Background: Since 2012, nurse practitioners (NPs) in Ontario have the professional capacity to assume the role of the most responsible provider (MRP) in hospitals; however, few have implemented this model. Aim: To explore the barriers and facilitators to the integration of the NP as MRP model of care in a hospital setting. Methods: A qualitative descriptive design with secondary data collected from a larger study, was used with principles from integrated knowledge translation. Findings: Thirteen barriers and eleven facilitators were found, such as: (i) challenges with off hour coverage; (ii) funding and remuneration; (iii) discrepancies in the employment standards regulations; and (iv) lack of a critical mass. Facilitators included the plan for role implementation, establishment of trust and leadership from the team. Conclusion: Many barriers, predominantly at the healthcare system-level, make it difficult to integrate the NP as MRP model of care in hospitals.

Inadequate cancer pain management is a global problem. The problem is particularly worse in developing countries where the majority of patients present with advanced stages of the disease. Nurses play an important role in cancer pain management because they spend the majority of their time with patients. The purpose of the study was to examine role of unit cultures on cancer pain management practices among nurses in Kenya. A focused ethnography was used to explore cancer pain management practices of two different units (general and private) within the same institution. Data were collected for four months in a national referral hospital in Nairobi, Kenya. Purposive sampling was used to recruit participants. A total of twenty five nurses and fourteen secondary participants (e.g., nurse managers) participated in this study. Data were collected through semi-structured interviews, observations, and document reviews. Content analysis was used to analyze the data. The study findings show that the unit culture plays a role in cancer pain management practices. For instance, nurses on the oncology unit prioritize pain while nurses on the private unit prioritize overall patient satisfaction. Nurses in both units do not conduct a comprehensive pain assessment and they do not use validated pain assessment tools. Facilitators, such as availability of analgesics and palliative care training, were helpful in managing cancer pain especially in the oncology unit. Barriers such as, negative attitudes towards opioids and doubting patients’ report of pain continue to hinder adequate cancer pain management in the private unit. Other barriers including lack of pain management policies, assessment tools, and workload, influence cancer pain management practices negatively in both units. Understanding the role of unit culture in nursing cancer pain management practices has important implications for policy and practice. Findings in this study show a divergence of the prevailing training of nurses on pain management and practice. Findings could be used to develop pain management policies and protocols for nurses to use as a guide in cancer pain management. Also, nurse managers could use this findings to improve practice for instance, training in cancer pain management could be expanded to include nurses in the private unit. In terms of research, studies could be done to capture patients’ perspectives regarding cancer pain management, or implementation studies could be carried out to alleviate the barriers identified. Lastly, tailored strategies aimed at changing the culture in a unit to enhance change in practice are needed.

With the rise of accidental fentanyl overdoses and recreational opioid use in college-aged populations, the need for campus-based overdose prevention and harm reduction measures is at an all-time high. Naloxone, an opioid antagonist, is an FDA-approved, lifesaving, medication which can be intranasally delivered by laypersons. Naloxone reverses opioid overdose, essentially buying time until an overdosing individual receives emergency medical attention. While some previous studies have examined access to naloxone on college campuses, to my knowledge no study has explored distribution of naloxone in residential college areas, such as dormitories and within Greek housing. Therefore, the purpose of this thesis was to identify themes in student perception surrounding naloxone, as well as potential processes and barriers/facilitators to naloxone distribution within residential areas (e.g., dormitories, sorority housing, and fraternity housing.) This study addresses these issues through qualitative, semi-structured, interviews with a convenience sample of students at the University of Central Florida, with questions informed by the Consolidated Framework for Implementation Research and Proctor et al. implementation outcomes. Seven students (n = 7) participated in the interview, all of whom either had personal experience with substance use disorder (SUD) or were close to someone with SUD. I analyzed data for themes using a mixed deductive-inductive template analysis approach in Dedoose software. Resulting themes relating to barriers to distribution within residential areas were as follows: lack of knowledge; fear of negative consequences from external parties; desire of administrators to maintain image of a “drug free campus”; lack of funding for distribution; student desire to avoid stigmatization. Resulting themes relating to facilitators to distribution in residential areas included the following: active involvement of peers; providing free naloxone; educating students about where to get and how to use naloxone; physical accessibility; and anonymous ways to access naloxone. Targeting residential areas for naloxone distribution was also discussed as a theme. Types of people who could/should be involved in naloxone distribution included the following: residential assistants; secondary distributors; pharmacists; UCF leadership; sorority and fraternity leaders; and student liaisons. Study results could be used to inform efforts at UCF and other colleges to expand naloxone access.

No description available.

A presente tese busca analisar iniciativas de inovação social, de três diferentes formatos organizacionais, tendo por referência abordagens da Nova Sociologia Econômica (NSE). Autores dessa corrente teórica, sugerem observar as ações econômicas, a partir de uma reconfiguração dos atores sociais, neste sentido, ampliam a noção da economia para além das questões mercantis e monetárias, considerando tal, como construção social. Esta tese parte da premissa de que a inovação social (IS) surge como resposta aos crescentes desafios socioeconômicos e ambientais, provenientes do modelo econômico global neoliberal, sendo uma iniciativa social tanto no processo como resultado e, portanto, uma inovação alternativa ao atual modelo de desenvolvimento econômico. Para isto, optou-se pela análise de iniciativas socialmente inovadoras, de três diferentes organizações, sendo, o Banco Palmas - um banco comunitário, localizado em Fortaleza (CE), a organização Cidades Sem Fome - uma organização não-governamental, localizada em São Paulo (SP) e o Colab - uma empresa privada, localizada em São Paulo (SP), e com atuação em diferentes estados brasileiros. A pergunta que norteou a pesquisa foi: \"Como ocorre a dinâmica da inovação social e quais são as barreiras e facilitadores deste modelo de inovação\"? Para responder esta pergunta, utilizou-se uma abordagem de pesquisa exploratória, descritivo-qualitativa, a partir de múltiplos casos. Foram utilizadas múltiplas fontes de evidências, tendo-se recorrido, assim, à técnica de triangulação de dados, através de entrevistas semiestruturadas, observação direta e análise documental, bem como à técnica de análise de conteúdo. Os resultados mostraram que a inovação social consiste em uma ação coletiva, configurada por uma lógica participativa e colaborativa, através de uma rede de atores. A partir das iniciativas investigadas e com base nas proposições teóricas da investigação, é possível afirmar que a inovação social tem sido capaz de provocar mudanças no ambiente político-institucional em que está inserida. Têm como um dos principais facilitadores, a participação dos atores sociais - beneficiários - no processo de gestão da solução empreendida, por meio da governança compartilhada. E como uma das principais barreiras, o contexto político-institucional, no aspecto legal. Verificou-se, a partir dos casos analisados, que a inovação é social tanto no processo como no resultado, sendo capaz de gerar e fortalecer novas relações entre os atores, e ainda, contribuir para o empowerment dos beneficiários, considerando-os como co-produtores de tais iniciativas. / The present thesis seeks to analyze initiatives of social innovation, of three different organizational formats, with reference to approaches of the New Economic Sociology (NSE). Authors of this theoretical current, suggest to observe the economic actions, from a reconfiguration of the social actors, in this sense, broaden the notion of the economy beyond the mercantile and monetary questions, considering such, as social construction. This thesis is based on the premise that social innovation (IS) emerges as a response to the growing socioeconomic and environmental challenges arising from the neoliberal global economic model, being a social initiative both in the process and result, and therefore an alternative innovation to the current model of economic development. For this, we opted for the analysis of socially innovative initiatives of three different organizations: Banco Palmas - a community bank, located in Fortaleza (CE), the organization Cidades Sem Fome - a nongovernmental organization located in São Paulo (SP) and Colab - a private company, located in São Paulo (SP), and operating in different Brazilian states. The question that guided the research was: \"How does the dynamics of social innovation occur and what are the barriers and facilitators of this innovation model\"? To answer this question, we used an exploratory, descriptive-qualitative research approach, based on multiple cases. Multiple sources of evidence were used and the data triangulation technique was used, through semi-structured interviews, direct observation and documentary analysis, as well as the technique of content analysis. The results showed that social innovation consists of a collective action, configured by a participatory and collaborative logic, through a network of actors. From the initiatives investigated and based on the theoretical propositions of research, it is possible to affirm that social innovation has been able to bring about changes in the political-institutional environment in which it is inserted. They have as one of the main facilitators, the participation of social actors - beneficiaries - in the process of managing the solution undertaken, through shared governance. And as one of the main barriers, the political-institutional context, in the legal aspect. It was verified, from the analyzed cases, that innovation is social both in the process and in the result, being able to generate and to strengthen new relations between the actors, and also, to contribute to the empowerment of the beneficiaries, considering them as co-producers of such initiatives.

Syfte: Syftet var att beskriva hur person - och miljöfaktorer stödjer eller hindrar utövandet av parasport. Metod: Litteraturöversikt valdes som design. Datainsamlingen skedde genom en litteratursökning med relevanta sökord i databaserna PubMed, CINAHL och SportDiscus. Litteratursökningen kompletterades med en manuell sökning i inkluderade studiers referenslistor. Litteratursökningen resulterade i fjorton studier där samtliga studier kvalitetsgranskades med tillräcklig god kvalitet. I analysen användes den arbetsterapeutiska PEO-modellen som ett raster för att finna likheter och skillnader i resultaten. Resultat: Två kategorier: Person och Miljö med underkategorierna: Stödjande faktorer och Hindrande faktorer i respektive kategori. Stödjande personfaktorer var förenat med ett flertal positiva upplevelser som en känsla av glädje, identitet och förbättrad hälsa. Stödjande miljöfaktorer var kopplat till stöd från familj och vänner, en känsla av lagtillhörighet och ett socialt stöd. Hindrande personfaktorer var upplevelsen av ett försämrat hälsotillstånd och att drabbas av sekundära medicinska komplikationer. De hindrande miljöfaktorerna förekom främst i den fysiska miljön och som ett bristande socialt stöd. Konklusion: Litteraturöversikten har givit en översyn om hur stödjande och hindrande faktorer påverkar utövandet av parasport samt bidragit med kunskap om hur parasport skulle kunna vara en del i arbetsterapeutens hälsofrämjande arbete. / Purpose: To describe experiences of how personal and environmental factors can enable or prevent participation in parasport among people with disabilities. Method: Literature review was selected as the design. The data collection was done by a literature search of relevant keywords in the databases PubMed, CINAHL and SportDiscus. The literature search was supplemented with a manual search in the reference lists of the included studies. The literature search resulted in fourteen studies which were all quality examined and of sufficient good quality. In the analysis the Person- Environment-Occupation Model was used as a grid to find similarities and differences in the results. Results: Two categories: Personal and Environmental, both with the subcategories: Facilitators and Barriers. Facilitating personal factors were associated with several positive experiences, such as a sense of joy, identity and improved health. Facilitating environmental factors were linked to the support of family and friends, a sense of team affiliation and social support. The factors of personal barriers were the experience of a decreasing state of health and being affected by secondary medical complications. The factors of environmental barriers were most commonly in the physical environment and a lack of social support. Conclusion: The literature review has given a review of facilitators and barriers when participating in parasport and contributed with knowledge about how parasport could be part of an occupational therapist’s work to promote health.

A presente tese busca analisar iniciativas de inovação social, de três diferentes formatos organizacionais, tendo por referência abordagens da Nova Sociologia Econômica (NSE). Autores dessa corrente teórica, sugerem observar as ações econômicas, a partir de uma reconfiguração dos atores sociais, neste sentido, ampliam a noção da economia para além das questões mercantis e monetárias, considerando tal, como construção social. Esta tese parte da premissa de que a inovação social (IS) surge como resposta aos crescentes desafios socioeconômicos e ambientais, provenientes do modelo econômico global neoliberal, sendo uma iniciativa social tanto no processo como resultado e, portanto, uma inovação alternativa ao atual modelo de desenvolvimento econômico. Para isto, optou-se pela análise de iniciativas socialmente inovadoras, de três diferentes organizações, sendo, o Banco Palmas - um banco comunitário, localizado em Fortaleza (CE), a organização Cidades Sem Fome - uma organização não-governamental, localizada em São Paulo (SP) e o Colab - uma empresa privada, localizada em São Paulo (SP), e com atuação em diferentes estados brasileiros. A pergunta que norteou a pesquisa foi: \"Como ocorre a dinâmica da inovação social e quais são as barreiras e facilitadores deste modelo de inovação\"? Para responder esta pergunta, utilizou-se uma abordagem de pesquisa exploratória, descritivo-qualitativa, a partir de múltiplos casos. Foram utilizadas múltiplas fontes de evidências, tendo-se recorrido, assim, à técnica de triangulação de dados, através de entrevistas semiestruturadas, observação direta e análise documental, bem como à técnica de análise de conteúdo. Os resultados mostraram que a inovação social consiste em uma ação coletiva, configurada por uma lógica participativa e colaborativa, através de uma rede de atores. A partir das iniciativas investigadas e com base nas proposições teóricas da investigação, é possível afirmar que a inovação social tem sido capaz de provocar mudanças no ambiente político-institucional em que está inserida. Têm como um dos principais facilitadores, a participação dos atores sociais - beneficiários - no processo de gestão da solução empreendida, por meio da governança compartilhada. E como uma das principais barreiras, o contexto político-institucional, no aspecto legal. Verificou-se, a partir dos casos analisados, que a inovação é social tanto no processo como no resultado, sendo capaz de gerar e fortalecer novas relações entre os atores, e ainda, contribuir para o empowerment dos beneficiários, considerando-os como co-produtores de tais iniciativas. / The present thesis seeks to analyze initiatives of social innovation, of three different organizational formats, with reference to approaches of the New Economic Sociology (NSE). Authors of this theoretical current, suggest to observe the economic actions, from a reconfiguration of the social actors, in this sense, broaden the notion of the economy beyond the mercantile and monetary questions, considering such, as social construction. This thesis is based on the premise that social innovation (IS) emerges as a response to the growing socioeconomic and environmental challenges arising from the neoliberal global economic model, being a social initiative both in the process and result, and therefore an alternative innovation to the current model of economic development. For this, we opted for the analysis of socially innovative initiatives of three different organizations: Banco Palmas - a community bank, located in Fortaleza (CE), the organization Cidades Sem Fome - a nongovernmental organization located in São Paulo (SP) and Colab - a private company, located in São Paulo (SP), and operating in different Brazilian states. The question that guided the research was: \"How does the dynamics of social innovation occur and what are the barriers and facilitators of this innovation model\"? To answer this question, we used an exploratory, descriptive-qualitative research approach, based on multiple cases. Multiple sources of evidence were used and the data triangulation technique was used, through semi-structured interviews, direct observation and documentary analysis, as well as the technique of content analysis. The results showed that social innovation consists of a collective action, configured by a participatory and collaborative logic, through a network of actors. From the initiatives investigated and based on the theoretical propositions of research, it is possible to affirm that social innovation has been able to bring about changes in the political-institutional environment in which it is inserted. They have as one of the main facilitators, the participation of social actors - beneficiaries - in the process of managing the solution undertaken, through shared governance. And as one of the main barriers, the political-institutional context, in the legal aspect. It was verified, from the analyzed cases, that innovation is social both in the process and in the result, being able to generate and to strengthen new relations between the actors, and also, to contribute to the empowerment of the beneficiaries, considering them as co-producers of such initiatives.

Made available in DSpace on 2014-08-20T13:49:11Z (GMT). No. of bitstreams: 1 Laura Garcia Jung.pdf: 992953 bytes, checksum: fed183a7221f12e2ee31773b4be8fb90 (MD5) Previous issue date: 2013-02-21 / In the last years, the new lifestyle conditions have determined sedentary behaviors, which in turn in increase the risk of non-communicable diseases. Regarding the individuals with intellectual deficit, this situation is even more risky because studies show that physical activity level of these individuals is lower as compared to the population. The purpose of this study is to describe the perceptions of family members of children with intellectual deficit aged 6 or more enrolled in the APAES of the Rio Grande do Sul regarding the barriers and facilitators for leisure-time physical activity of their offspring. A no probabilistic, intentional sample was selected. The APAES were contacted and data collection were delivered and handled back through the mail. A sample of 1191 individuals with intellectual deficit represented by their parents took part in the study. In terms of personal aspects, the main barriers for physical activity are related to lack of money and motivation preference for other activities than not physical activities. Regarding the environmental aspects, the main barrier is the absence of social projects near the individual‟s place. Family members responsible for individuals between 20 and 30 perceived the existence of places near their place; however they reported that these places are not accessible for individuals with intellectual deficit. Regarding the social aspects, lack of company is the main barrier for physical activity practice. It was concluded that some barriers and facilitators are linked to the stimulus that people with intellectual deficit receive. This stimulus might evoke the pleasure for physical activity practice and having a company of somebody is an important support due to the lack of independence and autonomy.Financial aspects also influence physical activity practice, which shall be minimized by public policies and social projects aimed to give opportunity to these individuals to practice some physical activity and, through an active lifestyle, achieve a greater quality of life / Nos últimos anos, as novas condições de vida têm determinado, de forma predominante, comportamentos sedentários, os quais desencadeiam o aumento das doenças crônicas não transmissíveis. Quanto às pessoas com déficit intelectual, essa situação se torna ainda mais agravante, pois estudos mostram que o nível de atividade física dessa população é inferior ao da população em geral. O objetivo do estudo é descrever a percepção dos familiares sobre as barreiras e os facilitadores da prática de atividade física no tempo livre, das pessoas com déficit intelectual maiores de seis anos inseridas nas APAES do Rio Grande do Sul. A seleção da amostra foi não probabilística intencional. A coleta de dados aconteceu por meio do contato com as APAES e os instrumentos foram entregues e retornaram via correio. A amostra foi composta por 1191 pessoas com déficit intelectual representadas no estudo pelos seus responsáveis. Nos aspectos pessoais, observa-se que as principais barreiras para a prática de AF estão relacionadas ao fator econômico e a preferência por outras atividades. Em relação aos aspectos ambientais, nota-se que a principal barreira é a ausência de projetos sociais próximos de casa. Para os responsáveis pelas pessoas entre 20 e 30, que percebem a presença de locais disponíveis próximos de casa, destacam que eles não são acessíveis. Quanto aos aspectos sociais, a falta de companhia é o principal fator identificado como barreira para a prática de AF. Conclui-se que algumas barreiras e facilitadores estão ligados ao estímulo que as pessoas com déficit intelectual recebem, pois podem despertar o gosto pela atividade física se houver companhia de alguém, tornando a atividade mais prazerosa como também propiciando condições para a prática devido às limitações que a maioria possui no aspecto social, relacionadas com a falta de independência e autonomia na execução desse tipo de atividade.Questões financeiras também interferem na prática de AF, as quais podem ser amenizadas com o investimento em políticas públicas e projetos sociais que oportunizem a essas pessoas a praticarem AF e, através de um estilo de vida ativo, possuírem uma melhor qualidade de vida

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.