The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

Professional growth and development in nursing is essential for public welfare and safety. The public expects competent and safe nursing care. Student nurses spend a large number of hours in the clinical practice as part of their professional and clinical development. A clinical environment that is supportive to the improvement of student teaching and learning is imperative to the development of competency of student nurses. One strategy that has been identified to facilitate professional growth and development in student nurses is mentoring in the clinical practice. This is where student nurses are socialized into the nursing profession by experienced professional nurses. Mentoring is regarded as the deliberate pairing of student nurses with an experienced and knowledgeable person. The primary purpose of this research was to explore and describe the experiences of student nurses regarding mentoring in the clinical practice at the Eastern Campus of the Free State School of Nursing (ECFSSON). The secondary purpose was to recommend to the nursing college and clinical service areas to jointly formulate guidelines for mentoring student nurses in the clinical practice. A qualitative, exploratory, descriptive and contextual research design was chosen in order to describe the experiences of mentoring of student nurses in the clinical practice. Purposive sampling was utilized to identify participants who complied with the set selection criteria. The sample comprised student nurses who were in their final year of the four year programme. Data collection took place by means of four focus group interviews with a total of twenty four student nurses (7:6:6:5), which was followed by a confirmatory focus group interview with ten participants. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on an audiotape and transcribed verbatim. Field notes were taken during each focus group. Content analysis of the data was analyzed by the researcher and an independent co–coder. After consensus and data saturation, four major themes and twenty–one sub–themes were identified. The first theme described the student nurses' experiences of being mentored in the clinical practice and has five sub–themes. The second theme described the student nurses' experiences regarding mentoring by personnel and has eight sub–themes. The third theme described the student nurses' experiences regarding mentoring in different disciplines. The fourth theme described the student nurses' experiences regarding mentoring in different institutions. Each of these themes was discussed together with relevant data obtained from literature and reduced to a conclusive statement which serves as a basis for recommendation to formulate guidelines for mentoring student nurses in the clinical practice. Several conclusions were reached. Student nurses have positive as well as negative experiences about their mentoring in clinical practice. The personnel in clinical practice have different roles in the mentoring of students and the responsibility of mentoring is not clear. The mentoring of lecturers from the educational institution was also experienced as not enough. The research report concluded with the researcher's evaluation of the research and recommendations for nursing service, nursing education and nursing research to improve mentoring of student nurses in clinical practice. / Thesis (M.Cur. (Nursing Education))--North-West University, Potchefstroom Campus, 2012.

Clinical research is conducted to advance human medicine by developing efficacious treatments and improving patient outcomes when new therapies are developed and implemented. Clinical trials are a subset of the types of clinical research conducted on human volunteers in the development of new drugs, devices and other therapies. Prior to the start of a trial, a country’s regulatory authority must review the trial to ensure it is scientifically and ethically sound. In Canada, the regulatory authority is Health Canada. The International Conference on Harmonization (ICH) of technical requirements for the registration of pharmaceutics for humans aims to provide ethical and scientific quality standards for design, conduct, data collection and reporting in clinical trials. The Good Clinical Practice (GCP) Guidelines were created by the ICH Steering Committee to assure the public that rights, safety and well being of subjects are protected according to the Declaration of Helsinki, and the clinical data obtained in a ICH/GCP compliant clinical trial will meet regulatory requirements. Health Canada has adopted the ICH/GCP Guidelines and therefore, in Canada, all clinical trials involving humans must comply with these Guidelines. The clinical trial coordinator is an important and central position on the research team executing many trial duties and communications. Regulatory authorities, Research Ethics Boards and the sponsor, overlook the role and responsibilities of a highly trained clinical coordinator, despite their vital and central position. The GCP Guidelines also fail to address the role and responsibilities of a clinical coordinator. Disconnect between guidelines, regulatory expectations and actual trial conduct provides an apparent need to formalize and clearly define the role and scope of a clinical coordinator. The Registered Nurse (RN) brings professionalism, knowledge, skill and a holistic perspective to the expanded role of a clinical coordinator and to the clinical trial. Highly trained health professionals are capable of assuming more responsibilities and executing clinical trial design, setup and management as compared to the traditional administrative roles of the clinical coordinator. The expanded role of the clinical coordinator is especially beneficial for Principal Investigator initiated trials due to limited research personnel and resources. Postoperative adhesions are a common complication following pelvic surgery, therefore, this clinical trial is relevant and a response to a healthcare need. My graduate studies focused on the development and set up of the clinical trial Protocol ADE002-2013 Phase I Trial of L-Alanyl-L-Glutamine for the Reduction of Peritoneal Adhesions in Adult Females Undergoing Myomectomy. My thesis is a discussion of general Canadian clinical trial research information followed by an explanation of how we executed the information to design and set up our PI initiated clinical trial. The value of the expanded role of the clinical coordinator as a member of the research team will also be discussed.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

Bakgrund Stress och liknande känslotillstånd hos nyutexaminerade sjuksköterskor är ett vanligt problem. Syfte Undersöka hur nyutexaminerade sjuksköterskor upplevde tiden före sin första anställning och under första året i yrkeslivet. Fokus lades på känslor av oförbereddhet och stress och huruvida det påverkade omvårdnaden, samt hur detta hade kunnat avhjälpas. Metodbeskrivning Sju semi-strukturerade kvalitativa intervjuer genomfördes. Insamlat material analyserades genom en modifierad version av kvalitativ innehållsanalys. Resultat Övergången från sjuksköterskestudent till yrkesverksam sjuksköterska kunde innebära psykiska och fysiska påfrestningar och leda till symptom på utmattningssyndrom. Faktorer för att undvika skadlig stress var att det sociala arbetet ansågs givande, god inskolning och handledning, samt stöd genom yrkesförlagd utbildning på arbetsplatsen. Positiv feedback under verksamhetsförlagd utbildning (VFU) ökade tron egenförmågan. Faktorer som påverkade övergången negativt var press från kollegor, brist på kunskap och rutin, höga förväntningar på sig själv och för lite undervisning i farmakologi, medicinsktekniska moment och medicinsk teori. Basal- och specialiserad omvårdnad, läkemedel- och medicintekniska moment blev lidande på grund av stress. Slutsats Första året inom sjuksköterskeyrket innebär ett stort ansvar med påföljande stress och liknande tillstånd. En trygg sjuksköterska riskerar mindre av dessa problem vilket leder till förbättrad omvårdnad och patientsäkerhet. För att få en trygg inskolning och kompensera för bristande erfarenhet i yrkesrollen krävs från arbetsgivarens sida en individanpassad handledning med mentor, god arbetsmiljö och handledning efter introduktionsperiodens slut och reflektionsgrupper. Utbildningen förser studenterna med trygghet genom VFU och omvårdnadsteori samtidigt som en större bredd inom medicin och farmakologi efterfrågas. En tuff inledande period kan delvis kompenseras av det sociala arbetet / Background Stress and similar feelings are common problems among newly graduated nursing students which can be caused by lack of skill while adjusting to work. Purpose The purpose of this study was to examine how newly graduated nurses experienced the time before their first employment as well the first year into the profession, focusing on whether feeling unprepared and/or stressed had any effect on patient-related care, and in that case unfold how this could have been prevented in any fashion. Method Seven semi-structured qualitative interviews with registered nurses were conducted. Data was analyzed through a modified version of qualitative content analysis. Results The transition phase from being a nursing student to becoming a certified nurse could cause both mental and physical stress, which in turn might lead to experiencing symptoms of fatigue. Factors that had a positive effect on coping were: a sense of fulfillment from social work, a positive acclimatization and tutoring, and receiving support throughout the entire trainee period. Positive feedback during this trainee period increased self-efficacy. Factors that had a negative effect on coping were; pressure from colleagues, a lack of competence and routine, high self-expectations and a lack of education regarding pharmacology, basic and specialized nursing, medicine and health technology. Conclusion The first year in the nursing profession includes great responsibility, stress and stress related conditions. The feeling of being confident in work related situations reduces the risk of developing stress related issues, and leads to improved care and patient safety. To compensate for the lack of experience in the professional role, the employers need to offer a good working environment with access to a mentor and participation in reflection groups during and after the introductory period. The nursing education provides a sufficient part of internship and nursing theory, but more training and theory in medicine and pharmacology is requested. Stress and related conditions during the first year in the nursing profession is partly compensated by feelings of joy perceived in the social work.

The intellectual impulsiveness of man to understand the unknown and the continual need of the society to improve healthcare have encouraged extensive investigation on numerous and diverse cause-and-effect relationships. The nature of this endeavor, however, renders the inability of investigator at all levels to escape beyond the narrow conceptual boundary described by an early French philosopher as the vicious cycle. To enjoy the theoretically plausible benefits of refined labor division, data-driven healthcare management, and real-time evidence-based practices, it must first be acknowledged that co-occurrence is better than cause-and-effect in explaining how an observation takes place at a particular time. This paper details a co-occurrence framework, and discusses its implications for the global healthcare system.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A presente pesquisa sobre o gozo na clínica com mulheres devastadas teve como foco o lugar ocupado pelo gozo em seu aspecto mortífero, de excesso e falta de medida, que se manifesta no âmbito das parcerias amorosas. Partindo das experiências relatadas por algumas analisandas, que as descrevem como "sair do corpo", "ficar louca", "descontrolada" ou "fora de si", e das formulações psicanalíticas a respeito do gozo feminino, buscou-se discutir a questão a partir dos referenciais propostos por Freud e Lacan no que diz respeito à constituição da feminilidade e do feminino, tais como a catástrofe e a devastação na ligação com a mãe e com o parceiro, a forma erotomaníaca de amar, além das duas formas de gozo nas mulheres. Entre os temas abordados nesta dissertação destacam-se as operações da castração e do Complexo de Édipo, juntamente com o seu elemento central, o falo, que permitem trazer à discussão algumas consequências para as mulheres, sobretudo as posições implicadas, a saber: o falo e a mascarada. O conceito de gozo é examinado através de três ser mascarada articulações principais. Primeiramente, a tentativa de Freud, que parece a mais antiga na psicanálise, de circunscrever um gozo propriamente feminino, ligado à satisfação da pulsão pela via da zona vaginal; em segundo lugar, o pensamento de Lacan em Diretrizes para um congresso sobre a sexualidade feminina (1958), em que ele recupera a questão freudiana do congresso sobre a sexualidade feminina gozo feminino, e posteriormente no Seminário 7:a ética da psicanálise (1959-1960), desenvolvido durante o período de preparação para o referido congresso, no qual Lacan eleva o gozo ao estatuto de conceito. Como desdobramento, encontram-se algumas articulações clínicas acerca do gozo devastador nos relacionamentos amorosos, tomando como referência a personagem da Erwartung, op. 17 , de Arnold Schoenberg e as mulheres que encontramos no dia a dia da clínica. / This study on jouissance within the clinical work with devastated women focuses on female sexuality, emphasizing the place of jouissance in its deadly and unlimited aspect of excess as present in the realm of love partnerships. Based on the sayings of certain analysands, such as having "the sensation of leaving the body", "going crazy", "losing control" or "going out of mind", in addition to the formulations concerning feminine jouissance, this paper discusses the issue according to the Freudian and Lacanian fundamentals of the constitution of femininity and the feminine, such as catastrophe and devastation in the girl's relationship with her mother and with her love partner,the erotomaniacal form of feminine love, and the two jouissances women can experience. Among the subjects covered in this dissertation are the operation of castration and of the Oedipus complex along with its core element, the phallus, and the feminine positions known as being the phallus and the masquerade. The concept of jouissance is examined through a threefold discussion: first, Freud's attempt to circumscribe a feminine jouissance as the satisfaction of the drive by the means of the vaginal zone; second, Lacan's developments in Guiding remarks for a convention on feminine sexuality (1958) and, finally, his ideas introduced in Seminar 7: The ethics of psychoanalysis (1959-1960), where he develops the concept of jouissance. As far as the clinical discussion is concerned, this paper relies not only on the analysands' sayings but also on the text of the female character from Arnold Schoenberg's opera Erwartung, op. 17.