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Information use in clinical practice: A case study of critical care nurses' enteral feeding decisionsMarshall, Andrea January 2008 (has links)
Doctor of Philosophy (PhD) / Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.
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Information use in clinical practice: A case study of critical care nurses' enteral feeding decisionsMarshall, Andrea January 2008 (has links)
Doctor of Philosophy (PhD) / Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.
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Street-involved women with co-occurring disorders: development of policy and practice recommendations for Street ConnectionsHeywood, Diane 07 December 2007 (has links)
Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support. / October 2007
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Street-involved women with co-occurring disorders: development of policy and practice recommendations for Street ConnectionsHeywood, Diane 07 December 2007 (has links)
Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.
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Street-involved women with co-occurring disorders: development of policy and practice recommendations for Street ConnectionsHeywood, Diane 07 December 2007 (has links)
Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.
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IT Management Consulting in Australia: A Major Issues StudyKennelly, Jason January 2005 (has links)
We are amidst a period of radical change in Management Consulting worldwide. The latter half of the twentieth century has seen major extensions to the range of services promoted under the umbrella of Management Consulting. The traditional Management Consulting Firms, such as McKinsey & Co., tend to provide strategy consulting. By contrast, the other multinational Management Consulting Firms have focused on Business Process Re-engineering and other services with an Information Technology emphasis. Significantly, several multinational Management Consulting Firms have come under the control of Information Technology companies. As yet, very little research has been conducted into the issues that Management Consultants face in Australia. This research project provides an empirical investigation aimed at identifying these issues. In doing so, the study intends to answer the following research question "What are the major issues facing Management Consulting Firms in Australia?" To assist in answering this overarching question the study endeavours to address three investigative questions (1) What is the relative severity of issues facing Management Consulting Firms in Australia? (2) What are the Knowledge Management related issues facing Management Consulting Firms in Australia? And (3) What distinctions can be made between Knowledge Management issues and approaches of small-medium sized Management Consulting Firms and large Management Consulting Firms? This thesis is a compilation and comparison of evidence gathered from four separate but related sub-studies into the Management Consulting industry. The first, a Context Case Study of Management Consulting issues faced by small-medium sized firms, aimed to generate a rich, qualitative description of the study context, which, in turn, provides background to a larger follow-up Issues Delphi Study. Interpretation of the data gathered for the Context Case Study focuses on gaps between the literature and observed practice. The Issues Delphi Study garners response from members of the Institute of Management Consultants (IMC) in two survey rounds that inventory issues and then gauge their importance. In addition, an exploratory and descriptive case study was performed to investigate Knowledge Management Strategies and Practices in the Australian branch of Accenture, a well known International Management Consulting Firm. Though the Accenture Case Study has an operational emphasis, both macro and micro issues of Knowledge Management are considered; macro issues pertain to the strategic leverage of Knowledge Assets, while micro issues pertain to creation, transfer and reuse of knowledge within the firm, and between the firm and its clients. Knowledge Management is identified as essential to the achievement of sustained competitive advantage for all Professional Service Firms; of which Management Consulting Firms are a subset. As such, a conceptual analysis of the Knowledge in Professional Service Firms model, developed by Empson and Morris (1998), was performed to enhance the researchers understanding of Knowledge Management in Management Consulting Firms. The analysis of the model's constructs and their relationships assists the researcher's analysis of data gathered from the other three sub-studies. In addition, the attempt to develop several model variants is explored and an argument for the resulting final model variant which incorporates a new construct, Knowledge Management, is presented. Finally, the study compares the issues identified from the four separate sub-studies. The issues gathered are mapped into Knowledge in Professional Service Firms model, providing useful insights into the importance of sound Knowledge Management practices in small, medium and large Management Consulting Firms.
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Process modelling success factors and measuresBandara, Wasana January 2007 (has links)
Business process modelling has gained widespread acceptance, particularly in large IT-enabled business projects. It is applied as a process design and management technique across all project lifecycle phases. While there has been much research on process modelling, there has been little attention on 'how to' conduct process modelling effectively, or on the evaluation of process modelling initiatives and outcomes. This study addresses this gap by deriving a process modelling success model that contains both the success factors (independent variables) and success dimensions (dependent variables) of process modelling. The study employs a multi-method approach, blending both qualitative and quantitative research methods. The research design commenced with a comprehensive literature review, which includes the first annotated bibliography in process modelling research. A multiple case study approach was used to build the conceptual process modelling success model which resulted in a model with eleven (11) success factors (namely Modeller Expertise, Team Structure, Project Management, User Competence, User Participation, Management Support, Leadership, Communication, Modelling Tool, Modelling Language and Modelling Methodology), two (2) moderating variables (namely Process Complexity and Project Importance) and five (5) process modelling success dimensions (namely Modeller Satisfaction, Model Quality, User Satisfaction, Model Use and Modelling Impact). This conceptual model was then operationalised and tested across a global sample, with an online survey instrument. 290 valid responses were received. The constructs were analysed seeking a parsimonious, valid and reliable model. The statistical analysis of this phase assisted in deriving the final process modelling success model. The dependent variables of this model consisted of three (3) contextual success factors (namely Top Management Support, Project Management and Resource Availability), two (2) Modelling specific success factors (namely Modelling Aids and Modeller Expertise), and two (2) moderating variables (namely Importance and Process Complexity). The dependent variable; Process Modelling Success (PMS) was derived with three (3) success measurement dimensions (namely Model Quality, Process Impacts and Process Efficiency). All resulting success factors proved to have a significant role in predicting process modelling success. Interaction effects with the moderating variables (Importance and Process Complexity) proved to exist with Top Management Support (TMS) and Resource Availability (RA). A close analysis to their interaction relationship illustrated that Importance (IMP) moderated the relationship between Top Management Support (TMS) and Process Modelling Success (PMS) in a linear manner and that Process Complexity (PC) moderated the relationship between Resource Availability (RA) and Process Modelling Success (PMS), also in a linear manner. This is the first reported study with empirical evidence on process modelling success. The progressive outcomes of this study have been readily accepted by the practitioner and academic community, with 16 published internationalrefereed- conference papers [including best paper award at the Pacific Asian Conference on Information Systems (PACIS 2004)], 2 journal publications, and over 5 major industry presentations made upon invitation.
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Linguistic Issues in Culturally Sensitive Assessment: A Rorschach Case StudyWeisberg, Lauren Margaret 17 December 2019 (has links)
No description available.
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Participativní rozpočet jako jeden z možných zdrojů finančních prostředků pro oblast sportu / Participatory budgeting as one of the possible sources of funding for sportJerieová, Berenika January 2016 (has links)
Title: Participatory budgeting as one of the possible sources of funding for sport Objectives: Examine particular project financing opportunities for the construction of a street workout park, possibly from public funds provided in grant programs to promote and support sport. Methods: The work used the method of document analysis, then synthesis of the data to create reports for a better orientation in grant programs and also the method of case studies to illustrate solid examples of grant applications. Results: The result is lucid table used for selecting the right grant program in respect of specific case. The work also includes ideas and recommendations based on personal experience gained by participating in the project Moje stopa financed by participatory budget. The result is a proposal to detach a separate program for sport in the upcoming next year of this project. Keywords: sports funding, grants, sport supporting programs, case study method
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The difficulties in implementing the case-study methodErlandsson, Daniel January 2017 (has links)
Since the requirements for a graduate to get an employment has changed must the also education of the graduates’ change. With this said must the education and the requirements for getting a employment have a positive correlation. There are studies that deduces that the case-study method has many beneficial properties that will help accomplishing this, but the case-study method does also come with some difficulties that should be had in mind when considering the implementing of the method. This paper has therefore been constructed to enlighten those who potentially thinks of using the case-study method as a pedagogic tool, in purpose to educate them about the difficulties. In this paper have the current literature been analysed and there been found difficulties in the implementation of the case-study method. These difficulties have therefore been categorised in the purpose the facilitate the conclusions.
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