associations between these practices and select teacher-level factors. The sample consisted of 72 preschool teachers. Observational data were collected on practices. Teachers self-reported on language and culture beliefs, Spanish speaking ability, and classroom composition. Results indicated that teachers, including those who spoke Spanish, used few linguistically responsive practices to support preschool DLLs. Only Spanish-speaking ability was related to practices. Implications for targeted professional development are discussed. PMID:27667968

Preschool Teachers' Language and Literacy Practices with Dual Language Learners.

PubMed

Sawyer, Brook E; Hammer, Carol Scheffner; Cycyk, Lauren M; López, Lisa; Blair, Clancy; Sandilos, Lia; Komaroff, Eugene

The purposes of this study were to (a) examine the degree to which teachers used linguistically responsive practices to support the language and literacy development of Spanish-speaking Dual Language Learners (DLL) and (b) to investigate the associations between these practices and select teacher-level factors. The sample consisted of 72 preschool teachers. Observational data were collected on practices. Teachers self-reported on language and culture beliefs, Spanish speaking ability, and classroom composition. Results indicated that teachers, including those who spoke Spanish, used few linguistically responsive practices to support preschool DLLs. Only Spanish-speaking ability was related to practices. Implications for targeted professional development are discussed.

An evaluation of CPD learning and impact upon positive practice change.

PubMed

Lee, Nancy-Jane

2011-05-01

This paper explores positive practice change in nursing and health care practice following continuing professional development (CPD). It is derived from a commissioned evaluation study within the United Kingdom (UK). Evaluation data was gathered using semi structured discussions with CPD participants, a convenience sample of line managers and University module leaders. Findings suggest that professional peer attitudes and support, when harnessed effectively in the practice setting, strongly enhance positive change. Conversely a lack of engagement with practice peers, a lack of strategic support and not knowing how to access support hinder change. The study found that learning need was often explored through personal development planning and appraisal, however there was little systematic follow up, review and support following learning. Interestingly the individual personal drive and enthusiasm of practitioners was perceived as the strongest factor helping practice change, while policy drivers and national health targets were secondary. Possible strategies to enhance positive practice change are explored. Copyright © 2010 Elsevier Ltd. All rights reserved.

Factor Structure of the Brief Multidimensional Measure of Religiousness/Spirituality in US and Indian Samples with Traumatic Brain Injury.

PubMed

Johnstone, Brick; Bhushan, Braj; Hanks, Robin; Yoon, Dong Pil; Cohen, Daniel

2016-04-01

The aim of this paper was to determine the factor structure of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) based on a sample of individuals from diverse cultures (i.e., USA, India), ethnicities (i.e., Caucasian, African-American, South Asian), and religions (i.e., Christian, Muslim, Hindu). A total of 109 individuals with traumatic brain injury (TBI) were included. Participants completed the BMMRS as part of a broader study on spirituality, religion, prosocial behaviors, and neuropsychological function. A principal components factor analysis with varimax rotation and Kaiser normalization identified a six-factor solution accounting for 72% of the variance in scores. Five of the factors were deemed to be interpretable and were labeled based on face validity as: (1) Positive Spirituality/Religious Practices; (2) Positive Congregational Support; (3) Negative Spirituality/Negative Congregational Support; (4) Organizational Religion; and (5) Forgiveness. The results were generally consistent with previous studies, suggesting the existence of universal religious, spiritual, and congregational support factors across different cultures and faith traditions. For health outcomes research, it is suggested that the BMMRS factors may be best conceptualized as measuring the following general domains: (a) emotional connectedness with a higher power (i.e., spirituality, positive/negative); (b) culturally based behavioral practices (i.e., religion); and (c) social support (i.e., positive/negative). The results indicate that factor relationships may differ among spiritual, religious, and congregational support variables according to culture and/or religious tradition.

What does it take to change practice? Perspectives of pharmacists in Ontario.

PubMed

Gregory, Paul A M; Teixeira, Beatriz; Austin, Zubin

2018-01-01

This is a time of rapid change in the profession of pharmacy. Anecdotally, there are concerns that the pace, extent and rate of practice evolution are lagging. There is little evidence documenting the influencers and mechanisms that drive practice changes forward in pharmacy in Canada. An exploratory qualitative method was selected, using both one-on-one interviews with self-categorized typical pharmacists and larger focus groups to provide context and confirmation of themes generated through interviews. Data were analyzed and coded using a constant-comparative iterative method, in order to generate themes related to the factors influencing pharmacists to actually change their practice. A total of 46 pharmacists meeting inclusion criteria participated in this study in focus groups, interviews or both. Nine themes were identified: 1) permission, 2) process pointers, 3) practice/rehearsal, 4) positive reinforcement, 5) personalized attention, 6) peer referencing, 7) physician acceptance, 8) patients' expectations and 9) professional identity supportive of a truly clinical role. One theme that did not emerge was payment, or remuneration, as a specific or isolated motivational factor for change. The complexity of practice change in pharmacy and the multiple factors highlighted in this study point to a more deliberate and concerted effort being needed by diverse pharmacy organizations (educators, regulators, employers, professional associations, etc.) to support pharmacists through the change management process. The "9 Ps of practice change" identified through this study can provide pharmacists with guidance in terms of how to better support evolution of the profession in a more time-efficient and effective manner.

Parental fatigue and parenting practices during early childhood: an Australian community survey.

PubMed

Cooklin, A R; Giallo, R; Rose, N

2012-09-01

Parenting behaviours are influenced by a range of factors, including parental functioning. Although common, the influence of parental fatigue on parenting practices is not known. The first aim of this study was to investigate the relationship between fatigue and parenting practices. The second aim was to identify parental psychosocial factors significantly associated with fatigue. A sample of 1276 Australian parents, of at least one child aged 0-5 years, completed a survey. Demographic, psychosocial (social support, coping responses) and parental sleep and self-care information was collected. Hierarchical regression was performed to assess the contribution of fatigue (modified Fatigue Assessment Scale) to parental practices (warmth, irritability and involvement), and parenting experiences (Parenting Stress Index, Parenting Sense of Competence Scale). Hierarchical multiple regression assessed the contribution of a range of parental sleep, psychosocial (social support, coping responses) and self-care variables to fatigue when demographic characteristics were held constant. Higher fatigue was significantly associated with lower parental competence (β=-0.17, P < 0.005), greater parenting stress (β= 0.21, P < 0.005) and more irritability in parent-child interactions (β= 0.11, P < 0.005). Several psychosocial characteristics were associated with higher parental fatigue, including inadequate social support, poorer diet, poorer sleep quality and ineffective coping styles including self-blame and behaviour disengagement. Fatigue is common, and results suggest that fatigue contributes to adverse parental practices and experiences. However, possible risk factors for higher fatigue were identified in this study, indicating opportunities for intervention, management and support for parents. © 2011 Blackwell Publishing Ltd.

Essentials of total quality management: a meta-analysis.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation. A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010. A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes. The review was limited to articles written in English language during the past 30 years. From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations. Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.

Research evidence utilization in policy development by child welfare administrators.

PubMed

Jack, Susan; Dobbins, Maureen; Tonmyr, Lil; Dudding, Peter; Brooks, Sandy; Kennedy, Betty

2010-01-01

An exploratory qualitative study was conducted to explore how child welfare administrators use research evidence in decision-making. Content analysis revealed that a cultural shift toward evidence-based practice (EBP) is occurring in Canadian child welfare organizations and multiple types of evidence inform policy decisions. Barriers to using evidence include individual, organizational, and environmental factors. Facilitating factors include the development of internal champions and organizational cultures that value EBP. Integrating research into practice and policy decisions requires a multifaceted approach of creating organizational cultures that support research utilization and supporting senior bureaucrats to use research evidence in policy development.

Dissemination of Health-Related Research among Scientists in Three Countries: Access to Resources and Current Practices

PubMed Central

2015-01-01

Objectives. In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. Methods. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. Findings. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Conclusion. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap. PMID:26495287

Dissemination of health-related research among scientists in three countries: access to resources and current practices.

PubMed

Tabak, Rachel G; Reis, Rodrigo S; Wilson, Paul; Brownson, Ross C

2015-01-01

In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap.

Computerized clinical decision support for prescribing: provision does not guarantee uptake

PubMed Central

Moxey, Annette; Robertson, Jane; Newby, David; Hains, Isla; Williamson, Margaret; Pearson, Sallie-Anne

2010-01-01

There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990–2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved. PMID:20064798

Sustaining Lesson Study: Resources and Factors that Support and Constrain Mathematics Teachers' Ability to Continue After the Grant Ends

NASA Astrophysics Data System (ADS)

Druken, Bridget Kinsella

Lesson study, a teacher-led vehicle for inquiring into teacher practice through creating, enacting, and reflecting on collaboratively designed research lessons, has been shown to improve mathematics teacher practice in the United States, such as improving knowledge about mathematics, changing teacher practice, and developing communities of teachers. Though it has been described as a sustainable form of professional development, little research exists on what might support teachers in continuing to engage in lesson study after a grant ends. This qualitative and multi-case study investigates the sustainability of lesson study as mathematics teachers engage in a district scale-up lesson study professional experience after participating in a three-year California Mathematics Science Partnership (CaMSP) grant to improve algebraic instruction. To do so, I first provide a description of material (e.g. curricular materials and time), human (attending district trainings and interacting with mathematics coaches), and social (qualities like trust, shared values, common goals, and expectations developed through relationships with others) resources present in the context of two school districts as reported by participants. I then describe practices of lesson study reported to have continued. I also report on teachers' conceptions of what it means to engage in lesson study. I conclude by describing how these results suggest factors that supported and constrained teachers' in continuing lesson study. To accomplish this work, I used qualitative methods of grounded theory informed by a modified sustainability framework on interview, survey, and case study data about teachers, principals, and Teachers on Special Assignment (TOSAs). Four cases were selected to show the varying levels of lesson study practices that continued past the conclusion of the grant. Analyses reveal varying levels of integration, linkage, and synergy among both formally and informally arranged groups of teachers. High levels of integration and linkage among groups of teachers supported them in sustaining lesson study practices. Groups of teachers with low levels of integration but with linked individuals sustained some level of practices, whereas teachers with low levels of integration and linkage constrained them in continuing lesson study at their site. Additionally, teachers' visions of lesson study and its uses shaped the types of activities teachers engaged, with well-developed conceptions of lesson study supporting and limited visions constraining the ability to attract or align resources to continue lesson study practices. Principals' support, teacher autonomy, and cultures of collaboration or isolation were also factors that either supported or constrained teachers' ability to continue lesson study. These analyses provide practical implications on how to support mathematics teachers in continuing lesson study, and theoretical contributions on developing the construct of sustainability within mathematics education research.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

PubMed

McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

2015-12-01

Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

Preparedness for physiotherapy in private practice: Novices identify key factors in an interpretive description study.

PubMed

Atkinson, Robyn; McElroy, Theresa

2016-04-01

Physiotherapists in Australia deliver services to a diverse range of clients, across many settings, however little research exists examining graduate preparedness for practice, even in the populous field of private practice. To explore novice physiotherapist perspectives on preparedness for work in private practice. The qualitative approach of interpretive description was used to guide in-depth interviews with 8 novice physiotherapists from 3 universities working in 5 private practices in Melbourne. All interviews were digitally recorded, transcribed verbatim and analyzed thematically. Four main themes influencing graduate preparedness for work in private practice were identified: 1) non-curricular experiences (e.g. sports training) 2) elective curricular: practicum experiences; 3) curricular: attainment of skills specific to private practice; and 4) the private practice setting: supportive colleagues. This combination of non-curricular, curricular, and practice setting factors offered the necessary scaffolding for the graduates to report feeling prepared for work in private practice. Non-curricular activities, radiological instruction, clinical placements, building supportive colleague relations and professional development in private practice are recommended as potential means of building preparedness in novice therapists. Findings have implications for physiotherapy students, educators and private practice clinics looking to recruit new graduates. Copyright © 2015 Elsevier Ltd. All rights reserved.

Development and construct validity of the Classroom Strategies Scale-Observer Form.

PubMed

Reddy, Linda A; Fabiano, Gregory; Dudek, Christopher M; Hsu, Louis

2013-12-01

Research on progress monitoring has almost exclusively focused on student behavior and not on teacher practices. This article presents the development and validation of a new teacher observational assessment (Classroom Strategies Scale) of classroom instructional and behavioral management practices. The theoretical underpinnings and empirical basis for the instructional and behavioral management scales are presented. The Classroom Strategies Scale (CSS) evidenced overall good reliability estimates including internal consistency, interrater reliability, test-retest reliability, and freedom from item bias on important teacher demographics (age, educational degree, years of teaching experience). Confirmatory factor analyses (CFAs) of CSS data from 317 classrooms were carried out to assess the level of empirical support for (a) a 4 first-order factor theory concerning teachers' instructional practices, and (b) a 4 first-order factor theory concerning teachers' behavior management practice. Several fit indices indicated acceptable fit of the (a) and (b) CFA models to the data, as well as acceptable fit of less parsimonious alternative CFA models that included 1 or 2 second-order factors. Information-theory-based indices generally suggested that the (a) and (b) CFA models fit better than some more parsimonious alternative CFA models that included constraints on relations of first-order factors. Overall, CFA first-order and higher order factor results support the CSS-Observer Total, Composite, and subscales. Suggestions for future measurement development efforts are outlined. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Dimensions of professional labor support for intrapartum practice.

PubMed

Sauls, Donna J

2006-01-01

To define and describe the dimensions of Professional Labor Support (PLS). A factor-analytic study was conducted with a random sample of 146 intrapartum nurses in Texas. Nurses' responses to the Labor Support Questionnaire (LSQ) were subjected to principal components analysis and descriptive analysis. A six-factor solution indicated the dimensions of PLS: Tangible Support, Advocacy, Emotional Support-Reassurance, Emotional Support-Creating Control, Security and Comfort, Emotional Support-Nurse Caring Behavior, and Informational Support. Although the presence of four dimensions was theorized, six dimensions were found. The emotional support dimension was identified by nurses as being an important component of labor support as indicated by the identification of three separate emotional support dimensions.

Pharmacy users’ expectations of pharmacy encounters: a Q‐methodological study

PubMed Central

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Åsa; Tully, Mary P.

2010-01-01

Abstract Background  Pharmacy practice is evolving according to general health‐care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under‐explored topic but crucial to understanding how pharmacy practice can evolve efficiently. Objective  To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Methods  Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Setting and participants  Eighty‐five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Results  Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual’s own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health‐care and lifestyle support. Discussion and conclusions  The systematic Q‐methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients’ expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. PMID:21199199

Pharmacy users' expectations of pharmacy encounters: a Q-methodological study.

PubMed

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Asa; Tully, Mary P

2011-12-01

Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. © 2010 Blackwell Publishing Ltd.

Profiling healthy eaters. Determining factors that predict healthy eating practices among Dutch adults.

PubMed

Swan, Emily; Bouwman, Laura; Hiddink, Gerrit Jan; Aarts, Noelle; Koelen, Maria

2015-06-01

Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's salutogenic framework for health development to examine a set of factors that predict healthy eating in a cross-sectional study of Dutch adults. Data were analyzed from participants (n = 703) who completed the study's survey in January 2013. Logistic regression analysis was performed to test the association of survey factors on the outcome variable high dietary score. In the multivariate logistic regression model, five factors contributed significantly (p < .05) to the predictive ability of the overall model: being female; living with a partner; a strong sense of coherence (construct from the salutogenic framework), flexible restraint of eating, and self-efficacy for healthy eating. Findings complement what is already known of the factors that relate to poor eating practices. This can provide nutrition promotion with a more comprehensive picture of the factors that both support and hinder healthy eating practices. Future research should explore these factors to better understand their origins and mechanisms in relation to healthy eating practices. Copyright © 2015 Elsevier Ltd. All rights reserved.

Supporting students' construction of scientific explanation through curricular scaffolds and teacher instructional practices

NASA Astrophysics Data System (ADS)

McNeill, Katherine Lynch

An essential goal of classroom science is to help all students become scientifically literate to encourage greater public understanding in a science infused world. This type of literacy requires that students participate in scientific inquiry practices such as construction of arguments or scientific explanations in which they justify their claims with appropriate evidence and reasoning. Although scientific explanations are an important learning goal, this complex inquiry practice is frequently omitted from k-12 science classrooms and students have difficulty creating them. I investigated how two different curricular scaffolds (context-specific vs. generic), teacher instructional practices, and the interaction between these two types of support influence student learning of scientific explanations. This study focuses on an eight-week middle school chemistry curriculum, How can I make new stuff from old stuff?, which was enacted by six teachers with 578 students during the 2004-2005 school year. Overall, students' written scientific explanations improved during the unit in which they were provided with multiple forms of teacher and curricular support. A growth curve model of student learning showed that there was a significant difference in the effect of the two curricular scaffolds towards the end of the unit and on the posttest. The context-specific scaffolds resulted in greater student learning of how to write scientific explanations, but only for three of the six teachers. The case studies created from the videotapes of classroom enactments revealed that teachers varied in which instructional practices they engaged in and the quality of those practices. Analyses suggested that the curricular scaffolds and teacher instructional practices were synergistic in that the supports interacted and the effect of the written curricular scaffolds depended on the teacher's enactment of the curriculum. The context-specific curricular scaffolds were more successful in supporting students in this complex task only when teachers' enactments provided generic support for scientific explanation through instructional practices. For teachers who did not provide their students with generic support, neither curricular scaffold was more effective. Classrooms are complex systems in which multiple factors and the interactions between those factors influence student learning.

Rethinking Teaching in STEM Education in a Community College: Role of Instructional Consultation and Digital Technologies

NASA Astrophysics Data System (ADS)

Kurland, Shelley Chih-Hsian

Community college faculty members educate almost half of all U.S. undergraduates, who are often more diverse and more academically underprepared when compared to undergraduate students who attend four-year institutions. In addition, faculty members in community colleges are facing increased accountability for meeting student learning outcomes, expectations to adjust their teaching practices to include active learning practices, and expectations to incorporate more technologies into the classroom. Faculty developers are one of the support structures that faculty members can look to in order to meet those challenges. A survey of literature in faculty development suggests that instructional consultation can play an important role in shaping and transforming teaching practices. Hence, this action research study examined my work using instructional consulting with four full-time STEM faculty colleagues in order to examine and shape their teaching practices with and without the use of digital technologies. The two foci of the research, examining shifts in faculty participants' teaching practices, and my instructional consulting practices, were informed by Thomas and Brown's (2011) social view of learning and the concept of teaching and learning in a "co-learning" environment. Two dominant factors emerged regarding faculty participants' shift in teaching practices. These factors concerned: 1) the perception of control and 2) individual faculty participant's comfort level, expectations, and readiness. In addition to these two dominant factors, the instructional consultation process also supported a range of shifts in either mindset and/or teaching practices. My analysis showed that the use of digital technologies was not an essential factor in shifting faculty participant mindset and/or teaching practices, instead digital technologies were used to enhance the teaching process and students' learning experiences.

Factors Predicting Burnout Among Chaplains: Compassion Satisfaction, Organizational Factors, and the Mediators of Mindful Self-Care and Secondary Traumatic Stress.

PubMed

Hotchkiss, Jason T; Lesher, Ruth

2018-06-01

This study predicted Burnout from the self-care practices, compassion satisfaction, secondary traumatic stress, and organizational factors among chaplains who participated from all 50 states (N = 534). A hierarchical regression model indicated that the combined effect of compassion satisfaction, secondary traumatic stress, mindful self-care, demographic, and organizational factors explained 83.2% of the variance in Burnout. Chaplains serving in a hospital were slightly more at risk for Burnout than those in hospice or other settings. Organizational factors that most predicted Burnout were feeling bogged down by the "system" (25.7%) and an overwhelming caseload (19.9%). Each self-care category was a statistically significant protective factor against Burnout risk. The strongest protective factors against Burnout in order of strength were self-compassion and purpose, supportive structure, mindful self-awareness, mindful relaxation, supportive relationships, and physical care. For secondary traumatic stress, supportive structure, mindful self-awareness, and self-compassion and purpose were the strongest protective factors. Chaplains who engaged in multiple and frequent self-care strategies experienced higher professional quality of life and low Burnout risk. In the chaplain's journey toward wellness, a reflective practice of feeling good about doing good and mindful self-care are vital. The significance, implications, and limitations of the study were discussed.

Relationships among factors affecting advanced practice registered nurses' job satisfaction and intent to leave: A systematic review.

PubMed

Han, Robin M; Carter, Patricia; Champion, Jane Dimmitt

2018-02-01

This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention. A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review. The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave. Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.

The influence of non-clinical patient factors on medical oncologists' decisions to recommend breast cancer adjuvant chemotherapy.

PubMed

Pini, T May; Hawley, Sarah T; Li, Yun; Katz, Steven J; Griggs, Jennifer J

2012-07-01

The extent to which medical oncologists consider non-clinical patient factors when deciding to recommend adjuvant chemotherapy is unknown. Medical oncologists who treated a population-based sample of early stage breast cancer patients reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries 2005-2007 were asked how strongly they consider a patient's ability to follow instructions, level of social support, and level of work support/flexibility in decisions to recommend adjuvant chemotherapy. Responses of 4 (Quite strongly) or 5 (Very strongly) on a five-point Likert scale defined strong consideration. Associations between oncologist/practice characteristics and strong consideration of each non-clinical factor were examined. 134 oncologists (66 %) reported strong consideration of one or more factor. Ability to follow instructions was strongly considered by 120 oncologists (59 %), social support by 78 (38 %), and work support/flexibility by 73 (36 %). Larger percent of practice devoted to breast cancer was associated with lower likelihood of strongly considering ability to follow instructions [odds ratio (OR) 0.98, 95 % confidence interval (CI) 0.97-0.99; P = 0.04]. Increased years in practice was associated with lower likelihood of strongly considering social support (OR 0.96, CI 0.93-0.99; P = 0.011), while non-white race (OR 2.1, CI 1.03-4.26; P = 0.041) and tumor board access (OR 2.04, CI 1.01-4.12; P = 0.048) were associated with higher likelihood. Non-white race was associated with strongly considering work support/flexibility (OR 2.44, CI 1.21-4.92; P = 0.013). Tumor board access (OR 2, CI 1.00-4.02; P = 0.051) was borderline significant. Non-clinical patient factors play a role in medical oncologist decision-making for breast cancer adjuvant chemotherapy recommendations.

Preschool Teachers' Language and Literacy Practices with Dual Language Learners

ERIC Educational Resources Information Center

Sawyer, Brook E.; Hammer, Carol Scheffner; Cycyk, Lauren M.; Lopez, Lisa; Blair, Clancy; Sandilos, Lia; Komaroff, Eugene

2016-01-01

The purposes of this study were to (a) examine the degree to which teachers used linguistically responsive practices to support the language and literacy development of Spanish-speaking Dual Language Learners (DLL) and (b) to investigate the associations between these practices and select teacher-level factors. The sample consisted of 72 preschool…

Preschool Teachers' Language and Literacy Practices with Dual Language Learners

ERIC Educational Resources Information Center

Sawyer, Brook E.; Hammer, Carol Scheffner; Cycyk, Lauren M.; López, Lisa; Blair, Clancy; Sandilos, Lia; Komaroff, Eugene

2016-01-01

The purposes of this study were to (a) examine the degree to which teachers used linguistically responsive practices to support the language and literacy development of Spanish-speaking Dual Language Learners (DLL) and (b) to investigate the associations between these practices and select teacher-level factors. The sample consisted of 72 preschool…

Testing Theoretical Relationships: Factors Influencing Positive Health Practices (PHP) in Filipino College Students

ERIC Educational Resources Information Center

Ayres, Cynthia; Mahat, Ganga; Atkins, Robert

2013-01-01

Objective: To examine variables influencing the positive health practices (PHP) of Filipino college students to gain a better understanding of health practices in this ethnic/racial group. Cross-sectional study tested theoretical relationships postulated among (a) PHP, (b) social support (SS), (c) optimism, and (d) acculturation. Participants: A…

Uncovering the factors that can support and impede post-disaster EIA practice in developing countries: The case of Aceh Province, Indonesia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gore, Tom; Fischer, Thomas B., E-mail: fischer@liverpool.ac.uk

The close relationship between environmental degradation and the occurrence and severity of disaster events has in recent years raised the profile of environmental assessment (EA) in the disaster management field. EA has been identified as a potentially supportive tool in the global effort to reduce disaster risk. As a component of this, attention has been brought specifically to the importance of the application of EA in the aftermath of disaster events in order to help prevent recurrence and promote sustainability. At the same time, however, it has also been recognised that post-disaster environments may be unfavourable to such practices. Lookingmore » at the practice of environmental impact assessment (EIA), this paper reports on a study which sought to identify more specifically the factors which can both support and hinder such practice following disaster events in a developing country context. Analysing the situation in Aceh Province, Indonesia, after the impact of two tsunamigenic earthquakes in late 2004 and early 2005, it is concluded that if EIA is to have a central role in the post-disaster period, pre-disaster preparation could be a key. -- Highlights: • Close relationship between environmental degradation and occurrence/severity of disaster events has raised profile of EA. • EA as a potentially supportive tool in the global effort to reduce disaster risk • Application of EA in the aftermath of disaster events to help prevent recurrence and promote sustainability • The paper looks at factors which can both support and hinder EA following disaster events in a developing country context. • We analyse the situation in Aceh Province, Indonesia, after the impact of two tsunamigenic earthquakes in 2004 and 2005.« less

Homework as a Family Literacy Practice: What Counts as Best Practices for Children Deemed as High Risk for Academic Failure Due to Socioeconomic Status

ERIC Educational Resources Information Center

Fox, Kathy R.

2016-01-01

Homework is a constant yet often controversial practice in homes and other settings. This study set out to determine answers to the question: "What practices were used to support children with homework in families deemed as at risk due to low socioeconomic factors?" Homework was examined as a common practice that routinely took place in…

Factors affecting the innovative practice of nurse managers in health organisations.

PubMed

Williams, Lindy; McMurray, Adela J

This exploratory study reports on two surveys conducted in metropolitan and rural health organisations. Two questionnaires consisting of open and closed questions were distributed to a total of 340 respondents resulting in 176 usable responses, yielding a response rate of 53%. The findings revealed that nurse managers require fairness, trust, recognition, supervisory encouragement, organisational support, and reward for efforts. These are key aspects of organisational climate, which support innovative practice. Experience and innovation were significantly related and other factors such as, management structures and management styles, also had an impact on nurse managers' ability to exhibit innovative behaviour in the 21st Century workplace.

Factors influencing healthcare service quality

PubMed Central

Mosadeghrad, Ali Mohammad

2014-01-01

Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

Developing a Web Platform to Support a Community of Practice: A Mixed Methods Study in Pediatric Physiotherapy.

PubMed

Pratte, Gabrielle; Hurtubise, Karen; Rivard, Lisa; Berbari, Jade; Camden, Chantal

2018-01-01

Web platforms are increasingly used to support virtual interactions between members of communities of practice (CoP). However, little is known about how to develop these platforms to support the implementation of best practices for health care professionals. The aim of this article is to explore pediatric physiotherapists' (PTs) perspectives regarding the utility and usability of the characteristic of a web platform developed to support virtual communities of practice (vCoP). This study adopted an explanatory sequential mixed methods design. A web platform supporting the interactions of vCoP members was developed for PTs working with children with developmental coordination disorder. Specific strategies and features were created to support the effectiveness of the platform across three domains: social, information-quality, and system-quality factors. Quantitative data were collected from a cross-sectional survey (n = 41) after 5 months of access to the web platform. Descriptive statistics were calculated. Qualitative data were also collected from semistructured interviews (n = 9), which were coded, interpreted, and analyzed by using Boucher's Web Ergonomics Conceptual Framework. The utility of web platform characteristics targeting the three key domain factors were generally perceived positively by PTs. However, web platform usability issues were noted by PTs, including problems with navigation and information retrieval. Web platform aiming to support vCoP should be carefully developed to target potential users' needs. Whenever possible, users should co-construct the web platform with vCoP developers. Moreover, each of the developed characteristics (eg, newsletter, search function) should be evaluated in terms of utility and usability for the users.

Breastfeeding promotion, support and protection: review of six country programmes.

PubMed

Mangasaryan, Nune; Martin, Luann; Brownlee, Ann; Ogunlade, Adebayo; Rudert, Christiane; Cai, Xiaodong

2012-08-01

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a "health equalizer" and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers' training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages.

An explanatory model of community pharmacists' support in the secondary prevention of cardiovascular disease.

PubMed

Puspitasari, Hanni P; Costa, Daniel S J; Aslani, Parisa; Krass, Ines

2016-01-01

Community pharmacists have faced ongoing challenges in the delivery of clinical pharmacy services. Various attitudinal and environmental factors have been found to be associated with the provision of general clinical pharmacy services or services which focus on a specific condition, including cardiovascular disease (CVD). However, the interrelationship and relative influence of explanatory factors has not been investigated. To develop a model illustrating influences on CVD support provision by community pharmacists. Mail surveys were sent to a random sample of 1350 Australian community pharmacies to investigate determinants of CVD support provision. A theoretical model modified from the Theory of Planned Behavior (TPB) was used as a framework for the survey instrument. Structural equation modeling was used to determine how pharmacists' attitudes and environmental factors influence CVD support. A response rate of 15.8% (209/1320) was obtained. The model for CVD support provision by community pharmacists demonstrated good fit: χ(2)/df = 1.403, RMSEA = 0.047 (90% CI = 0.031-0.062), CFI = 0.962, TLI = 0.955 and WRMR = 0.838. Factors found to predict CVD support included: two attitudinal latent factors ("subjective norms of pharmacists' role in CVD support" and "pharmacists' perceived responsibilities in CVD support") and environmental factors i.e. pharmacy infrastructure (documentation and a private area), workload, location; government funded pharmacy practice programs; and pharmacists' involvement with Continuing Professional Development and attendance at CVD courses. Pharmacists' attitudes appeared to be the strongest predictor of CVD support provision. The TPB framework was useful in identifying "subjective norms" and "pharmacists' beliefs" as key constructs of community pharmacists' attitudes. Community pharmacies would be able to provide such an advanced clinical service if they strongly believed that this was an acknowledged part of their scope of practice, had adequate infrastructure and employed sufficient numbers of pharmacists with appropriate and relevant knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory.

PubMed

Sohanpal, Ratna; Steed, Liz; Mars, Thomas; Taylor, Stephanie J C

2015-09-17

In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance. Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.

Predicting the scope of practice of family physicians.

PubMed

Wong, Eric; Stewart, Moira

2010-06-01

To identify factors that are associated with the scope of practice of FPs and GPs who have office-based practices. Secondary univariable and multivariable analyses of cross-sectional data from the 2001 National Family Physician Workforce Survey conducted by the College of Family Physicians of Canada. Canada. General community of FPs and GPs who spent most of their clinical time in office settings. Demographic characteristics and scope of practice score (SPS), which was the number of 12 selected medical services provided by office-based FPs and GPs. The multivariable model explained 35.1% of the variation in the SPS among participants. Geographic factors of provincial division and whether or not the population served was rural explained 30.5% of the variation in the SPS. Male physician sex, younger physician age, being in group practice, greater access to hospital beds, less access to specialists, main practice setting of an academic teaching unit, mixed method physician payment, additional structured postresidency training, and greater number of different types of allied health professionals in the main practice setting were also associated with higher SPSs. Geographic factors were the strongest determinants of scope of practice; physician-related factors, availability of health care resources to the main practice setting, and practice organization factors were weaker determinants. It is important to understand how and why geographic factors influence scope of practice, and whether a broad scope of practice independent of population needs benefits the population. This study supports primary care renewal efforts that use mixed payment systems, incorporate allied health care professionals into family and general practices, and foster group practices.

Factors associated with the effectiveness of continuing education in long-term care.

PubMed

Stolee, Paul; Esbaugh, Jacquelin; Aylward, Sandra; Cathers, Tamzin; Harvey, David P; Hillier, Loretta M; Keat, Nancy; Feightner, John W

2005-06-01

This article examines factors within the long-term-care work environment that impact the effectiveness of continuing education. In Study 1, focus group interviews were conducted with staff and management from urban and rural long-term-care facilities in southwestern Ontario to identify their perceptions of the workplace factors that affect transfer of learning into practice. Thirty-five people were interviewed across six focus groups. In Study 2, a Delphi technique was used to refine our list of factors. Consensus was achieved in two survey rounds involving 30 and 27 participants, respectively. Management support was identified as the most important factor impacting the effectiveness of continuing education. Other factors included resources (staff, funding, space) and the need for ongoing expert support. Organizational support is necessary for continuing education programs to be effective and ongoing expert support is needed to enable and reinforce learning.

Sustaining Lesson Study: Resources and Factors That Support and Constrain Mathematics Teachers' Ability to Continue after the Grant Ends

ERIC Educational Resources Information Center

Druken, Bridget Kinsella

2015-01-01

Lesson study, a teacher-led vehicle for inquiring into teacher practice through creating, enacting, and reflecting on collaboratively designed research lessons, has been shown to improve mathematics teacher practice in the United States, such as improving knowledge about mathematics, changing teacher practice, and developing communities of…

Validation of the Implementation Leadership Scale (ILS) in Substance Use Disorder Treatment Organizations

PubMed Central

Ehrhart, Mark G.; Torres, Elisa M.; Finn, Natalie K.; Roesch, Scott C.

2016-01-01

There have been recent calls for pragmatic measures to assess factors that influence evidence-based practice (EBP) implementation processes and outcomes. The Implementation Leadership Scale (ILS) is a brief and efficient measure that can be used for research or organizational development purposes to assess leader behaviors and actions that actively support effective EBP implementation. The ILS was developed and validated in mental health settings. This study validates the ILS factor structure with providers in alcohol and other drug (AOD) use treatment agencies. Participants were 323 service providers working in 72 workgroups from three AOD use treatment agencies. Confirmatory factor analyses and reliability analyses were conducted to examine the psychometric properties of the ILS. Convergent and discriminant validity were also assessed. Confirmatory factor analyses demonstrated good fit to the hypothesized first and second order factor structure. Internal consistency reliability was excellent. Convergent and discriminant validity was supported. The ILS psychometric characteristics, reliability, and validity were supported in AOD use treatment agencies. The ILS is a brief and pragmatic measure that can be used for research and practice to assess leadership for EBP implementation in AOD use treatment agencies. PMID:27431044

Validation of the Implementation Leadership Scale (ILS) in Substance use Disorder Treatment Organizations.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Torres, Elisa M; Finn, Natalie K; Roesch, Scott C

2016-09-01

There have been recent calls for pragmatic measures to assess factors that influence evidence-based practice (EBP) implementation processes and outcomes. The Implementation Leadership Scale (ILS) is a brief and efficient measure that can be used for research or organizational development purposes to assess leader behaviors and actions that actively support effective EBP implementation. The ILS was developed and validated in mental health settings. This study validates the ILS factor structure with providers in alcohol and other drug (AOD) use treatment agencies. Participants were 323 service providers working in 72 workgroups from three AOD use treatment agencies. Confirmatory factor analyses and reliability analyses were conducted to examine the psychometric properties of the ILS. Convergent and discriminant validity were also assessed. Confirmatory factor analyses demonstrated good fit to the hypothesized first and second order factor structure. Internal consistency reliability was excellent. Convergent and discriminant validity was supported. The ILS psychometric characteristics, reliability, and validity were supported in AOD use treatment agencies. The ILS is a brief and pragmatic measure that can be used for research and practice to assess leadership for EBP implementation in AOD use treatment agencies. Copyright © 2016 Elsevier Inc. All rights reserved.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

PubMed

Smith, Tony; Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

Ruralization of students’ horizons: insights into Australian health professional students’ rural and remote placements

PubMed Central

Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Introduction Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions. Methods Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results The core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions. Conclusions The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building. PMID:29430183

Factors influencing knowledge and practice of hygiene in Water, Sanitation and Hygiene (WASH) programme areas of Bangladesh Rural Advancement Committee.

PubMed

Akter, Tahera; Ali, Armm Mehrab

2014-01-01

Improved hygiene is one of the most effective means of reducing disease occurrence. However, a complete understanding of the factors that contribute to such improvement are not clear. This study explored factors that facilitate and/or impede hygiene behavior in water, sanitation and hygiene (WASH) intervention areas using qualitative research techniques. The Bangladesh Rural Advancement Committee (BRAC) has been providing WASH intervention to 150 rural upazilas (sub-districts) since 2006. For qualitative data collection, in-depth interviews were conducted with 144 purposively selected women from six upazilas across Bangladesh. A woman in the household was considered as a case and interviewed regarding various aspects of sanitation and hygiene, using a checklist. Some practices, such as cleanliness of latrines, and availability of soap, water, slippers in their designated place were physically verified. The respondents' hygiene behavior was mainly facilitated by improved knowledge and awareness of health and environment-related issues. Latrine ownership increased through financial assistance, resulting in improved privacy, social prestige, and a heightened sense of responsibility towards maintaining a healthy life. However, lack of interest in attending cluster meetings, traditional knowledge, poverty, and lack of will were some of the factors impeding knowledge and hygiene practice. In addition, attitude played a definitive role, with some respondents not practicing hygiene in spite of having the financial ability to do so. They expected full financial support for creating sanitation and hygiene facilities in their household despite BRAC's policy of providing such support only to the 'ultra-poor'. The identified impeding factors often act as barriers to transformation of hygiene-related knowledge into practice and practice into habit. More motivational cluster meetings with large-scale participation and periodic home visits by the programme organizers are imperative as they markedly improve hygiene behavior.

Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

PubMed

Hill, James R

2016-05-01

Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

Correlates of Social Support Among Latino Immigrants.

PubMed

Held, Mary L

2018-04-01

Latino immigrants encounter considerable stressors that pose risks to health and well-being during settlement in the USA. Social support serves as a protective factor that can help to buffer the negative effects of stress. Despite the importance of social support, we know little about how Latino immigrants differentially experience this protective factor. The current study analyzed data from 100 Latino immigrants residing in Tennessee. Hierarchical multiple regression analysis was employed to examine variation in self-reported social support by immigrant characteristics and immigration-related factors. Females, immigrants who are not married/cohabitating, and those who reported experiencing a greater number of discrete stressors in the USA each reported lower levels of social support. Implications for practice include an increased emphasis on assessing levels of social support and designing services to strengthen support for the most vulnerable immigrants. Future research should consider a longitudinal analysis and specific types of social support.

Opportunities for improved diabetes care among patients of safety net practices: a safety net providers' strategic alliance study.

PubMed

Reichsman, Ann; Werner, James; Cella, Peggi; Bobiak, Sarah; Stange, Kurt C

2009-01-01

To identify barriers and opportunities for quality diabetes care in safety net practices. In 3 federally qualified health centers and 1 free clinic, 19 primary care clinicians profiled patient and visit characteristics and quality of care measures for 181 consecutive visits by adult type 2 diabetic patients. Open-ended questions assessed patient and clinician perception of barriers to diabetes care and patient report of enabling factors. A multidisciplinary team identified themes from open-ended responses. Logistic regression analyses assessed the association of the identified barriers/enablers with 2 measures of quality care: glycosylated hemoglobin and prophylactic aspirin use. Ranked barriers noted by patients included adherence (40%), financial/insurance (23%), and psychosocial (13%) factors. Clinicians ranked systemic factors, including financial/ insurance (32%) and cultural/psychosocial (29%) factors, as important to adherence (29%) in determining quality diabetes care. Patients reported dietary and medical adherence (37%) and family/health care worker support (17%) as helpful factors. Among 175 patients with available data, glycosylated hemoglobin levels were associated with patient report of financial/insurance factors both as a barrier when visits and medications were unaffordable and as an opportunity when free or low-cost medications and services were provided. Patients' adherence with aspirin prophylaxis was strongly associated with African American race, prior prescription of aspirin and distribution of aspirin at the practice site (p<.001). Patients were less likely than clinicians to identify systemic and contextual factors contributing to poor diabetes care. From the front line's perspective, enabling patient self-management and systemic support is a target for improving diabetes care in safety net practices.

Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

PubMed

Verloo, Henk; Desmedt, Mario; Morin, Diane

2017-09-01

To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to evaluate the effectiveness of organisational strategies aimed at increasing professionals' confidence in Evidence-Based Practice, supporting its use and implementation. © 2017 John Wiley & Sons Ltd.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice.

PubMed

Rider, Elizabeth A; Gilligan, MaryAnn C; Osterberg, Lars G; Litzelman, Debra K; Plews-Ogan, Margaret; Weil, Amy B; Dunne, Dana W; Hafler, Janet P; May, Natalie B; Derse, Arthur R; Frankel, Richard M; Branch, William T

2018-05-08

Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction. To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians. From January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations. Sixty eight of the 92 (74%) study participants who received the survey provided written responses. All subjects who were sent the survey had participated in a year-long small-group faculty development program to enhance humanistic practice and teaching. As humanistic leaders, subjects should have insights into motivating and inhibiting factors. Participants' responses were analyzed using the constant comparative method. Motivators included an organizational culture that enhances humanism, which we judged to be the overarching theme. Related themes included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities that promote humanism, and practice structures that facilitate humanism. Impediments included top down organizational culture that inhibits humanism, along with related themes of non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. While healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus.

Private religious practice, spiritual coping, social support, and health status among older Korean adult immigrants.

PubMed

Lee, Kyoung Hag; Hwang, Myung Jin

2014-01-01

This study explored the role of spiritual factors and social support on the health status of 246 older Korean adult immigrants age 65 years or older. Ordinary least squares regression results revealed that private religious practice, spiritual coping, and social support were significantly associated with improved health status. However, stressors such as the lack of English proficiency and transportation, longer residency in the United States, and financial problems were significantly associated with lower health status. Social workers need to consider providing appropriate spiritual interventions and social support programs for older Korean adult immigrants so that they may better handle their stressors and health problems.

Need for ethics support in healthcare institutions: views of Dutch board members and ethics support staff.

PubMed

Dauwerse, Linda; Abma, Tineke; Molewijk, Bert; Widdershoven, Guy

2011-08-01

The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Most respondents see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice.

Introducing the Postsecondary Instructional Practices Survey (PIPS): A Concise, Interdisciplinary, and Easy-to-Score Survey.

PubMed

Walter, Emily M; Henderson, Charles R; Beach, Andrea L; Williams, Cody T

Researchers, administrators, and policy makers need valid and reliable information about teaching practices. The Postsecondary Instructional Practices Survey (PIPS) is designed to measure the instructional practices of postsecondary instructors from any discipline. The PIPS has 24 instructional practice statements and nine demographic questions. Users calculate PIPS scores by an intuitive proportion-based scoring convention. Factor analyses from 72 departments at four institutions (N = 891) support a 2- or 5-factor solution for the PIPS; both models include all 24 instructional practice items and have good model fit statistics. Factors in the 2-factor model include (a) instructor-centered practices, nine items; and (b) student-centered practices, 13 items. Factors in the 5-factor model include (a) student-student interactions, six items; (b) content delivery, four items; (c) formative assessment, five items; (d) student-content engagement, five items; and (e) summative assessment, four items. In this article, we describe our development and validation processes, provide scoring conventions and outputs for results, and describe wider applications of the instrument. © 2016 E. M. Walter et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Implementing mentor mothers in family practice to support abused mothers: study protocol.

PubMed

Loeffen, Maartje Jw; Lo Fo Wong, Sylvie H; Wester, Fred Pjf; Laurant, Miranda Gh; Lagro-Janssen, Antoine Lm

2011-10-18

Intimate partner violence is highly prevalent and mostly affects women with negative consequences for their physical and mental health. Children often witness the violence which has negative consequences for their well-being too. Care offered by family physicians is often rejected because abused women experience a too high threshold. Mentor mother support, a low threshold intervention for abused mothers in family practice, proved to be feasible and effective in Rotterdam, the Netherlands. The primary aim of this study is to investigate which factors facilitate or hinder the implementation of mentor mother support in family practice. Besides we evaluate the effect of mentor mother support in a different region. An observational study with pre- and posttests will be performed. Mothers with home living children or pregnant women who are victims of intimate partner violence will be offered mentor mother support by the participating family physicians. The implementation process evaluation consists of focus groups, interviews and questionnaires. In the effect evaluation intimate partner violence, the general health of the abused mother, the mother-child relationship, social support, and acceptance of professional help will be measured twice (t = 0 and t = 6 months) by questionnaires, reporting forms, medical records and interviews with the abused mothers. Qualitative coding will be used to analyze the data from the reporting forms, medical records, focus groups, interviews, and questionnaires. Quantitative data will be analyzed with descriptive statistics, chi square test and t-test matched pairs. While other intervention studies only evaluate the feasibility and effectiveness of the intervention, our primary aim is to evaluate the implementation process and thereby investigate which factors facilitate or hinder implementation of mentor mother support in family practice.

A cognitive framework to inform the design of professional development supporting teachers' classroom assessment of inquiry-based science

NASA Astrophysics Data System (ADS)

Matese, Gabrielle

Inquiry-based science places new demands on teachers for assessing students' growth, both of deep conceptual understanding as well as developing inquiry skills. In addition, new ideas about classroom assessment, such as the importance of formative assessment, are gaining currency. While we have ideas about what classroom assessment consistent with inquiry-based pedagogy might look like, and why it is necessary, we have little understanding of what it takes to implement it. That teachers face a challenge in doing so is well-documented. Researchers have noted that teachers attempting changes in classroom assessment often bring with them incompatible beliefs, knowledge, and practices. However, noting general incompatibility is insufficient to support addressing these issues through professional development. In response to this need, I initiated a research project to identify and describe in more detail the categories of beliefs, knowledge and skills that play an important role in inquiry-based science assessment practices. I created an assessment framework outlining specific categories of beliefs, knowledge, and skills affecting particular classroom assessment practices. I then used the framework to examine teachers' classroom assessment practices and to create comparative cases between three middle-school science teachers, highlighting how the different cognitive factors affect four particular assessment practices. The comparative cases demonstrate the framework's utility for analyzing and explicating teacher assessment practices. As a tool for analyzing and understanding teacher practice, the framework supports the design of professional development. To demonstrate the value of the framework, I draw on the comparative cases to identify implications for the design of professional development to support teachers' classroom assessment of inquiry-based science. In this dissertation I provide a brief overview of the framework and its rationale, present an example of the comparative case studies demonstrating the application of the framework and what it reveals about the cognitive influences on teacher practice, and outline the resulting design implications for professional development. This research allows us to better understand the cognitive factors underlying classroom assessment in inquiry-based science, and to design professional development to support teachers engaging in these practices.

Factors associated with early childhood education and care service implementation of healthy eating and physical activity policies and practices in Australia: a cross-sectional study.

PubMed

Wolfenden, Luke; Finch, Meghan; Nathan, Nicole; Weaver, Natasha; Wiggers, John; Yoong, Sze Lin; Jones, Jannah; Dodds, Pennie; Wyse, Rebecca; Sutherland, Rachel; Gillham, Karen

2015-09-01

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder's Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18-1.61; p = <0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

From challenges to advanced practice registered nursing role development: Qualitative interview study.

PubMed

Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija

2015-12-01

The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.

"Latte rural": the tangible and intangible factors important in the choice of a rural practice by recent GP graduates.

PubMed

Laurence, Caroline O; Williamson, Victoria; Sumner, Karen E; Fleming, Jenny

2010-01-01

A large of amount of literature exists on the factors that influence the recruitment and retention of rural general practitioners (GPs) in Australia and other countries. The selection of a rural practice location is known to be influenced by professional, personal and family, community and economic factors. Most of this research has been undertaken on the either the baby boomer generation or their predecessors, and this is likely to have influenced the responses gained. Generation X and Y doctors are known to have a different perception regarding workload, lifestyle and the support required to practise. The aim of this study was to explore, from a Generation X perspective, factors deemed important by general practice graduates in selecting a rural practice at completion of their training. The study also aimed to identify the process general practice graduates use to identify a potential rural practice, and when they commence this process. Semi-structured interviews were held with 15 rural pathway general practice registrars in their final year of training with 2 regional training providers in South Australia. The interview topics included source of information on potential practices, their ideal rural practice and community, the process used to select a practice, and when they commenced this process. Phenomenological hermeneutic thematic analysis of interview transcripts was undertaken to identify themes and sub-themes. For an ideal rural practice, registrars wished to work in a practice with a friendly atmosphere, good business structure, support from senior GPs and in close proximity to a hospital. They also wanted reasonable on-call arrangements, the chance to develop further skills (such as anaesthetics or obstetrics) and the freedom to practise according to their interests. They also emphasised the importance of a good team and an ethical practice. In terms of community, registrars wanted a positive living place, access to amenities such as childcare, good schools and the opportunity of work for their spouses. They also appreciated attractions such as the beach, or green farmland. Word of mouth, referrals by colleagues and experience of a practice were the most common approaches to finding a suitable rural practice. The majority of the registrars commenced selection of a rural practice in their last 6 months of training. Many of the factors identified by the Generation X registrars were similar to those identified by the previous generation. However, they also identified factors such as a positive team environment and practice with good ethics as important. The results can be used to tailor the marketing of rural practices to Generation X general practice registrars.

Enhancing the quality of supportive supervisory behavior in long-term care facilities.

PubMed

McGillis Hall, Linda; McGilton, Katherine S; Krejci, Janet; Pringle, Dorothy; Johnston, Erin; Fairley, Laura; Brown, Maryanne

2005-04-01

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

Maternal Personality, Parenting Cognitions and Parenting Practices

PubMed Central

Bornstein, Marc H.; Hahn, Chun-Shin; Haynes, O. Maurice

2011-01-01

A community sample of 262 European American mothers of firstborn 20-month-olds completed a personality inventory and measures of parenting cognitions (knowledge, self-perceptions, and reports about behavior) and was observed in interaction with their children from which measures of parenting practices (language, sensitivity, affection, and play) were independently coded. Factor analyses of the personality inventory replicated extraction of the Five-Factor model of personality (Openness, Neuroticism, Extraversion, Agreeableness, and Conscientiousness). Controlling for sociodemographic characteristics, the five personality factors qua variables and in patterns qua clusters related differently to diverse parenting cognitions and practices, supporting the multidimensional, modular, and specific nature of parenting. Maternal personality in the normal range, a theoretically important but empirically neglected factor in everyday parenting, has meaning in studies of parenting, child development, and family process. PMID:21443335

Maternal perceptions and factors affecting Kangaroo mother care continuum at home: a descriptive study.

PubMed

Raajashri, R; Adhisivam, B; Vishnu Bhat, B; Palanivel, C

2018-03-01

To estimate the proportion of mothers who continued to practice Kangaroo mother care (KMC) at home and evaluate potential factors influencing this practice. This descriptive study was conducted in a tertiary care teaching hospital in south India. Mothers of preterm and low birth weight infants were trained in KMC during hospital stay. During follow up after 45 days, data regarding their perceptions and the practice of KMC at home and the factors influencing them were collected using questionnaires. Among 200 mothers interviewed, 82.5% continued to practice KMC at home after discharge. The mean total duration of KMC was 30.2 days and average duration per day was 1.3 h. Support of family members was facilitatory in 70% and lack of privacy at home was hindering in 25%. After KMC training in hospital, majority of the post natal mothers were able to continue the practice satisfactorily at home despite hindering factors including lack of privacy. KMC training modules should emphasize continuing the practice at home after discharge and address the potential barriers for KMC continuum in the community.

Improving social connection through a communities-of-practice-inspired cognitive work analysis approach.

PubMed

Euerby, Adam; Burns, Catherine M

2014-03-01

Increasingly, people work in socially networked environments. With growing adoption of enterprise social network technologies, supporting effective social community is becoming an important factor in organizational success. Relatively few human factors methods have been applied to social connection in communities. Although team methods provide a contribution, they do not suit design for communities. Wenger's community of practice concept, combined with cognitive work analysis, provided one way of designing for community. We used a cognitive work analysis approach modified with principles for supporting communities of practice to generate a new website design. Over several months, the community using the site was studied to examine their degree of social connectedness and communication levels. Social network analysis and communications analysis, conducted at three different intervals, showed increases in connections between people and between people and organizations, as well as increased communication following the launch of the new design. In this work, we suggest that human factors approaches can be effective in social environments, when applied considering social community principles. This work has implications for the development of new human factors methods as well as the design of interfaces for sociotechnical systems that have community building requirements.

Factors related to coping strategies during Japanese physical therapy students' clinical practice.

PubMed

Higuchi, Daisuke; Echigo, Ayumi

2017-08-01

[Purpose] This study aimed to identify social skills and support that are related to the coping strategies Janpanese physical therapy students use during their clinical practice. [Subjects and Methods] Third-year students who were finished with their clinical practice participated. Self-administered questionnaires were used, including the daily life skill scale, social support scale, and tri-axial coping scale. Spearman's partial correlation coefficients were calculated between social skills, support of daily living, and coping strategies used during the clinical practice, while controlling for gender. [Results] A total of 56 completed questionnaires (median of age: 21 years; 27 males). Social skills during personal situations-knowledge summarization, self-esteem, and positive thinking-were significantly, positively correlated with planning and affirmative interpreting strategies to approach stressors regarding clinical practice, and negatively related to giving up strategies to avoid stressors. Intimacy, leadership, and empathy (social skills during interpersonal situations) were significantly, positively correlated with the following responses to approach stressors: catharsis, information gathering, and affirmative interpreting. Moreover, emotional/companionship social support was significantly, positively correlated with all avoidant coping strategies. [Conclusion] Japanese physical therapy students who had low personal and interpersonal social skills and excess emotional/companionship support in daily life tend to select avoidance, not approach, coping strategies during clinical practice.

Predictors of Supportive Message Expression and Reception in an Interactive Cancer Communication System

PubMed Central

KIM, EUNKYUNG; HAN, JEONG YEOB; SHAH, DHAVAN; SHAW, BRET; McTAVISH, FIONA; GUSTAFSON, DAVID H.; FAN, DAVID

2013-01-01

Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System “Living With Breast Cancer” program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer. PMID:22070449

[Parental practices and pedestrian risk behaviors in Chilean adolescents].

PubMed

Herrera, Andrea C; Repetto, Paula B

2014-08-01

Traffic accidents are the second leading cause of death among adolescents and young adults in Chile. However, few studies have examined this behavior among this age group. Parental practices have a great influence on risk behaviors in adolescents, such as substance use, sexuality and violence, among others. Specifically, we propose that these practices will influence pedestrian risk behaviors among adolescents. To study the role of parental practices such as mother and father support, and behavioral control (monitoring and presence of rules) in pedestrian risk behaviors of teenagers. A sample of 470 adolescents attending schools in the Metropolitan Region of Santiago, Chile were studied. They answered a self-administered questionnaire in which they were asked about parental practices and pedestrian risk behaviors. Analyses were performed using descriptive and inferential statistics, using multiple regression. Paternal support and the presence of rules were protective factors for pedestrian risky behaviors. However, maternal support or monitoring did not influence these behaviors. Parental practices influence pedestrian behaviors of teenagers. The study provides further evidence for the importance of these practices in the development of behavioral self-regulation.

Factors Promoting Vocational Students' Learning at Work: Study on Student Experiences

ERIC Educational Resources Information Center

Virtanen, Anne; Tynjälä, Päivi; Eteläpelto, Anneli

2014-01-01

In order to promote effective pedagogical practices for students' work-based learning, we need to understand better how students' learning at work can be supported. This paper examines the factors explaining students' workplace learning (WPL) outcomes, addressing three aspects: (1) student-related individual factors, (2) social and…

Factor Analysis of the Minnesota Infant Development Inventory Based on a Hispanic Migrant Population.

ERIC Educational Resources Information Center

Reilly, Amysue; Eaves, Ronald C.

2000-01-01

Completed the Minnesota Infant Development Inventory (MIDI), a parental report instrument, for 168 infants of Hispanic migrant workers and performed factor analysis of the MIDI scores. Results suggest that the one-factor solution is best for infants from Hispanic migrant families until future research supports other practices. (SLD)

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

PubMed

Parro Moreno, Ana; Serrano Gallardo, Pilar; Ferrer Arnedo, Carmen; Serrano Molina, Lucía; de la Puerta Calatayud, M Luisa; Barberá Martín, Aurora; Morales Asencio, José Miguel; de Pedro Gómez, Joan

2013-11-01

To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Cross-sectional, analytical, observational study. Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Breastfeeding Promotion, Support and Protection: Review of Six Country Programmes

PubMed Central

Mangasaryan, Nune; Martin, Luann; Brownlee, Ann; Ogunlade, Adebayo; Rudert, Christiane; Cai, Xiaodong

2012-01-01

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages. PMID:23016128

Returning to Work after Childbirth in Europe: Well-Being, Work-Life Balance, and the Interplay of Supervisor Support.

PubMed

Lucia-Casademunt, Ana M; García-Cabrera, Antonia M; Padilla-Angulo, Laura; Cuéllar-Molina, Deybbi

2018-01-01

Parents returning to work after the arrival of a new son or daughter is an important question for understanding the trajectory of people's lives and professional careers amid current debates about gender equality and work-life balance (WLB). Interestingly, current research concludes that general WLB practices at the workplace may be necessary in the specific case of women returning to work after childbirth because of the particular maternal and infant factors involved. However, WLB practices as a flexible arrangement may work against women because they may be viewed as a lack of organizational commitment. Therefore, research on this topic could benefit from considering supervisor support as a complement of such practices, but previous research has analyzed WLB and supervisor support separately and scarcely. To fill this gap in the literature, we use two sub-samples of 664 female employees and 749 male employees with children under the age of one from 27 European countries participating in the 6th European Working Conditions Survey (EWCS-2015) to study the impact of perceived WLB on European women's perceived well-being after childbirth, in contrast with previous literature. We also analyze the impact of perceived supervisor support (SS) and its interaction with perceived WLB on women's well-being after childbirth, and explore differences with men after childbirth, a collective underexplored by the literature. We find significant gender differences on the relative impact of WLB, SS, and their interaction on perceived job well-being. Our results have important implications for human resource practices in organizations. In particular, they suggest that gendered WLB practices should be encouraged, and stress the relevance of the human factor over human resource practices in addressing the difficulties that women returning to work face after childbirth.

Returning to Work after Childbirth in Europe: Well-Being, Work-Life Balance, and the Interplay of Supervisor Support

PubMed Central

Lucia-Casademunt, Ana M.; García-Cabrera, Antonia M.; Padilla-Angulo, Laura; Cuéllar-Molina, Deybbi

2018-01-01

Parents returning to work after the arrival of a new son or daughter is an important question for understanding the trajectory of people's lives and professional careers amid current debates about gender equality and work-life balance (WLB). Interestingly, current research concludes that general WLB practices at the workplace may be necessary in the specific case of women returning to work after childbirth because of the particular maternal and infant factors involved. However, WLB practices as a flexible arrangement may work against women because they may be viewed as a lack of organizational commitment. Therefore, research on this topic could benefit from considering supervisor support as a complement of such practices, but previous research has analyzed WLB and supervisor support separately and scarcely. To fill this gap in the literature, we use two sub-samples of 664 female employees and 749 male employees with children under the age of one from 27 European countries participating in the 6th European Working Conditions Survey (EWCS-2015) to study the impact of perceived WLB on European women's perceived well-being after childbirth, in contrast with previous literature. We also analyze the impact of perceived supervisor support (SS) and its interaction with perceived WLB on women's well-being after childbirth, and explore differences with men after childbirth, a collective underexplored by the literature. We find significant gender differences on the relative impact of WLB, SS, and their interaction on perceived job well-being. Our results have important implications for human resource practices in organizations. In particular, they suggest that gendered WLB practices should be encouraged, and stress the relevance of the human factor over human resource practices in addressing the difficulties that women returning to work face after childbirth. PMID:29467695

Job and life satisfaction and preference of future practice locations of physicians on remote islands in Japan.

PubMed

Nojima, Yoshiaki; Kumakura, Shunichi; Onoda, Keiichi; Hamano, Tsuyoshi; Kimura, Kiyoshi

2015-05-26

The objective of this research is to investigate job and life satisfaction and preference of future practice locations of physicians in rural and remote islands in Japan. A cross-sectional study was conducted for physicians who reside or resided on the Oki islands: isolated islands situated in the Sea of Japan between the Eurasian continent and the mainland of Japan. A questionnaire was sent to physicians on the Oki islands to evaluate physician satisfaction regarding job environment, career development, living conditions, salary, and support by local government. Data was analysed for 49 physicians; 47 were male and 2 were female, and the mean ± SD age was 44.3 ± 10.9 years. Among the variables related to physicians' satisfaction, most of the physicians (>90%) were satisfied with "team work" and "salary". On the other hand, the majority of physicians (approximately 70%) were not satisfied with the "opportunity to continue professional development". Age ≥ 50 years, graduates of medical schools other than Jichi Medical University (established in 1972 with the aim to produce rural physicians), self-selected the Oki islands as a practice location, and satisfaction in "work as a doctor", "opportunity to consult with peers about patients", "relationship with people in the community", and "acceptance by community" were found to be significant factors influencing the choice of the Oki islands as a future practice location. Factors influencing future practice locations on the remote islands were included in a self-reported questionnaire which illustrated the importance of factors that impact both the spouses and children of physicians. Improving work satisfaction, providing outreach support programmes for career development and professional support in rural practice, and building appropriate relationships between physicians and people in the community, which can in turn improve work satisfaction, may contribute to physicians' choices of practising medicine on rural and remote islands in Japan. Addressing family issues is also crucial in encouraging the choice of a rural medical practice location.

Undergraduate Health Students' Intention to Use Evidence-Based Practice After Graduation: A Systematic Review of Predictive Modeling Studies.

PubMed

Ramis, Mary-Anne; Chang, Anne; Nissen, Lisa

2018-04-01

Incorporating evidence-based practice (EBP) into clinical decision making and professional practice is a requirement for many health disciplines, yet research across health disciplines on factors that influence and predict student intention to use EBP following graduation has not been previously synthesized. To synthesize research on factors that influence development of EBP behaviors and subsequently predict undergraduate students' intention toward EBP uptake. A systematic review of prediction modeling studies was conducted according to a protocol previously published on the Prospero database: https://www.crd.york.ac.uk/PROSPERO/. The outcome variable was undergraduate students' future use or intention to use EBP. Evidence synthesis methods were guided by resources from the Cochrane Methods Prognosis Group Web site (https://prognosismethods.cochrane.org). Only three studies were found to meet inclusion criteria for the review. Factors relating to EBP capability, EBP attitudes, as well as clinical and academic support were identified as influential toward students' intention to use evidence in practice. Heterogeneity limited data pooling, consequently, results are presented in narrative and tabular form. Although using a developing method, this review presents a unique contribution to further discussions regarding students' intention to use EBP following graduation. Despite limitations, consideration of identified factors for undergraduate curriculum could support student's intention to use EBP in their respective clinical environments. © 2017 Sigma Theta Tau International.

Tale of Two Science Teachers' Formative Assessment Practices in a Similar School Environment

ERIC Educational Resources Information Center

Sathasivam, Renuka V.; Daniel, Esther G. S.

2016-01-01

There is an accumulating research base that supports the effectiveness of formative assessment practices in enhancing the quality of educational outcomes, yet research findings seem to indicate sluggish implementation of these formative assessment strategies in the classrooms. Many factors influence teachers' formative assessment practices…

Early Childhood Directors as Socializers of Emotional Climate

ERIC Educational Resources Information Center

Zinsser, Katherine M.; Denham, Susanne A.; Curby, Timothy W.; Chazan-Cohen, Rachel

2016-01-01

Early childhood centres are vibrant social communities where child and adult emotions are integral to learning. Previous research has focused on teaching practices that support children's social-emotional learning; fewer studies have attended to relevant centre-level factors, such as the emotional leadership practices of the centre director. The…

Audit of Cardiovascular Disease Risk Factors among Supported Adults with Intellectual Disability Attending an Ageing Clinic

ERIC Educational Resources Information Center

Wallace, Robyn A.; Schluter, Philip

2008-01-01

Background: Little is known about the cardiovascular disease (CVD) risk factor profile for older adults with intellectual disability (ID). As many CVD risk factors are treatable by lifestyle changes, confirmation of the risk factor profile for older adults with ID could substantially impact upon preventive health practices for this group. Method:…

Quantification and site-specification of the support practice factor when mapping soil erosion risk associated with olive plantations in the Mediterranean island of Crete.

PubMed

Karydas, Christos G; Sekuloska, Tijana; Silleos, Georgios N

2009-02-01

Due to inappropriate agricultural management practices, soil erosion is becoming one of the most dangerous forms of soil degradation in many olive farming areas in the Mediterranean region, leading to significant decrease of soil fertility and yield. In order to prevent further soil degradation, proper measures are necessary to be locally implemented. In this perspective, an increase in the spatial accuracy of remote sensing datasets and advanced image analysis are significant tools necessary and efficient for mapping soil erosion risk on a fine scale. In this study, the Revised Universal Soil Loss Equation (RUSLE) was implemented in the spatial domain using GIS, while a very high resolution satellite image, namely a QuickBird image, was used for deriving cover management (C) and support practice (P) factors, in order to map the risk of soil erosion in Kolymvari, a typical olive farming area in the island of Crete, Greece. The results comprised a risk map of soil erosion when P factor was taken uniform (conventional approach) and a risk map when P factor was quantified site-specifically using object-oriented image analysis. The results showed that the QuickBird image was necessary in order to achieve site-specificity of the P factor and therefore to support fine scale mapping of soil erosion risk in an olive cultivation area, such as the one of Kolymvari in Crete. Increasing the accuracy of the QB image classification will further improve the resulted soil erosion mapping.

The clinical utility index as a practical multiattribute approach to drug development decisions.

PubMed

Poland, B; Hodge, F L; Khan, A; Clemen, R T; Wagner, J A; Dykstra, K; Krishna, R

2009-07-01

We identify some innovative approaches to predicting overall patient benefit from investigational drugs to support development decisions. We then illustrate calculation of a probabilistic clinical utility index (CUI), an implementation of multiattribute utility that focuses on clinical attributes. We recommend use of the CUI for the support of early drug development decisions because of its practicality, reasonable accuracy, and transparency to decision makers, at stages in which financial factors that may dominate later-phase decisions are less critical.

Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

PubMed

Aarons, Gregory A; Sommerfeld, David H; Walrath-Greene, Christine M

2009-12-31

The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.

Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob

2014-09-15

The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less

Using the Practice Environment Scale of the Nursing Work Index on Asian nurses.

PubMed

Liou, Shwu-Ru; Cheng, Ching-Yu

2009-01-01

Researchers have used the Practice Environment Scale of the Nursing Work Index (PES-NWI) to examine the perception of practice environment among U.S. nurses in general; however, the scale has not been used to measure perceptions specifically among Asian nurses working in the United States, the largest group of international nurses in the nation. The purpose of this study was to test the reliability and the validity of the PES-NWI scale when applied to Asian nurses working in the United States. The study used a cross-sectional design with snowball sampling. Data from 230 Asian nurses who were born in Far Eastern countries and had worked at least 6 months in their current job at a U.S. hospital were analyzed, using Cronbach's alpha, item-total and interitem correlation, and factor analysis. The Cronbach's alpha for the PES-NWI was.96, and the item-total correlation coefficients ranged from.49 to.79. Five factors, which explained 59.12% of variance in the perception of practice environment, emerged: Nurse Participation and Development; Nurse Manager Ability, Leadership, and Support of Nurses; Nursing Foundations for Quality of Care; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations. Four derived factors were reconstructed, and one factor was renamed based on the meanings of scale items that were included in the factor. Study findings demonstrate that the PES-NWI is a reliable and a valid scale when applied to Asian nurses working in the United States. Findings also indicate that Asian nurses perceive practice environments differently than do American nurses, most likely due to dissimilar cultural beliefs. A better understanding of these differences may help develop more individualized support for Asian nurses as they adapt to working in the United States.

A guideline for interpersonal capabilities enhancement to support sustainable facility management practice

NASA Astrophysics Data System (ADS)

Sarpin, Norliana; Kasim, Narimah; Zainal, Rozlin; Noh, Hamidun Mohd

2018-04-01

Facility management is the key phase in the development cycle of an assets and spans over a considerable length of time. Therefore, facility managers are in a commanding position to maximise the potential of sustainability through the development phases from construction, operation, maintenance and upgrade leading to decommission and deconstruction. Sustainability endeavours in facility management practices will contribute to reducing energy consumption, waste and running costs. Furthermore, it can also help in improving organisational productivity, financial return and community standing of the organisation. Facility manager should be empowered with the necessary knowledge and capabilities at the forefront facing sustainability challenge. However, literature studies show a gap between the level of awareness, specific knowledge and the necessary skills required to pursue sustainability in the facility management professional. People capability is considered as the key enabler in managing the sustainability agenda as well as being central to the improvement of competency and innovation in an organisation. This paper aims to develop a guidelines for interpersonal capabilities to support sustainability in facility management practice. Starting with a total of 7 critical interpersonal capabilities factors identified from previous questionnaire survey, the authors conducted an interview with 3 experts in facility management to assess the perceived importance of these factors. The findings reveal a set of guidelines for the enhancement of interpersonal capabilities among facility managers by providing what can be done to acquire these factors and how it can support the application of sustainability in their practice. The findings of this paper are expected to form the basis of a mechanism framework developed to equip facility managers with the right knowledge, to continue education and training and to develop new mind-sets to enhance the implementation of sustainability measures in FM practices.

Parenting practices and adolescent sexual behavior: A longitudinal study

PubMed Central

Bersamin, Melina; Todd, Michael; Fisher, Deborah A.; Hill, Douglas L.; Grube, Joel W.; Walker, Samantha

2009-01-01

The effects of parental attitudes, practices, and television mediation on adolescent sexual behaviors were investigated in a study of adolescent sexuality and media (N=887). Confirmatory factor analyses supported an eight-factor parenting model with television mediation factors as constructs distinct from general parenting practices. Logistic regressions indicated that adolescents reporting greater parental disapproval and limits on viewing at Wave 1 were less likely to initiate oral sex between Waves 1 and 2. Adolescents who reported more sexual communication with parents were more likely to initiate oral sex. Results for vaginal intercourse were similar to those for oral sex. Co-viewing was a significant negative predictor of initiation of sexual behavior. Parental attitudes and television mediation can delay potentially risky adolescent sexual behaviors. PMID:19750131

Dependence and physical exercise: Spanish validation of the Exercise Dependence Scale-Revised (EDS-R).

PubMed

Sicilia, Alvaro; González-Cutre, David

2011-05-01

The purpose of this study was to validate the Spanish version of the Exercise Dependence Scale-Revised (EDS-R). To achieve this goal, a sample of 531 sport center users was used and the psychometric properties of the EDS-R were examined through different analyses. The results supported both the first-order seven-factor model and the higher-order model (seven first-order factors and one second-order factor). The structure of both models was invariant across age. Correlations among the subscales indicated a related factor model, supporting construct validity of the scale. Alpha values over .70 (except for Reduction in Other Activities) and suitable levels of temporal stability were obtained. Users practicing more than three days per week had higher scores in all subscales than the group practicing with a frequency of three days or fewer. The findings of this study provided reliability and validity for the EDS-R in a Spanish context.

Evidence of Convergent and Discriminant Validity of Child, Teacher, and Peer Reports of Teacher-Student Support

PubMed Central

Li, Yan; Hughes, Jan N.; Kwok, Oi-man; Hsu, Hsien-Yuan

2012-01-01

This study investigated the construct validity of measures of teacher-student support in a sample of 709 ethnically diverse second and third grade academically at-risk students. Confirmatory factor analysis investigated the convergent and discriminant validities of teacher, child, and peer reports of teacher-student support and child conduct problems. Results supported the convergent and discriminant validity of scores on the measures. Peer reports accounted for the largest proportion of trait variance and non-significant method variance. Child reports accounted for the smallest proportion of trait variance and the largest method variance. A model with two latent factors provided a better fit to the data than a model with one factor, providing further evidence of the discriminant validity of measures of teacher-student support. Implications for research, policy, and practice are discussed. PMID:21767024

Factors That Influence the Practice of Elective Induction of Labor

PubMed Central

Moore, Jennifer; Low, Lisa Kane

2012-01-01

Elective induction of labor has been linked to increased rates of prematurity and rising rates of cesarean birth. The purpose of this investigation was to evaluate current trends in induction of labor scholarship focusing on evidence-based factors that influence the practice of elective induction. A key word search was conducted to identify studies on the practice of elective induction of labor. Analysis of the findings included clustering and identification of recurrent themes among the articles with 3 categories being identified. Under each category, the words/phrases were further clustered until a construct could be named. A total of 49 articles met inclusion criteria: 7 patient, 6 maternity care provider, and 4 organization factors emerged. Only 4 of the articles identified were evidence based. Patient factors were divided into preferences/convenience, communication, fear, pressure/influence, trust, external influences, and technology. Provider factors were then divided into practice preferences/convenience, lack of information, financial incentives, fear, patient desire/demand, and technology. Organization factors were divided into lack of enforcement/accountability, hospital culture, scheduling of staff, and market share issues. Currently, there is limited data-based information focused on factors that influence elective induction of labor. Despite patient and provider convenience/preferences being cited in the literature, the evidence does not support this practice. PMID:22843006

Factors that influence the practice of elective induction of labor: what does the evidence tell us?

PubMed

Moore, Jennifer; Low, Lisa Kane

2012-01-01

Elective induction of labor has been linked to increased rates of prematurity and rising rates of cesarean birth. The purpose of this investigation was to evaluate current trends in induction of labor scholarship focusing on evidence-based factors that influence the practice of elective induction. A key word search was conducted to identify studies on the practice of elective induction of labor. Analysis of the findings included clustering and identification of recurrent themes among the articles with 3 categories being identified. Under each category, the words/phrases were further clustered until a construct could be named. A total of 49 articles met inclusion criteria: 7 patient, 6 maternity care provider, and 4 organization factors emerged. Only 4 of the articles identified were evidence based. Patient factors were divided into preferences/convenience, communication, fear, pressure/influence, trust, external influences, and technology. Provider factors were then divided into practice preferences/convenience, lack of information, financial incentives, fear, patient desire/demand, and technology. Organization factors were divided into lack of enforcement/accountability, hospital culture, scheduling of staff, and market share issues. Currently, there is limited data-based information focused on factors that influence elective induction of labor. Despite patient and provider convenience/preferences being cited in the literature, the evidence does not support this practice.

[How to improve practices and interventions for work integration of people with schizophrenia in France?].

PubMed

Pachoud, B; Llorca, P M; Azorin, J M; Dubertret, C; de Pierrefeu, I; Gaillard, R; Franck, N

2015-12-01

Getting and keeping a job are not only one of the criteria of recovery from schizophrenia, but are also one of its main means. Indeed, recovery is partly defined by the ability to work. Despite the lack of data in France about employment of people with schizophrenia, it is widely acknowledged that the employment rate of people with schizophrenia remains quite low, and frequently it is only an employment in sheltered workshops, not on the regular work market. International research data show that it is possible to improve significantly this employment rate, with an appropriate support, that is precisely defined by the current researches, and that is quickly spreading in most developed countries. The aim of this paper is to present, on the basis of a broad current literature review, the key predictive factors of the return to work for people with schizophrenia, and the strategies to optimize vocational services. It will appear that there are several ways to improve practices and interventions in France to support work integration. To begin with individual factors of work integration, dependant on each person, the clinical state and the cognitive skills (in a broad sense, including social cognition and metacognition) are to be taken into account, and optimized by means of the association of a finely tuned pharmacological treatment and psychosocial interventions such as cognitive remediation adjusted to the person's specific needs. The other main kind of factors is environmental factors, particularly the kind of vocational support, which turns out to have a major impact not only on job acquisition, but importantly also on job tenure. The most effective vocational services are based on the "Place and train" model, and even more precisely on the Individual Placement and Support (IPS) model, that allows to the majority of people with a severe mental illness (more than 50%) to obtain a competitive employment after 6 to 18 months of individualized support. This approach is now widely recommended as "an evidence-based practice" of rehabilitation. It is important to promote in France the development of this kind of practice, already implemented as an experiment by few militant and involved associations. This development remains in France slow and delayed (compared to the practices in the other European countries) because of the lack of public funding. It implies an evolution of the social and medico-social practices, taking into account current research data, and assessing the outcomes of their practices in order to improve them. The employment specialist (sometimes called also the "job coach") turns out to play a key role, emphasized by current research, implying, among many other tasks, to coordinate the net of people supporting the work integration, including the clinical team, the employer and the colleagues of the workplace. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Implementation of the NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Rationale and Study Design for Young Hearts, Strong Starts, a Cluster-Randomized Trial Targeting Body Mass Index, Blood Pressure, and Tobacco

PubMed Central

LaBresh, Kenneth A.; Lazorick, Suzanne; Ariza, Adolfo J.; Furberg, Robert D.; Whetstone, Lauren; Hobbs, Connie; de Jesus, Janet; Bender, Randall H.; Salinas, Ilse G.; Binns, Helen J.

2014-01-01

Background Cardiovascular disease (CVD) and the underlying atherosclerosis begin in childhood, and their presence and intensity are related to known cardiovascular disease risk factors. Attention to risk factor control in childhood has the potential to reduce subsequent risk of CVD. Objective The Young Hearts Strong Starts Study was designed to test strategies facilitating adoption of the National, Heart, Lung and Blood Institute supported Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. This study compares guideline-based quality measures for body mass index, blood pressure, and tobacco using two strategies: a multifaceted, practice-directed intervention versus standard dissemination. Study Design Two primary care research networks recruited practices and provided support for the intervention and outcome evaluations. Individual practices were randomly assigned to the intervention or control groups using a cluster randomized design based on network affiliation, number of clinicians per practice, urban versus nonurban location, and practice type. The units of observation are individual children because measure adherence is abstracted from individual patient’s medical records. The units of randomization are physician practices. This results in a multilevel design in which patients are nested within practices. The intervention practices received toolkits and supported guideline implementation including academic detailing, an ongoing e-learning group. This project is aligned with the American Board of Pediatrics Maintenance of Certification requirements including monthly physician self-abstraction, webinars, and other elements of the trial. Significance This trial will provide an opportunity to demonstrate tools and strategies to enhance CV prevention in children by guideline-based interventions. PMID:24295879

Understanding facilitators and barriers to reengineering the clinical research enterprise in community-based practice settings.

PubMed

Kukafka, Rita; Allegrante, John P; Khan, Sharib; Bigger, J Thomas; Johnson, Stephen B

2013-09-01

Solutions are employed to support clinical research trial tasks in community-based practice settings. Using the IT Implementation Framework (ITIF), an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use, we sought to understand the barriers and facilitators to clinical research in community-based practice settings preliminary to implementing new informatics solutions for improving clinical research infrastructure. The studies were conducted in practices within the Columbia University Clinical Trials Network. A mixed-method approach, including surveys, interviews, time-motion studies, and observations was used. The data collected, which incorporates predisposing, enabling, and reinforcing factors in IT use, were analyzed according to each phase of ITIF. Themes identified in the first phase of ITIF were 1) processes and tools to support clinical trial research and 2) clinical research peripheral to patient care processes. Not all of the problems under these themes were found to be amenable to IT solutions. Using the multi-level orientation of the ITIF, we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice-based settings. Developing strategies to target enabling and reinforcing factors, which focus on organizational factors, and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes, is most challenging. The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice settings. © 2013.

Implementing new care models: learning from the Greater Manchester demonstrator pilot experience.

PubMed

Elvey, Rebecca; Bailey, Simon; Checkland, Kath; McBride, Anne; Parkin, Stephen; Rothwell, Katy; Hodgson, Damian

2018-06-19

Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. Semi-structured interviews, with the data subjected to thematic analysis. Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.

SUPPORTING PHYSICIANS' PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI) AND QUALITY IMPROVEMENT THROUGH EXPLORATION OF POPULATION-BASED MEDICAL DATA.

PubMed

Baumgart, Leigh A; Bass, Ellen J; Lyman, Jason A; Springs, Sherry; Voss, John; Hayden, Gregory F; Hellems, Martha A; Hoke, Tracey R; Schlag, Katharine A; Schorling, John B

2010-01-01

Participating in self-assessment activities may stimulate improvement in practice behaviors. However, it is unclear how best to support the development of self-assessment skills, particularly in the health care domain. Exploration of population-based data is one method to enable health care providers to identify deficiencies in overall practice behavior that can motivate quality improvement initiatives. At the University of Virginia, we are developing a decision support tool to integrate and present population-based patient data to health care providers related to both clinical outcomes and non-clinical measures (e.g., demographic information). By enabling users to separate their direct impact on clinical outcomes from other factors out of their control, we may enhance the self-assessment process.

SUPPORTING PHYSICIANS’ PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI) AND QUALITY IMPROVEMENT THROUGH EXPLORATION OF POPULATION-BASED MEDICAL DATA

PubMed Central

Baumgart, Leigh A.; Bass, Ellen J.; Lyman, Jason A.; Springs, Sherry; Voss, John; Hayden, Gregory F.; Hellems, Martha A.; Hoke, Tracey R.; Schlag, Katharine A.; Schorling, John B.

2011-01-01

Participating in self-assessment activities may stimulate improvement in practice behaviors. However, it is unclear how best to support the development of self-assessment skills, particularly in the health care domain. Exploration of population-based data is one method to enable health care providers to identify deficiencies in overall practice behavior that can motivate quality improvement initiatives. At the University of Virginia, we are developing a decision support tool to integrate and present population-based patient data to health care providers related to both clinical outcomes and non-clinical measures (e.g., demographic information). By enabling users to separate their direct impact on clinical outcomes from other factors out of their control, we may enhance the self-assessment process. PMID:21874123

Differentiated Instruction: Understanding the Personal Factors and Organizational Conditions that Facilitate Differentiated Instruction in Elementary Mathematics Classrooms

ERIC Educational Resources Information Center

Abbati, Diana Guglielmo

2012-01-01

Differentiated instruction is a widely held practice used by teachers to provide diverse learners with complex learning opportunities in the area of mathematics. Research on differentiated instruction shows a multitude of factors that support high quality instruction in mixed-ability elementary classrooms. These factors include small-class size,…

Initial investigation of organisational factors associated with the implementation of active support.

PubMed

Fyffe, Chris; McCubbery, Jeffrey; Reid, Katharine J

2008-09-01

Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.

Turnover of regulated nurses in long-term care facilities.

PubMed

Chu, Charlene H; Wodchis, Walter P; McGilton, Katherine S

2014-07-01

To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover. © 2013 John Wiley & Sons Ltd.

Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study.

PubMed

Kabir, Ashraful; Maitrot, Mathilde Rose Louise

2017-01-01

Nutritional status differs between infants and young children living in slum and non-slum conditions-infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums. This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted. Feeding practices for infants and young children in families with working mothers are broadly determined by mothers' occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors. The results suggest a trade-off between mothers' work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes.

School Practices to Foster LGBT-Supportive Climate: Associations with Adolescent Bullying Involvement.

PubMed

Gower, Amy L; Forster, Myriam; Gloppen, Kari; Johnson, Abigail Z; Eisenberg, Marla E; Connett, John E; Borowsky, Iris W

2017-10-14

Lesbian, gay, bisexual, and transgender (LGBT) youth experience disproportionate rates of bullying compared to their heterosexual peers. Schools are well-positioned to address these disparities by creating supportive school climates for LGBT youth, but more research is needed to examine the variety of practices and professional development opportunities put in place to this end. The current study examines how school practices to create supportive LGBT student climate relate to student reports of bullying. Student-level data come from the 2013 Minnesota Student Survey, a state-wide survey of risk and protective factors. Ninth and eleventh grade students (N = 31,183) reported on frequency of physical and relational bullying victimization and perpetration and sexual orientation-based harassment. School administrators reported on six practices related to creating supportive LGBT school climate (N = 103 schools): having a point person for LGBT student issues, displaying sexual orientation-specific content, having a gay-straight alliance, discussing bullying based on sexual orientation, and providing professional development around LGBT inclusion and LGBT student issues. An index was created to indicate how many practices each school used (M = 2.45; SD = 1.76). Multilevel logistic regressions indicated that students attending schools with more supportive LGBT climates reported lower odds of relational bullying victimization, physical bullying perpetration, and sexual orientation-based harassment compared to students in schools with less supportive LGBT climates. Sexual orientation did not moderate these relations, indicating that LGBT-supportive practices may be protective for all students, regardless of their sexual orientation. Findings support school-wide efforts to create supportive climates for LGBQ youth as part of a larger bullying prevention strategy.

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

Additive benefits of autonomy support and enhanced expectancies for motor learning.

PubMed

Wulf, Gabriele; Chiviacowsky, Suzete; Cardozo, Priscila Lopes

2014-10-01

Two factors that have been shown to facilitate motor learning are autonomy support (AS) and enhanced expectancies (EE) for performance. We examined the individual and combined influences of these factors. In a 2 × 2 design, participants learning a novel motor skill (throwing with the non-dominant arm) were or were not provided a choice (AS) about the ball color on each of 6 10-trial blocks during practice, and were or were not given bogus positive social-comparative feedback (EE). This resulted in four groups: AS/EE, AS, EE, and C (control). One day after the practice phase, participants completed 10 retention and 10 transfer trials. The distance to the target--a bull's eye with a 1m radius and 10 concentric circles--was 7.5m during practice and retention, and 8.5m during transfer. Autonomy support and enhanced expectancies had additive advantages for learning, with both main effects being significant for retention and transfer. On both tests, the AS/EE group showed the greatest throwing accuracy. Also, the accuracy scores of the AS and EE groups were higher than those of the C group. Furthermore, self-efficacy measured after practice and before retention and transfer was increased by both AS and EE. Thus, supporting learners' need for autonomy by given them a small choice--even though it was not directly related to task performance--and enhancing their performance expectancies appeared to independently influence learning. Copyright © 2014 Elsevier B.V. All rights reserved.

Factors That Develop Effective Professional Learning Communities in Taiwan

ERIC Educational Resources Information Center

Chen, Peiying; Lee, Che-Di; Lin, Hongda; Zhang, Chun-Xi

2016-01-01

This research aimed to investigate the key factors of developing effective professional learning communities (PLCs) within the Taiwanese context. Four constructs--supportive and shared leadership, shared visions, collegial trust, and shared practices--were adopted and developed into an instrument for measuring PLC function. A stratified random…

The Development of a Scale to Assess Practitioner Capacity to Engage in Clinical Education

ERIC Educational Resources Information Center

Abey, Sally; Lea, Susan; Callaghan, Lynne; Cotton, Debby; Shaw, Steve

2015-01-01

Clinical educators play an important role in the development of clinical skills during health care undergraduates' practice placements. The supportiveness of the learning environment and the attitude of the clinical educator towards student development are considered to be important factors that impact upon practice placement experience, although…

Theoretical Beliefs and Instructional Practices Used for Teaching Spelling in Elementary Classrooms

ERIC Educational Resources Information Center

McNeill, Brigid; Kirk, Cecilia

2014-01-01

The current study aimed to examine teachers' reported spelling assessment and instruction practices. Analysis of the match between teachers' theoretical beliefs about spelling and their reported pedagogy was conducted to elucidate factors that may support or impede the use of evidence-based teaching strategies in the classroom. An electronic…

Linguistic Support for Non-Native English Speakers: Higher Education Practices in the United States

ERIC Educational Resources Information Center

Snow Andrade, Maureen; Evans, Norman W.; Hartshorn, K. James

2014-01-01

Higher education institutions in English-speaking nations host significant populations of non-native English speakers (NNES), both international and resident. English language proficiency is a critical factor to their success. This study reviews higher education practices in the United States related to this population. Findings indicate…

Interprofessional collaborative practice within cancer teams: Translating evidence into action. A mixed methods study protocol

PubMed Central

2010-01-01

Background A regional integrated cancer network has implemented a program (educational workshops, reflective and mentoring activities) designed to support the uptake of evidence-informed interprofessional collaborative practices (referred to in this text as EIPCP) within cancer teams. This research project, which relates to the Registered Nurses' Association of Ontario (RNAO) Best Practice Guidelines and other sources of research evidence, represents a unique opportunity to learn more about the factors and processes involved in the translation of evidence-based recommendations into professional practices. The planned study seeks to address context-specific challenges and the concerns of nurses and other stakeholders regarding the uptake of evidence-based recommendations to effectively promote and support interprofessional collaborative practices. Aim This study aims to examine the uptake of evidence-based recommendations from best practice guidelines intended to enhance interprofessional collaborative practices within cancer teams. Design The planned study constitutes a practical trial, defined as a trial designed to provide comprehensive information that is grounded in real-world healthcare dynamics. An exploratory mixed methods study design will be used. It will involve collecting quantitative data to assess professionals' knowledge and attitudes, as well as practice environment factors associated with effective uptake of evidence-based recommendations. Semi-structured interviews will be conducted concurrently with care providers to gather qualitative data for describing the processes involved in the translation of evidence into action from both the users' (n = 12) and providers' (n = 24) perspectives. The Graham et al. Ottawa Model of Research Use will serve to construct operational definitions of concepts, and to establish the initial coding labels to be used in the thematic analysis of the qualitative data. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interrelated contextual factors that enhance the uptake of EIPCP and changes in professional practices. Discussion The information obtained from the study will produce new knowledge on the interventions and sources of support most conducive to the uptake of evidence and building of capacity to sustain new interprofessional collaborative practice patterns. It will provide new information on strategies for overcoming barriers to evidence-informed interventions. The findings will also pinpoint critical determinants of 'what works and why' taking into account the interplay between evidence, operational, relational micro-processes of care, uniqueness of patients' needs and preferences, and the local context. PMID:20626858

An exploration of the perceived factors that affect the learning and transfer of skills taught to student midwives.

PubMed

Longworth, Mary K

2013-08-01

the aim of this study was to examine the attitudes of student midwives towards skills training and practise. The objectives were to explore the factors in the skills laboratory environment and in clinical practice which affect how successfully student midwives transfer into clinical practice the various skills they have learnt in preparation for an Objective Structured Clinical Examination. a review of the background literature revealed that there were many variables related to successful transfer of skills in general but there appeared to be a gap around perceived factors affecting transfer of skills of student midwives. a mixed methods design was conducted using both questionnaires and semi-structured interviews between June and August 2010. questionnaires were administered to all midwifery students at one university in Wales. These were later followed by semi-structured interviews for 6 student midwives who were purposively selected from all year groups. the results from the questionnaires revealed that a majority of students had positive attitudes to educators and mentors and to their skills acquisition experience in the skills laboratory and to the available opportunities to practise in clinical practice. Although students believed in the transferability of skills from the laboratory setting to clinical practice, a majority thought that clinical practice provided them with a better opportunity to learn clinical skills. The semi-structured interviews demonstrated that facilitating factors in the skills laboratory included having adequate instruction as well as having a designated space. Hindering factors included unrealistic models and equipment. In clinical practice, facilitating factors included having the opportunities to practise skills and support and feedback from the mentor. Hindering factors included deficits in the student-mentor relationship. this study highlighted that midwifery students must be adequately prepared to carry out clinical skills competently and effectively. Educators and mentors must provide adequate support and feedback to promote transfer of knowledge and skills into the workplace to optimise high standards of care for women and their babies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Rh Factor Blood Test

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The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

PubMed

Hansen, Dominique; Dendale, Paul; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Niebauer, Josef; Cornelissen, Veronique; Pedretti, Roberto; Geurts, Eva; Ruiz, Gustavo R; Corrà, Ugo; Schmid, Jean-Paul; Greco, Eugenio; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona S; Barna, Olga; Beckers, Paul; Bussotti, Maurizio; Fagard, Robert; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Neunhäuserer, Daniel; Reibis, Rona; Spruit, Martijn A; Stettler, Christoph; Takken, Tim; Tonoli, Cajsa; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick

2017-07-01

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

Genetic Counsellors and Private Practice: Professional Turbulence and Common Values.

PubMed

Collis, Sarah; Gaff, Clara; Wake, Samantha; McEwen, Alison

2017-12-27

Genetic counsellors face tensions between past and future identities: between established values and goals, and a broadening scope of settings and activities. This study examines the advent of genetic counsellors in private practice in Australia and New Zealand from the perspectives of the small numbers working in this sector and those who have only worked in public practice. Semi-structured interviews were conducted with 16 genetic counsellors who had experience in private practice, and 14 genetic counsellors without private sector experience. Results demonstrated that circumstantial and personal factors can mitigate the challenges experienced and the amount of support desired by those who had established a private practice, and those who were employed by private companies. Notably, most participants with private sector experience perceived themselves to be viewed negatively by other genetic counsellors. Most participants without private sector experience expressed concern that the challenges they believed genetic counsellors face in private practice may impact service quality, but wished to address such concerns by providing appropriate support. Together, our results reinforce that participants in private and public sectors are strong advocates for peer support, multidisciplinary team work, and professional development. These core values, and seeking understanding of different circumstances and support needs, will enable genetic counsellors in different sectors to move forward together. Our results suggest supports that may be acted upon by members of the profession, professional groups, and training programs, in Australia, New Zealand, and overseas.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa

PubMed Central

Daire, Judith; Gilson, Lucy

2014-01-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. PMID:25274644

The Association between Parent Early Adult Drug Use Disorder and Later Observed Parenting Practices and Child Behavior Problems: Testing Alternate Models

PubMed Central

Bailey, Jennifer A.; Hill, Karl G.; Guttmannova, Katarina; Oesterle, Sabrina; Hawkins, J. David; Catalano, Richard F.; McMahon, Robert J.

2012-01-01

This study tested the association between parent illicit drug use disorder (DUD) in early adulthood and observed parenting practices at ages 27 – 28 and examined the following three, theoretically-derived models explaining this link: a) a disrupted parent adult functioning model, b) a pre-existing parent personality factor model, c) a disrupted adolescent family process model. Associations between study variables and child externalizing problems also were examined. Longitudinal data linking two generations were drawn from the Seattle Social Development Project (SSDP) and The SSDP Intergenerational Project (TIP), and included 167 parents and their 2- to 8-year-old child. Path modeling revealed that parent DUD in early adulthood predicted later observed low-skilled parenting, which was related to child externalizing problems. The pre-existing parent personality factor model was supported. Parent negative emotionality accounted for the association between parent early adult DUD and later parenting practices. Parent negative emotionality also was related directly to child externalizing behavior. Limited support for the disrupted transition to adulthood model was found. The disrupted adolescent family process model was not supported. Results suggest that problem drug use that occurs early in adulthood may affect later parenting skills, independent of subsequent parent drug use. Findings highlight the importance of parent negative emotionality in influencing their own problem behavior, their interactions with their child, and their child’s problem behavior. Prevention and treatment programs targeting young adult substance use, poor parenting practices, and child behavior problems should address parent personality factors that may contribute to these behaviors. PMID:22799581

The association between parent early adult drug use disorder and later observed parenting practices and child behavior problems: testing alternate models.

PubMed

Bailey, Jennifer A; Hill, Karl G; Guttmannova, Katarina; Oesterle, Sabrina; Hawkins, J David; Catalano, Richard F; McMahon, Robert J

2013-05-01

This study tested the association between parent illicit drug use disorder (DUD) in early adulthood and observed parenting practices at ages 27-28 and examined the following 3 theoretically derived models explaining this link: (a) a disrupted parent adult functioning model,(b) a preexisting parent personality factor model, and (c) a disrupted adolescent family process model. Associations between study variables and child externalizing problems also were examined. Longitudinal data linking 2 generations were drawn from the Seattle Social Development Project (SSDP) and The SSDP Intergenerational Project (TIP), and included 167 parents and their 2- to 8-year-old child. Path modeling revealed that parent DUD in early adulthood predicted later observed low-skilled parenting, which was related to child externalizing problems. The preexisting parent personality factor model was supported. Parent negative emotionality accounted for the association between parent early adult DUD and later parenting practices. Parent negative emotionality also was related directly to child externalizing behavior. Limited support for the disrupted transition to adulthood model was found. The disrupted adolescent family process model was not supported. Results suggest that problem drug use that occurs early in adulthood may affect later parenting skills, independent of subsequent parent drug use. Findings highlight the importance of parent negative emotionality in influencing his or her own problem behavior, interactions with his or her child, and his or her child's problem behavior. Prevention and treatment programs targeting young adult substance use, poor parenting practices, and child behavior problems should address parent personality factors that may contribute to these behaviors.

Critical thinking: Reported enhancers and barriers by nurses in long-term care: implications for staff development.

PubMed

Raterink, Ginger

2011-01-01

Nursing acknowledges critical thinking as an important guide to clinical decision making. Agreement on how to define, teach, and evaluate this skill is lacking. The purpose of this study was to evaluate critical thinking in practice using a survey that asked nurses to evaluate work-related factors that enhance or pose barriers to the use of critical thinking in practice. Results indicated that enhancers and barriers to practice included teamwork, staffing patterns, and staff and administrator support. A relationship with patients was the most satisfying factor, whereas paperwork was the least. Staff development educators must consider the work environment aspects that affect performance and create the life long learning needed for increased competency in practice.

Decision-making in nursing practice: An integrative literature review.

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes. © 2017 John Wiley & Sons Ltd.

Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: a questionnaire survey conducted in Japan.

PubMed

Okato, Ayumi; Hashimoto, Tasuku; Tanaka, Mami; Tachibana, Masumi; Machizawa, Akira; Okayama, Jun; Endo, Mamiko; Senda, Masayoshi; Saito, Naoki; Iyo, Masaomi

2018-01-01

Child abuse and/or neglect is a serious issue, and in many cases, parents are the perpetrators. Hospital-based child protection teams (CPTs) play pivotal roles in the management of not only abused and/or neglected children but also of their parents; this is generally conducted through multidisciplinary practice. The aim of this study is to survey hospital-based CPT members to determine the professions they perceive to be most applicable to participation in CPTs. The participants were members of CPTs affiliated with hospitals that had pediatric emergency departments and which were located in Chiba Prefecture; specifically, 114 CPT members from 23 hospitals responded to this survey. The two main questionnaire items concerned are as follows: 1) each respondent's evaluation of conducting assessments, providing support, and implementing multidisciplinary collaborative practice in the treatment of abusive and negligent parents, and 2) each CPT member's opinion on the professions that are most important for CPT activities. An exploratory factor analysis (EFA) was performed to explore the factor structure of the data, and a correlation analysis was performed using the result obtained. The EFA returned two factors: multidisciplinary collaborative practice (α = 0.84) and assessment and support (α = 0.89). A correlational analysis showed that multidisciplinary collaborative practice had a positive correlation for obstetricians ( r = 0.315, p = 0.001), neonatologists ( r = 0.261, p = 0.007), midwives ( r = 0.248, p = 0.011), and psychiatrists ( r = 0.194, p = 0.048); however, assessment and support was only significantly correlated with midwives ( r = 0.208, p = 0.039). This study showed that hospital-based CPT members highly evaluate multidisciplinary collaborative practice for the management of abusive and/or negligent parents, and they believe that, in addition to pediatric physicians and nurses, perinatal care and mental health professionals are the most important participants in advanced CPT activities.

Measurement invariance of an instrument assessing sustainability of school-based universal behavior practices.

PubMed

Mercer, Sterett H; McIntosh, Kent; Strickland-Cohen, M Kathleen; Horner, Robert H

2014-06-01

The purpose of the study was to examine the extent to which the School-Wide Universal Behavior Sustainability Index: School Teams (SUBSIST; McIntosh, Doolittle, Vincent, Horner, & Ervin, 2009), a measure of school and district contextual factors that promote the sustainability of school practices, demonstrated measurement invariance across groups of schools that differed in length of time implementing school-wide Positive Behavioral Interventions and Supports (PBIS; Sugai & Horner, 2009), student ethnic composition, and student socioeconomic status (SES). School PBIS team members and district coaches representing 860 schools in 14 U.S. states completed the SUBSIST. Findings supported strong measurement invariance, for all items except 1, of a model with two school-level factors (School Priority and Team Use of Data) and 2 district-level factors (District Priority and Capacity Building) across groups of schools at initial implementation, institutionalization, and sustainability phases of PBIS implementation. Schools in the sustainability phase were rated significantly higher on School Priority and Team Use of Data than schools in initial implementation. Strong measurement invariance held across groups of schools that differed in student ethnicity and SES. The findings regarding measurement invariance are important for future longitudinal investigations of factors that may promote the sustained implementation of school practices. PsycINFO Database Record (c) 2014 APA, all rights reserved.

School-related social support and subjective well-being in school among adolescents: The role of self-system factors.

PubMed

Tian, Lili; Zhao, Jie; Huebner, E Scott

2015-12-01

This 6-week longitudinal study aimed to examine a moderated mediation model that may explain the link between school-related social support (i.e., teacher support and classmate support) and optimal subjective well-being in school among adolescents (n = 1316). Analyses confirmed the hypothesized model that scholastic competence partially mediated the relations between school-related social support and subjective well-being in school, and social acceptance moderated the mediation process in the school-related social support--> subjective well-being in school path and in the scholastic competence--> subjective well-being in school path. The findings suggested that both social contextual factors (e.g., school-related social support) and self-system factors (e.g., scholastic competence and social acceptance) are crucial for adolescents' optimal subjective well-being in school. Limitations and practical applications of the study were discussed. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The Effects of Organizational Learning Environment Factors on E-Learning Acceptance

ERIC Educational Resources Information Center

Cheng, Bo; Wang, Minhong; Moormann, Jurgen; Olaniran, Bolanle A.; Chen, Nian-Shing

2012-01-01

Workplace learning is an important means of employees' continuous learning and professional development. E-learning is being recognized as an important supportive practice for learning at work. Current research on the success factors of e-learning in the workplace has emphasized on employees' characteristics, technological attributes, and training…

Contextual Factors Related to Implementation and Reach of a Pragmatic Multisite Trial– The My Own Health Report (MOHR) Study

PubMed Central

Balasubramanian, Bijal A.; Heurtin-Roberts, Suzanne; Krasny, Sarah; Rohweder, Catherine; Fair, Kayla; Olmos, Tanya; Stange, Kurt C.; Gorin, Sherri Sheinfeld

2018-01-01

Background Contextual factors relevant to health care improvement studies are important for translating findings to other settings; however, these are rarely collected systematically and reported. This study articulates a prospective method for assessing contextual factors and describes factors related to implementation and patient reach of a pragmatic multisite trial conducted in nine primary care practices. Methods In a qualitative case-series, contextual factors were assessed from the My Own Health Report (MOHR) study, focused on systematically conducting health risk assessments and goal setting for unhealthy behaviors and behavioral health in primary care. Data were collected prospectively at baseline, mid-point, and end of intervention using a template that guided conduct of interviews and observations at practice sites. A multidisciplinary team used an iterative process to summarize themes describing contextual factors related to intervention implementation and patient reach, calculated by dividing the number of patients who completed the MOHR assessment by the number of patients offered MOHR. Results Contextual factors operational both within and external to the practice environment influenced implementation and patient reach over time. These included practice members’ motivations towards the MOHR intervention, practice staff capacity to take on additional responsibilities for implementation, practice information system capacity, external resources to support quality improvement, linkages with community resources, and fit of implementation strategy to patient populations. Conclusions Systematic assessment of contextual factors throughout implementation of quality improvement initiatives is needed to meaningfully interpret findings and translate lessons learned to other health care settings. Thus, knowledge of contextual factors is essential for scaling up of effective improvement strategies. PMID:28484066

The stakeholder preference for best management practices in the Three Gorges Reservoir Region.

PubMed

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived (P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

The Stakeholder Preference for Best Management Practices in the Three Gorges Reservoir Region

NASA Astrophysics Data System (ADS)

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived ( P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

Investigating the importance of various individual, interpersonal, organisational and demographic variables when predicting job burnout in disability support workers.

PubMed

Vassos, Maria V; Nankervis, Karen L

2012-01-01

Previous research has highlighted that factors such as large workload, role ambiguity, lack of support from colleagues, and challenging behaviour are associated with higher levels of burnout within the disability support worker (DSW) population. The aim of this research was to investigate which factors contribute the most to the prediction of the three facets of burnout--feeling exhausted and overextended by one's work (emotional exhaustion), detached and callous responses towards work (depersonalisation) and a lack of achievement and productivity within one's role (personal accomplishment). The factors chosen for analysis within this research were analysed within four categories linked to theories of burnout development (individual, interpersonal, organisational and demographic). A sample of 108 DSWs completed a questionnaire booklet that contained standardised measures of burnout and job stressors related to disability work. Results highlighted the importance of predictors such as challenging behaviour (interpersonal), workload (individual), supervisor support (individual), work-home conflict (individual), job feedback (individual), role ambiguity (organisational), low job status (organisational), role conflict (organisational), gender (demographic) and work hours (demographic) when predicting one or more of the facets of burnout. In conclusion, disability services and organisations may benefit from focusing on remodelling their staff-related organisational practices in order to prevent the development of burnout in their DSWs (e.g., increase supervision and support practices). Copyright © 2012 Elsevier Ltd. All rights reserved.

INCOMMANDS TDP: Human Factors Evaluation of the Command Decision Support Capability Prototype

DTIC Science & Technology

2009-03-01

CDSC) design with guidelines and principles stipulated in the INCOMMANDS TDP Human Factors Design and Evaluation Guide. 2. Usability and Utility...INCOMMANDS CDSC. The Heuristic Evaluation helps to ensure that the design of system is compliant with HCI best practices. Whereas the Usability and...implemented to confirm compliance with the INCOMMANDS TDP Human Factors Design and Evaluation Guide

Building new WDM regulations for the Namibian tourism sector on factors influencing current water-management practices at the enterprise level

NASA Astrophysics Data System (ADS)

Schachtschneider, Klaudia

Namibia's aridity is forcing its water sector to resort to new water resource management approaches, including water demand management (WDM). Such a change in management approach is facilitated through the country's opportunity at independence to rewrite and adapt its old policies, including those for water and tourism. Legal support for WDM through the Water Act and other sector-specific Acts is crucial to plan the practical implementation of WDM throughout the different water use sectors of Namibia. In order to be able to put the policy into practice, it is imperative to understand which factors motivate people to adopt WDM initiatives. Within the Namibian tourism industry three main factors have been identified which influence the water-management approaches at tourist facilities. This paper discusses how the water and tourism decision makers can consider these factors when developing new regulations to introduce WDM in the tourism sector.

Examining the Factor Structure and Reliability of the Safe Patient Handling Perception Scale: An Initial Validation Study.

PubMed

White-Heisel, Regina; Canfield, James P; Young-Hughes, Sadie

Perceiving imminent safe patient handling and movement (SPH&M) dangers may reduce musculoskeletal (MSK) injuries for nurses in the workplace. The purpose of this study is to develop and validate the 17-item Safe Patient Handling Perception Scale (SPHPS) as an evaluation instrument assessing perceptual risk of MSK injury based on SPH&M knowledge, practice, and resource accessibility in the workplace. Data were collected from a convenience sample (N = 117) of nursing employees at a Veteran Affairs Medical Center. Factor analysis identified three factors: knowledge, practice, and accessibility. The SPHPS demonstrated high levels of reliability, supported by acceptable alpha scores (SPHM knowledge [α = .866], SPHM practices [α = .901], and access to SPHM resources [α = .855]), in addition to the relatively low standard error of measurement scores (SEM). The study outcomes suggest that the SPHPS is a valid and reliable tool that can measure participants' perceived risk factors for MSK injuries.

Explaining use of food parenting practices: the importance of predisposing factors and parental cognitions.

PubMed

Gevers, Dorus Wm; van Assema, Patricia; de Vries, Nanne K; Kremers, Stef Pj

2017-09-01

The high energy intake from energy-dense foods among children in developed countries is undesirable. Improving food parenting practices has the potential to lower snack intakes among children. To inform the development of interventions, we aimed to predict food parenting practice patterns around snacking (i.e. 'high covert control and rewarding', 'low covert control and non-rewarding', 'high involvement and supportive' and 'low involvement and indulgent'). A cross-sectional survey was conducted. To predict the patterns of food parenting practices, multinomial logistic regression analyses were run with 888 parents. Predictors included predisposing factors (i.e. parents' and children's demographics and BMI, parents' personality, general parenting, and parenting practices used by their own parents) and parents' cognitions (i.e. perceived behaviour of other parents, subjective norms, attitudes, self-efficacy and outcome expectations). The Netherlands (October-November 2014). Dutch parents of children aged 4-12 years old. After backward elimination, nineteen factors had a statistically significant contribution to the model (Nagelkerke R 2=0·63). Overall, self-efficacy and outcome expectations were among the strongest explanatory factors. Considering the predisposing factors only, the general parenting factor nurturance most strongly predicted the food parenting clusters. Nurturance particularly distinguished highly involved parents from parents employing a pattern of low involvement. Parental cognitions and nurturance are important factors to explain the use of food parenting practices around snacking. The results suggest that intervention developers should attempt to increase self-efficacy and educate parents about what constitute effective and ineffective parenting practices. Promoting nurturance might be a prerequisite to achieve prolonged change.

The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice.

PubMed

Ginsburg, Liane; Castel, Evan; Tregunno, Deborah; Norton, Peter G

2012-08-01

Enhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature. Confirmatory factor analytic approaches are used to extensively test the Health Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors. Results support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups. Given increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important.

The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice

PubMed Central

Castel, Evan; Tregunno, Deborah; Norton, Peter G

2012-01-01

Background Enhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature. Methods Confirmatory factor analytic approaches are used to extensively test the Health Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors. Results Results support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups. Conclusions Given increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important. PMID:22562876

Burnout, career satisfaction, and well-being among US neurologists in 2016

PubMed Central

Shanafelt, Tait D.; Keran, Christopher M.; Levin, Kerry H.; Schwarz, Heidi B.; Molano, Jennifer R.; Vidic, Thomas R.; Kass, Joseph S.; Miyasaki, Janis M.; Sloan, Jeff A.; Cascino, Terrence L.

2017-01-01

Objective: To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. Methods: A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016. Results: Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction. Conclusions: Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists. PMID:28122905

Burnout, career satisfaction, and well-being among US neurologists in 2016.

PubMed

Busis, Neil A; Shanafelt, Tait D; Keran, Christopher M; Levin, Kerry H; Schwarz, Heidi B; Molano, Jennifer R; Vidic, Thomas R; Kass, Joseph S; Miyasaki, Janis M; Sloan, Jeff A; Cascino, Terrence L

2017-02-21

To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016. Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction. Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists. © 2017 American Academy of Neurology.

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

PubMed

Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

2016-05-13

Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

Implementing Schoolwide Positive Behavior Interventions and Supports in High Schools: Contextual Factors and Stages of Implementation

ERIC Educational Resources Information Center

Swain-Bradway, Jessica; Pinkney, Christopher; Flannery, K. Brigid

2015-01-01

Schoolwide positive behavior interventions and supports (SWPBIS) are an increasingly popular framework for school improvement practices, but many high schools are still lagging behind their elementary counterparts. High school leadership teams can struggle with merging the SWPBIS framework with current operations, and there are limited examples of…

Institutional Factors for Supporting Electronic Learning Communities

ERIC Educational Resources Information Center

Linton, Jayme N.

2017-01-01

This study was designed to explore how the electronic learning community (eLC) process at an established state virtual high school (SVHS) supported new and veteran online high school teachers through the communities of practice (CoP) framework. Specifically, this study focused on the institutionally-driven nature of the eLC process, using Wenger's…

Mentors' Views of Factors Essential for the Success of Beginning Teachers

ERIC Educational Resources Information Center

Barrera, Arnold; Braley, Richard; Slate, John R.

2008-01-01

The views of 46 mentors of first-year teachers were obtained regarding practices that they viewed as essential for their success in mentoring teachers. Specifically, they were queried about teacher involvement/support, staff development, administrative support, and resource materials. Almost all of the mentor teachers believed a teacher-mentoring…

Doing the Math: Supporting Students with Disabilities in Online Courses

ERIC Educational Resources Information Center

Serianni, Barbara A.; Coy, Kimberly

2014-01-01

The purpose of this article is to provide teachers and parents with a framework and practical ideas for supporting their students with disabilities in online mathematics. Through the fictional scenarios involving Martin and Liana, factors that may contribute to a successful online learning experience will be explored, highlighting the benefits and…

Self-Care for Health in Rural Hispanic Women at Risk for Postpartum Depression.

PubMed

Kim, Younglee; Dee, Vivien

2017-01-01

To determine factors that affect self-care of rural Hispanic women at risk for postpartum depression (PPD). This study was a descriptive cross-sectional design based on the key concepts of Orem's Self-care Deficit Nursing theory. Data were collected from 223 Hispanic postpartum women residing in Mecca, North Shore, and Thermal in California by an interviewer-administered survey. Four instruments were utilized: Edinburgh Postnatal Depression Scale (EPDS) for PPD, Multidimensional Scale of Perceived Social Support for social support, Duke University Religion Index (DUREL) for spirituality, and Self Rated Abilities for Health Practices for self-care. The prevalence of women at risk for PPD was about 43 %. Social support, spirituality, and self-care ability were significantly correlated in women with PPD. Social support was a strong factor in predicting self-care ability for 'Nutrition', 'Psychological well-being', 'Exercise', and 'Responsible Health Practices' in the rural Hispanic women at risk for PPD. The study findings can enable nurses and healthcare professionals to develop effective tailored interventions to assist rural Hispanic women's abilities to perform self-care for health, and in particular, during the postpartum period.

Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia.

PubMed

Gagnon, Marie-Pierre; Sánchez, Emília; Pons, Joan M V

2006-01-01

Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies. Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors. At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice. This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.

Leading Schools with Migrant Children in Shanghai: Understanding Policies and Practices

ERIC Educational Resources Information Center

Qian, Haiyan; Walker, Allan David

2017-01-01

Purpose: The purpose of this paper is threefold: to sketch the current policy context that frames the education of migrant children in Shanghai; to explore the work lives of school leaders in the privately owned but government-supported schools; and to understand the socio-cultural and educational factors that shape the leadership practices in…

Practices of and Roadblocks to Teacher Leadership in the United Arab Emirates' Schools

ERIC Educational Resources Information Center

Al-Taneiji, Shaikah; Ibrahim, Ali

2017-01-01

This study investigates teachers' perceptions of their leadership practices in United Arab Emirates schools and the contextual and personal factors which support or deter them from becoming teacher leaders. The study used a mixed research design. First, a self-administered questionnaire was completed by 937 teachers in one big city in the UAE.…

Moving Science off the "Back Burner": Meaning Making within an Action Research Community of Practice

ERIC Educational Resources Information Center

Goodnough, Karen

2008-01-01

In this study, the participants conceptualized and implemented an action research project that focused on the infusion of inquiry principles into a neglected science curriculum. Specific objectives were to find (a) What factors challenge and support the evolution of an action research community of practice? (b) How are teachers' beliefs about…

Navigating the Challenges of Becoming a Culturally Responsive Teacher: Supportive Networking May Be the Key

ERIC Educational Resources Information Center

Nilsson, Nina L.; Kong, Ailing; Hubert, Shantel

2016-01-01

Research shows graduates of teacher education programs do not always transfer, or apply, the best practices they learn to instructional practice due to factors related to course features, the student, and workplace environment (e.g., Brown & Bentley, 2004; de Jong et al., 2010). This study examined the challenges a secondary-level English…

The James Supportive Care Screening: integrating science and practice to meet the NCCN guidelines for distress management at a Comprehensive Cancer Center.

PubMed

Wells-Di Gregorio, Sharla; Porensky, Emily K; Minotti, Matthew; Brown, Susan; Snapp, Janet; Taylor, Robert M; Adolph, Michael D; Everett, Sherman; Lowther, Kenneth; Callahan, Kelly; Streva, Devita; Heinke, Vicki; Leno, Debra; Flower, Courtney; McVey, Anne; Andersen, Barbara Lee

2013-09-01

Selecting a measure for oncology distress screening can be challenging. The measure must be brief, but comprehensive, capturing patients' most distressing concerns. The measure must provide meaningful coverage of multiple domains, assess symptom and problem-related distress, and ideally be suited for both clinical and research purposes. From March 2006 to August 2012, the James Supportive Care Screening (SCS) was developed and validated in three phases including content validation, factor analysis, and measure validation. Exploratory factor analyses were completed with 596 oncology patients followed by a confirmatory factor analysis with 477 patients. Six factors were identified and confirmed including (i) emotional concerns; (ii) physical symptoms; (iii) social/practical problems; (iv) spiritual problems; (v) cognitive concerns; and (vi) healthcare decision making/communication issues. Subscale evaluation reveals good to excellent internal consistency, test-retest reliability, and convergent, divergent, and predictive validity. Specificity of individual items was 0.90 and 0.87, respectively, for identifying patients with DSM-IV-TR diagnoses of major depression and generalized anxiety disorder. Results support use of the James SCS to quickly detect the most frequent and distressing symptoms and concerns of cancer patients. The James SCS is an efficient, reliable, and valid clinical and research outcomes measure. Copyright © 2013 John Wiley & Sons, Ltd.

Confirmatory Factor Analysis of the Combined Social Phobia Scale and Social Interaction Anxiety Scale: Support for a Bifactor Model.

PubMed

Gomez, Rapson; Watson, Shaun D

2017-01-01

For the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) together, this study examined support for a bifactor model, and also the internal consistency reliability and external validity of the factors in this model. Participants ( N = 526) were adults from the general community who completed the SPS and SIAS. Confirmatory factor analysis (CFA) of their ratings indicated good support for the bifactor model. For this model, the loadings for all but six items were higher on the general factor than the specific factors. The three positively worded items had negligible loadings on the general factor. The general factor explained most of the common variance in the SPS and SIAS, and demonstrated good model-based internal consistency reliability (omega hierarchical) and a strong association with fear of negative evaluation and extraversion. The practical implications of the findings for the utilization of the SPS and SIAS, and the theoretical and clinical implications for social anxiety are discussed.

Confirmatory Factor Analysis of the Combined Social Phobia Scale and Social Interaction Anxiety Scale: Support for a Bifactor Model

PubMed Central

Gomez, Rapson; Watson, Shaun D.

2017-01-01

For the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) together, this study examined support for a bifactor model, and also the internal consistency reliability and external validity of the factors in this model. Participants (N = 526) were adults from the general community who completed the SPS and SIAS. Confirmatory factor analysis (CFA) of their ratings indicated good support for the bifactor model. For this model, the loadings for all but six items were higher on the general factor than the specific factors. The three positively worded items had negligible loadings on the general factor. The general factor explained most of the common variance in the SPS and SIAS, and demonstrated good model-based internal consistency reliability (omega hierarchical) and a strong association with fear of negative evaluation and extraversion. The practical implications of the findings for the utilization of the SPS and SIAS, and the theoretical and clinical implications for social anxiety are discussed. PMID:28210232

Practice change in community pharmacy: quantification of facilitators.

PubMed

Roberts, Alison S; Benrimoj, Shalom I; Chen, Timothy F; Williams, Kylie A; Aslani, Parisa

2008-06-01

There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated individually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors. To quantify facilitators of practice change in Australian community pharmacies. We employed a literature review and qualitative study to facilitate the design of a 43-item "facilitators of practice change" scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random sample of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's alpha, respectively. A total of 735 (37%) pharmacies responded, with 1303 individual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59-0.85; Cronbach's alpha 0.90), remuneration (0.52-0.74; 0.82), pharmacy layout (0.52-0.79; 0.81), patient expectation (0.52-0.85; 0.82), manpower/staff (0.49-0.66; 0.80), communication and teamwork (0.37-0.65; 0.77), and external support/assistance (0.47-0.69; 0.74). All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business, engaging pharmacists and their staff, policy makers, educators, and researchers. Further research is required to determine additional factors impacting the capacity of community pharmacies to implement change.

Novel setting for addressing tobacco-related disparities: a survey of community welfare organization smoking policies, practices and attitudes.

PubMed

Bonevski, B; O'Brien, J; Frost, S; Yiow, L; Oakes, W; Barker, D

2013-02-01

Research in the United States and Australia acknowledges the potential of non-government social and community service organizations (SCSOs) for reaching socially disadvantaged smokers. This study aimed to describe SCSO smoking policies and practices, and attitudes of senior staff towards smoking and cessation. It also investigated factors associated with positive tobacco control attitudes. In 2009, a cross-sectional telephone survey was undertaken of senior staff in Australian SCSOs, 149 respondents representing 93 organizations completed the survey (response rate=65%; 93/142). Most service clients (60%) remained in programs for 6 months plus, and 77% attended at least weekly. Although 93% of respondents indicated they had an organizational smoking policy, it often did not include the provision of smoking cessation support. Most respondents indicated that client smoking status was not recorded on case notes (78%). Attitudes were mostly positive towards tobacco control in SCSOs, with a mean (standard deviation) score of 8.3 (2.9) of a possible 13. The practice of assessing clients' interest in quitting was the only statistically significant factor associated with high tobacco control attitude scores. The results suggest that SCSOs are appropriate settings for reaching socially disadvantaged smokers with cessation support. Although generally receptive to tobacco control, organizations require further support to integrate smoking cessation support into usual care. In particular, education, training and support for staff to enable them to help their clients quit smoking is important.

Novel setting for addressing tobacco-related disparities: a survey of community welfare organization smoking policies, practices and attitudes

PubMed Central

Bonevski, B.; O’Brien, J.; Frost, S.; Yiow, L.; Oakes, W.; Barker, D.

2013-01-01

Research in the United States and Australia acknowledges the potential of non-government social and community service organizations (SCSOs) for reaching socially disadvantaged smokers. This study aimed to describe SCSO smoking policies and practices, and attitudes of senior staff towards smoking and cessation. It also investigated factors associated with positive tobacco control attitudes. In 2009, a cross-sectional telephone survey was undertaken of senior staff in Australian SCSOs, 149 respondents representing 93 organizations completed the survey (response rate = 65%; 93/142). Most service clients (60%) remained in programs for 6 months plus, and 77% attended at least weekly. Although 93% of respondents indicated they had an organizational smoking policy, it often did not include the provision of smoking cessation support. Most respondents indicated that client smoking status was not recorded on case notes (78%). Attitudes were mostly positive towards tobacco control in SCSOs, with a mean (standard deviation) score of 8.3 (2.9) of a possible 13. The practice of assessing clients’ interest in quitting was the only statistically significant factor associated with high tobacco control attitude scores. The results suggest that SCSOs are appropriate settings for reaching socially disadvantaged smokers with cessation support. Although generally receptive to tobacco control, organizations require further support to integrate smoking cessation support into usual care. In particular, education, training and support for staff to enable them to help their clients quit smoking is important. PMID:22798564

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: a time-lagged study.

PubMed

Spence Laschinger, Heather K; Nosko, Amanda; Wilk, Piotr; Finegan, Joan

2014-12-01

Recruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction. To test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses' job satisfaction were also examined. This study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model. Nurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment. The results suggest that nurses' job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses' satisfaction with their work in creating effective nursing work environments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study

PubMed Central

Maitrot, Mathilde Rose Louise

2017-01-01

Background Nutritional status differs between infants and young children living in slum and non-slum conditions—infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums. Methods This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted. Results Feeding practices for infants and young children in families with working mothers are broadly determined by mothers’ occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors. Conclusion The results suggest a trade-off between mothers’ work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes. PMID:28207894

A descriptive qualitative examination of knowledge translation practice among health researchers in Manitoba, Canada.

PubMed

Sibley, Kathryn M; Roche, Patricia L; Bell, Courtney P; Temple, Beverley; Wittmeier, Kristy D M

2017-09-06

The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT. Qualitative semi-structured interviews were conducted with 26 researchers studying in biomedical; clinical; health systems and services; and social, cultural, environmental and population health research. Interview questions were open-ended and probed participants' understanding of KT, their experiences in practicing KT, barriers and facilitators to practicing KT, and their needs for KT practice support. KT was broadly conceptualized across participants. Participants described a range of KT practice experiences, most of which related to dissemination. Participants also expressed a number of negative emotions associated with the practice of KT. Many individual, logistical, and systemic or organizational barriers to practicing KT were identified, which included a lack of institutional support for KT in both academic and non-academic systems. Participants described the presence of good relationships with stakeholders as a critical facilitator for practicing KT. The most commonly identified needs for supporting KT practice were access to education and training, and access to resources to increase awareness and promotion of KT. While there were few major variations in response trends across most areas of health research, the responses of biomedical researchers suggested a unique KT context, reflected by distinct conceptualizations of KT (such as commercialization as a core component), experiences (including frustration and lack of support), and barriers to practicing KT (for example, intellectual property concerns). The major findings of this study were the continued variations in conceptualization of KT, and persisting support needs that span basic individual to comprehensive systemic change. Expanding the study to additional regions of Canada will present opportunities to compare and contrast the state of KT practice and its influencing factors.

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

PubMed

Numminen, Olivia; Ruoppa, Eija; Leino-Kilpi, Helena; Isoaho, Hannu; Hupli, Maija; Meretoja, Riitta

2016-01-01

To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce. © 2015 John Wiley & Sons Ltd.

Hiring, Training, and Supporting Online Faculty for Higher Student Retention Efforts

ERIC Educational Resources Information Center

Portugal, Lisa Marie

2015-01-01

This study was a phenomenological study examining the experiences of faculty teaching in an online learning environment in order to identify the factors that could produce job burnout and stress in master's programs in education. The challenges and related stress-producing factors were also explored to identify best practices for online faculty…

The Relationship between Teacher Attitudes toward the Common Core State Standards and Informational Text

ERIC Educational Resources Information Center

Estruch, Marcie Jane

2018-01-01

This study sought to determine the relationship between teachers' attitudes toward the Common Core State Standards and three predetermined factors. These factors were (1) teachers' attitudes toward the practicality of pedagogical shift three, balancing informational and literary texts, (2) teachers' attitudes toward school support with the…

Factors affecting science reform: Bridging the gap between reform initiatives and teaching practices

NASA Astrophysics Data System (ADS)

Pensak, Karl John

In response to the perceived deficiencies in science education today, and to the expressed need for research into the culture of schools (due primarily to the failure of many science reforms in the past), this study used a broad based approach to study the gap between science education research and science education practice. This study identified 47 factors that may encourage or inhibit science curriculum reform. A survey was conducted to determine which factors were perceived to be important by local and national K-12 classroom teachers, science supervisors/coordinators, and college/university professors. Continual staff development (scheduled as part of teachers' work day/week/month), funding (for long-term staff development, teacher training and support, science laboratory facilities and materials), teacher motivation and "ownership" of the reform, the need for collaborative opportunities for classroom teachers, teachers' college preparation, textbook reform, community support, and reform initiatives that are "in tune" with assessment, are major factors identified as having a substantial affect on the successful adoption, implementation, and institutionalization of science reforms.

Promoting teacher quality and retention in special education.

PubMed

Billingsley, Bonnie S

2004-01-01

Qualified special educators are needed to carry out research-based practices in schools. The shortage of special educators, the high numbers of uncertified teachers, and high attrition rates threaten the practice of science in the schoolhouse and, consequently, the education that students with disabilities receive. If teachers are to use research-based practices to benefit students with disabilities, care must be directed toward teachers, what they do, and the complex conditions in which their practice occurs. In this discussion, I focus on four factors that are important to special education teacher retention--responsive induction programs, deliberate role design, positive work conditions and supports, and professional development. These retention-enhancing factors also serve to cultivate qualified special educators by providing the conditions in which they can thrive and grow professionally.

How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study.

PubMed

Parker, Vicki; McNeil, Karen; Higgins, Isabel; Mitchell, Rebecca; Paliadelis, Penelope; Giles, Michelle; Parmenter, Glenda

2013-12-01

Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn't and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.

How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study

PubMed Central

2013-01-01

Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. Conclusions The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP. PMID:24289815

[Accidents and violence in childhood and adolescence: risk and protective factors].

PubMed

Martins, Christine Baccarat de Godoy

2013-01-01

Singled out by statistics as the third leading cause of mortality in our country, external causes (accidents and violence) entail a great impact with economic, social and emotional rebound. Knowing the factors related to the event is essential, because it allows identifying and breaking the web that determines morbidity and mortality from external causes. The study aims to analyze the existing publications on the factors associated with accidents and violence, in order to provide theoretical support for professionals in their practices. This is a bibliographical study of the Liliacs, Medline and Scielo databanks. The knowledge of the risk and protection factors discussed in the present study enables subsidize the practice of social actors engaged in transforming the conditions that lead to accidents and violence.

Field evaluation of support practice (P-factor) for stone walls to control soil erosion in an arid area (Northern Jordan)

NASA Astrophysics Data System (ADS)

Gharaibeh, Mamoun; Albalasmeh, Ammar

2017-04-01

Stone walls have been adopted for long time to control water erosion in many Mediterranean countries. In soil erosion equations, the support practice factor (P-factor) for stone walls has not been fully studied or rarely taken into account especially in semi-arid and arid regions. Field studies were conducted to evaluate the efficiency of traditional stone walls and to quantify soil erosion in six sites in north and northeastern Jordan. Initial estimates using the Universal Soil Loss Equation (USLE) showed that rainfall erosion was reduced by 65% in areas where stone walls are present. Annual soil loss ranged from 5 to 15 t yr-1. The mean annual soil loss in the absence of stone walls ranged from 10-60 t ha-1 with an average value of 35 t ha-1. Interpolating the slope of thickness of A horizon provided an average initial estimate of 0.3 for P value.

A qualitative study of experienced nurses' voluntary turnover: learning from their perspectives.

PubMed

Hayward, Dana; Bungay, Vicky; Wolff, Angela C; MacDonald, Valerie

2016-05-01

The purpose of this research was to critically examine the factors that contribute to turnover of experienced nurses' including their decision to leave practice settings and seek alternate nursing employment. In this study, we explore experienced nurses' decision-making processes and examine the personal and environmental factors that influenced their decision to leave. Nursing turnover remains a pressing problem for healthcare delivery. Turnover contributes to increased recruitment and orientation cost, reduced quality patient care and the loss of mentorship for new nurses. A qualitative, interpretive descriptive approach was used to guide the study. Interviews were conducted with 12 registered nurses, averaging 16 years in practice. Participants were equally represented from an array of acute care inpatient settings. The sample drew on perspectives from point-of-care nurses and nurses in leadership roles, primarily charge nurses and clinical nurse educators. Nurses' decisions to leave practice were influenced by several interrelated work environment and personal factors: higher patient acuity, increased workload demands, ineffective working relationships among nurses and with physicians, gaps in leadership support and negative impacts on nurses' health and well-being. Ineffective working relationships with other nurses and lack of leadership support led nurses to feel dissatisfied and ill equipped to perform their job. The impact of high stress was evident on the health and emotional well-being of nurses. It is vital that healthcare organisations learn to minimise turnover and retain the wealth of experienced nurses in acute care settings to maintain quality patient care and contain costs. This study highlights the need for healthcare leaders to re-examine how they promote collaborative practice, enhance supportive leadership behaviours, and reduce nurses' workplace stressors to retain the skills and knowledge of experienced nurses at the point-of-care. © 2016 John Wiley & Sons Ltd.

Factors affecting professional ethics in nursing practice in Iran: a qualitative study.

PubMed

Dehghani, Ali; Mosalanejad, Leili; Dehghan-Nayeri, Nahid

2015-09-09

Professional ethics refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice. This study aimed to explore and describe factors that affect professional ethics in nursing practice in Iran. This qualitative study was conducted using conventional content analysis approach. Thirty nurses with at least 5 years of experience participated in the study; they were selected using purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis. After encoding and classifying the data, five major categories were identified: individual character and responsibility, communication challenges, organizational preconditions, support systems, educational and cultural development. Awareness of professional ethics and its contributing factors could help nurses and healthcare professionals provide better services for patients. At the same time, such understanding would be valuable for educational administrators for effective planning and management.

Psychometric Assessment of the Chinese Version of the Abbreviated Expanded Prostate Cancer Index Composite (EPIC-26) and the Clinical Practice Version (EPIC-CP) in Chinese Men With Prostate Cancer.

PubMed

Lam, Wendy W T; Tse, Michael A; Ng, Chris N L; Chung, Edward K M; Fielding, Richard

2017-06-01

The Expanded Prostate Cancer Index Composite (EPIC) instrument was designed to assess a range of health-related quality-of-life issues specifically relevant to patients with prostate cancer. This study examined the validity and reliability of Chinese versions of the 26-item EPIC and of the 16-item EPIC for Clinical Practice (EPIC-CP) in Chinese patients with prostate cancer. A Chinese version of the 26-item EPIC and the 16-item EPIC-CP were self-completed by 252 Chinese patients with prostate cancer who were recruited from three community-based cancer service centers. Confirmatory factors analysis assessed the factor structures of the EPIC and the EPIC-CP. Internal consistency and construct and clinical validities of the factor structures were assessed. Confirmatory factor analysis revealed that the original factor structure of both EPIC-26 and EPIC-CP showed good fit to this sample. A correlated model was superior to a hierarchical model in both EPIC-26 and EPIC-CP supporting the utility of the domain scores over the total scores. Cronbach α ranged from 0.55 to 0.91 for EPIC-26 and 0.44 to 0.67 for EPIC-CP. Construct validity was supported by correlations between EPIC-26/EPIC-CP and psychological distress measures. Clinical validity was supported by differentiation between patients with and without prostatectomy. These Chinese versions of the five-factor EPIC-26 and the EPIC-CP are valid and practical measures for assessing a range of health-related quality-of-life issues related to the diagnosis and treatment of prostate cancer, highlighting their utility in assessing health-related quality of life for patients diagnosed with prostate cancer. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

PubMed

Petersen, Juliana J; Paulitsch, Michael A; Mergenthal, Karola; Gensichen, Jochen; Hansen, Heike; Weyerer, Siegfried; Riedel-Heller, Steffi G; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Wiese, Birgitt; van den Bussche, Hendrik; Scherer, Martin; Dahlhaus, Anne

2014-08-07

In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors. Current Controlled Trials ISRCTN89818205.

Entering a world of uncertainty: community nurses' engagement with information and communication technology.

PubMed

Courtney-Pratt, Helen; Cummings, Elizabeth; Turner, Paul; Cameron-Tucker, Helen; Wood-Baker, Richard; Walters, Eugene Haydn; Robinson, Andrew Lyle

2012-11-01

Achieving adoption, use, and integration of information and communication technology by healthcare clinicians in the workplace is recognized as a challenge that requires a multifaceted approach. This article explores community health nurses' engagement with information and communication technology as part of a larger research project that investigated the delivery of self-management support to people with chronic obstructive pulmonary disease. Following a survey of computer skills, participants were provided with computer training to support use of the project information system. Changes in practice were explored using action research meetings and individual semistructured interviews. Results highlight three domains that affected nurses' acceptance, utilization, and integration of information and communication technology into practice; environmental issues; factors in building capacity, confidence, and trust in the technology; and developing competence. Nurses face individual and practice challenges when attempting to integrate new processes into work activities, and the use of participatory models to support adoption is recommended.

Predictors and enablers of mental health nurses' family-focused practice.

PubMed

Grant, Anne; Reupert, Andrea; Maybery, Darryl; Goodyear, Melinda

2018-06-27

Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family-focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses' personal characteristics and work setting are key factors in determining family-focused practice. This study extends current research by clearly highlighting predictors of family-focused practice and reporting how various enablers promoted family-focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere. © 2018 Australian College of Mental Health Nurses Inc.

Risk, Conflict, Mothers' Parenting, and Children's Adjustment in Low-Income, Mexican Immigrant, and Mexican American Families.

ERIC Educational Resources Information Center

Dumka, Larry E.; Roosa, Mark W.; Jackson, Kristina M.

1997-01-01

Reports on a test of a risk-stress process model. Examines the influence of mothers' supportive parenting and inconsistent discipline practices on risk factors and family conflict as these affect children's conduct disorder and depression. Tests on 121 families indicate that mothers' supportive patenting partially mediated family conflict effects…

A Practical Illustration of Multidimensional Diagnostic Skills Profiling: Comparing Results from Confirmatory Factor Analysis and Diagnostic Classification Models

ERIC Educational Resources Information Center

Kunina-Habenicht, Olga; Rupp, Andre A.; Wilhelm, Oliver

2009-01-01

In recent years there has been an increasing international interest in fine-grained diagnostic inferences on multiple skills for formative purposes. A successful provision of such inferences that support meaningful instructional decision-making requires (a) careful diagnostic assessment design coupled with (b) empirical support for the structure…

The Perceptions of Urban School Principals Regarding the Education of Students with Emotional and Behavioral Disorders

ERIC Educational Resources Information Center

Anoh, Jean-Dominique Herve

2013-01-01

This research investigated the perceptions and attitudes of principals and headmasters about the inclusion of students with emotional and behavioral disorders (EBD), the factors supporting or inhibiting school leaders in their effort to implement inclusive practices, and the approaches they use to initiate, facilitate, support and sustain the…

Using Educational Theory and Research to Refine Agricultural Extension: Affordances and Barriers for Farmers' Learning and Practice Change

ERIC Educational Resources Information Center

Sewell, A. M.; Hartnett, M. K.; Gray, D. I.; Blair, H. T.; Kemp, P. D.; Kenyon, P. R.; Morris, S. T.; Wood, B. A.

2017-01-01

Purpose: To examine the factors that support and hinder farmers' learning and to investigate the impact of an innovative learning program on farmers' practice change. Design/methodology/approach: Individual interviews and focus group discussions were held with 24 farmers over 20 months. Observations were made of these farmers as they participated…

Exploring Multi-Level System Factors Facilitating Educator Training and Implementation of Evidence-Based Practices (EBP): A Study Protocol

ERIC Educational Resources Information Center

Stahmer, Aubyn C.; Suhrheinrich, Jessica; Schetter, Patricia L.; Hassrick, Elizabeth McGee

2018-01-01

This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for…

Validity of the toddler feeding questionnaire for measuring parent authoritative and indulgent feeding practices which are associated with stress and health literacy among Latino parents of preschool children.

PubMed

Heerman, William J; Lounds-Taylor, Julie; Mitchell, Stephanie; Barkin, Shari L

2018-01-01

Understanding the contribution of parental feeding practices to childhood obesity among Latino children is a solution-oriented approach that can lead to interventions supporting healthy childhood growth and lowering rates of obesity. The purpose of this study was to confirm the reliability and validity of the Toddler Feeding Questionnaire (TFQ) to measure parental feeding practices among a sample of Spanish-speaking parent-preschool child pairs (n = 529), and to test the hypothesis that parent characteristics of body mass index (BMI), stress, and health literacy are associated with more indulgent and less authoritative feeding practices. Standardized parent-report questionnaires were completed during baseline interviews in a randomized controlled trial of an obesity prevention intervention. The TFQ includes subscales for indulgent practices (11 items), authoritative practices (7 items), and environmental influences (6 items) with response options scored on a 5-point Likert scale and averaged. Factor analysis confirmed a three-factor structure. Internal consistency was good for indulgent (α = 0.66) and authoritative (α = 0.65) practices but lower for environmental (α = 0.48). Spearman correlation showed indulgent practices and environmental influences were associated with unhealthy child diet patterns, whereas authoritative practices were associated with a healthier child diet. Multivariate linear regression showed higher parent stress was associated with higher indulgent and lower authoritative scores; higher parent health literacy was positively associated with indulgent scores. These results indicate the TFQ is a valid measure of authoritative and indulgent parent feeding practices among Spanish-speaking parents of preschool-age children and that stress and health literacy, potentially modifiable parent characteristics, could be targeted to support healthy feeding practices. Copyright © 2017 Elsevier Inc. All rights reserved.

Measuring Hope Among Children Affected by Armed Conflict: Cross-Cultural Construct Validity of the Children's Hope Scale.

PubMed

Haroz, Emily E; Jordans, Mark; de Jong, Joop; Gross, Alden; Bass, Judith; Tol, Wietse

2017-06-01

We investigated the cross-cultural construct validity of hope, a factor associated with mental health protection and promotion, using the Children's Hope Scale (CHS). The sample ( n = 1,057; 48% girls) included baseline data from three cluster-randomized controlled trials with children affected by armed conflict ( n = 329 Burundi; n = 403 Indonesia; n = 325 Nepal). The confirmatory factor analysis in each country indicated good fit for the hypothesized two-factor model. Analysis by gender indicated that configural invariance was supported and that scalar invariance was demonstrated in Indonesia. However, metric and scalar invariance were not supported in Burundi and Nepal. In country comparisons, configural and metric invariance were met, but scalar invariance was not supported. Evidence from this study supports the use of the CHS within various sociocultural settings and across genders, but direct comparisons of CHS scores across groups should be done with caution. Rigorous evaluations of the measurement properties of mental health protective and promotive factors are necessary to inform both research and practice.

Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: qualitative comparative case study in primary care.

PubMed

Wiener-Ogilvie, Sharon; Huby, Guro; Pinnock, Hilary; Gillies, John; Sheikh, Aziz

2008-06-04

Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice. Qualitative comparative case study using nine in-depth interviews and 2 focus groups with general practitioners and practice nurses, involved in delivering asthma care. Participants were purposively recruited from practices in a Scottish health board with high and low compliance with the BTS-SIGN asthma guideline. There was a marked difference in the way respondents from practices with high compliance and respondents from practices with low compliance spoke about the value of guidelines and the challenges of implementing them. On both accounts, the former were more positive than the latter and were able to be more specific about the strategies they used to overcome barriers to implementation. We explored the reason for this difference in response and identified practice organisation, centring on delegation of work to nurses, as a factor mediating the practice's level of compliance. Effective delegation was underpinned by organisation of asthma work among practice members who have the appropriate level of skills and knowledge, know and understand each others' work and responsibilities, communicate well among themselves and trust each others' skills. It was the combination of these factors which made for successful delegation and guideline implementation, not any one factor in isolation. In our sample of practices, teamwork and organisation of care within practices appeared to impact on guideline implementation and further larger studies are needed to explore this issue further. Isolated interventions such as measures to improve staff's knowledge or increased clinical resource and time, which are currently being considered, are unlikely to be effective unless practices are supported in developing their teams in a way which supports the deployment of these resources.

Sociocultural Influences on Arab Women's Participation in Breast Cancer Screening in Qatar.

PubMed

Hwang, Jasmine J; Donnelly, Tam T; Ewashen, Carol; McKiel, Elaine; Raffin, Shelley; Kinch, Janice

2017-04-01

Breast cancer, the most common cancer among Arab women in Qatar, significantly affects the morbidity and mortality of Arab women largely because of low participation rates in breast cancer screening. We used a critical ethnographic approach to uncover and describe factors that influence Arab women's breast cancer screening practices. We conducted semistructured interviews with 15 health care practitioners in Qatar. Through thematic analysis of the data, we found three major factors influencing breast cancer screening practices: (a) beliefs, attitudes, and practices regarding women's bodies, health, and illness; (b) religious beliefs and a culturally sensitive health care structure; and (c) culturally specific gender relations and roles. Arab women's health practices cannot be understood in isolation from the sociocultural environment. The problem of low rates of breast cancer screening practices and supportive interventions must be addressed within the context and not be limited to the individual.

Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace.

PubMed

Weber, Danielle; Janson, Anneka; Nolan, Michelle; Wen, Li Ming; Rissel, Chris

2011-11-30

Women's return to work can be a significant barrier to continued breastfeeding. Workplace policies and practices to promote and support continued, and longer duration of, breastfeeding are important. In the context of the introduction of a new breastfeeding policy for Area Health Services in New South Wales, Australia, a baseline survey was conducted to describe current practices and examine women's reports of perceived organisational support on breastfeeding intention and practice. A cross sectional survey of female employees of the Sydney South West Area Health Service was conducted in late 2009. A mailed questionnaire was sent to 998 eligible participants who had taken maternity leave over the 20-month period from January 2008 to August 2009. The questionnaire collected items assessing breastfeeding intentions, awareness of workplace policies, and the level of organisational and social support available. For those women who had returned to work, further questions were asked to assess the perceptions and practices of breastfeeding in the work environment, as well as barriers and enabling factors to combining breastfeeding and work. Returning to work was one of the main reasons women ceased breastfeeding, with 60 percent of women intending to breastfeed when they returned to work, but only 40 percent doing so. Support to combine breastfeeding and work came mainly from family and partners (74% and 83% respectively), with little perceived support from the organisation (13%) and human resources (6%). Most women (92%) had received no information from their managers about their breastfeeding options upon their return to work, and few had access to a room specially designated for breastfeeding (19%). Flexible work options and lactation breaks, as well as access to a private room, were identified as the main factors that facilitate breastfeeding at work. Enabling women to continue breastfeeding at work has benefits for the infant, employee and organisation. However, this baseline study of health employees revealed that women felt largely unsupported by managers and their organisation to continue breastfeeding at work.

Defining Contemplative Science: The Metacognitive Self-Regulatory Capacity of the Mind, Context of Meditation Practice and Modes of Existential Awareness

PubMed Central

Dorjee, Dusana

2016-01-01

The term ‘contemplative’ is now frequently used in the fast growing field of meditation research. Yet, there is no consensus regarding the definition of contemplative science. Meditation studies commonly imply that contemplative practices such as mindfulness or compassion are the subject of contemplative science. Such approach, arguably, contributes to terminological confusions in the field, is not conducive to the development of an overarching theory in contemplative science, and overshadows its unique methodological features. This paper outlines an alternative approach to defining contemplative science which aims to focus the research on the core capacities, processes and states of the mind modified by contemplative practices. It is proposed that contemplative science is an interdisciplinary study of the metacognitive self-regulatory capacity (MSRC) of the mind and associated modes of existential awareness (MEA) modulated by motivational/intentional and contextual factors of contemplative practices. The MSRC is a natural propensity of the mind which enables introspective awareness of mental processes and behavior, and is a necessary pre-requisite for effective self-regulation supporting well-being. Depending on the motivational/intentional and contextual factors of meditation practice, changes in the metacognitive self-regulatory processes enable shifts in MEA which determine our sense of self and reality. It is hypothesized that changes in conceptual processing are essential mediators between the MSRC, motivational/intentional factors, context of meditation practice, and the modulations in MEA. Meditation training fosters and fine-tunes the MSRC of the mind and supports development of motivational/intentional factors with the ultimate aim of facilitating increasingly advanced MEA. Implications of the proposed framework for definitions of mindfulness and for future systematic research across contemplative traditions and practices are discussed. It is suggested that the proposed definition of contemplative science may reduce terminological challenges in the field and make it more inclusive of varied contemplative practices. Importantly, this approach may encourage development of a more comprehensive contemplative science theory recognizing the essential importance of first- and second-person methods to its inquiry, thus uniquely contributing to our understanding of the mind. PMID:27909417

Human-factors engineering for smart transport: design support for car drivers and train traffic controllers.

PubMed

Lenior, Dick; Janssen, Wiel; Neerincx, Mark; Schreibers, Kirsten

2006-07-01

The theme Smart Transport can be described as adequate human-system symbiosis to realize effective, efficient and human-friendly transport of goods and information. This paper addresses how to attune automation to human (cognitive) capacities (e.g. to take care of information uncertainty, operator trust and mutual man-machine adaptations). An introduction to smart transport is presented, including examples of best practice for engineering human factors in the vehicle ergonomics and train traffic control domain. The examples are representative of an ongoing trend in automation and they show how the human role changes from controller to supervisor. Section 2 focuses on the car driver and systems that support, or sometimes even take over, critical parts of the driving task. Due to the diversity of driver ability, driving context and dependence between driver and context factors, there is a need for personalised, adaptive and integrated support. Systematic research is needed to establish sound systems. Section 3 focuses on the train dispatcher support systems that predict train movements, detect potential conflicts and show the dispatcher the possibilities available to solve the detected problems. Via thorough analysis of both the process to be controlled and the dispatcher's tasks and cognitive needs, support functions were developed as part of an already very complex supervision and control system. The two examples, although from a different field, both show the need for further development in cognitive modelling as well as for the value of sound ergonomics task analysis in design practice.

Measurement and evaluation practices of factors that contribute to effective health promotion collaboration functioning: A scoping review.

PubMed

Stolp, Sean; Bottorff, Joan L; Seaton, Cherisse L; Jones-Bricker, Margaret; Oliffe, John L; Johnson, Steven T; Errey, Sally; Medhurst, Kerensa; Lamont, Sonia

2017-04-01

The purpose of this scoping review was to identify promising factors that underpin effective health promotion collaborations, measurement approaches, and evaluation practices. Measurement approaches and evaluation practices employed in 14 English-language articles published between January 2001 and October 2015 were considered. Data extraction included research design, health focus of the collaboration, factors being evaluated, how factors were conceptualized and measured, and outcome measures. Studies were methodologically diverse employing either quantitative methods (n=9), mixed methods (n=4), or qualitative methods (n=1). In total, these 14 studies examined 113 factors, 88 of which were only measured once. Leadership was the most commonly studied factor but was conceptualized differently across studies. Six factors were significantly associated with outcome measures across studies; leadership (n=3), gender (n=2), trust (n=2), length of the collaboration (n=2), budget (n=2) and changes in organizational model (n=2). Since factors were often conceptualized differently, drawing conclusions about their impact on collaborative functioning remains difficult. The use of reliable and validated tools would strengthen evaluation of health promotion collaborations and would support and enhance the effectiveness of collaboration. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Software Quality Assurance and the Fleet Material Support Environment.

DTIC Science & Technology

1982-06-01

is one of utility; each factor identified could be applied to :t production environment. The interaction of support groups within an operational...ship-support functio2s. It is comprised of aoproxi- mately 250 people and is i furctionally oriented department. The Financial Sistems Desian and...that t h-, following specific conditions ?xist: 1. Poorly Defined Regu-rements/Speci-fica:-4ons a) FM1SO design procedures/practices tend to be appli

[Computer-assisted cardiovascular disease management: better implementation of care but no improvement in clinical outcomes].

PubMed

de Wit, Niek J

2012-01-01

Computer support is considered by many to be a promising strategy for improving healthcare interventions, especially in the management of chronic diseases. So far, however, evidence of the effectiveness of ICT support in healthcare is limited. Recently, computer-supported cardiovascular disease management was compared with usual care during an RCT comprised of 1100 primary care patients. This trial demonstrated that neither the clinical outcome nor the cardiovascular morbidity rate improved, even though management of the risk factors improved over 1 year of follow-up. The pragmatic design of the RCT in daily general practice may have restricted implementing the computer support, and may also have hampered the evaluation of the cardiovascular effects. The results demonstrate that although computer support may help improve the performance of disease management, its impact on disease outcomes is questionable. ICT innovations in healthcare require rigorous investigative evaluation before their implementation in daily practice can be justified.

Evidence-based practice: the importance of education and leadership.

PubMed

Johansson, Birgitta; Fogelberg-Dahm, Marie; Wadensten, Barbro

2010-01-01

To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. The present study highlights the value of education in research methods and the importance of supportive leadership. Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

PubMed

Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

2017-05-01

Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

Recruitment of general practices: Is a standardised approach helpful in the involvement of healthcare professionals in research?

PubMed

Riis, Allan; Jensen, Cathrine E; Maindal, Helle T; Bro, Flemming; Jensen, Martin B

2016-01-01

Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R-factors as determinants for successfully recruiting healthcare professionals: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect. This is a process evaluation of the seven R-factors. We applied these factors to guide the design of our recruitment strategy as well as to make adjustments when recruiting general practices in a guideline implementation study. In the guideline implementation study, we studied the effect of outreach visits, quality reports, and new patient stratification tools for low back pain patients. During a period of 15 months, we recruited 60 practices, which was fewer than planned (100 practices). In this evaluation, five of Solberg's seven R-factors were successfully addressed and two factors were not. The need to involve (reciprocity) end users in the development of new software and the amount of time needed to conduct recruitment (resolution) were underestimated. The framework of the seven R-factors was a feasible tool in our recruitment process. However, we suggest further investigation in developing systematic approaches to support the recruitment of healthcare professionals to research.

Use of an Ecological Model to Study Sexual Satisfaction in a Heterosexual Spanish Sample.

PubMed

Del Mar Sánchez-Fuentes, María; Salinas, José María; Sierra, Juan Carlos

2016-11-01

Sexual satisfaction is a key factor in sexual health and has been associated with quality of life. However, few studies have focused on the factors related to sexual satisfaction in the population in Spain. The main goal of this research was to analyze the predictive capacity of an ecological model for the study of sexual satisfaction in a Spanish sample of 723 men and 851 women, with mean age equal to 36.28 (SD = 12.59) and who were in a heterosexual relationship. We analyzed, using structural equation modeling, the degree to which sexual satisfaction was related to different variables. These variables were the following: personal variables (depression and sexual attitudes); interpersonal variables (relationship satisfaction, sexual function, and sexual assertiveness); social variables (social support, parenthood, and annual income); and cultural variables (political ideology, religion, and religious practice). In men, sexual satisfaction was directly predicted by relationship satisfaction and sexual function. Furthermore, political ideology, religious practice, social support, annual income, initiation sexual assertiveness, and sexual attitudes were indirectly associated with sexual satisfaction. In women, sexual satisfaction was directly predicted by relationship satisfaction, sexual function, sexual assertiveness, and sexual attitudes. In addition, political ideology, religious practice, and social support were indirectly associated with sexual satisfaction. Implications for research and therapy are also discussed.

Validation of an instrument to measure inter-organisational linkages in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

Factors influencing the development of evidence-based practice among nurses: a self-report survey

PubMed Central

2012-01-01

Background Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice. PMID:23092366

Peer learning partnerships: exploring the experience of pre-registration nursing students.

PubMed

Christiansen, Angela; Bell, Amelia

2010-03-01

This paper explores the impact of a peer learning initiative developed to facilitate, purposefully, mutually supportive learning relationships between student nurses in the practice setting. Finding effective strategies to support learning in the practice setting has been the focus of professional concern for a considerable time. In the UK clinical mentorship is seen as pivotal to ensuring fitness to practice; however, recent debate on the nature of learning has revealed the clinical workplace as a rich learning environment where learning occurs not only through hierarchical relationships, but also from a network of peer relationships. Formalising peer relationships through peer assisted learning is increasingly suggested as a strategy to support workplace learning and support novice students' transition to the clinical setting. Despite the developing literature in this field there is limited understanding about how students experience facilitated peer relationships. An interpretive qualitative design. Focus group interviews were used to collect interactive and situated discourse from nursing students who had recently participated in peer learning partnerships (n = 54). Narrative data were analysed thematically. Findings suggest that active support from a fellow student reduced the feelings of social isolation experienced by novice students in initial clinical placements, helping them to deal more effectively with the challenges faced and reducing the factors that have an impact on attrition. In addition, the reciprocity of the peer learning partnerships facilitated understanding of mentorship and created a heightened sense of readiness for registration and professional practice. Peer learning partnerships facilitated by mentors in clinical practice can support the transition to nursing for first year students and can help more experienced students gain a confidence and a heightened readiness for mentorship and registered practice. Facilitated peer learning partnerships can enhance the student experience in the practice setting and can help maximise opportunities for learning and support. This suggests that peer assisted learning is a legitimate area for innovation and further research.

Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature.

PubMed

Wyder, Marianne; Ehrlich, Carolyn; Crompton, David; McArthur, Leianne; Delaforce, Caroline; Dziopa, Fiona; Ramon, Shulamit; Powell, Elizabeth

2017-12-01

Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self-care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person-centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe. © 2017 Australian College of Mental Health Nurses Inc.

Clinicians' practice environment is associated with a higher likelihood of recommending cesarean deliveries.

PubMed

Cheng, Yvonne W; Snowden, Jonathan M; Handler, Stephanie; Tager, Ira B; Hubbard, Alan; Caughey, Aaron B

2014-08-01

Little data exist regarding clinicians' role in the rising annual incidence rate of cesarean delivery in the US. We aimed to examine if clinicians' practice environment is associated with recommending cesarean deliveries. This is a survey study of clinicians who practice obstetrics in the US. This survey included eight clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test and multivariable logistic regression were used for statistical comparison. Of 27 675 survey links sent, 3646 clinicians received and opened the survey electronically, and 1555 (43%) participated and 1486 (94%) completed the survey. Clinicians were categorized into three groups based on eight common obstetric vignettes as: more likely (n = 215), average likelihood (n = 1099), and less likely (n = 168) to recommend cesarean. Clinician environment factors associated with a higher likelihood of recommending cesarean included Laborists/Hospitalists practice model (p < 0.001), as-needed anesthesia support (p = 0.003), and rural/suburban practice setting (p < 0.001). We identified factors in clinicians' environment associated with their likelihood of recommending cesarean delivery. The decision to recommend cesarean delivery is a complicated one and is likely not solely based on patient factors.

EVALUATION OF A NURSE-LED HYPERTENSION MANAGEMENT INTERVENTION IN AUSTRALIAN GENERAL PRACTICE: THE IMPRESS INTERVENTION.

PubMed

Stephen, Catherine

2016-08-01

Hypertension is currently the most frequently seen condition in Australian general practice (Britt et al. 2015). Of the 4.6 million Australians living with hypertension, many struggle to keep their blood pressure under control and are at increased risk of renal failure, cardiovascular disease and premature death (Australian Institute of Health and Welfare, 2015; Cadilhac et al. 2012). The General Practice Nurse (GPN) has a significant role to play in supporting self-management and lifestyle risk factor reduction.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.

PubMed

Daire, Judith; Gilson, Lucy

2014-09-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Supervisors' perceptions of organizational policies are associated with their likelihood to accommodate back-injured workers.

PubMed

McGuire, Connor; Kristman, Vicki L; Shaw, William S; Loisel, Patrick; Reguly, Paula; Williams-Whitt, Kelly; Soklaridis, Sophie

2017-02-01

Background Low back pain (LBP) is a major concern among North American workplaces and little is known regarding a supervisor's decision to support job accommodation for workers with LBP. The extent to which supervisors are included in a company's effort to institute disability management policies and practices and workplace safety climate are two factors that may influence a supervisor's decision to accommodate workers with LBP. Objective Determine the association between supervisors' perceptions of disability management policies, corporate safety culture and their likelihood of supporting job accommodations for workers with LBP. Methods We conducted a cross-sectional study of supervisors (N=796) recruited from a non-random, convenience sample of 19 Canadian and US employers. The outcome was supervisors' likeliness to support job accommodation and the exposure was global work safety culture and disability management policies and practices. A multivariable generalized linear modelling strategy was used and final models for each exposure were obtained after assessing potential effect modifiers and confounders. Results In the study, 796 eligible supervisors from 19 employers participated. Disability management policies and practices were positively associated with supervisors' likeliness to accommodate (β=0.19; 95% CI: 0.13; 0.24) while no significant association was found between corporate safety culture (β= -0.084; 95% CI: -0.19; 0.027) and supervisors' likeliness to accommodate. Conclusions Employers should ensure that proactive disability management policies and practices are clearly communicated to supervisors in order to improve job modification and return to work efforts. Implications for Rehabilitation Low back pain (LBP) is a major workplace concern and little is known regarding what factors are associated with a supervisor's likelihood to support job accommodation for workers with LBP. The objective of this article was to determine the association between supervisors' perceptions of disability management policies and practices, corporate safety culture and their likelihood of support job accommodations for workers with LBP. Results suggest that disability management policies and practices are positively associated with supervisors' likelihood to accommodate while corporate safety culture is not. These results are important for employers as it suggests that employers should ensure that their disability management policies and practices are clearly communicated to supervisors in order to improve job accommodation and return to work efforts.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

PubMed

Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

2016-01-01

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

Cultural universality and specificity of student engagement in school: The results of an international study from 12 countries.

PubMed

Lam, Shui-fong; Jimerson, Shane; Shin, Hyeonsook; Cefai, Carmel; Veiga, Feliciano H; Hatzichristou, Chryse; Polychroni, Fotini; Kikas, Eve; Wong, Bernard P H; Stanculescu, Elena; Basnett, Julie; Duck, Robert; Farrell, Peter; Liu, Yi; Negovan, Valeria; Nelson, Brett; Yang, Hongfei; Zollneritsch, Josef

2016-03-01

A comprehensive understanding of the contextual factors that are linked to student engagement requires research that includes cross-cultural perspectives. This study investigated how student engagement in school is associated with grade, gender, and contextual factors across 12 countries. It also investigated whether these associations vary across countries with different levels of individualism and socio-economic development. The participants were 3,420 7th, 8th, and 9th grade students from Austria, Canada, China, Cyprus, Estonia, Greece, Malta, Portugal, Romania, South Korea, the United Kingdom, and the United States. The participants completed a questionnaire to report their engagement in school, the instructional practices they experienced, and the support they received from teachers, peers, and parents. Hierarchical linear modelling was used to examine the effects at both student and country levels. The results across countries revealed a decline in student engagement from Grade 7 to Grade 9, with girls reporting higher engagement than boys. These trends did not vary across the 12 countries according to the Human Development Index and Hofstede's Individualism Index. Most of the contextual factors (instructional practices, teacher support, and parent support) were positively associated with student engagement. With the exception that parent support had a stronger association with student engagement in countries with higher collectivism, most of the associations between the contextual factors and student engagement did not vary across countries. The results indicate both cultural universality and specificity regarding contextual factors associated with student engagement in school. They illustrate the advantages of integrating etic and emic approaches in cross-cultural investigations. © 2015 The British Psychological Society.

An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model.

PubMed

Grant, Bettyanne; Colello, Sandra; Riehle, Martha; Dende, Denise

2010-04-01

To discuss the new Magnet Model as it relates to the successful implementation of a practice change. There is growing international interest in the Magnet Recognition Programme. The latest generation of the Magnet Model has been designed not only as a road map for organizations seeking to achieve Magnet recognition but also as a framework for nursing practice and research in the future. The Magnet Model was used to identify success factors related to a practice change and to evaluate the nursing practice environment. Even when proposed changes to practice are evidence based and thoughtfully considered, the nurses' work environment must be supportive and empowering in order to yield successful and sustainable implementation of new practice. Success factors for implementation of a practice change can be illuminated by aligning environmental characteristics to the components of the new Magnet Model. The Magnet Model provides an exceptional framework for building an agile and dynamic work force. Thoughtful consideration of the components and inter-relationships represented in the new model can help to both predict and ensure organizational vitality.

Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program.

PubMed

Lowell, Anne; Kildea, Sue; Liddle, Marlene; Cox, Barbara; Paterson, Barbara

2015-02-05

The Strong Women, Strong Babies, Strong Culture Program (the Program) evolved from a recognition of the value of Aboriginal knowledge and practice in promoting maternal and child health (MCH) in remote communities of the Northern Territory (NT) of Australia. Commencing in 1993 it continues to operate today. In 2008, the NT Department of Health commissioned an evaluation to identify enabling factors and barriers to successful implementation of the Program, and to identify potential pathways for future development. In this paper we focus on the evaluation findings related specifically to the role of Aborignal cultural knowledge and practice within the Program. A qualitative evaluation utilised purposive sampling to maximise diversity in program history and Aboriginal culture. Semi-structured, in-depth interviews with 76 participants were recorded in their preferred language with a registered Interpreter when required. Thematic analysis of data was verified or modified through further discussions with participants and members of the evaluation team. Although the importance of Aboriginal knowledge and practice as a fundamental component of the Program is widely acknowledged, there has been considerable variation across time and location in the extent to which these cultural dimensions have been included in practice. Factors contributing to this variation are complex and relate to a number of broad themes including: location of control over Program activities; recognition and respect for Aboriginal knowledge and practice as a legitimate component of health care; working in partnership; communication within and beyond the Program; access to transport and working space; and governance and organisational support. We suggest that inclusion of Aboriginal knowledge and practice as a fundamental component of the Program is key to its survival over more than twenty years despite serious challenges. Respect for the legitimacy of Aboriginal knowledge and practice within health care, a high level of community participation and control supported through effective governance and sufficient organisational commitment as well as competence in intercultural collaborative practice of health staff are critical requirements for realising the potential for cultural knowledge and practice to improve Aboriginal health outcomes.

Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.

PubMed

Shoemaker, Sarah J; Staub-DeLong, Leah; Wasserman, Melanie; Spranca, Mark

2013-01-01

Pharmacies are key sources of medication information for patients, yet few effectively serve patients with low health literacy. The Agency for Healthcare Research and Quality (AHRQ) supported the development of four health literacy tools for pharmacists to address this problem, and to help assess and improve pharmacies' health literacy practices. This study aimed to understand the facilitators and barriers to the adoption and implementation of AHRQ's health literacy tools, particularly a tool to assess a pharmacy's health literacy practices. We conducted a comparative, multiple-case study of eight pharmacies, guided by an adaptation of Rogers's Diffusion of Innovations model. Data were collected and triangulated through interviews, site visit observations, and the review of documents, and analyzed on the factors affecting pharmacies' adoption decisions and implementation of the tools. Factors important to pharmacies' decision to adopt the health literacy tools included awareness of health literacy; a culture of innovation; a change champion; the relative advantage and compatibility of the tools; and an invitation to utilize and receive support to use the tools. The barriers included a lack of leadership support, limited staff time, and a perception of the tools as complex with limited value. For implementation, the primary facilitators were buy-in from leadership, qualified staff, college-affiliated change champions, the adaptability and organization of the tool, and support. Barriers to implementation were limited leadership buy-in, prioritization of other activities, lack of qualified staff, and tool complexity. If pharmacists are provided tools that could ultimately improve their health literacy practices and patient-centered services; and the tools have a clear relative advantage, are simple as well adaptable, and the pharmacists are supported in their efforts - either by colleagues or by collaborating with colleges of pharmacy-then there could be important progress toward achieving the goals of the National Action Plan for Health Literacy. Copyright © 2013 Elsevier Inc. All rights reserved.

Case management: developing practice through action research.

PubMed

Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen

2013-09-01

This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.

Development and Initial Validation of a Measure to Assess Factors Related to Sustainability of School-Wide Positive Behavior Support

ERIC Educational Resources Information Center

McIntosh, Kent; MacKay, Leslie D.; Hume, Amanda E.; Doolittle, Jennifer; Vincent, Claudia G.; Horner, Robert H.; Ervin, Ruth A.

2011-01-01

Sustainability of effective practices in schools is a critical area for research in any domain. The purpose of this article is to describe and evaluate the validity and reliability of a recently developed research instrument designed to evaluate schools' capacity to sustain school-wide positive behavior support (SWPBS) efforts at the universal…

Oncologist Support for Consolidated Payments for Cancer Care Management in the United States.

PubMed

Narayanan, Siva; Hautamaki, Emily

2016-07-01

The cost of cancer care in the United States continues to rise, with pressure on oncologists to provide high-quality, cost-effective care while maintaining the financial stability of their practice. Existing payment models do not typically reward care coordination or quality of care. In May 2014, the American Society of Clinical Oncology (ASCO) released a payment reform proposal (revised in May 2015) that includes a new payment structure for quality-of-care performance metrics. To assess US oncologists' perspectives on and support for ASCO's payment reform proposal, and to determine use of quality-of-care metrics, factors influencing their perception of value of new cancer drugs, the influence of cost on treatment decisions, and the perceptions of the reimbursement climate in the country. Physicians and medical directors specializing in oncology in the United States practicing for at least 2 years and managing at least 20 patients with cancer were randomly invited, from an online physician panel, to participate in an anonymous, cross-sectional, 15-minute online survey conducted between July and November 2014. The survey assessed physicians' level of support for the payment reform, use of quality-of-care metrics, factors influencing their perception of the value of a new cancer drug, the impact of cost on treatment decision-making, and their perceptions of the overall reimbursement climate. Descriptive statistics (chi-square tests and t-tests for discrete and continuous variables, respectively) were used to analyze the data. Logistic regression models were constructed to evaluate the main payment models described in the payment reform proposal. Of the 231 physicians and medical directors who participated in this study, approximately 50% strongly or somewhat supported the proposed payment reform. Stronger support was seen among survey respondents who were male, who rated the overall reimbursement climate as excellent/good, who have a contract with a commercial payer that reimburses for dispensed oral cancer drugs, or who practice in a hospital setting. The use of at least 1 quality-of-care metric was more common among respondents participating in an accountable care organization (ACO) than among those not participating in an ACO (92.6% vs 83.2%, respectively; P = .0380). The most common metric used by the physicians in their practice setting was patient satisfaction scores (60.1%). Accountability for delivering high-quality care was supported by 74.9% of respondents; those who practice in a hospital setting were twice as likely as those in private practice to support accountability for quality of care (81.3% vs 67.6%; odds ratio, 2.1; P = .0176). Support for ASCO's payment reform proposal is mixed among oncology physicians and medical directors, underscoring the importance of continuous and broader engagement of practicing physicians around the country via outreach and dialogue on topics that impact their clinical practices, as well as providing education or awareness activities by ASCO to its membership.

The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study

PubMed Central

2010-01-01

Background The Organizational Readiness to Change Assessment (ORCA) is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics. Methods Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline. Results Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4) versus low (n = 5)-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics. Conclusions The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice recommendations at follow-up. This supports the use of the ORCA to describe factors related to implementing practice recommendations in clinical settings. Future research utilizing larger sample sizes will be essential to support these preliminary findings. PMID:20546584

Vocational training courses as an intervention on change of work practice among immigrant cleaners.

PubMed

Jensen, Flemming W; Frydendall, Karen B; Flyvholm, Mari-Ann

2011-11-01

The aim of the study was to examine how knowledge and skills from vocational training courses on working techniques modified for immigrant cleaners are applied in practice and to identify factors that influence the implementation. The modifications of the standard course included language support with possibilities for translation and an extension of the duration of the course. The study is a prospective intervention study based on qualitative data. Data were collected as structured interviews and observations were carried out at the workplaces before and after the course. The study population included 31 immigrant cleaners from five different workplaces. Changes were observed in the use of working techniques (i.e., positioning of hands when using the floor mop). In some cases the use of the taught techniques was incorrect, partial, or only used part of the time. Interactions between individual factors (i.e., knowledge, awareness, capability, or work orientation) and environmental factors (i.e., equipment, time, workload, or physical surroundings) influenced the use of the techniques in practice. The course provided the participants with new working techniques through which some were able to reduce work related pain. However, with regard to incorrect and partial use of the working techniques, follow-up and post-training support is recommended. Copyright © 2011 Wiley Periodicals, Inc.

Role stressors and coping strategies among nurse managers.

PubMed

Udod, Sonia; Cummings, Greta G; Care, W Dean; Jenkins, Megan

2017-02-06

Purpose The purpose of this paper is to share preliminary evidence about nurse managers' (NMs) role stressors and coping strategies in acute health-care facilities in Western Canada. Design/methodology/approach A qualitative exploratory inquiry provides deeper insight into NMs' perceptions of their role stressors, coping strategies and factors and practices in the organizational context that facilitate and hinder their work. A purposeful sample of 17 NMs participated in this study. Data were collected through individual interviews and a focus group interview. Braun and Clarke's (2006) six phase approach to thematic analysis guided data analysis. Findings Evidence demonstrates that individual factors, organizational practices and structures affect NMs stress creating an evolving role with unrealistic expectations, responding to continuous organizational change, a fragmented ability to effectively process decisions because of work overload, shifting organizational priorities and being at risk for stress-related ill health. Practical implications These findings have implications for organizational support, intervention programs that enhance leadership approaches, address individual factors and work processes and redesigning the role in consideration of the role stress and work complexity affecting NMs health. Originality/value It is anticipated that health-care leaders would find these results concerning and inspire them to take action to support NMs to do meaningful work as a way to retain existing managers and attract front line nurses to positions of leadership.

Barriers to Practical Learning in the Field: A Qualitative Study of Iranian Nursing Students' Experiences.

PubMed

Jahanpour, Faezeh; Azodi, Parviz; Azodi, Farzan; Khansir, Ali Akbar

2016-06-01

Clinical training is an integral part of nursing education; however, some studies have shown that it is not always efficient. This study aimed to find out the factors that can impede nursing students' clinical learning. In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used, and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method. Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest impact on student learning. The competence of clinical instructors and staff is an important factor affecting students' training. The clinical learning environment does not always integrate theory and practice together. Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication are important factors in creating a clinical learning environment.

Organizations and social worker wellbeing: the intra-organizational context of practice and its impact on a practitioner's subjective well-being.

PubMed

Shier, Micheal L; Graham, John R

2013-01-01

This study aimed to better understand the varied factors that contribute to social worker subjective well-being (SWB) (the social science concept for happiness). Using qualitative methods of inquiry 19 social workers who reported having low to medium levels of workplace and profession satisfaction were interviewed to assess those factors within their lives that they perceived as impacting their well-being. One thematic category from the analysis was aspects of the intraorganizational context of workplaces that can impact social worker SWB. Respondents identified interpersonal workplace relationships, decision-making processes, management/supervisory dynamics, workload and workplace expectations, access to resources and infrastructure support, and inter-organizational relationships as key intra-organizational factors contributing to their overall wellbeing. In conclusion, these findings have practical application within organizations for structured policies and unstructured practices to improve social worker subjective well-being.

Development and validation of measures to assess prevention and control of AMR in hospitals.

PubMed

Flanagan, Mindy; Ramanujam, Rangaraj; Sutherland, Jason; Vaughn, Thomas; Diekema, Daniel; Doebbeling, Bradley N

2007-06-01

The rapid spread of antimicrobial resistance (AMR) in the US hospitals poses serious quality and safety problems. Expert panels, identifying strategies for optimizing antibiotic use and preventing AMR spread, have recommended hospitals undertake efforts to implement specific evidence-based practices. To develop and validate a measurement scale for assessing hospitals' efforts to implement recommended AMR prevention and control measures. Surveys were mailed to infection control professionals in a national sample of 670 US hospitals stratified by geographic region, bedsize, teaching status, and VA affiliation. : Four hundred forty-eight infection control professionals participated (67% response rate). Survey items measured implementation of guideline recommendations, practices for AMR monitoring and feedback, AMR-related outcomes (methicillin-resistant Staphylococcus aureus prevalence and outbreaks [MRSA]), and organizational features. "Derivation" and "validation" samples were randomly selected. Exploratory factor analysis was performed to identify factors underlying AMR prevention and control efforts. Multiple methods were used for validation. We identified 4 empirically distinct factors in AMR prevention and control: (1) practices for antimicrobial prescription/use, (2) information/resources for AMR control, (3) practices for isolating infected patients, and (4) organizational support for infection control policies. The Prevention and Control of Antimicrobial Resistance scale was reliable and had content and construct validity. MRSA prevalence was significantly lower in hospitals with higher resource/information availability and broader organizational support. The Prevention and Control of Antimicrobial Resistance scale offers a simple yet discriminating assessment of AMR prevention and control efforts. Use should complement assessment methods based exclusively on AMR outcomes.

Beyond these walls: Can psychosocial clubhouses promote the social integration of adults with serious mental illness in the community?

PubMed

Gumber, Shinakee; Stein, Catherine H

2018-03-01

The study examined factors associated with community integration experiences of adults with serious mental illness who were members of psychosocial rehabilitation clubhouses in New York City. Ninety-two clubhouse members completed an online survey. The study examined relative contribution of adults' reports of individual factors (self-reported psychiatric symptoms, self-esteem), community supports (self-reported employment status and perceived family support), and the clubhouse environment (self-reported time spent in the clubhouse, clubhouse supportiveness, and practical orientation) in accounting for variation in members' reports of social integration within the clubhouse and within the larger community. Hierarchical linear regression results suggest a differential pattern of variables associated with participants' experience of social integration within the clubhouse versus outside the clubhouse with the larger non-mental-health consumers. Adults' reports of more time spent in the clubhouse and perceptions of clubhouse environment as having a more practical orientation were associated with adults' reports of greater social integration within the clubhouse. In contrast, greater self-esteem and being independently employed were associated with greater social integration outside the clubhouse. Perceived family support was associated with higher levels of social integration both within and outside the clubhouse setting. Conclusion and Implication for Practice: Greater social integration of clubhouse members both in and outside the clubhouse environment is essential in understanding community integration. Recommendations for the clubhouse model to improve community integration experiences of its members are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Family Planning Practice Among Rural Reproductive-Age Married Women in Myanmar.

PubMed

Jirapongsuwan, Ann; Latt, Kyaw Thu; Siri, Sukhontha; Munsawaengsub, Chokchai

2016-05-01

A cross-sectional study was undertaken to investigate family planning (FP) practices and associated factors among reproductive-age married women. Data were collected by interviewing the 300 married women living in a rural area of Myanmar. The questionnaire had reliability coefficients ranging from .8 to .9. Results indicated that 73.3% of women performed FP, and contraceptive injection was the most common method. Significant associations were found with age 21 to 35 years (adjusted odds ratio [adj OR] = 3.748, 95% CI = 2.179-6.445), adequacy of income (adj OR = 2.520, 95% CI = 1.477-4.290), good attitude toward FP (adj OR = 0.386, 95% CI = 0.228-0.656), good support from health care providers (adj OR = 0.129, 95% CI = 0.054-0.313), good support from family (adj OR = 0.304, 95% CI = 0.163-0.565), good support from friends (adj OR = 0.344, 95% CI = 0.193-0.613), and FP practice. It is recommended that designing FP programs with peers and family involvement could increase the practice of FP among rural Myanmar women. © 2016 APJPH.

How Activism Features in the Career Lives of Four Generations of Canadian Nurses.

PubMed

MacDonnell, Judith A; Buck-McFadyen, Ellen

2016-11-01

Recent nursing research using a critical feminist lens challenges the prevailing view of political inertia in nursing. This comparative life history study using a critical feminist lens explores the relevance of activism with four generations of Canadian nurses. Purposeful sampling of Ontario nurses resulted in 40 participants who were diverse in terms of generation, practice setting, and activist practice. Interviews and focus groups were completed with the sample of Ontario registered nurses or undergraduate and graduate nursing students: 8 Generation X, 9 Generation Y (Millennials), 20 Boomers, and 3 Overboomers. Factors such as professional norms and personal and organizational supports shaped contradictory nursing activist identities, practices, and impacts. Gendered norms, organizational dynamics, and the political landscape influenced the meanings nurses attributed to critical incidents and influences that prompted activism inside and outside the workplace, shaping the transformative potential of nursing. Despite its limitations, the study has implications for creating professional and organizational supports for consideration of health politics and policy, and spaces for dialogue to support practice and research aligned with social justice goals.

Perinatal Practices & Traditions Among Asian Indian Women.

PubMed

Goyal, Deepika

2016-01-01

As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line-Associated Bloodstream Infections in a Pediatric Oncology Unit [Formula: see text].

PubMed

Linder, Lauri A; Gerdy, Cheryl; Abouzelof, Rouett; Wilson, Andrew

Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line-associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line-associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.

Exploring the factors contributing to empowerment of Turkish migrant women in the UK.

PubMed

Cakir, S Gulfem; Yerin Guneri, Oya

2011-06-01

This study examined the role of demographic factors (length of stay, education and language level), perceived discrimination, social support, four acculturation attitudes, and psychological distress in predicting empowerment among Turkish migrant women in the UK. The study sample comprised 248 Turkish migrant women (mean age: 34.38; SD: 7.6) living in London. Self-report questionnaires were used to assess empowerment, social support, acculturation attitude and psychological distress. The study hypothesized that perceived discrimination; acculturation attitudes of separation, assimilation and marginalization; and psychological distress would be negative predictors of empowerment and that social support and an integration acculturation attitude would be positive predictors of empowerment. To some extent, the study findings supported this hypothesis. Hierarchical regression analysis indicated psychological distress to be the most significant predictor of empowerment, with other significant predictors including level of education and social support. More specifically, lower levels of psychological distress and higher levels of education and social support appeared to predict greater empowerment. Based on these findings, it can be concluded that level of education and social support may function as protective factors and that psychological distress may function as a risk factor for empowerment in the migration context. The paper discusses the findings of this study in relation to the previous literature and notes their implications for future research and practice.

Health and safety matters! Associations between organizational practices and personal support workers' life and work stress in Ontario, Canada.

PubMed

Zeytinoglu, Isik U; Denton, Margaret; Brookman, Catherine; Davies, Sharon; Sayin, Firat K

2017-06-21

The home and community care sector is one of the fastest growing sectors globally and most prominently in mature industrialized countries. Personal support workers (PSWs) are the largest occupational group in the sector. This paper focuses on the emotional health of PSWs working in the home and community care sector in Ontario, Canada. The purpose of this paper is to present evidence on the associations between PSWs' life and work stress and organizational practices of full-time and guaranteed hours, and PSWs' perceptions of support at work and preference for hours. Data come from our 2015 survey of 1543 PSWs. Dependent variables are life and work stress. Independent variables are: objective organizational practices of full-time and guaranteed hours, and subjective organizational practices of perceived support at work, and preferred hours of work. Descriptive statistics, correlations and ordinary least square regression analyses with collinearity tests are conducted. Organizational practices of employing PSWs in full-time or guaranteed hours are not associated with their life and work stress. However, those who perceive support from their organizations are also the ones reporting lower life and work stress. In addition, those PSWs perceiving support from their supervisor report lower work stress. PSWs would like to work in their preferred hours, and those who prefer to work more hours report lower life and work stress, and conversely, those who prefer to work less hours report life and work stress. For PSWs in home and community care, perceived support from their organizations and supervisors, and employment in preferred hours are important factors related to their life and work stress.

Strategic planning: how medical practices can succeed in a post-healthcare-reform world.

PubMed

Howrigon, Ron

2013-01-01

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

Peer support for patients with type 2 diabetes: cluster randomised controlled trial.

PubMed

Smith, S M; Paul, G; Kelly, A; Whitford, D L; O'Shea, E; O'Dowd, T

2011-02-15

To test the effectiveness of peer support for patients with type 2 diabetes. Cluster randomised controlled. 20 general practices in the east of the Republic of Ireland. 395 patients (192 in intervention group, 203 in control group) and 29 peer supporters with type 2 diabetes. All practices introduced a standardised diabetes care system. The peer support intervention ran over a two year period and contained four elements: the recruitment and training of peer supporters, nine group meetings led by peer supporters in participant's own general practice, and a retention plan for the peer supporters. HbA(1c); cholesterol concentration; systolic blood pressure; and wellbeing score. There was no difference between intervention and control patients at baseline. All practices and 85% (337) of patients were followed up. At two year follow-up, there were no significant differences in HbA(1c) (mean difference -0.08%, 95% confidence interval -0.35% to 0.18%), systolic blood pressure (-3.9 mm Hg, -8.9 to 1.1 mm Hg), total cholesterol concentration (-0.03 mmol/L, -0.28 to 0.22 mmol/L), or wellbeing scores (-0.7, -2.3 to 0.8). While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up, particularly for systolic blood pressure (52% (87/166) >130 mm Hg in intervention v 61% (103/169) >130 mm Hg in control), these changes were not significant. The process evaluation indicated that the intervention was generally delivered as intended, though 18% (35) of patients in the intervention group never attended any group meetings. A group based peer support intervention is feasible in general practice settings, but the intervention was not effective when targeted at all patients with type 2 diabetes. While there was a trend towards improvements of clinical outcomes, the results do not support the widespread adoption of peer support. Trial registration Current Controlled Trials ISRCTN42541690.

Use of mobile device applications in Canadian dietetic practice.

PubMed

Lieffers, Jessica R L; Vance, Vivienne A; Hanning, Rhona M

2014-01-01

A cross-sectional web-based survey of dietitians was used to explore topics related to mobile devices and their applications (apps) in Canadian dietetic practice. A survey was drafted, posted on SurveyMonkey, and pretested with dietitians and dietetic interns. Dietitians of Canada (DC), a supporter of this work, promoted the survey to members through its monthly electronic newsletters from January 2012 to April 2012. Of 139 dietitians who answered some survey questions, 118 finished the survey; this represents a response rate of approximately 3%. Overall, 57.3% of respondents reported app use in practice, and 54.2% had a client ask about or use a nutrition/food app. About 40.5% of respondents had recommended nutrition/food apps to clients. Respondents were enthusiastic about apps, but many described challenges with use. From the survey data, three themes emerged that can affect dietitians' use of apps and whether they recommend apps to clients: mobile device and app factors (access to information/tools, content quality, usability, accessibility/compatibility, and cost), personal factors (knowledge, interest, suitability, and willingness/ability to pay), and workplace factors. Apps are now infiltrating dietetic practice. Several factors can affect dietitians' use of apps and whether they recommend them to clients. These findings will help guide future development and use of apps in practice.

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery.

PubMed

Kilcullen, Meegan; Ireland, Susan

2017-05-11

Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

Introducing the Learning Practice--III. Leadership, empowerment, protected time and reflective practice as core contextual conditions.

PubMed

Rushmer, Rosemary; Kelly, Diane; Lough, Murray; Wilkinson, Joyce E; Davies, Huw T O

2004-08-01

This paper is the third of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we provide a systematic literature review of contextual factors that either play a key role in providing a facilitative context for a Learning Practice or manifest themselves as barriers to any Practice's attempts to develop a learning culture. Core contextual conditions are identified as, first, the requirement for strong and visionary leadership. Leaders who support and develop others, ask challenging questions, are willing to be learners themselves, see possibilities and make things happen, facilitate learning environments. The second core condition is the involvement and empowerment of staff where changes grow from the willing participation of all concerned. The third prerequisite is the setting-aside of times and places for learning and reflection. This paper contributes to the wider quality improvement debate in three main ways. First, by highlighting the local contextual issues that are most likely to impact on the success or failure of a Practice's attempts to work towards a learning culture. Second, by demonstrating that the very same factors can either help or hinder depending on how they are manifest and played out in context. Third, it adds to the evidence available to support the case for LOs in health care settings.

The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.

PubMed

Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth

2018-02-01

To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.

Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

PubMed

Wong, Eliza M L; Zhong, Xue Bing; Sit, Janet W H; Chair, Sek Ying; Leung, Doris Y P; Leung, Carmen; Leung, K C

2016-09-01

This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

Reducing cognitive skill decay and diagnostic error: theory-based practices for continuing education in health care.

PubMed

Weaver, Sallie J; Newman-Toker, David E; Rosen, Michael A

2012-01-01

Missed, delayed, or wrong diagnoses can have a severe impact on patients, providers, and the entire health care system. One mechanism implicated in such diagnostic errors is the deterioration of cognitive diagnostic skills that are used rarely or not at all over a prolonged period of time. Existing evidence regarding maintenance of effective cognitive reasoning skills in the clinical education, organizational training, and human factors literatures suggest that continuing education plays a critical role in mitigating and managing diagnostic skill decay. Recent models also underscore the role of system level factors (eg, cognitive decision support tools, just-in-time training opportunities) in supporting clinical reasoning process. The purpose of this manuscript is to offer a multidisciplinary review of cognitive models of clinical decision making skills in order to provide a list of best practices for supporting continuous improvement and maintenance of cognitive diagnostic processes through continuing education. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Personal responsibility in oral health: ethical considerations.

PubMed

Albertsen, Andreas

2012-11-30

Personal responsibility is a powerful idea supported by many values central to West European thought. On the conceptual level personal responsibility is a complex notion. It is important to separate the concept of being responsible for a given state of affairs from the concept of holding people responsible by introducing measures that decrease their share of available resources. Introducing personal responsibility in oral health also has limitations of a more practical nature. Knowledge, social status and other diseases affect the degree to which people can be said to be responsible for their poor oral health. These factors affect people's oral health and their ability to take care of it. Both the conceptual and practical issues at stake are not reasons to abandon the idea of personal responsibility in oral health, but they do affect what the notion means and when it is reasonable to hold people responsible. They also commit people who support the idea of personal responsibility in oral health to supporting the idea of societal responsibility for mitigating the effects of factors that diminish people's responsibility and increase the available information and knowledge in the population.

Ethics support in community care makes a difference for practice.

PubMed

Magelssen, Morten; Gjerberg, Elisabeth; Lillemoen, Lillian; Førde, Reidun; Pedersen, Reidar

2018-03-01

Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities. To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities. Two online questionnaires about the municipal ethics activities. Participants and research context: A total of 137 municipal contact persons for the ethics project answered the first survey (55% response rate), whereas 217 ethics facilitators responded to the second survey (33% response rate). Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services. Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision. This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators. It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors.

Kentucky pharmacists' opinions of the potential reclassification of pseudoephedrine as a legend drug

PubMed Central

Monson, Kathleen E.; Freeman, Patricia R.; Goodin, Amie J.; Talbert, Jeffery; Blumenschein, Karen

2015-01-01

Objectives To collect and analyze Kentucky pharmacists' opinions of the effectiveness of current methamphetamine precursor controls, to analyze proposed legislation to make pseudoephedrine (PSE) a legend drug, and to analyze the potential impact of such legislation on pharmacy practice and patients. Design Descriptive, nonexperimental survey study. Setting Kentucky; June through October 2012. Participants 431 Kentucky community pharmacists. Intervention Mailed survey. Main outcome measures Perceived efficacy of current methamphetamine precursor controls, anticipated impact on individual pharmacy practices and patients of proposed legislation to make PSE available by prescription only, and current opinions about the proposed legislation. Results Analysis of 431 community pharmacists showed that approximately 77% believed proposed legislation to make PSE available by prescription only would be effective in reducing methamphetamine abuse and methamphetamine-related laboratory incidents, with 56.2% indicating support for the proposed legislation. Pharmacists practicing in chain pharmacies were 2.9 times more likely to support the legislation than pharmacists practicing in independent pharmacies. Additional factors influencing pharmacist support included Kentucky region of practice, anticipated impact on time spent on PSE activities, pharmacy profit, methamphetamine abuse, and methamphetamine-related laboratory incidents. Pharmacists practicing in regions of Kentucky associated with higher methamphetamine abuse appear to more strongly support the proposed legislation. Conclusion Pharmacists are at the frontline of PSE distribution. Gaining a better understanding of issues surrounding the distribution of PSE will enhance the likelihood that future legislation may be crafted to reduce methamphetamine production, laboratory incidents, and abuse while minimizing inconvenience and cost. PMID:25063261

Kentucky pharmacists' opinions of the potential reclassification of pseudoephedrine as a legend drug.

PubMed

Monson, Kathleen E; Freeman, Patricia R; Goodin, Amie J; Talbert, Jeffery; Blumenschein, Karen

2014-01-01

To collect and analyze Kentucky pharmacists' opinions of the effectiveness of current methamphetamine precursor controls, to analyze proposed legislation to make pseudoephedrine (PSE) a legend drug, and to analyze the potential impact of such legislation on pharmacy practice and patients. Descriptive, nonexperimental survey study. Kentucky; June through October 2012. 431 Kentucky community pharmacists. Mailed survey. Perceived efficacy of current methamphetamine precursor controls, anticipated impact on individual pharmacy practices and patients of proposed legislation to make PSE available by prescription only, and current opinions about the proposed legislation. Analysis of 431 community pharmacists showed that approximately 77% believed proposed legislation to make PSE available by prescription only would be effective in reducing methamphetamine abuse and methamphetamine-related laboratory incidents, with 56.2% indicating support for the proposed legislation. Pharmacists practicing in chain pharmacies were 2.9 times more likely to support the legislation than pharmacists practicing in independent pharmacies. Additional factors influencing pharmacist support included Kentucky region of practice, anticipated impact on time spent on PSE activities, pharmacy profit, methamphetamine abuse, and methamphetamine-related laboratory incidents. Pharmacists practicing in regions of Kentucky associated with higher methamphetamine abuse appear to more strongly support the proposed legislation. Pharmacists are at the frontline of PSE distribution. Gaining a better understanding of issues surrounding the distribution of PSE will enhance the likelihood that future legislation may be crafted to reduce methamphetamine production, laboratory incidents, and abuse while minimizing inconvenience and cost.

Health workers' views of a program to facilitate physical health care in mental health settings: implications for implementation and training.

PubMed

Baker, Wendy; Harris, Melanie; Battersby, Malcolm

2014-12-01

Physical comorbidities shorten the lifespan of people with severe mental illness therefore mental health clinicians need to support service users in risk factor-related behaviour change. We investigated mental health care workers' views of a physical health self-management support program in order to identify implementation requirements. Qualitative interviews were conducted with workers who had differing levels of experience with a self-management support program. Themes were identified using interpretive descriptive analysis and then matched against domains used in implementation models to draw implications for successful practice change. Three main themes emerged related to: (1) understandings of disease management within job roles; (2) requirements for putting self-management support into practice; and (3) challenges of coordination in disease management. Priority domains from implementation models were inner and outer health service settings. While staff training is required, practice change for care which takes account of both mental and physical health also requires changes in organisational frameworks. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Impact of electronic medical record on physician practice in office settings: a systematic review

PubMed Central

2012-01-01

Background Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned. Results For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives. In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process. Conclusions Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review. PMID:22364529

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations.

PubMed

Williams-Whitt, Kelly; Bültmann, Ute; Amick, Benjamin; Munir, Fehmidah; Tveito, Torill H; Anema, Johannes R

2016-12-01

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool.

PubMed

Rooney, Deborah M; Hananel, David M; Covington, Benjamin J; Dionise, Patrick L; Nykamp, Michael T; Pederson, Melvin; Sahloul, Jamal M; Vasquez, Rachael; Seagull, F Jacob; Pinsky, Harold M; Sweier, Domenica G; Cooke, James M

2018-04-01

Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of adolescents' motivation for educational attainment.

PubMed

Cham, Heining; Hughes, Jan N; West, Stephen G; Im, Myung Hee

2014-06-01

The Adolescent Motivation for Educational Attainment Questionnaire is a 32-item questionnaire (we drew 20 items from 3 subscales of the Educational Motivation Questionnaire; Murdock, 1999) that was developed to measure multiple potential dimensions of adolescents' motivation to complete high school and enroll in post-secondary education, including competence and effort beliefs; perceived value of education; and peer, teacher, and parent support for educational attainment. We assessed a multiethnic sample (N = 569) of low-achieving students who started 1st grade together in 1 urban and 2 small city school districts. Participants were assessed over 2 consecutive years (Grades 8 and 9 given prior grade retention, or Grades 9 and 10 if not retained). Exploratory factor analyses identified 4 correlated dimensions underlying the questionnaire responses. Subsequent confirmatory factor analyses provided support for a bifactor model, which includes a general factor of students' basic educational motivation, and specific factors of (a) teacher educational expectations, (b) peer aspirations, and (c) value of education. Measurement invariance of the bifactor model was established across students' gender and ethnicity (Caucasian, African American, and Hispanic) and year of testing. Criterion-related validity of the general and specific factors with students' school belonging, student-teacher warmth and conflict, disciplinary practices, letter grade, conduct problems, and behavioral engagement was examined. Practical implications of the measure are discussed.

Assessment of Adolescents’ Motivation for Educational Attainment

PubMed Central

Cham, Heining; Hughes, Jan N.; West, Stephen G.; Im, Myung Hee

2015-01-01

The Adolescent Motivation for Educational Attainment Questionnaire is a 32-item questionnaire (we drew 20 items from 3 subscales of the Educational Motivation Questionnaire; Murdock, 1999) that was developed to measure multiple potential dimensions of adolescents’ motivation to complete high school and enroll in post-secondary education, including competence and effort beliefs; perceived value of education; and peer, teacher, and parent support for educational attainment. We assessed a multiethnic sample (N = 569) of low-achieving students who started 1st grade together in 1 urban and 2 small city school districts. Participants were assessed over 2 consecutive years (Grades 8 and 9 given prior grade retention, or Grades 9 and 10 if not retained). Exploratory factor analyses identified 4 correlated dimensions underlying the questionnaire responses. Subsequent confirmatory factor analyses provided support for a bifactor model, which includes a general factor of students’ basic educational motivation, and specific factors of (a) teacher educational expectations, (b) peer aspirations, and (c) value of education. Measurement invariance of the bifactor model was established across students’ gender and ethnicity (Caucasian, African American, and Hispanic) and year of testing. Criterion-related validity of the general and specific factors with students’ school belonging, student–teacher warmth and conflict, disciplinary practices, letter grade, conduct problems, and behavioral engagement was examined. Practical implications of the measure are discussed. PMID:24588748

Psychometric analysis of two new scales: the evidence-based practice nursing leadership and work environment scales.

PubMed

Pryse, Yvette; McDaniel, Anna; Schafer, John

2014-08-01

Those in nursing have been charged with practicing to the full extent of their education and training by the Institute of Medicine. Therefore, evidence-based practice (EBP) has never been more important to nursing than in the current healthcare environment. Frequently the burden of EBP is the responsibility of the bedside practitioner, but has been found to be a process that requires leadership and organizational support. A key underlying component of a strong EBP environment includes effective communications and collaboration among staff and nursing leadership. Developing measurement tools that examine the milieu and nursing leadership in which the staff nurse practices is an important component of understanding the factors that support or hinder EBP. The aim of this study is to report on the development and analysis of two new scales designed to explore leadership and organizational support for EBP. The EBP Nursing Leadership Scale (10 items) examines the staff nurses perception of support provided by the nurse manager for EBP, and the EBP Work Environment Scale (8 items) examines organizational support for EBP. Staff nurses who worked at least .5 FTE in direct patient care, from two inner city hospitals (n = 422) completed the scales. The scales were evaluated for internal consistency reliability with the Cronbach alpha technique, content validity using a panel of experts, and construct validity by The content validity index computed from expert rankings was .78 to 1.0 with an average of.96. Cronbach's alpha was .96 (n = 422) for the EBP Nursing Leadership Scale and .86 (n = 422) for the EBP Work Environment Scale. Factor analysis confirmed that each scale measured a unidimensional construct (p < .000). The EBP Nursing Leadership Scale and the EBP Work Environment Scale are psychometrically sound instruments to examine organizational influences on EBP. © 2014 Sigma Theta Tau International.

Supports for medical students during rural clinical placements: factors associated with intention to practise in rural locations.

PubMed

King, Katherine R; Purcell, Rachael A; Quinn, Stephen J; Schoo, Adrian M; Walters, Lucie K

2016-01-01

Through rural clinical schools (RCSs), medical students may undertake an extended block of clinical training in rural Australia. The premise of these placements is that meaningful rural exposure will facilitate rural career uptake. RCSs offer a range of supports to facilitate student engagement in the program. This study aims to analyse RCS students' perceptions of these supports and impact on intentions to work rurally. Between September 2012 and January 2013 RCS students were invited to complete questions regarding perceptions of student support, as a part of the annual Federation of Australian Medical Educators survey. Multivariable logistic regression was used to identify associations between supports and intentions for rural internship or career. There were 454 participants. A majority of students (n=349, 79.1%) felt well supported by their RCS. Students from a rural background (odds ratio (OR)=1.64 (95% confidence interval (CI):1.13-2.38)), or who indicated that their placement had a positive impact on their wellbeing (OR=1.38 (95%CI:1.07-1.80)), were more likely to intend to complete a rural internship. Those who felt socially isolated were less likely to elect this (OR=0.82 (0.70-0.97)). Outcomes were similar for those indicating a preference for rural or remote practice after completing training. Student perceptions of supports offered by RCSs were generally very positive. Perceptions of financial support were not predictive of rural career intent. Although this does not negate the importance of providing appropriate financial supports, it does demonstrate that student wellbeing is a more important recruitment factor for rural practice.

Defining and evaluating perceptions of victim blame in antigay hate crimes.

PubMed

Cramer, Robert J; Nobles, Matt R; Amacker, Amanda M; Dovoedo, Lisa

2013-09-01

Victimology research often hinges on attribution of blame toward victims despite a lack of conceptual agreement on the definition and measure of the construct. Drawing on established blame attribution and intent literature, the present study evaluates psychometric properties of the Perceptions of Victim Blame Scale (PVBS) using mock jury samples in a vignette-based capital murder antigay hate crime context. Factor analyses show support for a three-factor structure with the following perceptions of victim blame subscales: Malice, Recklessness, and Unreliability. All factors displayed expected positive associations with homonegativity and authoritarianism. Likewise, all factors displayed null relations with trait aggression and social desirability. Only the Malice factor predicted sentencing decisions after controlling for crime condition and support for the death penalty. Results are reviewed with respect to blame attribution theory and practical application of a revised PVBS.

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

Noneconomic factors influencing scrap metal disposition decisions at DOE and NRC-licensed nuclear facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ewen, M.D.; Robinson, L.A.

1997-02-01

The U.S. Environmental Protection Agency (EPA) is currently developing radiation protection standards for scrap metal, which will establish criteria for the unconditional clearance of scrap from nuclear facilities. In support of this effort, Industrial Economics, Incorporated is assessing the costs and benefits attributable to the rulemaking. The first step in this analysis is to develop an in-depth understanding of the factors influencing scrap disposition decisions, so that one can predict current and future practices under existing requirements and compare them to the potential effects of EPA`s rulemaking. These baseline practices are difficult to predict due to a variety of factors.more » First, because decommissioning activities are just beginning at many sites, current practices do not necessarily provide an accurate indicator of how these practices may evolve as site managers gain experience with related decisions. Second, a number of different regulations and policies apply to these decisions, and the interactive effects of these requirements can be difficult to predict. Third, factors other than regulatory constraints and costs may have a significant effect on related decisions, such as concerns about public perceptions. In general, research suggests that these factors tend to discourage the unconditional clearance of scrap metal.« less

Psychological distress, health protection, and sexual practices among young men who have sex with men: Using social action theory to guide HIV prevention efforts.

PubMed

Holloway, Ian W; Traube, Dorian E; Schrager, Sheree M; Tan, Diane; Dunlap, Shannon; Kipke, Michele D

2017-01-01

The present study addresses gaps in the literature related to theory development for young men who have sex with men (YMSM) sexual practices through the application and modification of Social Action Theory. Data come from the Healthy Young Men study (N = 526), which longitudinally tracked a diverse cohort of YMSM ages 18-24 to characterize risk and protective factors associated with drug use and sexual practices. Structural equation modeling examined the applicability of, and any necessary modifications to a YMSM-focused version of Social Action Theory. The final model displayed excellent fit (CFI = 0.955, TLI = 0.947, RMSEA = 0.037) and suggested concordance between social support and personal capacity for sexual health promotion. For YMSM, practicing health promotion and avoiding practices that may put them at risk for HIV was associated with both social isolation and psychological distress (β = -0.372, t = -4.601, p<0.001); psychological distress is an internalized response to environmental and cognitive factors and sexual practices are an externalized response. Results point to the utility of Social Action Theory as a useful model for understanding sexual practices among YMSM, the application of which shows health protective sexual practices are a function of sociocognitive factors that are influenced by environmental contexts. Social Action Theory can help prevention scientists better address the needs of this vulnerable population.

Context before implementation: a qualitative study of decision makers' views of a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing.

PubMed

Cabassa, Leopoldo J; Stefancic, Ana

2018-04-04

People with serious mental illness die at an earlier age than people in the general population largely due to cardiovascular disease. Healthy lifestyle interventions can help reduce this health inequity. In this qualitative study, we examined the perceptions that decision makers in supportive housing agencies had toward a peer-led healthy lifestyle intervention and their views of contextual factors that could shape implementation at these agencies. A purposive sample of 12 decision makers from three supportive housing agencies was recruited. We presented participants a vignette describing our peer-led intervention and used semistructured qualitative interviews to examine their views. Interviews were recorded, professionally transcribed, and analyzed using directed content analysis. Participants reported positive views toward the intervention with the most valued intervention attributes being relative advantage over existing services, compatibility to clients' needs, ability to pilot the intervention, and cost. A model emerged from our data depicting multilevel contextual factors believed to shape the implementation of our intervention at these agencies, including system- (funding, marketability, and external regulations), organization- (leadership support, fit with organization, staff buy-in and burden), and client-level (adaptability to clients' needs, and clients' buy-in) factors. Study findings illustrate the importance of understanding the context of practice before implementation. This examination can help identify critical views from decision makers that could undermine or advance the integration of peer-led interventions in supportive housing agencies and help identify structures, policies, and organizational practices that can inform the implementation process.

Emotional and tangible social support in a German population-based sample: Development and validation of the Brief Social Support Scale (BS6).

PubMed

Beutel, Manfred E; Brähler, Elmar; Wiltink, Jörg; Michal, Matthias; Klein, Eva M; Jünger, Claus; Wild, Philipp S; Münzel, Thomas; Blettner, Maria; Lackner, Karl; Nickels, Stefan; Tibubos, Ana N

2017-01-01

Aim of the study was the development and validation of the psychometric properties of a six-item bi-factorial instrument for the assessment of social support (emotional and tangible support) with a population-based sample. A cross-sectional data set of N = 15,010 participants enrolled in the Gutenberg Health Study (GHS) in 2007-2012 was divided in two sub-samples. The GHS is a population-based, prospective, observational single-center cohort study in the Rhein-Main-Region in western Mid-Germany. The first sub-sample was used for scale development by performing an exploratory factor analysis. In order to test construct validity, confirmatory factor analyses were run to compare the extracted bi-factorial model with the one-factor solution. Reliability of the scales was indicated by calculating internal consistency. External validity was tested by investigating demographic characteristics health behavior, and distress using analysis of variance, Spearman and Pearson correlation analysis, and logistic regression analysis. Based on an exploratory factor analysis, a set of six items was extracted representing two independent factors. The two-factor structure of the Brief Social Support Scale (BS6) was confirmed by the results of the confirmatory factor analyses. Fit indices of the bi-factorial model were good and better compared to the one-factor solution. External validity was demonstrated for the BS6. The BS6 is a reliable and valid short scale that can be applied in social surveys due to its brevity to assess emotional and practical dimensions of social support.

Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness.

PubMed

Fries, Christopher J

2008-11-01

ABSTRACTOBJECTIVETo develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSIONThis study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.

Storage of household firearms: an examination of the attitudes and beliefs of married women with children

PubMed Central

Johnson, R. M.; Runyan, C. W.; Coyne-Beasley, T.; Lewis, M. A.; Bowling, J. M.

2008-01-01

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n = 185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon–Mann–Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices. PMID:17890758

Supporting Pre-Service Teachers to Enhance the Effectiveness of Their Classroom Practice through Engaging with the "Voice" of Their Pupils

ERIC Educational Resources Information Center

Hopkins, Elizabeth Anne

2014-01-01

The research reported here was focussed on accessing the perceptions of pre-service teachers regarding the critical factors which support highly effective learning in schools in the United Kingdom. Their perceptions were arranged into a taxonomy so that they can be used as a starting point for their reflections on the observations they make of…

Measuring Hope Among Children Affected by Armed Conflict: Cross-Cultural Construct Validity of the Children’s Hope Scale

PubMed Central

Haroz, Emily E.; Jordans, Mark; de Jong, Joop; Gross, Alden; Bass, Judith; Tol, Wietse

2018-01-01

We investigated the cross-cultural construct validity of hope, a factor associated with mental health protection and promotion, using the Children’s Hope Scale (CHS). The sample (n = 1,057; 48% girls) included baseline data from three cluster-randomized controlled trials with children affected by armed conflict (n = 329 Burundi; n = 403 Indonesia; n = 325 Nepal). The confirmatory factor analysis in each country indicated good fit for the hypothesized two-factor model. Analysis by gender indicated that configural invariance was supported and that scalar invariance was demonstrated in Indonesia. However, metric and scalar invariance were not supported in Burundi and Nepal. In country comparisons, configural and metric invariance were met, but scalar invariance was not supported. Evidence from this study supports the use of the CHS within various sociocultural settings and across genders, but direct comparisons of CHS scores across groups should be done with caution. Rigorous evaluations of the measurement properties of mental health protective and promotive factors are necessary to inform both research and practice. PMID:26508802

MATERNAL CHRONOLOGICAL AGE, PRENATAL AND PERINATAL HISTORY, SOCIAL SUPPORT, AND PARENTING OF INFANTS

PubMed Central

Bornstein, Marc H.; Putnick, Diane L.; Suwalsky, Joan T. D.; Gini, Motti

2018-01-01

The role of maternal chronological age in prenatal and perinatal history, social support, and parenting practices of new mothers (N = 335) was examined. Primiparas of 5-month-old infants ranged in age from 13 to 42 years. Age effects were zero, linear, and nonlinear. Nonlinear age effects were significantly associated up to a certain age with little or no association afterward; by spline regression, estimated points at which the slope of the regression line changed were 25 years for prenatal and perinatal history, 31 years for social supports, and 27 years for parenting practices. Given the expanding age range of first-time parents, these findings underscore the importance of incorporating maternal age as a factor in studies of parenting and child development. PMID:16942495

Conservative Protestantism and attitudes toward corporal punishment, 1986-2014.

PubMed

Hoffmann, John P; Ellison, Christopher G; Bartkowski, John P

2017-03-01

Research indicates that conservative Protestants are highly supportive of corporal punishment. Yet, Americans' support for this practice has waned during the past several decades. This study aggregates repeated cross-sectional data from the General Social Surveys (GSS) to consider three models that address whether attitudes toward spanking among conservative Protestants shifted relative to those of other Americans from 1986 to 2014. Although initial results reveal a growing gap between conservative Protestants and the broader American public, we find that average levels of support have remained most robust among less educated conservative Protestants, with some erosion among more highly educated conservative Protestants. Moreover, trends in variability suggest that conservative Protestants exhibit more cohesive support for this practice than do others. These results provide a window into the cultural contours of religious change and the social factors that facilitate such change. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessment of water, sanitation, and hygiene practice and associated factors among people living with HIV/AIDS home based care services in Gondar city, Ethiopia

PubMed Central

2012-01-01

Background People living with HIV/AIDS have substantially greater need for water, sanitation, and hygiene. Encouraging hygiene education for People Living with HIV/AIDS in home based care services and additional support for the provision of water, sanitation, and hygiene services is recommended. Methods A cross-sectional study was carried during 2009 to assess water, sanitation status and hygiene practices and associated factors among People Living with HIV/AIDS in home based care services in Gondar city of Ethiopia. A systematic random sampling was used to select study subjects from 900 Home Based Care clients of People Living HIV/AIDS in Gondar city. Data was collected from 296 People Living with HIV/AIDS from two NGO’s in the city. For in-depth interview, four different categories were participated. Logistic regression and thematic framework analysis were performed for quantitative and qualitative part respectively. Results Two hundred ninety four subjects (72.8% (214) females and 27.2% (80) males) were studied. The mean age was 35.8 ± 8.7 years. In the study, 42.9% (126) of the households have unimproved water status, 67% (197) of the households have unimproved sanitation status, and 51.7% (152) of the households have poor hygienic practice. Diarrhoea with water status; educational status and latrine availability with sanitation status; and hand washing device availability and economical reasons for the affordability of soap with hygienic practice were significantly associated. Economical reasons and hygiene education were factors that affect water, sanitation, and hygienic practice. Stigma and discrimination were minimized as a factor in the study area. Conclusions There is high burden of water, sanitation and hygiene in people living HIV/AIDS in home based care services. Encouraging hygiene education for people living HIVAIDS in home based care services and additional support for the provision of water, sanitation, and hygiene services is recommended. PMID:23216835

Exercise Dose in Clinical Practice

PubMed Central

Wasfy, Meagan; Baggish, Aaron L.

2016-01-01

There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice. PMID:27267537

Exercise Dose in Clinical Practice.

PubMed

Wasfy, Meagan M; Baggish, Aaron L

2016-06-07

There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice. © 2016 American Heart Association, Inc.

Examining the factor structure of the Multiple Sclerosis Impact Scale.

PubMed

Fitzgerald, Shawn M; Li, Jian; Rumrill, Phillip D; Merchant, William; Bishop, Malachy

2014-01-01

The purpose of this study was to investigate the factor structure of the Multiple Sclerosis Impact Scale (MSIS-29) to assess its suitability for modeling the impact of MS on a nation-wide sample of individuals from the United States. Investigators completed a Confirmatory Factor Analysis (CFA) to examine the two-factor structure proposed by Hobart et al. [17]. Although the original MSIS-29 factor structure did not fit the data exactly, the hypothesized two-factor model was partially supported in the current data. Implications for future instrument development and rehabilitation practice are discussed.

Point-of-care Cognitive Support Technology in Emergency Departments: A Scoping Review of Technology Acceptance by Clinicians.

PubMed

Jun, Shelly; Plint, Amy C; Campbell, Sandy M; Curtis, Sarah; Sabir, Kyrellos; Newton, Amanda S

2018-05-01

Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED. We systematically searched 10 electronic databases and gray literature published from January 2006 to December 2016. Studies of any design assessing an ED-based POC cognitive support technology were considered eligible for inclusion. Studies were required to report outcome data for technology acceptance. Two reviewers independently screened studies for relevance and quality. Study quality was assessed using the Mixed-Methods Appraisal Tool. A descriptive analysis of the features of POC cognitive support technology for each study is presented, illustrating trends in technology development and evaluation. A thematic analysis of clinician, technical, patient, and organizational factors associated with technology acceptance is also presented. Of the 1,563 references screened for eligibility, 24 met the inclusion criteria and were included in the review. Most studies were published from 2011 onward (88%), scored high for methodologic quality (79%), and examined POC technologies that were novel and newly introduced into the study setting (63%). Physician use of POC technology was the most commonly studied (67%). Technology acceptance was frequently conceptualized and measured by factors related to clinician attitudes and beliefs. Experience with the technology, intention to use, and actual use were also more common outcome measures of technology acceptance. Across studies, perceived usefulness was the most noteworthy factor impacting technology acceptance, and clinicians generally had positive perceptions of the use of POC cognitive support technology in the ED. However, the actual use of POC cognitive support technology reported by clinicians was low-use, by proportion of patient cases, ranged from 30% to 59%. Of the 24 studies, only two studies investigated acceptance of POC cognitive support technology currently implemented in the ED, offering "real-world" clinical practice data. All other studies focused on acceptance of novel technologies. Technical aspects such as an unfriendly user interface, presentation of redundant or ambiguous information, and required user effort had a negative impact on acceptance. Patient expectations were also found to have a negative impact, while patient safety implications had a positive impact. Institutional support was also reported to impact technology acceptance. Findings from this scoping review suggest that while ED clinicians acknowledge the utility and value of using POC cognitive support technology, actual use of such technology can be low. Further, few studies have evaluated the acceptance and use of POC technologies in routine care. Prospective studies that evaluate how ED clinicians appraise and consider POC technology use in clinical practice are now needed with diverse clinician samples. While this review identified multiple factors contributing to technology acceptance, determining how clinician, technical, patient, and organizational factors mediate or moderate acceptance should also be a priority. © 2017 by the Society for Academic Emergency Medicine.

Factors associated with high levels of physical activity among adults with intellectual disability.

PubMed

Temple, Viviene A

2009-03-01

The aim was to identify factors associated with physical activity participation among active (i.e. more than or equal to 10,000 steps per day) individuals with intellectual disability. Staff at day program and supported employment organizations were asked to identify individuals they believed were physically active. To verify participants were active, 7-day pedometer data were collected. Using these data, 13 participants met the inclusion criterion of 10,000 steps per day from 37 individuals identified by staff. Participants (n=13) ranged in age from 18 to 46 years (mean=34, SD= 8) and seven were male. In-depth semistructured interviews were conducted to explore the environmental and social supports for these high levels of physical activity. Three major themes were identified from content and thematic analyses. Key individuals and organizations were important in fostering initial interests and the development of skills. Coaches, staff and parents were important in 'showing them how.' For example, how to vacuum or stack produce, how to bowl, how to use weight training equipment or helping to plan a safe walking route. Motivation for initial and ongoing participation was associated with friendship and social connection. Practical support was needed for continued participation. In particular, transportation and affordable activities were very important. Fostering practical skills, supporting the social aspects of physical activity and keeping activities low cost are important enabling and reinforcing factors for physical activity among active persons with intellectual disability.

Nursing service innovation: A case study examining emergency nurse practitioner service sustainability.

PubMed

Fox, Amanda; Gardner, Glenn; Osborne, Sonya

2018-02-01

This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.

Understanding work contextual factors: a short-cut to evidence-based practice?

PubMed

Wallin, Lars; Ewald, Uwe; Wikblad, Karin; Scott-Findlay, Shannon; Arnetz, Bengt B

2006-01-01

It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of getting research into practice and should be considered in future implementation projects.

Social support and support groups among people with HIV/AIDS in Ghana.

PubMed

Abrefa-Gyan, Tina; Wu, Liyun; Lewis, Marilyn W

2016-01-01

HIV/AIDS, a chronic burden in Ghana, poses social and health outcome concerns to those infected. Examining the Medical Outcome Study Social Support Survey (MOS-SSS) instrument among 300 Ghanaians from a cross-sectional design, Principal Component Analysis yielded four factors (positive interaction, trust building, information giving, and essential support), which accounted for 85.73% of the total variance in the MOS-SSS. A logistic regression analysis showed that essential support was the strongest predictor of the length of time an individual stayed in the support group, whereas positive interaction indicated negative association. The study's implications for policy, research, and practice were discussed.

Coordination of care by primary care practices: strategies, lessons and implications.

PubMed

O'Malley, Ann S; Tynan, Ann; Cohen, Genna R; Kemper, Nicole; Davis, Matthew M

2009-04-01

Despite calls from numerous organizations and payers to improve coordination of care, there are few published accounts of how care is coordinated in real-world primary care practices. This study by the Center for Studying Health System Change (HSC) documents strategies that a range of physician practices use to coordinate care for their patients. While there was no single recipe for coordination given the variety of patient, physician, practice and market factors, some cross-cutting lessons were identified, such as the value of a commitment to interpersonal continuity of care as a foundation for coordination. Respondents also identified the importance of system support for the standardization of office processes to foster care coordination. While larger practices may have more resources to invest, many of the innovations described could be scaled to smaller practices. Some coordination strategies resulted in improved efficiency over time for practices, but by and large, physician practices currently pursue these efforts at their own expense. In addition to sharing information on effective strategies among practices, the findings also provide policy makers with a snapshot of the current care coordination landscape and implications for initiatives to improve coordination. Efforts to provide technical support to practices to improve coordination, for example, through medical-home initiatives, need to consider the baseline more typical practices may be starting from and tailor their support to practices ranging widely in size, resources and presence of standardized care processes. If aligned with payment incentives, some of these strategies have the potential to increase quality and satisfaction among patients and providers by helping to move the health care delivery system toward better coordinated care.

Building Change Readiness Practices for Information Technology Support Staff

ERIC Educational Resources Information Center

Perkins, Dianna Joseph

2014-01-01

With the turbulent economic conditions of the healthcare market, organizational leaders are faced with significant factors driving unprecedented change. Healthcare organizations are challenged with reimbursement reductions, high costs, modification of government regulations, and demanding healthcare consumers. Survival for healthcare organizations…

The support-control continuum: An investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings.

PubMed

Price, Owen; Baker, John; Bee, Penny; Lovell, Karina

2018-01-01

De-escalation techniques are recommended to manage violence and aggression in mental health settings yet restrictive practices continue to be frequently used. Barriers and enablers to the implementation and effectiveness of de-escalation techniques in practice are not well understood. To obtain staff descriptions of de-escalation techniques currently used in mental health settings and explore factors perceived to influence their implementation and effectiveness. Qualitative, semi-structured interviews and Framework Analysis. Five in-patient wards including three male psychiatric intensive care units, one female acute ward and one male acute ward in three UK Mental Health NHS Trusts. 20 ward-based clinical staff. Individual semi-structured interviews were digitally recorded, transcribed verbatim and analysed using a qualitative data analysis software package. Participants described 14 techniques used in response to escalated aggression applied on a continuum between support and control. Techniques along the support-control continuum could be classified in three groups: 'support' (e.g. problem-solving, distraction, reassurance) 'non-physical control' (e.g. reprimands, deterrents, instruction) and 'physical control' (e.g. physical restraint and seclusion). Charting the reasoning staff provided for technique selection against the described behavioural outcome enabled a preliminary understanding of staff, patient and environmental influences on de-escalation success or failure. Importantly, the more coercive 'non-physical control' techniques are currently conceptualised by staff as a feature of de-escalation techniques, yet, there was evidence of a link between these and increased aggression/use of restrictive practices. Risk was not a consistent factor in decisions to adopt more controlling techniques. Moral judgements regarding the function of the aggression; trial-and-error; ingrained local custom (especially around instruction to low stimulus areas); knowledge of the patient; time-efficiency and staff anxiety had a key role in escalating intervention. This paper provides a new model for understanding staff intervention in response to escalated aggression, a continuum between support and control. It further provides a preliminary explanatory framework for understanding the relationship between patient behaviour, staff response and environmental influences on de-escalation success and failure. This framework reveals potentially important behaviour change targets for interventions seeking to reduce violence and use of restrictive practices through enhanced de-escalation techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review.

PubMed

Huijg, Johanna M; Gebhardt, Winifred A; Verheijden, Marieke W; van der Zouwe, Nicolette; de Vries, Juriena D; Middelkoop, Barend J C; Crone, Mathilde R

2015-02-01

Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices. Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors. Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants. This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

A Practical Measure of Student Motivation: Establishing Validity Evidence for the Expectancy-Value-Cost Scale in Middle School

ERIC Educational Resources Information Center

Kosovich, Jeff J.; Hulleman, Chris S.; Barron, Kenneth E.; Getty, Steve

2015-01-01

We present validity evidence for the Expectancy-Value-Cost (EVC) Scale of student motivation. Using a brief, 10-item scale, we measured middle school students' expectancy, value, and cost for their math and science classes in the Fall and Winter of the same academic year. Confirmatory factor analyses supported the three-factor structure of the EVC…

At-Risk Youth: Theory, Practice, Reform. Source Books on Education, Volume 49. Garland Reference Library of Social Science, Volume 1021.

ERIC Educational Resources Information Center

Kronick, Robert F., Ed.

To reduce the number of school dropouts and youth homicides and to change poor social outcomes for children and youth at risk, it is necessary to consider socially imposed risk factors and reconceptualize ways of thinking about risk. Chapters in this collection discuss risk factors and show that schools can become supportive environments that…

Factors Considered by Elementary Teachers When Developing and Modifying Mathematical Tasks to Support Children's Mathematical Thinking

NASA Astrophysics Data System (ADS)

Fredenberg, Michael Duane

The idea that problems and tasks play a pivotal role in a mathematics lesson has a long standing in mathematics education research. Recent calls for teaching reform appeal for training teachers to better understand how students learn mathematics and to employ students' mathematical thinking as the basis for pedagogy (CCSSM, 2010; NCTM, 2000; NRC 1999). The teaching practices of (a) developing a task for a mathematics lesson and, (b) modifying the task for students while enacting the lesson fit within the scope of supporting students' mathematical thinking. Surprisingly, an extensive search of the literature did not yield any research aimed to identify and refine the constituent parts of the aforementioned teaching practices in the manner called for by Grossman and xiii colleagues (2009). Consequently, my research addresses the two questions: (a) what factors do exemplary elementary teachers consider when developing a task for a mathematics lesson? (b) what factors do they consider when they modify a task for a student when enacting a lesson? I conducted a multiple case study involving three elementary teachers, each with extensive training in the area of Cognitively Guided Instruction (CGI), as well as several years experience teaching mathematics following the principles of CGI (Carpenter et al., 1999). I recorded video of three mathematics lessons with each participant and after each lesson I conducted a semi-structured stimulated recall interview. A subsequent follow-up clinical interview was conducted soon thereafter to further explore the teacher's thoughts (Ginsberg, 1997). In addition, my methodology included interjecting myself at select times during a lesson to ask the teacher to explain her reasoning. Qualitative analysis led to a framework that identified four categories of influencing factors and seven categories of supporting objectives for the development of a task. Subsets of these factors and objectives emerged as particularly relevant when the teachers decided to modify a task. Moreover, relationships between and among the various factors were identified. The emergent framework from this study offers insight into decompositions of the two teaching practices of interest, and, in particular, the utility of the number choices made by the teachers.

Academic or community practice? What is driving decision-making and career choices.

PubMed

Goudreau, Bernadette J; Hassinger, Taryn E; Hedrick, Traci L; Slingluff, Craig L; Schroen, Anneke T; Dengel, Lynn T

2018-06-18

Identifying factors that impact progression of surgery trainees into academic versus non-academic practices may permit tailoring residency experiences to promote academic careers in institutions charged with the training of future surgeon scientists. The aim of this study was to identify factors associated with progression of surgery trainees into academic versus non-academic practice. A survey was distributed to 135 surgeons graduating from the University of Virginia residency program from 1964-2016, a single academic institution. Questions addressed practice type, research productivity, work/life balance, mentorship, and overall sentiment toward research and academic surgery. A 5-point Likert scale measured career satisfaction and influence of factors in practice setting choice. Of the 135 surveys that were electronically distributed, 69 participants responded (response rate: 51%). Of the 54 with known current practice types, 34 (63%) were academic and 20 (37%) non-academic. Academic surgeons reported more publications by the conclusion of surgery training (56% vs 25% with >10 publications, P = .02). More academic surgeons reported >$100,000 in student debt at graduation (44% vs 25%, P < .05). Factors encouraging an academic career were similar for both types of surgeons, including involvement in education of trainees and access to mentorship. Both groups were discouraged from an academic practice by requirements of grant-writing and funding responsibilities. Surgeons in academic practice were more likely to recommend surgery as a career to a current medical student (100% vs 70%, P = .001). This knowledge may help to tailor training experiences to promote academic careers. By supporting funding mechanisms and grant-writing programs, while encouraging mentorship and productive research experiences, current surgical trainees may be more enthusiastic about a career in academic practice. Copyright © 2018 Elsevier Inc. All rights reserved.

Doctors' perspectives on the viability of rural practice.

PubMed

Jones, J A; Humphreys, J S; Adena, M A

2004-01-01

Private practitioners play a vital role in meeting the health needs of rural communities. However, the prospect of operating a private practice business in rural Australia seems to be increasingly unattractive, because many communities are forced to recruit salaried or overseas-trained doctors. This study focuses on rural practices as businesses whose viability influences their attractiveness for the recruitment and retention of practitioners. The specific objectives are to ascertain which factors contribute to or threaten practice viability in rural areas, and whether they vary according to the degree of rurality or geographical remoteness. This study is based on data collected from a national study into the viability of rural general practice undertaken jointly by the Rural Doctors Association of Australia and Monash University School of Rural Health Bendigo. The Rural Remote and Metropolitan Area (RRMA) classification was used as the indicator of rurality. The study surveyed all general practitioners practising in rural or remote regions of Australia (RRMAs 3 to 7). Only practitioners with some financial interest in the practice were selected for this analysis. Free-text responses to the two questions 'What are the key factors contributing to the viability of your practice?' and 'What factors would put the viability of your practice at risk?' were analysed using qualitative content analysis. Factors were derived iteratively through higher-level aggregation of responses. Chi-square tests were used to make comparisons across the RRMA categories. The national survey achieved a response rate of 35% of the entire population of GPs practising in RRMA 3 to 7 regions. Of these, 1050 respondents were relevant to this analysis. Seven major factors were identified by practitioners as the main contributors to practice viability. 'Practice characteristics' was nominated by 59% of respondents, followed by 'Income' (31%), 'Personal circumstances', 'Workforce' and 'Community characteristics' (all approximately 23%), 'GP activities and workload' (16%) and 'Professional support' (12%). Eight main factors were identified by practitioners as threats to viability. 'Workforce' was nominated by 57% of respondents, followed by 'Financial' (44%), 'Medico-legal' (33%), 'Administration-political' (16%), 'Community characteristics' (15%), 'GP-practice characteristics' and 'Personal circumstances' (10%) and 'Family circumstances' (3%). Across RRMA 3 to 5 the order of the percentage of respondents identifying each factor was generally consistent, with significant differences in the magnitude of the percentages for three contributing factors and four risk factors. While respondent numbers in RRMA 6 and 7 communities were low, significance testing did reveal differences between them and the rural communities on two contributing and one risk factor. Practice viability is a major factor affecting the attractiveness of rural and remote practice for intending and existing GPs. Initiatives designed to contribute to viability will not be successful unless measures are also adopted to address perceived threats. This study highlights the systemic nature of the factors which contribute to and threaten practice viability. Although a primary component of practice viability is economic, with income from consultations being critical, the importance of the interrelationships between the main viability factors should not be underestimated. Clearly a multifaceted systemic response is required to overcome problems associated with rural workforce recruitment of future and burnout of current rural GPs.

The Impact of Patient Suicide on the Professional Practice of Swiss Psychiatrists and Psychologists.

PubMed

Gulfi, Alida; Castelli Dransart, Dolores Angela; Heeb, Jean-Luc; Gutjahr, Elisabeth

2016-02-01

Many psychiatrists and psychologists are likely to experience a patient suicide at a point in their professional career. The present paper examines the effects of patient suicide on psychiatrists' and psychologists' professional reactions and working practices and investigates factors that may affect the severity of repercussions on their professional lives. Data from 271 psychiatrists and psychologists working in various institutional settings and in private practice in French-speaking Switzerland were collected by a written questionnaire. Psychiatrists and psychologists reported a range of professional reactions and changes in working practices following a patient suicide. Professional reactions and changes in working practices were more significant among women. The length of therapy and the emotional closeness with the deceased patient were predictive of a greater impact. In contrast, social and psychological support served as a protective factor by reducing negative repercussions on professional practice. Finally, the impact of losing a patient to suicide did not differ between psychiatrists and psychologists in institutional settings and those in private practice. Although patient suicide affected the professional life of psychiatrists and psychologists, it also encouraged them to review and adjust their working practices.

The Shame and Guilt Scales of the Test of Self-Conscious Affect-Adolescent (TOSCA-A): Factor Structure, Concurrent and Discriminant Validity, and Measurement and Structural Invariance Across Ratings of Males and Females.

PubMed

Watson, Shaun; Gomez, Rapson; Gullone, Eleonora

2017-06-01

This study examined various psychometric properties of the items comprising the shame and guilt scales of the Test of Self-Conscious Affect-Adolescent. A total of 563 adolescents (321 females and 242 males) completed these scales, and also measures of depression and empathy. Confirmatory factor analysis provided support for an oblique two-factor model, with the originally proposed shame and guilt items comprising shame and guilt factors, respectively. Also, shame correlated with depression positively and had no relation with empathy. Guilt correlated with depression negatively and with empathy positively. Thus, there was support for the convergent and discriminant validity of the shame and guilt factors. Multiple-group confirmatory factor analysis comparing females and males, based on the chi-square difference test, supported full metric invariance, the intercept invariance of 26 of the 30 shame and guilt items, and higher latent mean scores among females for both shame and guilt. Comparisons based on the difference in root mean squared error of approximation values supported full measurement invariance and no gender difference for latent mean scores. The psychometric and practical implications of the findings are discussed.

Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace

PubMed Central

2011-01-01

Background Women's return to work can be a significant barrier to continued breastfeeding. Workplace policies and practices to promote and support continued, and longer duration of, breastfeeding are important. In the context of the introduction of a new breastfeeding policy for Area Health Services in New South Wales, Australia, a baseline survey was conducted to describe current practices and examine women's reports of perceived organisational support on breastfeeding intention and practice. Methods A cross sectional survey of female employees of the Sydney South West Area Health Service was conducted in late 2009. A mailed questionnaire was sent to 998 eligible participants who had taken maternity leave over the 20-month period from January 2008 to August 2009. The questionnaire collected items assessing breastfeeding intentions, awareness of workplace policies, and the level of organisational and social support available. For those women who had returned to work, further questions were asked to assess the perceptions and practices of breastfeeding in the work environment, as well as barriers and enabling factors to combining breastfeeding and work. Results Returning to work was one of the main reasons women ceased breastfeeding, with 60 percent of women intending to breastfeed when they returned to work, but only 40 percent doing so. Support to combine breastfeeding and work came mainly from family and partners (74% and 83% respectively), with little perceived support from the organisation (13%) and human resources (6%). Most women (92%) had received no information from their managers about their breastfeeding options upon their return to work, and few had access to a room specially designated for breastfeeding (19%). Flexible work options and lactation breaks, as well as access to a private room, were identified as the main factors that facilitate breastfeeding at work. Conclusions Enabling women to continue breastfeeding at work has benefits for the infant, employee and organisation. However, this baseline study of health employees revealed that women felt largely unsupported by managers and their organisation to continue breastfeeding at work. PMID:22129232

Parents’ Activity-Related Parenting Practices Predict Girls’ Physical Activity

PubMed Central

DAVISON, KIRSTEN KRAHNSTOEVER; CUTTING, TANJA M.; BIRCH, LEANN L.

2008-01-01

Purpose Using a sample of 180 9-yr-old girls and their parents, this study examined (a) parents’ activity-related parenting strategies and similarities and differences in such strategies for mothers and fathers, and (b) links between activity-related parenting strategies and girls’ physical activity patterns. Methods Measures of girls’ physical activity included the Children’s Physical Activity scale, participation in organized sports, and physical fitness. We developed a questionnaire to assess ways in which parents promote physical activity among their children. Results Exploratory and confirmatory factor analyses identified two factors for each parent including logistic support of girls’ activity (i.e., enrolling girls in sports and driving them to events) and parents’ explicit modeling (i.e., the extent to which parents used their own behavior to encourage their daughters to be active). Mothers reported significantly higher levels of logistic support than fathers, whereas fathers reported higher levels of explicit modeling than mothers. Although mothers and fathers tended to report different methods of support, both methods were associated with higher physical activity among girls. Finally, girls reported significantly higher levels of physical activity when at least one parent reported high levels of overall support in comparison to no parents; no significant differences were identified for support from one versus two parents. Conclusion Results from this study indicate the positive contribution that parents can have on activity practices of their young daughters. PMID:12972881

Validity and reliability of the "German Utilization Questionnaire-Dissemination and Use of Research" to measure attitude, availability, and support toward implementation of research in nursing practice.

PubMed

Haslinger-Baumann, Elisabeth; Lang, Gert; Müller, Gerhard

2014-01-01

In nursing practice, research results have to undergo a systematic process of transformation. Currently in Austria, there is no empirical data available concerning the actual implementation of research results. An English validated questionnaire was translated into German and tested for validity and reliability. A survey of 178 registered nurses (n = 178) was conducted in a multicenter, quantitative, cross-sectional study in Austria in 2011. Cronbach's alpha values (.82-.92) were calculated for 4 variables ("use," "attitude," "availability," "support") after the reduction of 7 irrelevant items. Exploratory factor analysis was calculated with Kaiser-Meyer-Olkin (KMO) ranging from .78 to .92; the total variance ranged from 46% to 56%. A validated German questionnaire concerning the implementation of research results is now available for the nursing practice.

Participant recruitment to FiCTION, a primary dental care trial - survey of facilitators and barriers.

PubMed

Keightley, A; Clarkson, J; Maguire, A; Speed, C; Innes, N

2014-11-01

To identify reasons behind a lower than expected participant recruitment rate within the FiCTION trial, a multi-centre paediatric primary dental care randomised controlled trial (RCT). An online survey, based on a previously published tool, consisting of both quantitative and qualitative responses, completed by staff in dental practices recruiting to FiCTION. Ratings from quantitative responses were aggregated to give overall scores for factors related to participant recruitment. Qualitative responses were independently grouped into themes. Thirty-nine anonymous responses were received. Main facilitators related to the support received from the central research team and importance of the research question. The main barriers related to low child eligibility rates and the integration of trial processes within routine workloads. These findings have directed strategies for enhancing participant recruitment at existing practices and informed recruitment of further practices. The results help provide a profile of the features required of practices to successfully screen and recruit participants. Future trials in this setting should consider the level of interest in the research question within practices, and ensure trial processes are as streamlined as possible. Research teams should actively support practices with participant recruitment and maintain enthusiasm among the entire practice team.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

The Influence of Contextual Factors on the Sustainability of Professional Development Outcomes

NASA Astrophysics Data System (ADS)

Sandholtz, Judith Haymore; Ringstaff, Cathy

2016-03-01

This study investigated how contextual factors influenced the sustainability of outcomes from a 3-year, state-funded professional development program that provided science assistance for K-2 teachers in small, rural school districts. The research used a case-study approach with a purposive sample of five elementary schools that varied in instructional time in science several years after the funding period. The primary data sources were teacher surveys and interviews conducted 2 and 3 years after the end of the professional development program. The findings highlight variations across schools and the influence of principal support, resources, collegial support, personal commitment, and external factors. The research holds practical implications for enhancing long-term sustainability of professional development outcomes in science education.

Perceptions about labor companionship at public teaching hospitals in three Arab countries.

PubMed

Kabakian-Khasholian, Tamar; El-Nemer, Amina; Bashour, Hyam

2015-06-01

To explore the perspectives of women, female relatives, and healthcare providers on labor companionship. In a qualitative study, data were collected from women giving birth, female family members, and healthcare staff via semi-structured interviews in three large public teaching hospitals in Beirut (Lebanon), Damascus (Syria), and Mansoura (Egypt) between May and December 2012. Focus groups were conducted with midwives, nurses, and medical residents. Data were assessed by thematic analysis. A total of 69 women, 57 female relatives, and 28 obstetricians were interviewed, and two focus groups discussions occurred. Women reported that being alone during labor raises feelings of fear and anxiety. They reported appreciating professional support, but found comfort in the psychological support offered by family members during labor. Midwives and nurses pointed to structural factors related to the organization of care and to the marginalization of their role as barriers to implementing best practices. Obstetricians referred to the absence of prenatal education classes, and social norms as factors impeding the organization of labor support initiatives. Implementing labor companionship can improve women's childbirth experiences and outcomes. Organizational structural barriers and non-supportive providers' attitudes need to be addressed to influence hospital practices. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Early problem behavior among children from low-income, mother-headed families: a multiple risk perspective.

PubMed

Olson, Sheryl L; Ceballo, Rosario; Park, Curie

2002-12-01

Examined proximal and contextual factors most strongly related to externalizing behavior among young children growing up in low-income, mother-headed families. Participants were 50 low-income single mothers and their preschool-age children who were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high levels of punitive disciplinary practices, low levels of maternal emotional well-being) and contextual (low maternal support, high levels of family stress) risk were assessed in relation to maternal reports of child externalizing behavior and an index of negative child behavior during a clean-up task. Child defiance during the clean-up task was highly associated with punitive maternal control in the same situation but had no other direct correlates. However, multiple risk factors representing both proximal and contextual variables were associated with variations in children's behavior problem scores. Mothers of children with high behavior problem scores reported lower feelings of self-efficacy in handling child care and emotional stressors, more frequent use of punitive child disciplinary practices, and lower feelings of satisfaction with the quality of their supportive resources than others. Maternal self-evaluations of coping efficacy mediated the relation between perceived support and child behavior problems, suggesting that constructs of personal control are important to represent in future studies of highly stressed parents.

Culture matters: a case of school health promotion in Canada.

PubMed

McIsaac, Jessie-Lee D; Read, Kendra; Veugelers, Paul J; Kirk, Sara F L

2017-04-01

Rising concerns of poor health behaviours of children and youth have stimulated international support for a comprehensive approach to promoting the development of healthy behaviours in the early years. Health promoting schools (HPS) is increasingly adopted as an approach to guide supportive practices, but there is limited research that has reported how to effectively implement HPS at a population level. The purpose of this research was to qualitatively explore the factors preventing and facilitating implementation of HPS practices in the Canadian province of Nova Scotia. Interviews (n = 23) were conducted with school stakeholders (principals, teachers and parents) from a diverse sample of schools (n = 9) and data were analysed to develop an understanding of how school circumstances and experiences influenced HPS implementation. At a broad level, the reported barriers were structural and systemic, whereas the facilitating factors were related to organizational capacity and political leadership. It was evident that implementing and sustaining HPS required a shift in values and integration of supportive school health practices into school priorities. The results suggest that, without addressing the competing culture, which is persistently reinforced by strict academic mandates and unhealthy community norms, HPS will be vulnerable to circumstances that prevent implementation. Considering the emerging importance of mental wellbeing, it will also be important to provide schools with adequate and appropriate staff capacity and support to address this issue. Sustaining the positive effects of HPS will require continuous engagement and collaboration with multiple stakeholders to embed health promotion into school community norms. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

PubMed

Anglin, Grace; Tu, H A; Liao, Kristie; Sessums, Laura; Taylor, Erin Fries

2017-09-01

Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid Services (CMS) was key to achieving broad payer engagement in CPC, but CMS's dual role as initiative convener and participating payer at times made collaboration challenging. CMS was able to build trust with other payers by clarifying which parts of CPC could be adapted to regional contexts, deferring to other payers for these decisions, and increasing opportunities for payers to meet with CMS representatives. CPC demonstrates that when certain facilitating factors are present, payers can overcome competitive market dynamics and competing institutional priorities to align financial incentives, quality measurement, and data feedback to support practice transformation. Lessons from this large-scale, multipayer initiative may be helpful for other multipayer efforts getting under way. © 2017 Milbank Memorial Fund.

A sequential factorial analysis approach to characterize the effects of uncertainties for supporting air quality management

NASA Astrophysics Data System (ADS)

Wang, S.; Huang, G. H.; Veawab, A.

2013-03-01

This study proposes a sequential factorial analysis (SFA) approach for supporting regional air quality management under uncertainty. SFA is capable not only of examining the interactive effects of input parameters, but also of analyzing the effects of constraints. When there are too many factors involved in practical applications, SFA has the advantage of conducting a sequence of factorial analyses for characterizing the effects of factors in a systematic manner. The factor-screening strategy employed in SFA is effective in greatly reducing the computational effort. The proposed SFA approach is applied to a regional air quality management problem for demonstrating its applicability. The results indicate that the effects of factors are evaluated quantitatively, which can help decision makers identify the key factors that have significant influence on system performance and explore the valuable information that may be veiled beneath their interrelationships.

Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation.

PubMed

Loeffen, Maartje J W; Daemen, Jasper; Wester, Fred P J F; Laurant, Miranda G H; Lo Fo Wong, Sylvie H; Lagro-Janssen, Antoine L M

2017-12-01

Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression. Identify factors determining implementation success of mentor mother support in family practice. Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data. The identification and discussion of abuse is hindered by family physicians' attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner's violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals. To improve successful implementation of mentor mother support in primary care, we should focus on family physicians' attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care. [Box: see text].

Validating the Changes to Self-identity After Total Laryngectomy.

PubMed

Bickford, Jane; Coveney, John; Baker, Janet; Hersh, Deborah

2018-05-25

A total laryngectomy often prolongs life but results in long-term disablement, disfigurement, and complex care needs. Current clinical practice addresses the surgical options, procedures, and immediate recovery. Less support is available longer-term despite significant changes to aspects of personhood and ongoing medical needs. The aim of this study was to explore the experience of living with and/or supporting individuals with a laryngectomy at least 1 year after surgery. Constructivist grounded theory methods and symbolic interactionism were used to guide collection and analysis of interview data from 28 participants (12 individuals with a laryngectomy, 9 primary supporters, and 7 health professionals). The phenomena of "validating the altered self after total laryngectomy" highlighted how individuals, postlaryngectomy, navigate and negotiate interactions due to the disruption of their self-expression, related competencies, and roles. Several reframing patterns representing validation of the self emerged from the narratives. They were as follows: destabilized, resigned, resolute, and transformed. The data describe the influence of the processes of developing competence and building resilience, combined with contextual factors, for example, timing and turning points; being supported; and personal factors on these reframing patterns. The findings further our understanding of the long-term subjective experience of identity change after laryngectomy and call attention to the persisting need for psychosocial support. This research provides important evidence for evaluating and strengthening the continuum of services (specialist to community) and supporting social participation, regardless of communication method, and for competency training for all involved to optimize person-centered practices.

Direct access: factors that affect physical therapist practice in the state of Ohio.

PubMed

McCallum, Christine A; DiAngelis, Tom

2012-05-01

Direct access to physical therapist services is permitted by law in the majority of states and across all practice settings. Ohio enacted such legislation in 2004; however, it was unknown how direct access had affected actual clinical practice. The purpose of this study was to describe physical therapist and physical therapist practice environment factors that affect direct access practice. A 2-phase, mixed-method descriptive study was conducted. In the first phase, focus group interviews with 32 purposively selected physical therapists were completed, which resulted in 8 themes for an electronically distributed questionnaire. In the second phase, survey questionnaires were distributed to physical therapists with an e-mail address on file with the Ohio licensing board. An adjusted return rate of 23% was achieved. Data were analyzed for descriptive statistics. A constant comparative method assessed open-ended questions for common themes and patterns. Thirty-one percent of the respondents reported using direct access in physical therapist practice; however, 80% reported they would practice direct access if provided the opportunity. Physical therapists who practiced direct access were more likely to be in practice 6 years or more and hold advanced degrees beyond the entry level, were American Physical Therapy Association members, and had supportive management and organizational practice policies. The direct access physical therapist practice was generally a locally owned suburban private practice or a school-based clinic that saw approximately 6% to 10% of its patients by direct access. The majority of patients treated were adults with musculoskeletal or neuromuscular impairments. Nonresponse from e-mail may be associated with sample frame bias. Implementation of a direct access physical therapist practice model is evident in Ohio. Factors related to reimbursement and organizational policy appear to impede the process.

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents' accounts.

PubMed

Carolan, Ian; Smith, Trish; Hall, Andy; Swallow, Veronica M

2014-07-07

Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and Language and cultural barriers. Health care professionals will benefit from using the communities of child-healthcare practice model when they support parents of children with chronic kidney disease. Understanding some of the factors that may influence the development of communities of child-healthcare practice will help professionals to tailor information and support for parents learning to manage their child's healthcare. Our results are potentially transferrable to professionals managing the care of children and young people with other long-term conditions.

A practical scale for Multi-Faceted Organizational Health Climate Assessment.

PubMed

Zweber, Zandra M; Henning, Robert A; Magley, Vicki J

2016-04-01

The current study sought to develop a practical scale to measure 3 facets of workplace health climate from the employee perspective as an important component of a healthy organization. The goal was to create a short, usable yet comprehensive scale that organizations and occupational health professionals could use to determine if workplace health interventions were needed. The proposed Multi-faceted Organizational Health Climate Assessment (MOHCA) scale assesses facets that correspond to 3 organizational levels: (a) workgroup, (b) supervisor, and (c) organization. Ten items were developed and tested on 2 distinct samples, 1 cross-organization and 1 within-organization. Exploratory and confirmatory factor analyses yielded a 9-item, hierarchical 3-factor structure. Tests confirmed MOHCA has convergent validity with related constructs, such as perceived organizational support and supervisor support, as well as discriminant validity with safety climate. Lastly, criterion-related validity was found between MOHCA and health-related outcomes. The multi-faceted nature of MOHCA provides a scale that has face validity and can be easily translated into practice, offering a means for diagnosing the shortcomings of an organization or workgroup's health climate to better plan health and well-being interventions. (c) 2016 APA, all rights reserved).

Lean practices for quality results: a case illustration.

PubMed

Hwang, Pauline; Hwang, David; Hong, Paul

2014-01-01

Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks. Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

Transfusion in critically ill children: indications, risks, and challenges.

PubMed

Parker, Robert I

2014-03-01

To provide a concise review of transfusion-related issues and practices in the pediatric patient population, with a focus on those issues of particular importance to the care of critically ill children. Electronic search of the PubMed database using the search terms "pediatric transfusion," "transfusion practices," "transfusion risks," "packed red blood cell transfusion," "white blood cell transfusion," "platelet transfusion," "plasma transfusion," and "massive transfusion" either singly or in combination. All identified articles published since 2000 were manually reviewed for study design, content, and support for indicated conclusions, and the bibliographies were scrutinized for pertinent references not identified in the PubMed search. Selected studies from this group were then manually reviewed for possible inclusion in this review. Well-designed studies have demonstrated the benefit of "restrictive" transfusion practices across the entire age spectrum of pediatric patients across a wide spectrum of pediatric illness. However, clinician implementation of the more restrictive transfusion practices supported by these studies is variable. Additionally, the utilization of both platelet and plasma transfusions in either a "prophylactic" or "therapeutic" setting appears to be greater than that supported by published data. The preponderance of prospective, randomized trials and retrospective analyses support the use of a restrictive packed RBC transfusion policy in most clinical conditions in children. Neonatal transfusions guidelines rely largely on "expert opinion" rather than experimental data. Current transfusion practices for both platelets and coagulant products (e.g., fresh-frozen plasma and recombinant-activated factor VII) are poorly aligned with recommended transfusion guidelines. As with adults, current transfusion practices in children often do not reflect implementation of our current knowledge on the need for transfusion. Greater efforts to implement current evidence-based transfusion practices are needed.

Associations of contextual risk and protective factors with fathers' parenting practices in the postdeployment environment.

PubMed

Davis, Laurel; Hanson, Sheila K; Zamir, Osnat; Gewirtz, Abigail H; DeGarmo, David S

2015-08-01

Deployment separation and reunifications are salient contexts that directly impact effective family functioning and parenting for military fathers. Yet, we know very little about determinants of postdeployed father involvement and effective parenting. The present study examined hypothesized risk and protective factors of observed parenting for 282 postdeployed fathers who served in the National Guard/Reserves. Preintervention data were employed from fathers participating in the After Deployment, Adaptive Parenting Tools randomized control trial. Parenting practices were obtained from direct observation of father-child interaction and included measures of problem solving, harsh discipline, positive involvement, encouragement, and monitoring. Risk factors included combat exposure, negative life events, months deployed, and posttraumatic stress disorder symptoms. Protective factors included education, income, dyadic adjustment, and social support. Results of a structural equation model assessing risk and protective factors for an effective parenting construct indicated that months deployed, income, and father age were most related to observed parenting, explaining 16% of the variance. We are aware of no other study using direct parent-child observations of fathers' parenting skills following overseas deployment. Implications for practice and preventive intervention are discussed. (c) 2015 APA, all rights reserved).

The Impact of Organizational Factors and Government Policy on Psychiatric Nurses' Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland.

PubMed

Grant, Anne; Reupert, Andrea

2016-05-01

Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services. © The Author(s) 2016.

Nurses' perceptions of their professional practice environment: a cross-sectional study.

PubMed

Cao, Yingjuan; DiGiacomo, Michelle; Salamonson, Yenna; Li, Ye; Huai, Baosha; Davidson, Patricia M

2015-12-01

To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Globally, the environments in which nurses work influence the quality of nursing practice and health care. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2·66-3·05. All subscales except work motivation (3·05, standard deviation: 0·44) scored less than 3·0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. © 2015 John Wiley & Sons Ltd.

Psychological distress, health protection, and sexual practices among young men who have sex with men: Using social action theory to guide HIV prevention efforts

PubMed Central

Holloway, Ian W.; Traube, Dorian E.; Schrager, Sheree M.; Tan, Diane; Dunlap, Shannon; Kipke, Michele D.

2017-01-01

The present study addresses gaps in the literature related to theory development for young men who have sex with men (YMSM) sexual practices through the application and modification of Social Action Theory. Data come from the Healthy Young Men study (N = 526), which longitudinally tracked a diverse cohort of YMSM ages 18–24 to characterize risk and protective factors associated with drug use and sexual practices. Structural equation modeling examined the applicability of, and any necessary modifications to a YMSM-focused version of Social Action Theory. The final model displayed excellent fit (CFI = 0.955, TLI = 0.947, RMSEA = 0.037) and suggested concordance between social support and personal capacity for sexual health promotion. For YMSM, practicing health promotion and avoiding practices that may put them at risk for HIV was associated with both social isolation and psychological distress (β = -0.372, t = -4.601, p<0.001); psychological distress is an internalized response to environmental and cognitive factors and sexual practices are an externalized response. Results point to the utility of Social Action Theory as a useful model for understanding sexual practices among YMSM, the application of which shows health protective sexual practices are a function of sociocognitive factors that are influenced by environmental contexts. Social Action Theory can help prevention scientists better address the needs of this vulnerable population. PMID:28886128

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

Facilitating the implementation of evidence- based practice through contextual support and nursing leadership.

PubMed

Kueny, Angela; Shever, Leah L; Lehan Mackin, Melissa; Titler, Marita G

2015-01-01

Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

Support for At-Risk Girls: A School-Based Mental Health Nursing Initiative.

PubMed

Adamshick, Pamela

2015-09-01

Mental health problems often go undiagnosed or unaddressed until a crisis or extreme event brings the problem to the forefront. Youth are particularly at risk for lack of identification and treatment in regard to mental health issues. This article describes an advanced nursing practice mental health initiative for at-risk teenage girls based on Hildegard Peplau's nursing theory, group process, and healing through holistic health approaches. A support group, RICHES, was developed with focus on core components of relationships, identity, communication, health, esteem, and support. The acronym RICHES was chosen as the name of the support group. Selected themes and issues addressed in this school-based support group are illustrated in case vignettes. Through a collaborative approach with the community and school, this practice initiative presents a unique healing process that extends knowledge in the realm of intervention with at-risk teenage girls. Further research is needed on the efficacy of support groups to modify risk factors and to address goals for primary prevention in at-risk teenage girls. © The Author(s) 2014.

Investigating the factors that affect the communication of death-related bad news to people with intellectual disabilities by staff in residential and supported living services: An interview study.

PubMed

Tuffrey-Wijne, I; Rose, T

2017-08-01

Most staff working in intellectual disability services will be confronted with people with intellectual disabilities who need support around death, dying and bereavement. Previous studies suggest that intellectual disability staff tend to protect clients from knowing about death and avoid communication about death. The aims of this study were to gain further insight into the individual, organisational and contextual factors that affect the communication of death-related bad news to people with intellectual disabilities by intellectual disability staff and to develop guidelines for services to enable appropriate communication with clients about death and dying. Semi-structured interviews were held with 20 social care staff working in intellectual disability residential or supported living services in London, who had supported a client affected by death-related bad news in the past 6 months. Staff found supporting people with intellectual disabilities around death and dying extremely difficult and tended to avoid communication about death. The following factors had a particularly strong influence on staff practice around communicating death-related bad news: fear and distress around death; life and work experience; and organisational culture. Staff attitudes to death communication had a stronger influence than their client's level of cognitive or communicative abilities. Managers were important role models. Service managers should ensure not only that all their staff receive training in death, loss and communication but also that staff are enabled to reflect on their practice, through emotional support, supervision and team discussions. Future work should focus on the development and testing of strategies to enable intellectual disability staff to support their clients in the areas of dying, death and bereavement. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Planning practice in support of economically and environmentally sustainable roads in floodplains: the case of the Mekong delta floodplains.

PubMed

Douven, Wim; Buurman, Joost

2013-10-15

Road development in relatively undisturbed floodplain systems, such as the floodplains of the Mekong River, will impact hydraulics and interrupt the natural flow of water. This affects the ecology and environment, and the livelihoods of people who depend on fishing and agriculture. On the other hand, floods can severely damage road infrastructure in years with large floods and can cause high annual maintenance costs. Improving road development practices in floodplains is a complex, multidimensional task involving hydraulic and geotechnical analysis, ecosystem analysis, socio-economic analysis, policy analysis, etc. This paper analyses the planning practice of road development and rehabilitation and how this practice can be improved in support of economically and environmentally sustainable roads in floodplains. It is concluded that although ample technical, planning and environmental assessment guidelines exist, guidelines need updating to address cumulative impacts at floodplain level and factors hampering the implementation in guidelines should be addressed in the guideline design (process). Copyright © 2013 Elsevier Ltd. All rights reserved.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

PubMed

Spence Laschinger, Heather K; Fida, Roberta

2015-05-01

A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

Examining the perceptions, preferences, and practices that influence healthy aging for African American older adults: an ecological perspective.

PubMed

Waites, Cheryl

2013-10-01

This study explored the healthy aging and health promotion perceptions, preferences, and practices of a purposive sample of African American older adults who resided in two communities in the south. An ecological framework was used to capture environmental factors, perceptions regarding access to health promotion resources, and health behavior preferences and practices. A mixed-method approach was used. Health supporting amenities were mapped, focus groups were conducted, and demographic information was obtained. The data were merged to create consolidated themes. The results indicated that health promotion amenities were available, but with some limitations. Convenient access to transportation strongly affected ability to use resources. Older adults were interested in preserving their health and independence, but some had difficulty staying motivated to maintain a healthy lifestyle. They wanted easier access to amenities. Implications for best practice include attention to culturally responsive outreach, motivating with social support and incentives, and developing community-based culturally compatible programming.

Survey of expert practice and perceptions of the supporting clinical evidence for the management of uveitis-related cataract and cystoid macular oedema.

PubMed

Sreekantam, Sreekanth; Denniston, Alastair K O; Murray, Philip I

2011-10-01

To survey the practice of uveitis experts in the management of uveitic cataract and cystoid macular oedema (CMO). A structured questionnaire containing two clinical scenarios was sent to members of the International Uveitis Study Group (IUSG). The questionnaire surveyed both respondents' current practice and their perception of the supporting clinical evidence. For uveitic cataract, 70% required a 3-month inflammation-free period before surgery, and 76% gave a prophylactic preoperative systemic corticosteroid. For uveitic CMO, 87% gave corticosteroids, usually orally. Preferred second-line agents were methotrexate (39%), cyclosporin (24%), azathioprine (17%), and mycophenolate (7%). Respondents suggested the evidence underlying their decisions was either absent or relatively weak (levels III or IV), and in most cases personal experience was a factor. This survey highlights areas of consensus and variation among uveitis experts in managing uveitic cataract and CMO, and emphasizes the need for further clinical trials to establish the best practice.

Navigating towards improved surgical safety using aviation-based strategies.

PubMed

Kao, Lillian S; Thomas, Eric J

2008-04-01

Safety practices in the aviation industry are being increasingly adapted to healthcare in an effort to reduce medical errors and patient harm. However, caution should be applied in embracing these practices because of limited experience in surgical disciplines, lack of rigorous research linking these practices to outcome, and fundamental differences between the two industries. Surgeons should have an in-depth understanding of the principles and data supporting aviation-based safety strategies before routinely adopting them. This paper serves as a review of strategies adapted to improve surgical safety, including the following: implementation of crew resource management in training operative teams; incorporation of simulation in training of technical and nontechnical skills; and analysis of contributory factors to errors using surveys, behavioral marker systems, human factors analysis, and incident reporting. Avenues and challenges for future research are also discussed.

Beyond the limitations of best practices: how logic analysis helped reinterpret dual diagnosis guidelines.

PubMed

Brousselle, Astrid; Lamothe, Lise; Mercier, Céline; Perreault, Michel

2007-02-01

The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts.

Development and Psychometric Testing of the Iceland-Family Illness Beliefs Questionnaire.

PubMed

Gisladottir, Margret; Svavarsdottir, Erla Kolbrun

2016-08-01

Illness beliefs affect how individuals and families deal with illness. A valid and reliable instrument has not yet been developed to measure "illness beliefs" in family nursing research and clinical practice. This article describes the purpose, reliability, validity, and the potential clinical and research applications of a new instrument, the Iceland-Family Illness Beliefs Questionnaire (ICE-FIBQ). The ICE-FIBQ is a short, self-report measure of an individual's beliefs about illness. Drawing from an advanced nursing practice model called the Illness Beliefs Model, the instrument was developed to measure illness beliefs about (a) cause of illness, that is, etiology; (b) control of illness on family and control of family on illness; (c) effect of illness on the individual and family; (d) illness suffering; and (e) support received from health care professionals during illness. The instrument was tested on 139 family caregivers of adolescents/youth with an illness or a disorder. Exploratory factor analysis reduced the original questionnaire from eight to seven items with a one-factor solution (Cronbach's α = .780). Confirmatory factor analysis supported the one-factor solution (Cronbach's α = .789). Further research is needed to determine concurrent validity with other illness belief/illness perception scales and if the instrument is sensitive to capture change in illness beliefs following family nursing intervention. © The Author(s) 2016.

I know what you did last summer (and it was not CBT): a factor analytic model of international psychotherapeutic practice in the eating disorders.

PubMed

Tobin, David L; Banker, Judith D; Weisberg, Laura; Bowers, Wayne

2007-12-01

Although several studies have shown that eating disorders clinicians do not generally use treatment manuals, findings regarding what they do use have typically been vague, or closely linked to a particular theoretical approach. Our goal was to identify what eating disorder clinicians do with their patients in a more theoretically neutral context. We also sought to describe an empirically defined approach to psychotherapeutic practice as defined by clinicians via factor analysis. A survey developed for this study was administered to 265 clinicians recruited online and at regional and international meetings for eating disorders professionals. Only 6% of respondents reported they adhered closely to treatment manuals and 98% of the respondents indicated they used both behavioral and dynamically informed interventions. Factor analysis of clinicians' use of 32 therapeutic strategies suggested seven dimensions: Psychodynamic Interventions, Coping Skills Training, Family History, CBT, Contracts, Therapist Disclosure, and Patient Feelings. The findings of this study suggest that most clinicians use a wide array of eating disorder treatment interventions drawn from empirically supported treatments, such as CBT-BN, and from treatments that have no randomized controlled trial support. Factor analysis suggested theoretically linked dimensions of treatment, but also dimensions that are common across models. (c) 2007 by Wiley Periodicals, Inc.

Diffuse nutrient losses and the impact factors determining their regional differences in four catchments from North to South China

NASA Astrophysics Data System (ADS)

Zhang, Yongyong; Zhou, Yujian; Shao, Quanxi; Liu, Hongbin; Lei, Qiuliang; Zhai, Xiaoyan; Wang, Xuelei

2016-12-01

Diffuse nutrient loss mechanism is complicated and shows remarkably regional differences due to spatial heterogeneities of underlying surface conditions, climate and agricultural practices. Moreover, current available observations are still hard to support the identification of impact factors due to different time or space steps. In this study, an integrated water system model (HEQM) was adopted to obtain the simulated loads of diffuse components (carriers: runoff and sediment; nutrient: total nitrogen (TN) and total phosphorous (TP)) with synchronous scales. Multivariable statistical analysis approaches (Analysis of Similarity and redundancy analysis) were used to assess the regional differences, and to identify impact factors as well as their contributions. Four catchments were selected as our study areas, i.e., Xiahui and Zhangjiafen Catchments of Miyun Basin in North China, Yuliang and Tunxi Catchments of Xin'anjiang Basin in South China. Results showed that the model performances of monthly processes were very good for runoff and good for sediment, TN and TP. The annual average coefficients of all the diffuse components in Xin'anjiang Basin were much greater than those in Miyun Basin, and showed significantly regional differences. All the selected impact factors interpreted 72.87-82.16% of the regional differences of carriers, and 62.72-71.62% of those of nutrient coefficients, respectively. For individual impact factor categories, the critical category was geography, followed by land-use/cover, carriers, climate, as well as soil and agricultural practices in Miyun Basin, or agricultural practices and soil in Xin'anjiang Basin. For individual factors, the critical factors were locations for the carrier regional differences, and carriers or chemical fertilizer for the nutrient regional differences. This study is expected to promote further applications of integrated water system model and multivariable statistical analysis in the diffuse nutrient studies, and provide a scientific support for the diffuse pollution control and management in China.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

PubMed

Regan, Sandra; Wong, Carol; Laschinger, Heather K; Cummings, Greta; Leiter, Michael; MacPhee, Maura; Rhéaume, Ann; Ritchie, Judith A; Wolff, Angela C; Jeffs, Lianne; Young-Ritchie, Carol; Grinspun, Doris; Gurnham, Mary Ellen; Foster, Barbara; Huckstep, Sherri; Ruffolo, Maurio; Shamian, Judith; Burkoski, Vanessa; Wood, Kevin; Read, Emily

2017-05-01

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility. © 2017 John Wiley & Sons Ltd.

Maintenance Cognitive Stimulation Therapy (CST) in practice: study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Cognitive Stimulation Therapy (CST) is a psychosocial evidence-based group intervention for people with dementia recommended by the UK NICE guidelines. In clinical trials, CST has been shown to improve cognition and quality of life, but little is known about the best way of ensuring implementation of CST in practice settings. A recent pilot study found that a third of people who attend CST training go on to run CST in practice, but staff identified a lack of support as a key reason for the lack of implementation. Methods/design There are three projects in this study: The first is a pragmatic multi-centre, randomised controlled trial (RCT) of staff training, comparing CST training and outreach support with CST training only; the second, the monitoring and outreach trial, is a phase IV trial that evaluates implementation of CST in practice by staff members who have previously had the CST manual or attended training. Centres will be randomised to receive outreach support. The primary outcome measure for both of these trials is the number of CST sessions run for people with dementia. Secondary outcomes include the number of attenders at sessions, job satisfaction, dementia knowledge and attitudes, competency, barriers to change, approach to learning and a controllability of beliefs and the level of adherence. Focus groups will assess staff members’ perceptions of running CST groups and receiving outreach support. The third study involves monitoring centres running groups in their usual practice and looking at basic outcomes of cognition and quality of life for the person with dementia. Discussion These studies assess the effects of outreach support on putting CST into practice and running groups effectively in a variety of care settings with people with dementia; evaluate the effectiveness of CST in standard clinical practice; and identify key factors promoting or impeding the successful running of groups. Trial registration Clinical trial ISRCTN28793457. PMID:22735077

Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns.

PubMed

Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur

2013-08-01

The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Challenges in the Care of Clients with Established Cardiovascular Disease: Lessons Learned from Australian Community Pharmacists

PubMed Central

Puspitasari, Hanni P.; Aslani, Parisa; Krass, Ines

2014-01-01

Background As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD) as a case study, we explored factors that influence community pharmacists’ everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD. Methods In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a “grounded-theory” approach. Results Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the “people” factors, including their own attitudes and beliefs as well as those of clients and doctors; the “environment” within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists’ contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration. Conclusion Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society. PMID:25409194

Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists.

PubMed

Puspitasari, Hanni P; Aslani, Parisa; Krass, Ines

2014-01-01

As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD) as a case study, we explored factors that influence community pharmacists' everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD. In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a "grounded-theory" approach. Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the "people" factors, including their own attitudes and beliefs as well as those of clients and doctors; the "environment" within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists' contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration. Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

PubMed

Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

2012-02-07

Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.

Employer Factors Related to Workers' Compensation Claims and Disability Management.

ERIC Educational Resources Information Center

Habeck, Rochelle V.; And Others

1991-01-01

Explored empirical relationship between employer disability prevention and management practices and their workers' compensation claims experience. Data from 124 firms revealed high variability among firms within same industry and operating under same state workers' compensation statute. Findings support assumption that significant portion of…

Mothers of children with externalizing behavior problems: cognitive risk factors for abuse potential and discipline style and practices.

PubMed

McElroy, Erika M; Rodriguez, Christina M

2008-08-01

Utilizing the conceptual framework of the Social Information Processing (SIP) model (Milner, 1993, 2000), associations between cognitive risk factors and child physical abuse risk and maladaptive discipline style and practices were examined in an at-risk population. Seventy-three mothers of 5-12-year-old children, who were identified by their therapist as having an externalizing behavior problem, responded to self-report measures pertaining to cognitive risk factors (empathic perspective taking, frustration tolerance, developmental expectations, parenting locus of control), abuse risk, and discipline style and practices. The Child Behavior Checklist (CBCL) provided a confirmation of the child's externalizing behaviors independent of the therapist's assessment. The results of this study suggest several cognitive risk factors significantly predict risk of parental aggression toward children. A parent's ability to empathize and take the perspective of their child, parental locus of control, and parental level of frustration tolerance were significant predictors of abuse potential (accounting for 63% of the variance) and inappropriate discipline practices (accounting for 55% of the variance). Findings of the present study provide support for processes theorized in the SIP model. Specifically, results underscore the potential role of parents' frustration tolerance, developmental expectations, locus of control, and empathy as predictive of abuse potential and disciplinary style in an at-risk sample.

Clinical, information and business process modeling to promote development of safe and flexible software.

PubMed

Liaw, Siaw-Teng; Deveny, Elizabeth; Morrison, Iain; Lewis, Bryn

2006-09-01

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

The Utility of the Family Empowerment Scale With Custodial Grandmothers

PubMed Central

Hayslip, Bert; Smith, Gregory C.; Montoro-Rodriguez, Julian; Streider, Frederick H.; Merchant, William

2016-01-01

The Family Empowerment Scale (FES) was developed specifically to assess empowerment in families with emotional disorders. Its relevance to custodial grandfamilies is reflected in the difficulties in grandchildren's social, emotional, and behavioral functioning, wherein such difficulties may be explained via either reactions to changes in their family structure or in their responses to the newly formed family unit. Utilizing 27 items derived from the 34-item version of the FES, which had represented differential levels of empowerment (family, service system, community) as indexed by one's attitudes, knowledge, and behavior, we explored the factor structure, internal consistency, construct, and convergent validity of the FES with grandparent caregivers. Three-hundred forty-three (M age = 58.45, SD = 8.22, n Caucasian = 152, n African American = 149, n Hispanic = 38) custodial grandmothers caring for grandchildren between ages 4 and 12 years completed the 27 FES items and various measures of their psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. Factor analysis revealed three factors that differed slightly from the originally proposed FES subscales: Parental Self-Efficacy/Self-Confidence, Service Activism, and Service Knowledge. Each of the factors was internally consistent, and derived factor scores were moderately interrelated, speaking to the question of convergent validity. The construct validity of these three factors was evidenced by meaningful patterns of statistically significant correlations with grandmothers’ psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. These factor scores were independent of grandmother age, health, and education. These findings suggest the newly identified FES factors to be valuable in understanding empowerment among grandmother caregivers. PMID:26452627

The Utility of the Family Empowerment Scale With Custodial Grandmothers.

PubMed

Hayslip, Bert; Smith, Gregory C; Montoro-Rodriguez, Julian; Streider, Frederick H; Merchant, William

2017-03-01

The Family Empowerment Scale (FES) was developed specifically to assess empowerment in families with emotional disorders. Its relevance to custodial grandfamilies is reflected in the difficulties in grandchildren's social, emotional, and behavioral functioning, wherein such difficulties may be explained via either reactions to changes in their family structure or in their responses to the newly formed family unit. Utilizing 27 items derived from the 34-item version of the FES, which had represented differential levels of empowerment (family, service system, community) as indexed by one's attitudes, knowledge, and behavior, we explored the factor structure, internal consistency, construct, and convergent validity of the FES with grandparent caregivers. Three-hundred forty-three ( M age = 58.45, SD = 8.22, n Caucasian = 152, n African American = 149, n Hispanic = 38) custodial grandmothers caring for grandchildren between ages 4 and 12 years completed the 27 FES items and various measures of their psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. Factor analysis revealed three factors that differed slightly from the originally proposed FES subscales: Parental Self-Efficacy/Self-Confidence, Service Activism, and Service Knowledge. Each of the factors was internally consistent, and derived factor scores were moderately interrelated, speaking to the question of convergent validity. The construct validity of these three factors was evidenced by meaningful patterns of statistically significant correlations with grandmothers' psychological well-being, grandchild psychological difficulties, emotional support, and parenting practices. These factor scores were independent of grandmother age, health, and education. These findings suggest the newly identified FES factors to be valuable in understanding empowerment among grandmother caregivers.

Inter-professional education of prospective speech-language therapists and primary school teachers through shared professional practice placements.

PubMed

Wilson, Leanne; McNeill, Brigid; Gillon, Gail T

2017-07-01

Preliminary studies of inter-professional education (IPE) among student speech-language therapists (SLTs) and student teachers suggest that workshop-based applications are beneficial in preparing participants for elements of collaborative practice. Situating IPE within the students' professional practice placements may provide another useful avenue to develop attitudes, knowledge and skills for inter-professional collaboration. Research examining the impact of different approaches to IPE is required to advance our understanding of effective design and evaluation of such initiatives. To understand how student SLTs and student teachers develop competency for collaborative practice when co-working during professional practice placements to support children's speech and literacy development. A case study design was used to monitor the impact of the IPE. Student SLTs (n = 4) were paired with student teachers (n = 4) to participate in shared professional practice placements in junior school classrooms. An inductive thematic analysis of interviews conducted with participants after the IPE was employed to explore the development of competencies in collaborative practice. Change in inter-disciplinary knowledge and perceptions over the IPE was evaluated via survey to further explore the development of collaborative competencies. Integration of qualitative and quantitative findings suggested that participants began to develop four broad areas of collaborative competency: understanding of professional roles and expertise, communication skills to support shared decision-making, inter-dependency in supporting children's learning, and flexibility to implement alternative instructional practices. Interview analysis also revealed factors related to the facilitators and learning contexts that supported and/or limited the collaboration between participants. Shared placement experiences between student SLTs and student teachers may be an effective method for building participants' competencies in multiple aspects of collaborative practice. Active facilitation by both SLT and classroom teacher supervisors alongside careful consideration of learning contexts (e.g., classroom structure) will help to ensure that learning is maximized for prospective professionals. © 2016 Royal College of Speech and Language Therapists.

Staff views on wellbeing for themselves and for service users.

PubMed

Schrank, Beate; Brownell, Tamsin; Riches, Simon; Chevalier, Agnes; Jakaite, Zivile; Larkin, Charley; Lawrence, Vanessa; Slade, Mike

2015-02-01

Wellbeing is an important outcome in the context of recovery from mental illness. The views of mental health professionals on wellbeing may influence their approach to supporting recovery. This study aims to explore views held by mental health staff about factors influencing their own wellbeing and that of service users with psychosis. Semi-structured interviews were conducted with 14 mental health staff in South London who had worked with people with psychosis. Thematic analysis was used to analyse the data and comparisons were made between staff views of wellbeing for themselves and service users. Staff participants held similar conceptualisations of wellbeing for themselves and for service users. However, they suggested a differential impact on wellbeing for a number of factors, such as balance, goals and achievement, and work. Staff employed a more deficit-based perspective on wellbeing for service users and a more strengths-based view for themselves. Staff stated a recovery orientation in principle, but struggled to focus on service user strengths in practice. A stronger emphasis in clinical practice on amplifying strengths to foster self-management is indicated, and staff may need support to achieve this emphasis, e.g. through specific interventions and involvement of peer support workers.

Environmental influences on alcohol consumption practices of alcoholic beverage servers.

PubMed

Nusbaumer, Michael R; Reiling, Denise M

2002-11-01

Public drinking establishments have long been associated with heavy drinking among both their patrons and servers. Whether these environments represent locations where heavy drinking is learned (learning hypothesis) or simply places where already-heavy drinkers gather in a supportive environment (selection hypothesis) remains an important question. A sample of licensed alcoholic beverage servers in the state of Indiana, USA, was surveyed to better understand the drinking behaviors of servers within the alcohol service industry. Responses (N = 938) to a mailed questionnaire were analyzed to assess the relative influence of environmental and demographic factors on the drinking behavior of servers. Stepwise regression revealed "drinking on the job" as the most influential environmental factor on heavy drinking behaviors, followed by age and gender as influential demographic factors. Support was found for the selection hypothesis, but not for the learning hypothesis. Policy implications are discussed. factors on the drinking behavior of servers. Stepwise regression revealed "drinking on the job" as the most influential environmental factor on heavy drinking behaviors, followed by age and gender as influential demographic factors. Support was found for the selection hypothesis, but not for the learning hypothesis. Policy implications are discussed.

Lessons Learned: Newly Hired Nurses' Perspectives on Transition Into Practice.

PubMed

Ziebert, Carolyn; Klingbeil, Carol; Schmitt, Catherine A; Stonek, Alice V; Totka, Joan P; Stelter, Ashley; Schiffman, Rachel F

2016-01-01

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes.

The PTSD Practitioner Registry: An Innovative Tracking, Dissemination, and Support Tool for Providers in Military and Nonmilitary Settings

DTIC Science & Technology

2016-10-01

are being conducted with 60 providers to assess practitioner needs and interests in the registry as well as pre-test the proposed registry survey . In...15. SUBJECT TERMS PTSD, qualitative interviews, survey development, best practices, CPGs 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...being; and to identify factors enabling the implementation of clinical best practices in the treatment of PTSD. This clinician-informed online survey and

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

PubMed Central

Laws, Rachel A; Kemp, Lynn A; Harris, Mark F; Davies, Gawaine Powell; Williams, Anna M; Eames-Brown, Rosslyn

2009-01-01

Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices. Conclusion The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. PMID:19825189

ESL students learning biology: The role of language and social interactions

NASA Astrophysics Data System (ADS)

Jaipal, Kamini

This study explored three aspects related to ESL students in a mainstream grade 11 biology classroom: (1) the nature of students' participation in classroom activities, (2) the factors that enhanced or constrained ESL students' engagement in social interactions, and (3) the role of language in the learning of science. Ten ESL students were observed over an eight-month period in this biology classroom. Data were collected using qualitative research methods such as participant observation, audio-recordings of lessons, field notes, semi-structured interviews, short lesson recall interviews and students' written work. The study was framed within sociocultural perspectives, particularly the social constructivist perspectives of Vygotsky (1962, 1978) and Wertsch (1991). Data were analysed with respect to the three research aspects. Firstly, the findings showed that ESL students' preferred and exhibited a variety of participation practices that ranged from personal-individual to socio-interactive in nature. Both personal-individual and socio-interactive practices appeared to support science and language learning. Secondly, the findings indicated that ESL students' engagement in classroom social interactions was most likely influenced by the complex interactions between a number of competing factors at the individual, interpersonal and community/cultural levels (Rogoff, Radziszewska, & Masiello, 1995). In this study, six factors that appeared to enhance or constrain ESL students' engagement in classroom social interactions were identified. These factors were socio-cultural factors, prior classroom practice, teaching practices, affective factors, English language proficiency, and participation in the research project. Thirdly, the findings indicated that language played a significant mediational role in ESL students' learning of science. The data revealed that the learning of science terms and concepts can be explained by a functional model of language that includes: (1) the use of discourse to construct meanings, (2) multiple semiotic representations of the thing/process, and (3) constructing taxonomies and ways of reasoning. Other important findings were: talking about language is integral to biology teaching and learning, ESL students' prior knowledge of everyday words does not necessarily help them interpret written questions on worksheets, and ESL students' prior knowledge of concepts in their first language does not necessarily support concept learning in the second language.

Mediating role of psychological well-being in the relationship between organizational support and nurses' outcomes: A cross-sectional study.

PubMed

Pahlevan Sharif, Saeed; Ahadzadeh, Ashraf Sadat; Sharif Nia, Hamid

2018-04-01

To examine the relationship between organizational support for nursing practice and nurse-assessed quality of care and nurses' job satisfaction in hospital settings and to investigate the mediating role of psychological well-being in the aforementioned relationships. There has been growing concern about quality of care in healthcare organizations. The past research has documented the effect of nurse practice environment on nurses' quality of care and job satisfaction. However, little is known about the underlying mechanism behind these associations. A cross-sectional survey was undertaken. Data were collected from two large public hospitals in Iran between February - March 2017. A sample of 345 nurses participated in the study. Data were analysed using descriptive statistics and partial least squared-structural equation modelling. The results showed that nurses' perception of organizational support was related to their quality of care, job satisfaction and psychological well-being. Also, there was a positive relationship between nurses' psychological well-being and their quality of care and job satisfaction. Moreover, psychological well-being partially mediated the relationship between organizational support with nurse-assessed quality of care and nurses' job satisfaction. The findings suggest that organizational support for nursing practice and psychological well-being are two factors that contribute to caring behaviour of nurses and their job satisfaction. Also, positively perceived organizational support generates favourable psychological well-being which in turn enhances nurses' quality of care and job satisfaction. The findings highlight the importance of establishing a supportive nurse practice environment and paying attention to the nurses' psychological well-being in healthcare sectors. © 2017 John Wiley & Sons Ltd.

Women's autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua.

PubMed

Ziaei, Shirin; Contreras, Mariela; Zelaya Blandón, Elmer; Persson, Lars-Åke; Hjern, Anders; Ekström, Eva-Charlotte

2015-08-01

To evaluate the associations of women's autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua. Cross-sectional study. Feeding practices and children's nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women's autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women's social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles. Los Cuatro Santos area, rural Nicaragua. A total of 1371 children 0-35 months of age. Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller. While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

Authoritative school climate, number of parents at home, and academic achievement.

PubMed

Huang, Francis L; Eklund, Katie; Cornell, Dewey G

2017-12-01

School climate is widely recognized as an important factor in promoting student academic achievement. The current study investigated the hypothesis that a demanding and supportive school climate, based on authoritative school climate theory, would serve as a protective factor for students living with 1 or no parents at home. Using a statewide sample of 56,508 middle school students from 415 public schools in 1 state, results indicated that student perceptions of disciplinary structure, academic demandingness, and student support all had positive associations with student self-reported grade point average (GPA). In addition, findings showed that academic expectations and student support were more highly associated with GPA for students not living with any parent. Implications for policy and practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Development and Evaluation of the Telephone Crisis Support Skills Scale.

PubMed

Kitchingman, Taneile A; Wilson, Coralie J; Caputi, Peter; Woodward, Alan; Hunt, Tara

2015-01-01

Although telephone services continue to play an important role in the delivery of front-line crisis support, published evidence of the standardized assessment of such services does not exist to date. To describe the development of the Telephone Crisis Support Skills Scale (TCSSS), an instrument to assess workers' intentions to use recommended skills with callers, and to evaluate its factor structure and reliability. TCSSS items were mapped to a national telephone crisis support practice model. A national sample of workers (n = 210) completed the TCSSS as part of a larger online survey. Principal axis factoring was used to evaluate the structure of the instrument. Internal consistency was assessed by Cronbach's α values. A single factor accounted for more than 40% of the variance within TCSSS ratings, indicating unidimensional structure. Cronbach's α coefficients suggested adequate internal consistency. Results indicate that the TCSSS is an internally consistent, unidimensional scale, sufficiently sensitive to detect workers' skill priorities for different caller problem types. Further study is required to confirm the factor structure and reliability of the TCSSS using workers from different organizations. Following further evaluation, the TCSSS may be applied to assessing readiness for and quality of service delivery.

Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Aldrich, Alison M; Sova, Lindsey N; Gaughan, Alice A; Slevin, Caitlin M; Hebert, Courtney; Hade, Erinn; Buck, Jacalyn; Grove, Michele; Huerta, Timothy R

2017-06-28

Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.

Factors Supporting the Employment of Young Adult Peer Providers: Perspectives of Peers and Supervisors.

PubMed

Delman, Jonathan; Klodnick, Vanessa V

2017-10-01

Peer providers are a promising practice for transition-age youth community mental health treatment engagement and support, yet little is known about the experience of being a young adult peer provider or what helps to make an individual in this role successful. Utilizing a capital theory lens, this study uses data from focus groups (two with young adult peer providers and two with their supervisors) to examine facilitators of young adult peer provider success in community mental health treatment settings. Eight factors were identified as critical to young adult peer provider on-the-job success: persistence, job confidence, resilience, job training, skilled communications with colleagues, regular and individualized supervision, support from colleagues, and family support. Findings suggest that young adult peer providers may benefit immensely from an agency level focus on fostering social organizational capital as well as more individualized efforts to increase cultural, social, and psychological capital through training and supervision.

Influence of Lifestyle Factors on Breast Cancer Risk

PubMed Central

Dieterich, Max; Stubert, Johannes; Reimer, Toralf; Erickson, Nicole; Berling, Anika

2014-01-01

Summary Breast Cancer (BC) is a life-changing event. Compared to other malignancies in women, BC has received considerably more public attention. Despite improved neoadjuvant, adjuvant, and palliative treatment strategies for each characteristic molecular BC subtype, recommendations for evidence-based preventive strategies for BC treatment are not given equivalent attention. This may be partly due to the fact that high-quality long-term prevention studies are still difficult to carry out and are thus underrepresented in international studies. The aim of this review is to discuss the most relevant lifestyle factors associated with BC and to identify and discuss the evidence supporting practical prevention strategies that can be used in everyday clinical practice. PMID:25759623

Dignity-conserving care: application of research findings to practice.

PubMed

McClement, Susan E; Chochinov, Harvey M; Hack, Thomas F; Kristjanson, Linda J; Harlos, Mike

2004-04-01

A central tenet of palliative care is to help people die with "dignity". The widespread use of this term presupposes that this construct is well understood from the perspective of the terminally ill, and that the factors that bolster or erode dignity are known. However, the paucity of research related to these issues suggests otherwise. Over the past 5 years, this research team, headed by Dr Chochinov, has undertaken a programme of research aimed at explicating what dignity means to those who are terminally ill, and identifying those factors that support and undermine dignity in this patient population. This article will provide a synopsis of that work, with an emphasis on the application of research findings for practice.

Individual and contextual factors for the child abuse potential of Croatian mothers: The role of social support in times of economic hardship.

PubMed

Ajduković, Marina; Rajter, Miroslav; Rezo, Ines

2018-04-01

The study assessed mothers' risk for abusing their children in middle adolescence in relation to individual and contextual factors during the economic crisis in Croatia. Socioeconomic status of mothers, family economic pressure, and mothers' exposure to stress were measured. Special attention was given to the perceived availability of social support as one of protective factors potentially buffering the negative impact of risks of child abuse. The community sample included 746 mothers (Mage = 42.85; SDage = 5.319). The results showed that the risk of child abuse is higher for mothers with lower education, those who perceive themselves as suffering greater family economic hardship, those who have experienced a higher number of stressful events, and those with lower social support. When the mothers perceive a lower availability of social support, the effects of exposure to cumulative risk, namely the combination of socioeconomic status, economic pressure, and exposure to stress, are stronger. Since social support proved to be one of the key protective factors in the relationship between adverse life circumstances and parenting, the development of effective and non-stigmatized interventions aiming to increase social support, positive social relationships, and adequate parenting practices for parents facing economic hardship is an important direction for future family policy measures. Copyright © 2018 Elsevier Ltd. All rights reserved.

Factors shaping intersectoral action in primary health care services.

PubMed

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

Factors associated with the career path choices of veterinarians in western Canada

PubMed Central

Jelinski, Murray D.; Campbell, John R.; Naylor, Jonathan M.; Lawson, Karen L.; Derkzen, Dena

2009-01-01

This second of 2 articles, relating to the veterinary profession in western Canada, explores the factors associated with veterinarians’ career path choices. Among other factors, companion animal (small animal and equine) (CA) practitioners were less likely to have been raised in, or near to, a small center (≤ 10 000), were more concerned with their workload (hours of work and number of nights on-call), and preferred to work in progressive practices. Food animal (FA) practitioners were more likely to be male, have been raised in a small center, have been raised in the Province of Saskatchewan, and to have self-assessed themselves as having an above average knowledge of agriculture at the time they applied for admission to veterinary college. Mixed animal (MA) practitioners had more factors in common with FA than with CA practitioners. Three main factors were associated with leaving mixed or food animal practice: hours of work and too many nights on-call, the level of remuneration, and lack of support and mentorship. PMID:19721783

Use of human patient simulation and the situation awareness global assessment technique in practical trauma skills assessment.

PubMed

Hogan, Michael P; Pace, David E; Hapgood, Joanne; Boone, Darrell C

2006-11-01

Situation awareness (SA) is defined as the perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. This construct is vital to decision making in intense, dynamic environments. It has been used in aviation as it relates to pilot performance, but has not been applied to medical education. The most widely used objective tool for measuring trainee SA is the Situation Awareness Global Assessment Technique (SAGAT). The purpose of this study was to design and validate SAGAT for assessment of practical trauma skills, and to compare SAGAT results to traditional checklist style scoring. Using the Human Patient Simulator, we designed SAGAT for practical trauma skills assessment based on Advanced Trauma Life Support objectives. Sixteen subjects (four staff surgeons, four senior residents, four junior residents, and four medical students) participated in three scenarios each. They were assessed using SAGAT and traditional checklist assessment. A questionnaire was used to assess possible confounding factors in attaining SA and overall trainee satisfaction. SAGAT was found to show significant difference (analysis of variance; p < 0.001) in scores based on level of training lending statistical support to construct validity. SAGAT was likewise found to display reliability (Cronbach's alpha 0.767), and significant scoring correlation with traditional checklist performance measures (Pearson's coefficient 0.806). The questionnaire revealed no confounding factors and universal satisfaction with the human patient simulator and SAGAT. SAGAT is a valid, reliable assessment tool for trauma trainees in the dynamic clinical environment created by human patient simulation. Information provided by SAGAT could provide specific feedback, direct individualized teaching, and support curriculum change. Introduction of SAGAT could improve the current assessment model for practical trauma education.

Factors associated with differences in quit rates between "specialist" and "community" stop-smoking practitioners in the english stop-smoking services.

PubMed

McDermott, Máirtín S; Beard, Emma; Brose, Leonie S; West, Robert; McEwen, Andy

2013-07-01

Behavioral support improves smokers' chances of quitting, but quit rates are typically lower for smokers supported by "community practitioners" for whom smoking cessation is a small part of their job than for those supported by "specialist practitioners" for whom it is the main role. This article examined the factors that might contribute to this. A total of 573 specialist practitioners and 466 community practitioners completed a 42-item online survey that covered demographic and employment information, current practices, levels of training, and 4-week CO-verified quit rates. Responses were compared for community and specialist practitioners. Mediation analysis was undertaken to assess how far "structural" and "modifiable" variables account for the difference in quit rates. Specialist practitioners reported higher 4-week CO-verified quit rates than community practitioners (63.6% versus 50.4%, p < .001). Practitioners also differed significantly in employment variables, evidence-based practices, and levels of training. Six "modifiable" variables (proportion of clients using an "abrupt" quit model, duration of first session, always advising on medications, number of days training received, number of sessions observed when starting work, and number of sessions having been observed in practice and received feedback) mediated the association between practitioners' role and quit rates over and above the "structural" variables, explaining 14.3%-35.7% of the variance in the total effect. "Specialist" practitioners in the English stop-smoking services report higher success rates than "community" practitioners and this is at least in part attributable to more extensive training and supervision and greater adherence to evidence-based practice including advising on medication usage and promoting abrupt rather than gradual quitting.

Development of the Supported Decision Making Inventory System.

PubMed

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

Paediatric nurses' understanding of the process and procedure of double-checking medications.

PubMed

Dickinson, Annette; McCall, Elaine; Twomey, Bernadette; James, Natalie

2010-03-01

To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC). A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process. A descriptive qualitative design was used. Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis. This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients. While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.

Factors influencing the implementation of evidence in Chinese nursing practice.

PubMed

Cheng, Lei; Broome, Marion E; Feng, Sheng; Hu, Yan

2017-12-01

To explore the influencing factors from staff nurses, nurse managers, nursing directors and a physician involved in nursing evidence implementation in Mainland China. Although the need for evidence-based nursing is well recognised, continuous efforts are needed to strive for closing the gap from evidence to action. Previous studies have explored influencing factors from individual and organisational perspectives in Western countries. However, it remains unclear what the influences (i.e., context and culture) in the developing countries as China. A grounded theory design using in-depth individual interviews was conducted. Interviews with 56 participants from 24 evidence-based nursing implementation projects were conducted in Mainland China. Constant comparative analysis was used to discover the concepts describing the influencing factors during the implementation process. Factors that influenced implementation of evidence-based practice in the Chinese context were identified. These included the leaders of the projects, the nature of the evidence, practising nurses, patients involved in the projects, the system where the projects were implemented, as well as the influence from outside of the system. A variety of factors influencing evidence implementation in Chinese nursing context were identified and further explored from the perspective of different project leaders and culture influence. There is apparently a strong demand for a supportive system, targeted strategies to facilitate various evidence implementations and integrated core elements of evidence-based practice at the point care. The blurred boundaries and complexity of influencing factors call for a systematic and dynamic perspective during implementation. The competitive priorities emphasise the importance of integration between clinical nursing care and evidence-based practice. © 2017 John Wiley & Sons Ltd.

Factors Associated With the Perception of Family Nursing Practice Among Mental Health Nurses in Taiwan.

PubMed

Hsiao, Chiu-Yueh; Tsai, Yun-Fang

2015-11-01

The aim of this study was to examine factors that influenced the perceptions of mental health nurses about involving families in their nursing practice. A sample of 175 Taiwanese mental health nurses who are employed in both inpatient and community settings completed structured questionnaires designed to measure empathy, attitudes about involving families in care, and perceptions of family nursing practice. Data were analyzed using descriptive statistics, Pearson's product-moment correlation, t test, one-way ANOVA, and a hierarchical multiple regression analysis. Positive perceptions of family nursing practice were correlated with more years of clinical experience in mental health, empathy, supportive attitudes toward the importance of family nursing care, and personal experiences with family members with serious illness in need of professional care. These findings may assist in the development of effective educational programs designed to help nurses integrate family nursing knowledge and skills in the care of patients and families experiencing mental illness. © The Author(s) 2015.

Teaching with Videogames: How Experience Impacts Classroom Integration

ERIC Educational Resources Information Center

Bell, Amanda; Gresalfi, Melissa

2017-01-01

Digital games have demonstrated great potential for supporting students' learning across disciplines. But integrating games into instruction is challenging and requires teachers to shift instructional practices. One factor that contributes to the successful use of games in a classroom is teachers' experience implementing the technologies. But how…

Emotional Sequelae of Abortion: Implications for Clinical Practice.

ERIC Educational Resources Information Center

Lemkau, Jeanne Parr

1988-01-01

Summarizes literature on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Discusses characteristics of woman, social support and cultural milieu around the abortion, the medical environment and abortion procedure itself, and events subsequent to abortion which may cause conflict. Discusses implications…

What Factors Sustain Professional Growth among School Counselors?

ERIC Educational Resources Information Center

Konstam, Varda; Cook, Amy L.; Tomek, Sara; Mahdavi, Esmaeil; Gracia, Robert; Bayne, Alexander H.

2015-01-01

This study examined relationships among self-reported professional expertise, organizational support of evidence-based practices (EBP), and professional growth. Data were collected from 85 members of American School Counseling Association (ASCA). School counselors with higher self-reported expertise reported that they were more likely to improve…

Multidimensional Assessment of Spirituality/Religion in Patients with HIV: Conceptual Framework and Empirical Refinement

PubMed Central

Kudel, Ian; Cotton, Sian; Leonard, Anthony C.; Tsevat, Joel; Ritchey, P. Neal

2011-01-01

A decade ago, an expert panel developed a framework for measuring spirituality/religion in health research (Brief Multidimensional Measure of Religiousness/Spirituality), but empirical testing of this framework has been limited. The purpose of this study was to determine whether responses to items across multiple measures assessing spirituality/religion by 450 patients with HIV replicate this model. We hypothesized a six-factor model underlying a collective of 56 items, but results of confirmatory factor analyses suggested eight dimensions: Meaning/Peace, Tangible Connection to the Divine, Positive Religious Coping, Love/Appreciation, Negative Religious Coping, Positive Congregational Support, Negative Congregational Support, and Cultural Practices. This study corroborates parts of the factor structure underlying the Brief Multidimensional Measure of Religiousness/Spirituality and some recent refinements of the original framework. PMID:21136166

Multidimensional assessment of spirituality/religion in patients with HIV: conceptual framework and empirical refinement.

PubMed

Szaflarski, Magdalena; Kudel, Ian; Cotton, Sian; Leonard, Anthony C; Tsevat, Joel; Ritchey, P Neal

2012-12-01

A decade ago, an expert panel developed a framework for measuring spirituality/religion in health research (Brief Multidimensional Measure of Religiousness/Spirituality), but empirical testing of this framework has been limited. The purpose of this study was to determine whether responses to items across multiple measures assessing spirituality/religion by 450 patients with HIV replicate this model. We hypothesized a six-factor model underlying a collective of 56 items, but results of confirmatory factor analyses suggested eight dimensions: Meaning/Peace, Tangible Connection to the Divine, Positive Religious Coping, Love/Appreciation, Negative Religious Coping, Positive Congregational Support, Negative Congregational Support, and Cultural Practices. This study corroborates parts of the factor structure underlying the Brief Multidimensional Measure of Religiousness/Spirituality and some recent refinements of the original framework.

Theory versus practice in Strategic Environmental Assessment (SEA)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lobos, Víctor, E-mail: vlobosg@gmail.com; Centro de Estudios del Desarrollo, San Crescente 551, Las Condes, Santiago; Partidario, Maria

Could the theory of Strategic Environmental Assessment (SEA) be ahead of its time and decoupled from its practice? This paper evolved in search for this leading research question. Over the years the discourse on SEA experienced a gradual shift from the technocratic and rationalist thinking that supported its origin to more strategic approaches and integrated concepts, suggested since the mid 1990's. In this paper we share the results of our analysis of international thinking and practical experience with SEA. Results reveal that SEA practice changes very slowly when compared to advanced thinking supporting the noted shift. Current SEA practice showsmore » to be still predominantly rooted in the logic of projects' environmental impact assessment (EIA). It is strongly bound to legal and regulatory requirements, and the motivation for its application persists being the delivery of environmental (or final) reports to meet legal obligations. Even though advanced SEA theoretical thinking claim its potential to help decisions to look forward, change mind-sets and the rationale of decision-making to meet sustainability challenges and enhance societal values, we note a weak relationship between the theoretical development of SEA and its practice. Why is this happening? Which factors explain this apparent inertia, resistance to change, in the SEA practice? Results appear to demonstrate the influence of assumptions, understandings, concepts, and beliefs in the use of SEA, which in turn suggest the political sensitivity of the instrument. - Highlights: • Theoretical thinking in SEA is ahead of its time. • SEA international practice reveals inertia to move out of project’ EIA comfort zone. • World current SEA practice show similar understandings of 30 years ago. • 100 world reports and survey of practitioners supported world review. • SEA great challenge is to change paradigms into new scientific complexity theories.« less

Selecting the "Best" Factor Structure and Moving Measurement Validation Forward: An Illustration.

PubMed

Schmitt, Thomas A; Sass, Daniel A; Chappelle, Wayne; Thompson, William

2018-04-09

Despite the broad literature base on factor analysis best practices, research seeking to evaluate a measure's psychometric properties frequently fails to consider or follow these recommendations. This leads to incorrect factor structures, numerous and often overly complex competing factor models and, perhaps most harmful, biased model results. Our goal is to demonstrate a practical and actionable process for factor analysis through (a) an overview of six statistical and psychometric issues and approaches to be aware of, investigate, and report when engaging in factor structure validation, along with a flowchart for recommended procedures to understand latent factor structures; (b) demonstrating these issues to provide a summary of the updated Posttraumatic Stress Disorder Checklist (PCL-5) factor models and a rationale for validation; and (c) conducting a comprehensive statistical and psychometric validation of the PCL-5 factor structure to demonstrate all the issues we described earlier. Considering previous research, the PCL-5 was evaluated using a sample of 1,403 U.S. Air Force remotely piloted aircraft operators with high levels of battlefield exposure. Previously proposed PCL-5 factor structures were not supported by the data, but instead a bifactor model is arguably more statistically appropriate.

Risk Mitigation of Emerging Zoonoses: Hendra Virus and Non-Vaccinating Horse Owners.

PubMed

Manyweathers, J; Field, H; Jordan, D; Longnecker, N; Agho, K; Smith, C; Taylor, M

2017-12-01

Hendra virus was identified in horses and humans in 1994, in Queensland, Australia. Flying foxes are the natural host. Horses are thought to acquire infection by direct or indirect contact with infected flying fox urine. Humans are infected from close contact with infected horses. To reduce risk of infection in horses and humans, Australian horse owners are encouraged to vaccinate horses against the virus and adopt property risk mitigation practices that focus on reducing flying fox horse contact and contamination of horses' environment with flying fox bodily fluids. This study investigates uptake of four Hendra virus risk mitigation practices in a sample of non- and partially vaccinating horse owners living close to previous Hendra virus cases. Protection motivation theory was used to develop a conceptual model to investigate risk perception and coping factors associated with uptake of risk mitigation practices. An online survey was administered via Facebook pages of veterinary clinics close to previous Hendra virus cases. Factors associated with uptake of risk mitigation practices were investigated using univariate and multivariate binary logistic regression. Belief that a risk mitigation practice would be effective in reducing Hendra virus risk was significantly associated with the uptake of that practice. Issues around the practicality of implementing risk mitigation practices were found to be the greatest barrier to uptake. Factors that relate to risk immediacy, such as nearby infection, were identified as more likely to trigger uptake of risk mitigation practices. The role of veterinarians in supporting Hendra risk mitigation was identified as more influential than that of respected others or friends. Findings from this study are being used to assist stakeholders in Australia responsible for promotion of risk mitigation practice in identifying additional pathways and reliable influencing factors that could be utilized for engaging and communicating with horse owners to promote Hendra virus risk mitigation behaviour. © 2017 Blackwell Verlag GmbH.

Family physicians in Switzerland: transition from residency to family practice.

PubMed

Buddeberg-Fischer, Barbara; Klaghofer, Richard; Stamm, Martina

2011-01-01

The study is concerned with family physicians in the transition phase from residency to practice. Factors relating to the decision to take up a career in family medicine rather than a different medical career are investigated. Further, incentives and disincentives for starting a family practice as well as factors influencing the decision about practice location and practice model are addressed. In a prospective cohort study on physicians' career development, 88 family physicians and 437 physicians aspiring to a different medical career participated in a questionnaire survey on the reasons for their choice of specialty and career, their mentoring support, and their work-life balance aspirations. Quantitative and qualitative data were analyzed using hierarchical logistic regression and content analysis, respectively. Family physician tutors should actively approach trainees in medical school and residency, pointing out the advantages of family medicine in terms of continuity of patient contact and the wide range of illnesses and patients, as well as the prospect of a work-life balance tailored to personal needs. Unlike other countries, Switzerland started its structured residency-training programs only recently.

Factors affecting the frequency of health enhancing behaviors by the elderly.

PubMed Central

Stoller, E P; Pollow, R

1994-01-01

The authors examined the frequency of health-enhancing behaviors practiced by the elderly living in community settings, with emphasis on the impact of disease and disability on the frequency of those practices. Data were collected through personal interviews with a probability sample of 667 respondents in a 4-county region of northeastern New York. Almost all respondents said they engaged in at least one health-enhancing practice on a regular basis. The most commonly reported behaviors involved dietary practices. Results of the analysis support the importance of differentiating among health-enhancing behaviors that are undertaken as primary levels of prevention, in contrast to those undertaken as secondary or tertiary levels of prevention. PMID:8190861

Economic determinants of breastfeeding in Haiti: The effects of poverty, food insecurity, and employment on exclusive breastfeeding in an urban population.

PubMed

Lesorogol, Carolyn; Bond, Caitlin; Dulience, Sherlie Jean Louis; Iannotti, Lora

2018-04-01

There is limited and inconsistent empirical evidence regarding the role of economic factors in breastfeeding practices, globally. Studies have found both negative and positive associations between low income and exclusive breastfeeding (EBF). Employment, which should improve household income, may reduce EBF due to separation of mother and infant. In the context of a randomized controlled study of lipid-based complementary feeding in an urban slum in Cap Haitien, Haiti, we examined the economic factors influencing breastfeeding practices using mixed methods. Findings demonstrate relationships between urban context, economic factors, and breastfeeding practices. Poverty, food insecurity, time constraints, and limited social support create challenges for EBF. Maternal employment is associated with lower rates of EBF and less frequent breastfeeding. Extreme food insecurity sometimes leads to increased exclusive breastfeeding among Haitian mothers, what we call "last resort EBF." In this case, women practice EBF because they have no alternative food source for the infant. Suggested policies and programs to address economic constraints and promote EBF in this population include maternal and child allowances, quality child care options, and small-scale household urban food production. © 2017 John Wiley & Sons Ltd.

Psychosocial factors associated with flourishing among Australian HIV-positive gay men.

PubMed

Lyons, Anthony; Heywood, Wendy; Rozbroj, Tomas

2016-09-15

Mental health outcomes among HIV-positive gay men are generally poorer than in the broader population. However, not all men in this population experience mental health problems. Although much is known about factors associated with depression and anxiety among HIV-positive gay men, little is known about factors associated with positive mental health. Such knowledge can be useful for optimizing well-being support programs for HIV-positive gay men. In this study, we examined flourishing, which broadly covers most aspects of positive mental health. A sample of 357 Australian HIV-positive gay men completed a survey on their mental health and well-being, including the Flourishing Scale. Given the lack of previous research, we explored a wide range of psychosocial factors, including demographics, stigma, discrimination, and social support, to identify key factors linked to flourishing. The sample showed a similar level of flourishing to those in general population samples. Several independent factors were found to be associated with flourishing outcomes. Those who were most likely to be flourishing tended to have low or no internalized HIV-related stigma, were employed, received higher levels of practical support, had a sense of companionship with others, and felt supported by family. These and other findings presented in this article may be used to help inform strategies for promoting optimal levels of mental health, and its associated general health benefits, among HIV-positive gay men.

A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

PubMed

Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

2016-06-29

The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is a national evaluation of an ambitious large-scale dissemination and implementation effort focused on transforming smaller primary care practices. Insights will help to inform the design of national health care practice extension systems aimed at supporting practice transformation efforts in the USA. NCT02560428 (09/21/15).

Audit in general practice: factors influencing participation.

PubMed Central

Baker, R.; Robertson, N.; Farooqi, A.

1995-01-01

OBJECTIVE--To identify the factors influencing participation in a single topic audit initiated by a medical audit advisory group. DESIGN--Interview and questionnaire survey of general practitioners who had been invited to take part in an audit of vitamin B-12. SETTING--All 147 general practices in Leicestershire. MAIN OUTCOME MEASURES--Aspects of structure, attitude, and behaviour that influenced participation or non-participation. RESULTS--75 practices completed the audit, 49 withdrew after initial agreement, and 23 refused to take part at the outset. Participants were more likely than those who refused to view the advisory group as useful or a threat and to have positive thoughts about audit but less likely to have previously undertaken audit entailing implementation of change. Participants were more likely than those who withdrew to have positive thoughts about audit and to have discussed whether to take part within the practice but were less likely to view the advisory group as useful. The most common reason given for withdrawal was lack of time. CONCLUSIONS--Participation was influenced by attitudes towards audit in general and the advisory group in particular and by aspects of behaviour such as communication within the practice. Practical support and resources may help some practices undertake audit, but advisory groups must also deal with attitudes and unsatisfactory communication in practice teams. PMID:7613323

Chinese and US Middle-School Science Teachers' Autonomy, Motivation, and Instructional Practices

NASA Astrophysics Data System (ADS)

Robertson, Laura; Jones, M. Gail

2013-06-01

This study examined Chinese and US middle-school science teachers' perceptions of autonomy support. Previous research has documented the link between teachers' perceptions of autonomy and the use of student-oriented teaching practices for US teachers. But is not clear how the perception of autonomy may differ for teachers from different cultures or more specifically how motivation factors differ across cultures. The survey measured teachers' motivation, perceptions of constraints at work, perceptions of students' motivation, and level of autonomy support for students. Exploratory factor analysis of responses for the combined teacher sample (n = 201) was carried out for each of the survey assessments. Significance testing for Chinese (n = 107) and US (n = 94) teachers revealed significant differences in teachers' motivation and perceptions of constraints at work and no significant differences for perceptions of students' motivation or their level of autonomy support for students. Chinese teachers' perceptions of constraints at work, work motivation, and perceptions of student motivation were found to significantly predict teachers' autonomy support. For the US teachers, teacher motivation was the only significant predictor of teachers' autonomy support. A sub-sample of teachers (n = 19) was interviewed and results showed that teachers in both countries reported that autonomy was important to their motivation and the quality of science instruction they provided to students. The primary constraints on teaching reported by the US teachers related to materials and laboratory space while the Chinese teachers reported constraints related to the science curriculum and standards.

Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.

PubMed

Darlington, Yvonne; Feeney, Judith A; Rixon, Kylie

2005-10-01

The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.

Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians.

PubMed

Morton, Suzanne; Shih, Sarah C; Winther, Chloe H; Tinoco, Aldo; Kessler, Rodger S; Scholle, Sarah Hudson

2015-01-01

Health information technology (IT) offers promising tools for improving care coordination. We assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards. We surveyed physician-owned and hospital/health system-affiliated primary care practices that achieved patient-centered medical home recognition and participated in the Meaningful Use program, and community health clinics with patient-centered medical home recognition (most with certified electronic health record systems). The response rate was 35.1%. We ascertained whether practices had implemented proposed objectives and perceptions of their importance. We analyzed the association of organizational and contextual factors with self-reported use of health IT to support care coordination activities. Although 78% of the 350 respondents viewed timely notification of hospital discharges as very important, only 48.7% used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6% of practices; however, merely 47.7% considered this activity very important. Greater use of health IT to support care coordination activities was positively associated with the presence of a nonclinician responsible for care coordination and the practice's capacity for systematic change. Even among practices having a strong commitment to the medical home model, the use of health IT to support care coordination objectives is not consistent. Health IT capabilities are not currently aligned with clinicians' priorities. Many practices will need financial and technical assistance for health IT to enhance care coordination. © 2015 Annals of Family Medicine, Inc.

The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial.

PubMed

LeBlanc, Annie; Ruud, Kari L; Branda, Megan E; Tiedje, Kristina; Boehmer, Kasey R; Pencille, Laurie J; Van Houten, Holly; Matthews, Marc; Shah, Nilay D; May, Carl R; Yawn, Barbara P; Montori, Victor M

2012-05-28

Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient's values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. NCT00388050.

Results of the 2013 Association of Residents in Radiation Oncology career planning survey of practicing physicians in the United States.

PubMed

Mattes, Malcolm D; Golden, Daniel W; Mohindra, Pranshu; Kharofa, Jordan

2014-08-01

The goal of this study was to develop insights about the job application process for graduating radiation oncology residents from the perspective of those involved in hiring. In May and June 2013, a nationwide electronic survey was sent to 1,671 practicing radiation oncologists in academic and private practice settings. Descriptive statistics are reported. In addition, subgroup analysis was performed. Surveys were completed by 206 physicians. Ninety-six percent were willing to hire individuals directly from residency. Participants believed that the first half of the fourth postgraduate year is the most appropriate time for residents to begin networking and the beginning of the fifth postgraduate year is the most appropriate time to begin contacting practices in pursuit of employment. Seventy percent began interviewing 4 to 9 months before the job start date, and 84% interviewed ≤6 candidates per available position. The 5 most important factors to participants when evaluating prospective candidates were (from most to least important) work ethic, personality, interview impression, experience in intensity-modulated radiation therapy, and flexibility. Factors that participants believed should be most important to candidates when evaluating practices included a collegial environment; emphasis on best patient care; quality of equipment, physics, dosimetry, and quality assurance; quality of the support staff and facility; and a multidisciplinary approach to patient care. Those in academics rated research-related factors higher than those in private practice, who rated business-related factors higher. The perspectives of practicing physicians on the job application process are documented to provide a comprehensive resource for current and future residents and employers. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The structure of social exchange in self-help support groups: development of a measure.

PubMed

Brown, Louis D; Tang, Xiaohui; Hollman, Ruth L

2014-03-01

Self-help support groups are indigenous community resources designed to help people manage a variety of personal challenges, from alcohol abuse to xeroderma pigmentosum. The social exchanges that occur during group meetings are central to understanding how people benefit from participation. This paper examines the different types of social exchange behaviors that occur during meetings, using two studies to develop empirically distinct scales that reliably measure theoretically important types of exchange. Resource theory informed the initial measurement development efforts. Exploratory factor analyses from the first study led to revisions in the factor structure of the social exchange scales. The revised measure captured the exchange of emotional support, experiential information, humor, unwanted behaviors, and exchanges outside meetings. Confirmatory factor analyses from a follow-up study with a different sample of self-help support groups provided good model fit, suggesting the revised structure accurately represented the data. Further, the scales demonstrated good convergent and discriminant validity with related constructs. Future research can use the scales to identify aspects of social exchange that are most important in improving health outcomes among self-help support group participants. Groups can use the scales in practice to celebrate strengths and address weaknesses in their social exchange dynamics.

Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research.

PubMed

Hand, Carri L; Wilkins, Seanne; Letts, Lori J; Law, Mary C

2013-10-01

Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult. This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease. Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes. For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments. Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

Relationships between evidence-based practice, quality improvement and clinical error experience of nurses in Korean hospitals.

PubMed

Hwang, Jee-In; Park, Hyeoun-Ae

2015-07-01

This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based practice (EBP) and quality improvement (QI), and the relationships between evidence-based practice, quality improvement and clinical errors. Understanding the factors affecting evidence-based practice and quality improvement activities and their relationships with clinical errors is important for designing strategies to promote evidence-based practice, quality improvement and patient safety. A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based practice Questionnaire and quality improvement scale developed in this study. Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based practice scores whereas age and job position were associated with quality improvement scores. There were positive, moderate correlations between evidence-based practice and quality improvement scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality improvement skills scores than those who had. The findings indicated the necessity of educational support regarding evidence-based practice and quality improvement for younger staff nurses who have no master degrees. Enhancing quality improvement skills may reduce clinical errors. Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based practice and quality improvement. © 2013 John Wiley & Sons Ltd.

Understanding the Factors that Support the Use of Active Learning Teaching in STEM Undergraduate Courses: Case Studies in the Field of Geoscience

NASA Astrophysics Data System (ADS)

Iverson, Ellen A. Roscoe

The purpose of this study was to understand the factors that support the adoption of active learning teaching strategies in undergraduate courses by faculty members, specifically in the STEM disciplines related to geoscience. The focus of the study centered on the context of the department which was identified as a gap in evaluation and educational research studies of STEM faculty development. The study used a mixed-method case study methodology to investigate the influences of departmental context on faculty members' adoption of active-learning teaching practices. The study compared and contrasted the influence of two faculty development strategies initiated in the field of geoscience. Six university geoscience departments were selected that had participated in two national geoscience professional development programs. Data were generated from 19 faculty interviews, 5 key informant interviews, and documents related to departmental and institutional context. The study concluded that two main factors influenced the degree to which faculty who participated in geoscience faculty development reported adoption of active learning pedagogies. These conclusions are a) the opportunity to engage in informal, regular conversations with departmental colleagues about teaching promoted adoption of new teaching approaches and ideas and b) institutional practices regarding the ways in which teaching practices were typically measured, valued, and incentivized tended to inhibit risk taking in teaching. The conclusions have implications related to institutional policy, faculty development, and the role of evaluation.

The roles of deliberate practice and innate ability in developing expertise: evidence and implications.

PubMed

Kulasegaram, Kulamakan M; Grierson, Lawrence E M; Norman, Geoffrey R

2013-10-01

Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance. This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search. Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability. No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance. © 2013 John Wiley & Sons Ltd.

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice

PubMed Central

Sabus, Carla; Spake, Ellen

2016-01-01

Background and purpose New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Design Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. Methods The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Results Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Conclusion Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR. PMID:29355199

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

PubMed

Sabus, Carla; Spake, Ellen

2016-01-01

New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.

Nurses' Perceived Skills and Attitudes About Updated Safety Concepts: Impact on Medication Administration Errors and Practices.

PubMed

Armstrong, Gail E; Dietrich, Mary; Norman, Linda; Barnsteiner, Jane; Mion, Lorraine

Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. The purpose of this study was to assess bedside nurses' perceived skills and attitudes about updated safety concepts and examine their impact on medication administration errors and adherence to safe medication administration practices. Findings support the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors.

Economic feasibility of alternative practitioners for provision of dental care to the underserved.

PubMed

Matthiesen, Anne

2012-01-01

This study assesses the viability of three alternative practitioner types for provision of dental care to the underserved. Key factors modeled include compensation, training and practice costs, productivity, and payer mix scenarios. Utilizing dental therapists or dental health aide therapists is cost-effective for enhancing access. However, to be sustainable, the practices will require a subsidy or a better reimbursement than modeled. Without tuition support, the debt burden will deter applicants mostlikely to treat the underserved.

Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study.

PubMed

Cole, Judith A; Smith, Susan M; Hart, Nigel; Cupples, Margaret E

2013-08-28

Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients' perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice. Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved. We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of 'delicious' but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed. Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients' difficulties in overcoming negative social influences and maintaining interest in living healthily.

Factors associated with the quality of life of family carers of people with dementia: A systematic review.

PubMed

Farina, Nicolas; Page, Thomas E; Daley, Stephanie; Brown, Anna; Bowling, Ann; Basset, Thurstine; Livingston, Gill; Knapp, Martin; Murray, Joanna; Banerjee, Sube

2017-05-01

Family carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia. Searches on terms including "carers," "dementia," "family," and "quality of life" in research databases. Findings were synthesized inductively, grouping factors associated with carer QOL into themes. A total of 909 abstracts were identified. Following screening, lateral searches, and quality appraisal, 41 studies (n = 5539) were included for synthesis. A total of 10 themes were identified: demographics; carer-patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and future. The quality and level of evidence supporting each theme varied. We need further research on what factors predict carer QOL in dementia and how to measure it. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

PubMed

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People’s Republic of China

PubMed Central

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics. PMID:27621600

Use of information and communication technologies to support effective work practice innovation in the health sector: a multi-site study.

PubMed

Westbrook, Johanna I; Braithwaite, Jeffrey; Gibson, Kathryn; Paoloni, Richard; Callen, Joanne; Georgiou, Andrew; Creswick, Nerida; Robertson, Louise

2009-11-08

Widespread adoption of information and communication technologies (ICT) is a key strategy to meet the challenges facing health systems internationally of increasing demands, rising costs, limited resources and workforce shortages. Despite the rapid increase in ICT investment, uptake and acceptance has been slow and the benefits fewer than expected. Absent from the research literature has been a multi-site investigation of how ICT can support and drive innovative work practice. This Australian-based project will assess the factors that allow health service organisations to harness ICT, and the extent to which such systems drive the creation of new sustainable models of service delivery which increase capacity and provide rapid, safe, effective, affordable and sustainable health care. A multi-method approach will measure current ICT impact on workforce practices and develop and test new models of ICT use which support innovations in work practice. The research will focus on three large-scale commercial ICT systems being adopted in Australia and other countries: computerised ordering systems, ambulatory electronic medical record systems, and emergency medicine information systems. We will measure and analyse each system's role in supporting five key attributes of work practice innovation: changes in professionals' roles and responsibilities; integration of best practice into routine care; safe care practices; team-based care delivery; and active involvement of consumers in care. A socio-technical approach to the use of ICT will be adopted to examine and interpret the workforce and organisational complexities of the health sector. The project will also focus on ICT as a potentially disruptive innovation that challenges the way in which health care is delivered and consequently leads some health professionals to view it as a threat to traditional roles and responsibilities and a risk to existing models of care delivery. Such views have stifled debate as well as wider explorations of ICT's potential benefits, yet firm evidence of the effects of role changes on health service outcomes is limited. This project will provide important evidence about the role of ICT in supporting new models of care delivery across multiple healthcare organizations and about the ways in which innovative work practice change is diffused.

Psychological Resources, Personality Traits and Buddhism: A Study of Italian Young Adults.

PubMed

Giannini, Marco; Loscalzo, Yura; Beraldi, Daniela; Gori, Alessio

2018-04-28

We aimed to examine whether young adults practicing Buddhism have elevated levels of psychological resources and specific personality traits compared to Catholics and Atheists. We recruited 184 participants: Soka Gakkai Buddhists (n = 60); non-practicing Roman Catholic Church believers (n = 62); Atheists (n = 62). We found that the Buddhists have higher optimism than both Catholics and Atheists. They also have higher self-efficacy and self-esteem than Catholics and higher perceived social support than Atheists. Concerning global personality factors, they are more extraverted than the other groups, and they are less tough-minded than Catholics. Differences also emerged relating some primary personality factors. Since we did not find differences between Catholics and Atheists about psychological resources, we speculate that religion alone does not provide an efficacious source of psychological resources; it could be that religious practice is determinant.

Beyond the limitations of best practices: How logic analysis helped reinterpret dual diagnosis guidelines

PubMed Central

Brousselle, Astrid; Lamothe, Lise; Mercier, Céline; Perreault, Michel

2012-01-01

The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts. PMID:17689316

[Fostering compliance by understanding its mechanisms].

PubMed

Neves, Chantal; Lecointre, Brigitte

2014-01-01

In the context of chronic disease, nurses play an essential role in the long-term support of the patient. The therapeutic alliance which they create with the patient enables them to detect the various factors which influence compliance, or on the contrary, the non-compliance of the patient. They work in a context of interdisciplinarity in a collaborative practice in which the patient is a partner. Their interventions aim to support the patient in adopting the right health strategies.

Cultivating a culture of research in nursing through a journal club for leaders: A pilot study.

PubMed

Kjerholt, Mette; Hølge-Hazelton, Bibi

2018-01-01

To describe whether an action learning-inspired journal club for nurse leaders can develop the leaders' self-perceived competences to support a research culture in clinical nursing practice. Development of clinical research capacity and nurse leaders with the requisite competences are key factors in evidence-based health care practice. This study describes how nurse leaders at a large regional hospital took part in a journal club for nurse leaders, with a view to developing their competences to support a nursing research culture in their departments. A pilot study using a multimethod approach to evaluate the journal club for nurse leaders. Four nurse leaders participated in the journal club for nurse leaders. Content analysis on the data was performed. Data revealed that participation in journal club for nurse leaders gave the leaders a feeling of increased competences to support nursing research culture in their departments. They stated that the action learning approach and the competences of the facilitator were key factors in this outcome. An action learning-inspired journal club for nurse leaders can be useful and meaningful to nurse leaders in developing leadership competences. As an approach in journal club for nurse leaders, action learning can develop nurse leaders' competence to support a research culture, and thus ensure evidence-based nursing is practised. © 2017 John Wiley & Sons Ltd.

The Promise of Motivational Interviewing in School Mental Health

ERIC Educational Resources Information Center

Frey, Andy J.; Cloud, Richard N.; Lee, Jon; Small, Jason W.; Seeley, John R.; Feil, Edward G.; Walker, Hill M.; Golly, Annemieke

2011-01-01

In recent years, the science of developing and implementing interventions addressing school-related risk factors has produced many advances. This article addresses the promise of a cross-disciplinary practice approach known as motivational interviewing in school settings. Specifically, the supporting evidence as well as the process and principles…

Playing in the Virtual Sandbox: Students' Collaborative Practices in Minecraft

ERIC Educational Resources Information Center

Davis, Katie; Boss, Julian A.; Meas, Perry

2018-01-01

Researchers, teachers, and the news media have touted Minecraft as an effective, engaging way to promote students' 21st century skills, including collaboration. However, little is known about what collaboration looks like in Minecraft, including what factors support and undermine high quality collaboration. The current exploratory study…

Youth Ministry after Christendom

ERIC Educational Resources Information Center

Myers, William R.

2016-01-01

The author identifies historic factors supportive of the 20th-century church's embrace of a program model for youth ministry while showing how its location outside the centering practices of the church by century's end produced a strong theological critique. The presence of both qualitative and quantitative research data and the reality of…

Keys to Successful Leadership: High Support for Capable and Versatile Principals

ERIC Educational Resources Information Center

Tornsen, Monika

2010-01-01

What are the prerequisites for principals' success within a decentralized and deregulated Swedish-policy environment characterized by democratic equity values and neo-liberal practices? Twenty-four secondary school principals identified internal and external factors that promote or inhibit principals' success. The discussion concerns whether the…

Educational Leadership in Singapore: Tight Coupling, Sustainability, Scalability, and Succession

ERIC Educational Resources Information Center

Dimmock, Clive; Tan, Cheng Yong

2013-01-01

Purpose: While Singapore's outstanding educational achievements are well known worldwide, there is a disproportionate paucity of literature on school leadership practices that contribute to and support pedagogical initiatives that--along with socio-cultural factors--are normally considered responsible for its educational success. The aim of this…

Spatially targeted social interventions to improve BMP adoption in Maryland watersheds

USDA-ARS?s Scientific Manuscript database

The results of surveys of stakeholders knowledge and attitudes related to water resources, pollution and Best Management Practices (BMPs) are analyzed and used to develop a model of BMP adoption likelihood based on socio-economic factors. The model is integrated into a Diagnostic Decision Support Sy...

Survivor-Defined Practice in Domestic Violence Work: Measure Development and Preliminary Evidence of Link to Empowerment.

PubMed

Goodman, Lisa A; Thomas, Kristie; Cattaneo, Lauren Bennett; Heimel, Deborah; Woulfe, Julie; Chong, Siu Kwan

2016-01-01

Survivor-defined practice, characterized by an emphasis on client choice, partnership, and sensitivity to the unique needs, contexts, and coping strategies of individual survivors, is an aspirational goal of the domestic violence (DV) movement, assumed to be a key contributor to empowerment and other positive outcomes among survivors. Despite its central role in DV program philosophy, training, and practice, however, our ability to assess its presence and its presumed link to well-being has been hampered by the absence of a way to measure it from survivors' perspectives. As part of a larger university-community collaboration, this study had two aims: (a) to develop a measure of survivor-defined practice from the perspective of participants, and (b) to assess its relationship to safety-related empowerment after controlling for other contributors to survivor well-being (e.g., financial stability and social support). Results supported the reliability and validity of the Survivor-Defined Practice Scale (SDPS), a nine-item measure that assesses participants' perception of the degree to which their advocates help them achieve goals they set for themselves, facilitate a spirit of partnership, and show sensitivity to their individual needs and styles. The items combined to form one factor indicating that the three theoretical aspects of survivor-defined practice may be different manifestations of one underlying construct. Results also support the hypothesized link between survivor-defined practice and safety-related empowerment. The SDPS offers DV programs a mechanism for process evaluation that is rigorous and rooted in the feminist empowerment philosophy that so many programs espouse. © The Author(s) 2014.

An investigation of the ways in which public health nutrition policy and practices can address climate change.

PubMed

Sulda, Heidi; Coveney, John; Bentley, Michael

2010-03-01

To develop a framework to guide action in the public health nutrition workforce to develop policies and practices addressing factors contributing to climate change. Action/consultative research. Interviews - South Australia, questionnaire - Australia. Interviews - key informants (n 6) were from various government, academic and non-government positions, invited through email. Questionnaire - participants were members of the public health nutrition workforce (n 186), recruited to the study through emails from public health nutrition contacts for each State in Australia (with the exception of South Australia). Support by participants for climate change as a valid role for dietitians and nutritionists was high (78 %). However, climate change was ranked low against other public health nutrition priorities. Support of participants to conduct programmes to address climate change from professional and work organisations was low. The final framework developed included elements of advocacy/lobbying, policy, professional recognition/support, organisational support, knowledge/skills, partnerships and programmes. This research demonstrates a need for public health nutrition to address climate change, which requires support by organisations, policy, improved knowledge and increased professional development opportunities.

A social-ecological analysis of the self-determination literature.

PubMed

Shogren, Karrie A

2013-12-01

This paper uses a social-ecological lens to examine self-determination research, attempting to organize what is known (and unknown) about contextual factors that have the potential to impact the development and expression of self-determined behavior in people with disabilities across multiple ecological systems. Identifying and categorizing the contextual factors that researchers suggest influence self-determination have the potential to allow for the development of a framework that promotes systematic consideration of contextual factors when designing, implementing, and evaluating supports to promote self-determination. Directions for future research and practice are discussed.

A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.

PubMed

Dunn, Sandra; Sprague, Ann E; Grimshaw, Jeremy M; Graham, Ian D; Taljaard, Monica; Fell, Deshayne; Peterson, Wendy E; Darling, Elizabeth; Harrold, JoAnn; Smith, Graeme N; Reszel, Jessica; Lanes, Andrea; Truskoski, Carolyn; Wilding, Jodi; Weiss, Deborah; Walker, Mark

2016-05-04

There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance. A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use. Study results will provide essential data to develop knowledge translation strategies for facilitating practice change, which can be further evaluated through a future cluster randomized trial.

Associations of contextual risk and protective factors with fathers’ parenting practices in the post-deployment environment

PubMed Central

Davis, Laurel; Hanson, Sheila K.; Zamir, Osnat; Gewirtz, Abigail H.; DeGarmo, David S.

2015-01-01

Deployment separation and reunifications are salient contexts that directly impact effective family functioning and parenting for military fathers. Yet, we know very little about determinants of post-deployed father involvement and effective parenting. The present study examined hypothesized risk and protective factors of observed parenting for 282 post-deployed fathers who served in the Army National Guard/Reserves. Pre-intervention data were employed from fathers participating in the After Deployment, Adaptive Parenting Tools (ADAPT) randomized control trial. Parenting practices were obtained from direct observation of father-child interaction and included measures of problem solving, harsh discipline, positive involvement, encouragement, and monitoring. Risk factors included combat exposure, negative life events, months deployed, and PTSD symptoms. Protective factors included education, income, dyadic adjustment, and social support. Results of a structural equation model predicting an effective parenting construct indicated that months deployed, income, and father age were most related to observed parenting, explaining 16% of the variance. We are aware of no other study utilizing direct parent-child observations of father’s parenting skills following overseas deployment. Implications for practice and preventive intervention are discussed. PMID:26213794

Exploring the adequacy of smoking cessation support for pregnant and postpartum women

PubMed Central

2013-01-01

Background Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach. Methods Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming. Results Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues. Conclusions The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers’ competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members. PMID:23672201

Factors Influencing Suicide Behaviours in Immigrant and Ethno-Cultural Minority Groups: A Systematic Review.

PubMed

Lai, Daniel W L; Li, Lun; Daoust, Gabrielle D

2017-06-01

This paper reviews recent literature on factors influencing suicide behaviours, including thoughts, plans, and attempts, in immigrant and ethno-cultural minority groups, to inform a more comprehensive understanding of suicide behaviours in increasingly culturally diverse populations. Thirty-three studies published between 2002 and 2013 were identified through digital databases searches and included in this review. Analysis of study findings focused on impacts of ethno-cultural identity and acculturation, other cultural and immigration influences, and family and community supports on suicide behaviours. Policy, practice, and research recommendations are identified, to inform relevant suicide prevention efforts and enhance mental health supports for immigrant and ethno-cultural minority populations.

Pathways of professional learning for elementary science teachers using computer learning environments

NASA Astrophysics Data System (ADS)

Williams, Latonya Michelle

This dissertation reports on a three year study designed to investigate the trajectories of two urban elementary school teachers---a novice and an experienced teacher---learning to teach a science curriculum unit using an inquiry approach supported by the Web-based Inquiry Science Environment (WISE). This research investigated teachers' development in knowledge and practice. Through analyses of video records of classroom instruction and professional development meetings, repeated interviews, and student assessments, I have produced case studies of teachers' journeys as they implement the technological inquiry-based instructional model. This study captures the interplay between the teachers' pedagogical content knowledge, enacted practice, and insights into students' thinking about complex science ideas. I trace the factors that encouraged and supported the teachers' development, in addition to the kinds of struggles they faced and overcame. I discuss the social supports I provided for the teachers, including scaffolding them in reflecting on their practice, assisting them with curriculum customizations, and supporting their learning such as arranging online interactions with scientists. I analyze spontaneous activities such as teachers' own reflections. The results suggest that the novice and experienced teacher's classroom practices became more inquiry oriented across time. For both teachers, use of technology accompanied an increase in science dialogue with small groups in years two and three. The novice teacher began asking inquiry questions in her second year of classroom experience, after a great deal of professional support. Both teachers improved in their pedagogical content knowledge from years one through three as a result of the varied professional development supports. The results suggest that teachers' improvement in instructional strategies and pedagogical content knowledge accompanied students' improvement in understanding of the science content.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impact of organisational characteristics on turnover intention among care workers in nursing homes in Korea: a structural equation model.

PubMed

Ha, Jong Goon; Man Kim, Ji; Hwang, Won Ju; Lee, Sang Gyu

2014-09-01

The aim of the present study was to analyse the impact of organisational characteristics on the turnover intention of care workers working at nursing homes in Korea. Study participants included 504 care workers working at 14 nursing homes in Korea. The variables measured were: high-performance work practices, consisting of five subfactors (official training, employment stability, autonomy, employee participation and group-based payment); organisational commitment, consisting of three subfactors (affective, normative and continuance commitment); organisational support; and turnover intention. The inter-relationship between high-performance work practices, organisational support, organisational commitment and turnover intention and the fit of the hypothetical model were analysed using structural equation modelling. According to our analysis, high-performance work practices not only had a direct effect on turnover intention, but also an indirect effect by mediating organisational support and commitment. The factor having the largest direct influence on turnover intention was organisational commitment. The results of the present study suggest that to improve health conditions for frail elderly patients at nursing homes, as well as the efficiency of nursing homes through the continuance of nursing service and enhancement of quality of service, long-term care facilities should reduce the turnover intention of care workers by increasing their organisational commitment by actively implementing high-performance work practices.

Using a knowledge utilization framework to explore how findings from one study can be applied to other nursing contexts.

PubMed

Olsen, P R; Bradbury-Jones, C

2013-09-01

To discuss the complexities of moving research into practice and through a case example, explore how empirical findings from one specific study could be applied to nursing in other contexts. The processes of moving research findings into practice are complex and multidimensional. In this paper, an innovative approach to social support, network-focused nursing (NFN), is used as a case example to illustrate these complexities. Social support is associated with better recovery and survival after illness and based on this, a NFN programme was developed in a Danish oncology youth unit. Subsequently, a research study was undertaken to investigate the programme and based on the findings, the concept NFN was developed. A knowledge utilization framework is used to explore how empirical findings from the NFN study could be applied to nursing more generally. Aligned with this, the specific considerations for implementing NFN are explicated. Strong leadership, education, management support and effective communication are critical factors for research utilization. Moving research into practice requires openness to new ideas. Nursing and healthcare policies therefore need to support environments in which creativity and innovation can flourish. NFN was developed in teenager and young adult cancer care, but its principles may be transferable to other clinical environments. It is important that nurse managers and policy makers ensure that support and education are available to nurses to facilitate moving research into practice. Moreover, resources need to be considered, particularly in countries where financial and organizational infrastructures may be weak. © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.

Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents.

PubMed

Blomqvist, Ylva Thernström; Frölund, Lovisa; Rubertsson, Christine; Nyqvist, Kerstin Hedberg

2013-06-01

Kangaroo Mother Care (KMC) supports parents' role at the neonatal intensive care unit (NICU). To enhance parents' provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC. To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents' discontinuation of KMC. A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants' medical records. A questionnaire, based on scientific literature and the researchers' clinical experience, was completed by the mothers and the fathers separately, shortly after the infant's discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic. Four categories were identified in parents' responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants' feeding process as an obstacle to KMC. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge. Interventions for enhancing parents' opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment. © 2012 Nordic College of Caring Science.

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey.

PubMed

Flurey, Caroline A; Hewlett, Sarah; Rodham, Karen; White, Alan; Noddings, Robert; Kirwan, John R

2018-06-01

To investigate the existence and distribution of 2 typologies (termed "factors") of men with rheumatoid arthritis (RA) identified through our previous Q-methodology study (n = 30) in a larger sample of men with RA, and whether differences in psychosocial impact or support preferences exist between the 2 factors, and between men and women with RA. A postal survey was sent to 620 men with RA from 6 rheumatology units across England, and the support preferences section of the survey was given to 232 women with RA. A total of 295 male patients (47.6%) and 103 female patients (44.4%) responded; 15 male participants had missing data, and thus 280 were included in the analysis. Of these, 61 (22%) were assigned to factor A ("accept and adapt"), 120 (35%) were assigned to factor B ("struggling to match up"), and 99 (35%) were unassigned. The two factors differed significantly, with factor B reporting more severe disease, less effective coping strategies, and poorer psychological status. For support, men favored a question and answer session with a consultant (54%) or specialist nurse (50%), a website for information (69%), a talk by researchers (54%), or a symptom management session (54%). Overall, women reported more interest in support sessions than men, with ≥50% of women reporting interest in nearly every option provided. Some men accept and adapt to their RA, but others (43%) report severe disease, less effective coping, and poor psychological status. Men's preferences for support are practical, with a focus on expanding their knowledge. © 2017 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

Worker assessments of organizational practices and psychosocial work environment are associated with musculoskeletal injuries in hospital patient care workers.

PubMed

Reme, Silje Endresen; Shaw, William S; Boden, Leslie I; Tveito, Torill H; O'Day, Elizabeth Tucker; Dennerlein, Jack T; Sorensen, Glorian

2014-07-01

Hospital patient care (PC) workers have high rates of workplace injuries, particularly musculoskeletal injuries. Despite a wide spectrum of documented health hazards, little is known about the association between psychosocial factors at work and OSHA-recordable musculoskeletal injuries. PC-workers (n = 1,572, 79%) completed surveys assessing a number of organizational, psychosocial and psychological variables. Associations between the survey responses and injury records were tested using bivariate and multivariate analyses. A 5% of the PC-workers had at least one OSHA-recordable musculoskeletal injury over the year, and the injuries were significantly associated with: organizational factors (lower people-oriented culture), psychosocial factors (lower supervisor support), and structural factors (job title: being a patient care assistant). The results show support for a multifactorial understanding of musculoskeletal injuries in hospital PC-workers. An increased focus on the various dimensions associated with injury reports, particularly the organizational and psychosocial factors, could contribute to more efficient interventions and programs. © 2014 Wiley Periodicals, Inc.

Burnout and stress amongst interns in Irish hospitals: contributing factors and potential solutions.

PubMed

Hannan, E; Breslin, N; Doherty, E; McGreal, M; Moneley, D; Offiah, G

2018-05-01

The transition from medical school to internship can be daunting for newly qualified doctors. High rates of stress and burnout have been reported, with negative impacts on patient care and physician wellbeing. We surveyed interns in our hospital group to evaluate rates of stress and burnout, as well as identify the causative factors and propose potential solutions to these. A hundred and one interns working in four different hospitals over a 2-year period were invited to participate in an anonymous survey. The survey collected basic demographic details and surveyed aspects of mental health using the burnout scale, Maslach Burnout Inventory (MBI) and the stress scale and 12-item General Health Questionnaire (GHQ-12). Interns were also asked to rate a variety of workplace factors on a Likert scale based on the degree of stress caused. Finally, they were surveyed on their awareness of support services available to them. Our results showed that 37% of interns met the criteria for psychological distress, high levels of emotional exhaustion, high depersonalisation and a low sense of personal accomplishment were reported in 55.4, 51.5 and 41.6%, respectively. Inadequate preparation for practice, financial worries, poor role definition and sleep deprivation were reported as significant stressors. Most were unaware of available support services and expressed interest in leaving Ireland after internship. Burnout and stress are significant problems amongst doctors in Irish hospitals. Ensuring better preparation for clinical practice and awareness of support services is vital to tackle this issue.

Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.

PubMed

Schneider, Jennifer L; Davis, James; Kauffman, Tia L; Reiss, Jacob A; McGinley, Cheryl; Arnold, Kathleen; Zepp, Jamilyn; Gilmore, Marian; Muessig, Kristin R; Syngal, Sapna; Acheson, Louise; Wiesner, Georgia L; Peterson, Susan K; Goddard, Katrina A B

2016-02-01

Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

Using analytic hierarchy process to identify the nurses with high stress-coping capability: model and application.

PubMed

F C Pan, Frank

2014-03-01

Nurses have long been relied as the major labor force in hospitals. Featured with complicated and highly labor-intensive job requirement, multiple pressures from different sources was inevitable. Success in identifying stresses and accordingly coping with such stresses is important for job performance of nurses, and service quality of a hospital. Purpose of this research is to identify the determinants of nurses' capabilities. A modified Analytic Hierarchy Process (AHP) was adopted. Overall, 105 nurses from several randomly selected hospitals in southern Taiwan were investigated to generate factors. Ten experienced practitioners were included as the expert in the AHP to produce weights of each criterion. Six nurses from two regional hospitals were then selected to test the model. Four factors are then identified as the second level of hierarchy. The study result shows that the family factor is the most important factor, and followed by the personal attributes. Top three sub-criteria that attribute to the nurse's stress-coping capability are children's education, good career plan, and healthy family. The practical simulation provided evidence for the usefulness of this model. The study suggested including these key determinants into the practice of human-resource management, and restructuring the hospital's organization, creating an employee-support system as well as a family-friendly working climate. The research provided evidence that supports the usefulness of AHP in identifying the key factors that help stabilizing a nursing team.

Using Analytic Hierarchy Process to Identify the Nurses with High Stress-Coping Capability: Model and Application

PubMed Central

F. C. PAN, Frank

2014-01-01

Abstract Background Nurses have long been relied as the major labor force in hospitals. Featured with complicated and highly labor-intensive job requirement, multiple pressures from different sources was inevitable. Success in identifying stresses and accordingly coping with such stresses is important for job performance of nurses, and service quality of a hospital. Purpose of this research is to identify the determinants of nurses' capabilities. Methods A modified Analytic Hierarchy Process (AHP) was adopted. Overall, 105 nurses from several randomly selected hospitals in southern Taiwan were investigated to generate factors. Ten experienced practitioners were included as the expert in the AHP to produce weights of each criterion. Six nurses from two regional hospitals were then selected to test the model. Results Four factors are then identified as the second level of hierarchy. The study result shows that the family factor is the most important factor, and followed by the personal attributes. Top three sub-criteria that attribute to the nurse's stress-coping capability are children's education, good career plan, and healthy family. The practical simulation provided evidence for the usefulness of this model. Conclusion The study suggested including these key determinants into the practice of human-resource management, and restructuring the hospital's organization, creating an employee-support system as well as a family-friendly working climate. The research provided evidence that supports the usefulness of AHP in identifying the key factors that help stabilizing a nursing team. PMID:25988086

Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings.

PubMed

Perry, Lin; Bellchambers, Helen; Howie, Andrew; Moxey, Annette; Parkinson, Lynne; Capra, Sandra; Byles, Julie

2011-10-01

This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

PubMed

Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

2017-01-01

NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015. Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R 2 values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. © British Journal of General Practice 2017.

Parenting practices regarding TV viewing in low-income Mexican American mothers of preschoolers: Development of the Parenting Practices Regarding TV Viewing (PPRTV) scale

PubMed Central

Thompson, Darcy A.; Johnson, Susan L.; Vandewater, Elizabeth A.; Schmiege, Sarah J.; Boles, Richard E.; Lev, Jerusha; Tschann, Jeanne M.

2016-01-01

Objective To develop and test a comprehensive, culturally-based measure of parenting practices regarding TV viewing in low-income Mexican American mothers of preschoolers. Methods Low-income Mexican American female primary caregivers of preschoolers were recruited in urban safety-net pediatric clinics during the 2013-14 academic year. Items on parenting practices regarding TV viewing were developed from a prior scale, review of the literature, and results from semi-structured interviews. Items were administered by phone and analyses included evaluation of the factor structure and psychometric properties of a 40-item measure of Parenting Practices Regarding TV Viewing (PPRTV). Results Using exploratory factor analysis, a 7-factor model emerged as the best fit for the data representing the following domains of parenting practices: Time Restriction, Behavioral Control, Instructive Practices, Coviewing, Planful Restriction, Reactive Content Restriction, and Commercial Endorsement. Internal reliabilities were acceptable (Cronbach's alpha> 0.75). Correlations among the resulting subscales were small to moderate (rs = 0.01-0.43). Subscales were correlated with child TV viewing amounts: Time Restriction (−0.14, p<0.05); Behavioral Control (0.27, p<0.001); Coviewing (0.16, p<0.01); Planful Restriction (−0.20, p<0.001); Commercial Endorsement (0.11, p<0.05), which provides support for construct validity. Conclusion The Parenting Practices Regarding TV Viewing (PPRTV) scale measures 7 domains of parenting practices, and has good initial reliability and validity. It allows investigators to conduct more in-depth evaluations of the role parents play in socializing young children on TV use. Results of such work will be important to informing the design of interventions aiming to ensure healthy screen media habits in young children. PMID:27355878

Factors influencing professional life satisfaction among neurologists.

PubMed

Teixeira-Poit, Stephanie M; Halpern, Michael T; Kane, Heather L; Keating, Michael; Olmsted, Murrey

2017-06-19

Predicted shortages in the supply of neurologists may limit patients' access to and quality of care for neurological disorders. Retaining neurologists already in practice provides one opportunity to support the overall supply of practicing neurologists. Understanding factors associated with professional life satisfaction (and dissatisfaction) and implementing policies to enhance satisfaction may encourage neurologists to remain in clinical practice. In this paper, we present results from the first study examining factors associated with professional life satisfaction among a large sample of U.S, neurologists. We collaborated with the AAN to survey a sample of U.S. neurologists about their professional life satisfaction. Analyses examined the association of physician and practice characteristics with aspects of professional life satisfaction, including satisfaction with their career in medicine, medical specialty, current position, relationship with colleagues, relationship with patients, work/life balance, and pay. The study population consisted of 625 neurologists. In multivariate regression analyses, no single group or population stratum indicated high (or low) responses to all aspects of satisfaction. Older neurologists reported higher satisfaction with career, specialty, and relationship with patients than younger neurologists. Female neurologists had significantly lower satisfaction with pay than male neurologists. Neurologists who spent more time in research and teaching had greater satisfaction with specialty, relationship with colleagues, and relationship with patients than those spending no time in research. Neurologists who practiced in small cities/rural areas reported lower satisfaction across multiple dimensions than those practicing in large urban areas. Neurologists in solo practice had greater satisfaction with the relationship with their patients, but lower satisfaction with pay. Satisfaction is a multidimensional construct that is associated with physician and practice characteristics. Enhancing professional life satisfaction among neurologists requires multiple strategies, such as promoting comparable wages for men and women, providing collaboration and research opportunities, and providing resources for small and rural practices.

Effective communication with older adults.

PubMed

Daly, Louise

2017-06-07

Communication is an essential aspect of life, yet it can be taken for granted. Its centrality to being in the world and in professional practice often becomes evident when nurses and older adults encounter communication difficulties. The factors that can affect nurses' communication with older adults relate to the older adult, the nurse, sociocultural considerations and the environment, and the interactions between these factors. In adopting a person-centred approach to communicating with older adults, it is necessary to get to know the person as an individual and ensure communication meets their needs and abilities. Effective communication is essential in nursing practice and requires professional competence and engagement. This article can be used by nurses to support effective communication with older adults across the continuum of care.

[Working environment and educational environment are two sides of the same coin].

PubMed

Kannegaard, Pia Nimann; Holm, Ellen Astrid

2014-01-20

Educational environment is of major importance for job satisfaction and it consists of several components including curriculum and values of the organization. Educational climate is the environment, as the individual physicians perceive it. Motivation is important for job satisfaction as well as for learning. Autonomy, responsibility, supervision, feedback are all important factors influencing motivation and learning. These factors must be supported through appropriate organization of work in hospital departments and in general practice.

Relations Among Student Attention Behaviors, Teacher Practices, and Beginning Word Reading Skill

PubMed Central

Sáez, Leilani; Folsom, Jessica Sidler; Al Otaiba, Stephanie; Schatschneider, Christopher

2011-01-01

The role of student attention for predicting kindergarten word reading was investigated among 432 students. Using SWAN behavior rating scores, we conducted an exploratory factor analysis, which yielded three distinct factors that reflected selective attention. In this study, we focused on the role of one of these factors, which we labeled attention-memory behaviors, for predicting reading performance. Teacher ratings of attention predicted word reading above and beyond the contribution of phonological awareness and vocabulary knowledge. In addition, the relations between four teacher practices and attention ratings for predicting reading performance were examined. Using HLM, significant interactions between student attention and teacher practices observed during literacy instruction were found. In general, as ratings of attention improved, better kindergarten word reading performance was associated with high levels of classroom behavior management. However, by mid-year, better word reading performance was not associated with high levels of teacher task- orienting. A significant three-way interaction was also found among attention, individualized instruction, and teacher task re-directions. The role of regulating kindergarten student attention to support beginning word reading skill development is discussed. PMID:22207616

Health workforce needs: projections complicated by practice and technology changes.

PubMed

Cunningham, Rob

2013-10-22

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these and other factors for public workforce policies.

Nursing students' intentions to use research as a predictor of use one year post graduation: a prospective study.

PubMed

Forsman, Henrietta; Wallin, Lars; Gustavsson, Petter; Rudman, Ann

2012-09-01

Graduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students' intentions to use research in clinical practice after undergraduate study. To investigate graduating nursing students' intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation. A follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education). A sample of 1319 respondents was prospectively followed. Graduating nursing students' intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care. Thirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects. Students rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students' intention to use research to improve subsequent behavior. Focusing on strengthening students' capability beliefs and providing support for research use appear as promising target activities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Competing infant feeding information in mothers' networks: advice that supports v. undermines clinical recommendations.

PubMed

Ashida, Sato; Lynn, Freda B; Williams, Natalie A; Schafer, Ellen J

2016-05-01

To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas. Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices. Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA. Eighty-one low-income mothers of infants between 0 and 12 months old. Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95% CI 1·2, 38·1) and not adding cereal in the infant's bottle (OR=15·9; 95% CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours. Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers' networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers' social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers' infant care career may be beneficial.

Physical activity practice among children and adolescents with visual impairment--influence of parental support and perceived barriers.

PubMed

Greguol, Márcia; Gobbi, Erica; Carraro, Attilio

2015-01-01

To analyze the practice of physical activity among children and adolescents with visual impairments (VI), regarding the possible influence of parental support and perceived barriers. Twenty-two young people with VIs (10 + 2.74 years old) and one of each of their parents were evaluated. They responded to the Physical Activity Questionnaire for Older Children (PAQ-C), Baecke Questionnaire, the Parental Support Scale and a questionnaire about perceived barriers to physical activity. The independent samples t-test, pearson correlation test and chi-square test were performed. Blind young people showed lower physical activity levels. There were significant correlations both between parents' physical activity and the support offered to children and between the PAQ-C results and the importance given by young people to physical activity, but only for those aged between 8 and 10 years old. The main perceived barriers were lack of security, motivation, professional training and information about available physical activity programs. The influence of parental support seems to be an important factor in the adoption of a physically active lifestyle for young people with VI. Parents and children should have more information about the benefits and opportunities of physical activity. Implications for Rehabilitation Young people with visual impairment should be encouraged by parents to practice physical activity. More information should be provided on the benefits of physical activity to both parents and children. Professional training should be available to help support this group become more active.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

PubMed Central

Dahrouge, Simone; Hogg, William E.; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K.; Kristjansson, Elizabeth; Fletcher, John

2012-01-01

Background: Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. Methods: In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. Results: A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = −6.3, 95% confidence interval [CI] −11.9 to −0.6) and practices in the established capitation model (β = −9.1, 95% CI −14.9 to −3.3) but not for those with salaried remuneration (β = −0.8, 95% CI −6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. Interpretation: No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology. PMID:22143227

Physical activity and associated factors in high-school adolescents in Southern Brazil.

PubMed

Fermino, Rogério César; Rech, Cassiano Ricardo; Hino, Adriano Akira Ferreira; Rodriguez Añez, Ciro Romelio; Reis, Rodrigo Siqueira

2010-12-01

To estimate the prevalence of physical activity in adolescents and to identify associated factors. A cross-sectional study was conducted with a representative sample (n=1,518, 59.2% females) of students aged between 14 and 18 years, enrolled in the public school network of the city of Curitiba, Southern Brazil, in 2006. Physical activity practice was self-reported, according to the number of days per week when they perform moderate to vigorous physical activity lasting > 60 minutes. This practice was analyzed in two distinct models. In the first model, the variable was dichotomized into "0 day" and "> 1 day"; in the second, into "< 4 days" and "> 5 days". Independent variables were as follows: biological-demographic (sex, age, body mass index); socioeconomic (parents' level of education, number of cars); behavioral (number of hours spent watching television, number of hours spent using a computer); and sociocultural (social support from family and friends and the perception of barriers to the practice of activities), tested with Poisson regression. In the first model of analysis, the prevalence of physical activity was 58.2% (75.1% in males; 46.5% in females; p<0.001), while, in the second, it was 14.5% (22.3% and 9.1%, respectively; p<0.001). In the first model, the variables associated with physical activity were: male sex (PR=1.63, 95% CI: 1.48;1.78), social support from family (PR=1.14, 95% CI: 1.05;1.23), social support from friends (PR=1.52, 95% CI: 1.31;1.78) and high perception of barriers (PR=0.54, 95% CI: 0.46;0.62). In the second model, only male sex (PR=2.45, 95% CI: 1.73;3.46) and high perception of barriers (PR=0.24, 95% CI: 0.15;0.38) were associated with physical activity. More than half of adolescents practice physical activity at least one day of the week, although 14.5% achieved the current recommendations. The recommended levels are associated with a lower number of factors. Gender and perception of barriers were consistently associated with physical activity levels.

Technological, Pedagogical, and Content Knowledge (TPACK): An Educational Landscape for Tertiary Science Faculty

NASA Astrophysics Data System (ADS)

Lavadia, Linda

Earlier studies concluded that technology's strength is in supporting student learning rather than as an instrument for content delivery (Angeli & Valanides, 2014). Current research espouses the merits of the Technological Pedagogical Content Knowledge (TPACK) framework as a guide for educators' reflections about technology integration within the context of content and instructional practice. Grounded by two theoretical frameworks, TPACK (Mishra & Koehler, 2006; 2008) and Rogers' (1983, 1995) theory of diffusion of innovation, the purpose of this mixed-methods research was two-fold: to explore the perceived competencies of tertiary science faculty at higher education institutions with respect to their integration of technology within the constructs of pedagogical practice and content learning and to analyze whether these perceived competencies may serve as predictive factors for technology adoption level. The literature review included past research that served as models for the Sci-TPACK instrument. Twenty-nine professors of tertiary science courses participated in an online Likert survey, and four professors provided in-depth interviews on their TPACK practices. Quantitative analysis of data consisted of descriptive and reliability statistics, calculations of means for each of the seven scales or domains of TPACK, and regression analysis. Open-ended questions on the Likert survey and individual interviews provided recurrent themes of the qualitative data. Final results revealed that the participants integrate technology into pedagogy and content through a myriad of TPACK practices. Regression analysis supported perceived TPACK competencies as predictive factors for technology adoption level.

Social support: an important factor for quality of life in women with hirsutism.

PubMed

Ekbäck, Maria Palmetun; Lindberg, Magnus; Benzein, Eva; Årestedt, Kristofer

2014-12-20

Women with hirsutism have reported imparied health and health-related quality of life (HRQoL). Social support is a factor that might increase HRQoL in chronic diseases, but little is known about this association among women with hirsutism. The aim of the study was to describe social support and explore its association with HRQoL among women with hirsutism. A further aim was to compare HRQoL in women with hirsutism with a Swedish normal population. A questionnaire including socio-demographic questions, Short-Form Health Survey (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS), and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was answered by 127 women with hirsutism. Multiple regression analyses showed significant associations between social support and all health dimensions in the SF-36, also after the model was adjusted for age, hairiness and body mass index. Compared to the normal Swedish population, women with hirsutism reported significantly lower HRQoL in all dimensions of the SF-36 (p < 0.01). There is a significant positive association between social support and HRQoL, demonstrating its importance for the ability to adapt to problems associated with hirsutism. As women with hirsutism reported poorer HRQoL compared to the normal population, social support may be a factor to consider in clinical practice.

Returning to productive activities: Perspectives of individuals with long-standing acquired brain injuries.

PubMed

Petrella, L; McColl, M A; Krupa, T; Johnston, J

2005-08-20

The primary objective of this study was to understand how intrinsic and extrinsic factors influence productive involvement over time. Given this relatively unexplored area of study, an interpretive research paradigm was incorporated using the grounded theory methodology. Six participants were recruited based on inclusion criteria. They had been living with a brain injury for an average of 14 years. The primary method of data collection was semi-structured interviews, which was supplemented by programme reports to enhance methodological triangulation. The results revealed that factors influencing involvement in productive activities over time were conceptually linked to learning about one's capacity. These factors involved: an opportunity to try, support and feedback from others, experimenting, and participants' appraisals of themselves. Recommendations for clinical practice include incorporating the postulates of the social cognitive theory in rehabilitation and moving from a deficits approach towards a strengths model of practice.

Factor structure of a standards-based inventory of competencies in social work with groups.

PubMed

Macgowan, Mark J; Dillon, Frank R; Spadola, Christine E

2018-01-01

This study extends previous findings on a measure of competencies based on Standards for Social Work Practice with Groups. The Inventory of Competencies in Social Work with Groups (ICSWG) measures confidence in performing the Standards. This study examines the latent structure of the Inventory, while illuminating the underlying structure of the Standards. A multinational sample of 586 persons completed the ICSWG. Exploratory factor analysis (EFA), reliability estimates, standard error of measurement estimates, and a range of validity tests were conducted. The EFA yielded a six-factor solution consisting of core values, mutuality/connectivity, collaboration, and three phases of group development (planning, beginnings/middles, endings). The alphas were .98 for the scale and ranged from .85 to .95 for the subscales. Correlations between the subscales and validators supported evidence of construct validity. The findings suggest key group work domains that should be taught and practiced in social work with groups.

Implementation Science: Why it matters for the future of social work.

PubMed

Cabassa, Leopoldo J

2016-01-01

Bridging the gap between research and practice is a critical frontier for the future of social work. Integrating implementation science into social work can advance our profession's effort to bring research and practice closer together. Implementation science examines the factors, processes, and strategies that influence the uptake, use, and sustainability of empirically-supported interventions, practice innovations, and social policies in routine practice settings. The aims of this paper are to describe the key characteristics of implementation science, illustrate how implementation science matters to social work by describing several contributions this field can make to reducing racial and ethnic disparities in mental health care, and outline a training agenda to help integrate implementation science in graduate-level social work programs.

Implementation Science: Why it matters for the future of social work

PubMed Central

Cabassa, Leopoldo J.

2016-01-01

Bridging the gap between research and practice is a critical frontier for the future of social work. Integrating implementation science into social work can advance our profession’s effort to bring research and practice closer together. Implementation science examines the factors, processes, and strategies that influence the uptake, use, and sustainability of empirically-supported interventions, practice innovations, and social policies in routine practice settings. The aims of this paper are to describe the key characteristics of implementation science, illustrate how implementation science matters to social work by describing several contributions this field can make to reducing racial and ethnic disparities in mental health care, and outline a training agenda to help integrate implementation science in graduate-level social work programs. PMID:28216992

Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation

PubMed Central

Loeffen, Maartje J.W.; Daemen, Jasper; Wester, Fred P.J.F.; Laurant, Miranda G.H.; Lo Fo Wong, Sylvie H.; Lagro-Janssen, Antoine L.M.

2017-01-01

Abstract Background: Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression. Objectives: Identify factors determining implementation success of mentor mother support in family practice. Methods: Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data. Results: The identification and discussion of abuse is hindered by family physicians’ attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner’s violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals. Conclusion: To improve successful implementation of mentor mother support in primary care, we should focus on family physicians’ attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care. KEY MESSAGES We need to focus on family physicians’ attitudes towards IPV to improve the support for mothers experiencing IPV. As ‘paraprofessional friends,’ mentor mothers offer low-threshold support that is complementary to professional support. PMID:28095727

Are medical educators following General Medical Council guidelines on obesity education: if not why not?

PubMed Central

2013-01-01

Background Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools. Methods Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions. Results Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies. Conclusions Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically. PMID:23578257

Exploring the Gap for Effective Extension of Professional Active Life in Europe

NASA Astrophysics Data System (ADS)

Leonard, Will; Afsarmanesh, Hamideh; Msanjila, Simon S.; Playfoot, Jim

Extending Professional Active Life (ePAL [2]) of elder people in Europe is affected by a number of factors in the market and society, which have the potential to either positively and negatively influence it. Current practices indicate that the European society, while started to act on this subject, is still slow to recognize the rationale behind and importance of fully supporting the extension of active professional life of seniors. Similarly, the capacity of the service sector to fully support the involvement of seniors in economical activities is at present limited, given the huge number of these seniors in different countries who need to be mobilized. This paper seeks to highlight the identified gaps related to effective mechanisms by which Europe can support its willing senior professionals to remain active. The study on gap identification addresses relevant technological, social, and organizational factors and external influences which have the potential to impact successful future life of elderly population. It also presents the methodology that is applied in our study to identify and analyze the gaps between the current practices in this area, the so-called baseline [2], and the desired future for this area as inspired in the ePAL vision [1] addressed in other research.

Occupational health and safety management practices and musculoskeletal disorders in aged care.

PubMed

Oakman, Jodi; Bartram, Timothy

2017-05-15

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

Online communities of practice as a communication resource for community health nurses working with homeless persons.

PubMed

Valaitis, Ruta K; Akhtar-Danesh, Noori; Brooks, Fiona; Binks, Sally; Semogas, Dyanne

2011-06-01

This study explored community health nurses' viewpoints about a Canadian online community of practice to support their practice with homeless or under-housed populations. Community health nurses who specifically work with homeless and marginally housed populations often report feelings of isolation and stress in managing complex problems in resource constraints. To strengthen intra-professional ties and enhance information access, an online community of practice was designed, implemented and evaluated by and for them. Q-methodology was used. Sixty-six statements about the community of practice were collected from an online survey and focus groups, refined and reduced to 44 statements. In 2009, sixteen participants completed the Q-sort activity, rating each statement relative to the others. Scores for each participant were subjected to by-person factor analysis. Respondents fell into two groups -tacit knowledge warriors and tacit knowledge communicators. Warriors strongly believed that the community of practice could combat stigma associated with homelessness and promote awareness of homelessness issues, and valued its potential to validate and improve practice. Communicators would have used the community of practice more with increased discussion, facilitation and prompt responses. Generally, nurses viewed the community of practice as a place to share stories, validate practice and adapt best practices to their work context. Online communities of practice can be valuable to nurses in specialized fields with limited peer support and access to information resources. Tacit knowledge development is important to nurses working with homeless populations: this needs to be valued in conjunction with scientifically based knowledge. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Rural exposure during medical education and student preference for future practice location - a case of Botswana.

PubMed

Arscott-Mills, Tonya; Kebaabetswe, Poloko; Tawana, Gothusang; Mbuka, Deogratias O; Makgabana-Dintwa, Orabile; Sebina, Kagiso; Kebaetse, Masego; Mokgatlhe, Lucky; Nkomazana, Oathokwa

2016-06-10

Botswana's medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum. This study explored the impact of rural training on students' attitudes towards rural practice. The University of Botswana family medicine rural training sites, Maun and Mahalapye. The study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. The thirty-six participants' age averaged 23 years and 48.6% were male. Thirtythree desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice. The majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.Keyords: rural health, student perceptions.

Cluster randomised controlled trial of a multicomponent intervention to support the implementation of policies and practices that promote healthier environments at junior sports clubs: study protocol

PubMed Central

Milner, Sharin; Sherker, Shauna; Clinton-McHarg, Tara; Dray, Julia; Zukowski, Nadya; Gonzalez, Sharleen; Kingsland, Melanie; Ooi, Jia Ying; Murphy, Allan; Brooke, Daisy; Wiggers, John

2018-01-01

Introduction A large proportion of children and adolescents participate in organised sport, making community sports clubs a promising setting to support healthy behaviours. To date, however, there have been few interventions conducted in junior sports clubs that have targeted health-promoting practices. The primary aim of this pilot study is to assess the potential effectiveness of an intervention to implement health-promoting policies and practices in junior sporting clubs targeting alcohol and tobacco practices, healthy food and beverage availability, and physical activity via participation in sport. A secondary outcome is to assess the impact of such strategies on child exposure to alcohol and tobacco use at the club, purchasing behaviours by/for children at the club canteen and child sports participation opportunities. Methods and analysis The study will employ a cluster randomised controlled trial design and be conducted in metropolitan and regional areas of two Australian states. Randomisation will occur at the level of the football league. Community football clubs with over 40 junior players (players under 18 years) within each league will be eligible to participate. The intervention will be developed based on frameworks that consider the social, cultural and environmental factors that influence health behaviours. Intervention clubs will be supported to implement 16 practices targeting alcohol management, tobacco use, nutrition practices, new player recruitment activity, equal participation for players and the development of policies to support these practices. Trained research staff will collect outcome data via telephone interviews at baseline and follow-up. Interviews will be conducted with both club representatives and parents of junior players. Ethics and dissemination The study has been approved by the University of Newcastle Human Research Ethics Committee (H-2013-0429). The results of the study will be disseminated via peer-reviewed publications and presentations at conferences. Trial registration number ACTRN12617001044314; Pre-results. PMID:29362260

A qualitative study of clinic and community member perspectives on intervention toolkits: "Unless the toolkit is used it won't help solve the problem".

PubMed

Davis, Melinda M; Howk, Sonya; Spurlock, Margaret; McGinnis, Paul B; Cohen, Deborah J; Fagnan, Lyle J

2017-07-18

Intervention toolkits are common products of grant-funded research in public health and primary care settings. Toolkits are designed to address the knowledge translation gap by speeding implementation and dissemination of research into practice. However, few studies describe characteristics of effective intervention toolkits and their implementation. Therefore, we conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. In this qualitative descriptive study we conducted focus groups and interviews with a purposive sample of community health coalition members, public health experts, and primary care professionals between November 2010 and January 2012. The transdisciplinary research team used thematic analysis to identify themes and a cross-case comparative analysis to explore variation by participant role and toolkit experience. Ninety six participants representing primary care (n = 54, 56%) and community settings (n = 42, 44%) participated in 18 sessions (13 focus groups, five key informant interviews). Participants ranged from those naïve through expert in toolkit development; many reported limited application of toolkits in actual practice. Participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired. Irrespective of perceived quality, participants experienced with practice change emphasized that leadership, staff buy-in, and facilitative support was essential for intervention toolkits to be translated into changes in clinic or public -health practice. Given the emphasis on toolkits in supporting implementation and dissemination of research and clinical guidelines, studies are warranted to determine when and how toolkits are used. Funders, policy makers, researchers, and leaders in primary care and public health are encouraged to allocate resources to foster both toolkit development and implementation. Support, through practice facilitation and organizational leadership, are critical for translating knowledge from intervention toolkits into practice.

The case for full practice authority.

PubMed

Holmes, Olivia; Kinsey-Weathers, Shanieka

2016-03-01

The Institute of Medicine (IOM) recommended in its 2010 report on the future of nursing that advanced practice registered nurses (APRNs) should factor prominently in providing care to the millions of Americans who access healthcare services under the Affordable Care Act (ACA). The IOM also recommended that APRNs practice to the full extent of their education and training.However, many states have laws in place that limit full practice authority for APRNs, specifically NPs, in providing basic health services such as primary care. These laws place restrictions on independent practice and Medicaid and Medicare reimbursement, which prevent nurses from “responding effectively to rapidly changing health care settings and an evolving health care system.” Less than half of the United States has adopted full practice authority licensure and practice laws (see APRN practice authority at a glance). This article discusses how the primary care needs of millions of Americans can be met by granting full practice authority to APRNs nationwide and provides evidence to support the high level of care these practitioners can provide independently.

Teachers' Needs in Supporting Students with a Disability in the Classroom: A Research Report.

ERIC Educational Resources Information Center

Eraclides, George

An Australian study explored what teachers thought about working with students with disabilities and what kind of factors affected their practices. Twelve teachers from Box Hill Institute in Melbourne were interviewed using questions grouped into these four categories: background and experience, attitude, professional issues, and recommendations.…

Equity-Minded Faculty Development: An Intersectional Identity-Conscious Community of Practice Model for Faculty Learning

ERIC Educational Resources Information Center

Costino, Kimberly A.

2018-01-01

Equity-minded institutional transformation requires robust faculty learning. Research has shown that the single most important factor in student success is faculty interaction. Positive, supportive, and empowering faculty interaction is particularly important to the success of female students, poor and working class students, and students of…

Knowledge Translation: Supports, Challenges, and Opportunities for Change in Early Intervention

ERIC Educational Resources Information Center

Rabinowicz, Susan; Ray, Sharon

2018-01-01

Knowledge translation (KT) provides a lens to examine the process of moving research-informed knowledge into early intervention practice (P. Sudsawad, 2007). The process of KT entails cognitive, affective, and behavioral stages that are mediated by factors intrinsic and extrinsic to the practitioner. Facilitators and barriers to this process may…

Psychometric Support for a New Measure of Authoritative, Authoritarian, and Permissive Parenting Practices: Cross-Cultural Connections.

ERIC Educational Resources Information Center

Robinson, Clyde C.; And Others

This study examined the psychometric characteristics of a 62-item parenting questionnaire completed by parents from the United States, Australia, China, and Russia. Factor analyses yielded three global parenting dimensions for each culture which were consistent with D. Baumrind's (1971) authoritative, authoritarian, and permissive typologies. The…

Considerations for lunar colony communications systems

NASA Technical Reports Server (NTRS)

Dowling, Richard P.

1992-01-01

This paper addresses system aspects of communications for a lunar colony. Human factors are particularly noted. The practical aspects of communications infrastructure are emphasized rather than specific technologies. Communications needs for mission support and morale are discussed along with potential means of satisfying them. Problem areas are identified and some possible solutions are considered.

Sexual Violence through a Social Justice Paradigm: Framing and Applications

ERIC Educational Resources Information Center

Hong, Luoluo; Marine, Susan B.

2018-01-01

In this chapter, we explore the factors that support the occurrence of sexual violence, including the role of interlocking systems of oppression. Traditional conceptions of "prevention" are deconstructed, a social justice paradigm for addressing sexual violence is advanced, and examples of how the paradigm can be applied to practice are…

Determining Effective Teaching Behaviors through the Hiring Process

ERIC Educational Resources Information Center

Schumacher, Gary; Grigsby, Bettye; Vesey, Winona

2015-01-01

Purpose: One bad hiring decision can lead to low student achievement. Research supports that teachers are the most influential factor in student success. As a result, principals' current practice of hiring teachers based on intuition and likeability must change. Given the current high stakes era, principals need reassurance that the teachers they…

Media and Democracy. A Response to "The Need for Media Education in Democratic Education"

ERIC Educational Resources Information Center

Mason, Lance E.

2015-01-01

This response supports Stoddard's (2014) assertion that media education should be considered a crucial factor of democratic education and offers both extensions and cautions related to that end. Extensions include practical suggestions for studying the non-neutrality of technology. The author also cautions educators that if media education and…

The Nature of Institutional Heteronormativity in Primary Schools and Practice-Based Responses

ERIC Educational Resources Information Center

DePalma, Renee; Atkinson, Elizabeth

2010-01-01

Concern for school-based homophobia is increasing, yet there is a tendency to focus on individual incidents of homophobic bullying rather than the cultural and institutional factors supporting them. We analyse ways in which institutional heteronormativity operates in primary schools and report results from our research in UK schools that…

Anxiety Sensitivity and Panic Attacks: A 1-Year Longitudinal Study

ERIC Educational Resources Information Center

Li, Wen; Zinbarg, Richard E.

2007-01-01

The hypothesis that anxiety sensitivity (AS) is a risk factor for panic genesis has obtained compelling support, but the clinical/practical importance of AS in panic genesis has been questioned. In addition, the association between panic experience and AS increase has not been clearly demonstrated. Through this 1-year longitudinal study among…

Factors Deterring Schools from Mixed Attainment Teaching Practice

ERIC Educational Resources Information Center

Taylor, Becky; Francis, Becky; Archer, Louise; Hodgen, Jeremy; Pepper, David; Tereshchenko, Antonina; Travers, Mary-Claire

2017-01-01

Mixed-attainment teaching has strong support from research and yet English schools are far more likely to teach students in "ability" groups. Although research has considered some of the specific benefits of mixed-attainment grouping, there has been little attention to the reasons schools avoid it. This article explores data from the…

Identifying the Factors Leading to Success: How an Innovative Science Curriculum Cultivates Student Motivation

ERIC Educational Resources Information Center

Scogin, Stephen C.

2016-01-01

"PlantingScience" is an award-winning program recognized for its innovation and use of computer-supported scientist mentoring. Science learners work on inquiry-based experiments in their classrooms and communicate asynchronously with practicing plant scientist-mentors about the projects. The purpose of this study was to identify specific…

As Nearly Uniform as Practicable?

ERIC Educational Resources Information Center

Rossmiller, Richard A.

Results of a review of Wisconsin's general program for providing financial support to local school districts are presented in this paper, with a focus on developments of the 1980s. First, a brief history of the state aid program from 1949-80 is provided. The next section identifies seven disequalizing factors of the equalization aid program and…

Some Additional Lessons from the Wechsler Scales: A Rejoinder to Kaufman and Keith.

ERIC Educational Resources Information Center

Macmann, Gregg M.; Barnett, David W.

1994-01-01

Reacts to previous arguments regarding verbal and performance constructs of Wechsler Scales. Contends that general factor model is more plausible representation of data for these scales. Suggests issue is moot when considered in regards to practical applications. Supports analysis of needed skills and instructional environments in educational…

Best Practices in the Navy’s Energy Programs Strategic Communication Factors Operating in the Tactical Forces

DTIC Science & Technology

2009-12-01

Management Pilot Project.” NRSW E -Notes, No. 132, January 30, 2008. http://secnavportal.donhq.navy.mil/ portal /server.pt/gateway/PTARGS_0_0_2426...CONSERVATION.........................................................................................52 E . MATERIAL AND SOCIAL INCENTIVES IMPACT BEHAVIOR...73 E . SUPPORT AN INTEGRATED COMMUNICATION PROCESS...........75 VI. METHODS

Indications for Vitamin B12 Therapy

PubMed Central

Delva, M. Dianne; Anderson, J.E.

1992-01-01

A retrospective chart audit was undertaken to determine the clinical reasons for vitamin B12 therapy in family practice. Abnormal laboratory tests and symptoms were the most common reasons for initiating therapy. The high proportion of cases with little supporting evidence of B12 deficiency suggests that other factors influence treatment decisions. PMID:20469527

The Ethical Issues Rating Scale: An Instrument for Measuring Ethical Orientation of College Students toward Various Business Practices.

ERIC Educational Resources Information Center

Daniel, Larry G.; And Others

1997-01-01

Factor analysis of data from 213 college business students supported the existence of 5 constructs for the Ethical Issues Rating Scale, an instrument measuring respondents' assessment of the importance of various ethical issues. Suggestions about refining the instrument and using it are discussed. (SLD)

Developing Knowledge Creating Technical Education Institutions through the Voice of Teachers: Content Analysis Approach

ERIC Educational Resources Information Center

Song, Ji Hoon; Kim, Hye Kyoung; Park, Sunyoung; Bae, Sang Hoon

2014-01-01

The purpose of this study was to develop an empirical data-driven model for a knowledge creation school system in career technical education (CTE) by identifying supportive and hindering factors influencing knowledge creation practices in CTE schools. Nonaka and colleagues' (Nonaka & Konno, 1998; Nonaka & Takeuchi, 1995) knowledge…

Factors Influencing Beliefs for Adoption of a Learning Analytics Tool: An Empirical Study

ERIC Educational Resources Information Center

Ali, Liaqat; Asadi, Mohsen; Gasevic, Dragan; Jovanovic, Jelena; Hatala, Marek

2013-01-01

Present research and development offer various learning analytics tools providing insights into different aspects of learning processes. Adoption of a specific tool for practice is based on how its learning analytics are perceived by educators to support their pedagogical and organizational goals. In this paper, we propose and empirically validate…

Researchers Supporting Schools to Improve Health: Influential Factors and Outcomes of Knowledge Brokering in the COMPASS Study

ERIC Educational Resources Information Center

Brown, Kristin M.; Elliott, Susan J.; Leatherdale, Scott T.

2018-01-01

Background: Although schools are considered opportune settings for youth health interventions, a gap between school health research and practice exists. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used integrated knowledge translation to enhance schools' uptake of research findings. Schools…

Flow chemistry and polymer-supported pseudoenantiomeric acylating agents enable parallel kinetic resolution of chiral saturated N-heterocycles

NASA Astrophysics Data System (ADS)

Kreituss, Imants; Bode, Jeffrey W.

2017-05-01

Kinetic resolution is a common method to obtain enantioenriched material from a racemic mixture. This process will deliver enantiopure unreacted material when the selectivity factor of the process, s, is greater than 1; however, the scalemic reaction product is often discarded. Parallel kinetic resolution, on the other hand, provides access to two enantioenriched products from a single racemic starting material, but suffers from a variety of practical challenges regarding experimental design that limit its applications. Here, we describe the development of a flow-based system that enables practical parallel kinetic resolution of saturated N-heterocycles. This process provides access to both enantiomers of the starting material in good yield and high enantiopurity; similar results with classical kinetic resolution would require selectivity factors in the range of s = 100. To achieve this, two immobilized quasienantiomeric acylating agents were designed for the asymmetric acylation of racemic saturated N-heterocycles. Using the flow-based system we could efficiently separate, recover and reuse the polymer-supported reagents. The amide products could be readily separated and hydrolysed to the corresponding amines without detectable epimerization.

Problems, policies and politics: making the case for better assistive technology provision in Australia.

PubMed

Layton, Natasha

2015-05-01

Substantial evidence supports assistive technology and environmental adaptations as key enablers to participation. In order to realise the potential of these interventions, they need to be both recognised in policy, and resourced in practice. This paper uses political theory to understand the complexities of assistive technology (AT) policy reform in Australia. AT research will not be influential in improving AT policy without consideration of political drivers. Theories of policy formation are considered, with Kingdon's (2003) theory of multiple streams identified as a useful lens through which to understand government actions. This theory is applied to the case of current AT policy reformulation in Australia. The convergence model of problem identification, policy formulation and political will is found to be an applicable construct with which to evaluate contemporary policy changes. This paper illustrates the cogency of this theory for the field of AT, in the case of Australia's recent disability and aged care reforms. Political theory provides a way of conceptualising the difficulties of consumers and AT practitioners experience in getting therapeutically valid solutions into public policy, and then getting policies prioritised and funded. It is suggested that AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice. AT practitioners generally lack political awareness or an understanding of the drivers of policy. The effectiveness of AT practitioners at a systemic level will remain limited without consideration of policy drivers. AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice.

Community assets and capabilities to recruit and retain GPs: the Community Apgar Questionnaire in rural Victoria.

PubMed

Terry, Daniel R; Baker, Ed; Schmitz, David F

2016-01-01

Rural communities continue to experience significant challenges recruiting and retaining physicians. The Community Apgar Questionnaire (CAQ) was developed in Idaho in the USA to comprehensively assess the characteristics associated with successful recruitment and retention of rural physicians. The CAQ has been utilised and validated across the USA; however, its value in rural Australia has not been examined. The objective of this study was to use the CAQ in rural Australia to examine its utility and develop a greater understanding of the community factors that impact general practitioner (GP) recruitment and retention. The project conducted structured face-to-face interviews with hospital chief executive officers (CEOs) and directors of clinical services (DCSs) from 14 of the 21 (76%) health services that agreed to participate in rural north-eastern Victoria, Australia. The interviews were undertaken to complete the CAQ, which contains 50 questions centred on factors that influence physician recruitment and retention. Once completed, CAQs were scored by assigning quantitative values to a community's strengths and challenges including the level of importance placed on each factor. As such, the most important factors in physician recruitment, whether they are advantages or challenges for that community, were then weighed for their relative importance. Scores were then combined to create a CAQ score. To ensure reliability and validity of the results, three additional CAQs were purposefully administered to key general practices within the region. The 14 rural communities exhibited cumulative CAQ scores ranging from a high of 387 to a low score of 61. This suggests the tool was sensitive enough to differentiate between communities that were high and low performers in terms of physician recruitment. The groups of factors that had the greatest impact on recruitment and retention were ranked highest to lowest and included medical support, hospital/community support, economic, scope of practice and geographic factors. Overall, the highest individual factors to impact recruitment and retention were perception of quality, hospital leadership, nursing workforce and transfer arrangements. Conversely, the lowest factors and challenges to recruitment and retention were family related, specifically spousal satisfaction and access to schools. Hume, in rural Victoria, was the first international site to implement the CAQ to differentially diagnose a community's relative strengths and challenges in recruiting and retaining GPs, while supporting health facilities to prioritise achievable goals to improve long-term retention strategies. It provided each community with a tailored gap analysis, while confidentially sharing best practices of other health facilities. Within Hume, open communication and trust between GPs and health facility leadership and nursing staff ensures that GPs can feel valued and supported. Possible solutions for GP recruitment and retention must consider the social, employment and educational opportunities that are available for spouses and children. Participation in the program was useful as it helped health facilities ascertain how they were performing while highlighting areas for improvement.

The patient centered medical home: mental models and practice culture driving the transformation process.

PubMed

Cronholm, Peter F; Shea, Judy A; Werner, Rachel M; Miller-Day, Michelle; Tufano, Jim; Crabtree, Benjamin F; Gabbay, Robert

2013-09-01

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized. To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project. Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania. A total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation. Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice-patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care. Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.

Grower networks support adoption of innovations in pollination management: The roles of social learning, technical learning, and personal experience.

PubMed

Garbach, Kelly; Morgan, Geoffrey P

2017-12-15

Management decisions underpinning availability of ecosystem services and the organisms that provide them in agroecosystems, such as pollinators and pollination services, have emerged as a foremost consideration for both conservation and crop production goals. There is growing evidence that innovative management practices can support diverse pollinators and increase crop pollination. However, there is also considerable debate regarding factors that support adoption of these innovative practices. This study investigated pollination management practices and related knowledge systems in a major crop producing region of southwest Michigan in the United States, where 367 growers were surveyed to evaluate adoption of three innovative practices that are at various stages of adoption. The goals of this quantitative, social survey were to investigate grower experience with concerns and benefits associated with each practice, as well as the influence of grower networks, which are comprised of contacts that reflect potential pathways for social and technical learning. The results demonstrated that 17% of growers adopted combinations of bees (e.g. honey bees, Apis mellifera, with other species), representing an innovation in use by early adopters; 49% of growers adopted flowering cover crops, an innovation in use by the early majority 55% of growers retained permanent habitat for pollinators, an innovation in use by the late majority. Not all growers adopted innovative practices. We found that growers' personal experience with potential benefits and concerns related to the management practices had significant positive and negative relationships, respectively, with adoption of all three innovations. The influence of these communication links likely has different levels of importance, depending on the stage of the adoption that a practice is experiencing in the agricultural community. Social learning was positively associated with adopting the use of combinations of bees, highlighting the potentially critical roles of peer-to-peer networks and social learning in supporting early stages of adoption of innovations. Engaging with grower networks and understanding grower experience with benefits and concerns associated with innovative practices is needed to inform outreach, extension, and policy efforts designed to stimulate management innovations in agroecosystems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictors of Online Health Information Seeking Among Women with Breast Cancer: The Role of Social Support Perception and Emotional Well-Being

PubMed Central

Kim, Sojung Claire; Shah, Dhavan V.; Namkoong, Kang; McTavish, Fiona M.; Gustafson, David H.

2013-01-01

This study attempts to examine the role of social support perception and emotional well-being on online information seeking among cancer patients within the context of CHESS, a well-established Interactive Cancer Communication System (ICCS). Factor and regression analyses conducted among 231 breast cancer patients revealed that social support perception and emotional well-being interacted with each other to influence online health information seeking. Patients with low social support perception and high emotional well-being were most likely to seek health information, whereas patients with high social support perception and high emotional well-being sought out the same information least. Practical implications of the study findings were further discussed. PMID:24634575

Predictors of Online Health Information Seeking Among Women with Breast Cancer: The Role of Social Support Perception and Emotional Well-Being.

PubMed

Kim, Sojung Claire; Shah, Dhavan V; Namkoong, Kang; McTavish, Fiona M; Gustafson, David H

2013-01-01

This study attempts to examine the role of social support perception and emotional well-being on online information seeking among cancer patients within the context of CHESS, a well-established Interactive Cancer Communication System (ICCS). Factor and regression analyses conducted among 231 breast cancer patients revealed that social support perception and emotional well-being interacted with each other to influence online health information seeking. Patients with low social support perception and high emotional well-being were most likely to seek health information, whereas patients with high social support perception and high emotional well-being sought out the same information least. Practical implications of the study findings were further discussed.