The aim of this study is to determine the effectiveness of simulation training in improving the clinical competence of pupil nurses. A quantitative, quasi-experimental, non-equivalent control group before-after design is used. The method of data collection is observation using check lists. The population for this study includes the second-year pupil nurses (N=43) following the two-year programme leading to enrolment as a nurse at the Gauteng learning centre of a private hospital group during 2011-2012. The results reveal that although there is proof that clinical training in simulation improves the competence levels of the experimental group in the procedure administration of oral medication over a period of time, there is no proof that this is true for the procedure observation of patients’ neurological functions and, therefore, the researcher cannot come to a definite conclusion about the effectiveness of simulation training / Health Studies / M.A. (Health Studies)

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment. / Charge nurse participants did not dialogue explicitly about their functions in terms of communication and intraprofessional team building. Since charge nurses have an increasing involvement with mentoring novice nurses and new staff, they would benefit from developing coaching skills. Given the current environment, their responsibilities in these areas may need to be better articulated so that they can focus on increasing these abilities. / by Terry L. Eggenberger. / Signature page missing one signature and the date. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

A formação do médico durante a graduação é um longo processo de aquisição de competências referentes ao domínio técnico, ético e relacional da profissão, que reafirmam valores históricos, e ganham contornos atuais no discurso da humanização das práticas de saúde. As diretrizes curriculares para o curso médico preconizam desenvolver habilidades de comunicação, valores éticos, e atitudes de sensibilidade e compreensão com o sofrimento alheio, pois se sabe que, na medicina, relações sem o legítimo interesse e preocupação com o outro comprometem a qualidade da própria realização técnica do ato médico. Entretanto, os estudos evidenciam grandes dificuldades nesse aspecto da humanização das práticas. Uma das causas dessa aridez afetiva e das dificuldades na relação com o paciente seria a formação centrada na aquisição de competência técnico-científica de forma tecnicista. Como contraponto, tentou-se incluir disciplinas de humanidades médicas nos currículos, o que tem se mostrado tarefa árdua. A difícil inclusão de temas humanísticos e desenvolvimento de competência ético-relacional nas escolas médicas fazem pensar que aspectos mais sutis na construção da identidade médica podem estar corroborando com tais fatos. A subjetividade contemporânea (valores, modelos, inscrições de significado), redimensionada na cultura médica, moldaria relações entre as pessoas no ambiente de ensino que dificultaria a experiência intersubjetiva, resultando em uma educação médica que ressalta a tecnologia e se abstém do seu potencial interativo. Com base nessa tese, nosso estudo buscou identificar as dimensões culturais mais importantes na construção das subjetividades contemporâneas no tocante à medicina e investigar o encontro intersubjetivo (professor-aluno, aluno-aluno, professor-professor) no contexto da formação médica. Pela abordagem qualitativa, buscamos interpretar-compreender como um conjunto mais amplo de aspectos da contemporaneidade, combinados na forma de três núcleos temáticos - o Eu, a Tecnologia e a Interatividade -, imprimiam-se no cotidiano de professores e de alunos em momentos diferentes do aprendizado. Percebemos que as dificuldades para a experiência intersubjetiva se manifestam e se reforçam nos processos interativos já durante a graduação. Comportamentos narcísicos, relações instrumentais, violência, e a baixa qualidade organizacional da gestão das práticas assistenciais sobressaem na análise dos dados. Concluímos, com base nesses resultados, que a formação humanística melhor se desenvolverá por meio de: 1. o aprimoramento das disciplinas de humanidades médicas; 2. a integração de sua temática com a prática clínica; 3. a conscientização dos professores quanto ao seu papel de modelo junto aos alunos e quanto à importância de saber trabalhar temas humanísticos em sua área de atuação; 4. a humanização dos serviços de saúde que participam do ensino médico; 5. e, essencialmente, por meio de um processo educacional que permita a aproximação da educação com a ética no viver institucional / The medical training during undergraduation is a long process of acquiring competences related to the technical, ethical and relational aspects of the profession, reaffirming historic values, and, in the present, the themes of the so called \"humanization of the health practices\". The curricular guidelines for medical school indicates the development of communication skills, ethical values and attitudes of sensitivity and understanding towards the suffering of others, because, it is known that in medicine, relationships without a legitimate interest and concern for others compromise the quality of the technical realization of the medical act. However, studies show great difficulties in this aspect of the humanization of practices. One of the causes of the resistance and emotional difficulties in the doctor-patient relation would be the training focused on the acquisition of technical and scientific competence in a technicist way. As a counterpoint, it has been tried to include humanities in the medical curriculum, not an easy task. The difficult in the inclusion of humanistic issues and development of ethical and relational competence in the medical schools suggests that there are possibly some more subtle aspects in the construction of medical identity corroborating these facts. The contemporary subjectivity (figures, models, meanings), reflected on the medical culture, would shape personal and professional relations in the educational environment in such a way that it would make difficult the intersubjective experiences, resulting in a medical education that emphasizes the technology and decreases the importance of the interactivity. Our purpose in this study was to identify the most important cultural dimensions in the construction of contemporary subjectivities in relation to medicine, and study the intersubjective meeting (teacher-student, student-student, teacher-teacher) in the context of the medical undergraduate. By the qualitative approach, we seek to understand or interpret some contemporary aspects united in three groups of themes - the Self, the Technology and the Interactivity - and their influence in the daily life of teachers and students at different moments of learning. It was felt that the difficulties in the intersubjective experience were manifested and reinforced in the interactive processes during undergraduation. Narcissistic behaviors, instrumental relationships, violence, and poor quality of organizational management of the care practices emerged in the data analysis. We concluded that the humanistic training could develop better by: 1. an improvement in medical humanities disciplines; 2. the integration of its program with clinical practice; 3. the awareness of teachers about being a model to the students and the importance of inserting humanistic issues in its own area of learning; 4. the humanization of health services that take part in medical education; 5. and, primarily, by an educational process that approaches ethics and education in the institutional environment.

In order to prepare counselor-trainees to practice competently and maximize client outcomes, counselor-trainees must develop a broader understanding and explanation, called a case conceptualization, of their clients presenting problems, personality, and systemic dynamics. There is a limited body of research that examines the effects of training on the ability for counselors to develop an effective case conceptualization. This is the first study to train counselors to develop competence in formulating an integrative case conceptualization. This quasi-experimental study aimed to determine whether an intervention had an effect on the 85 counselors in training that participated in a 2-hour training. Data was analyzed using paired sample t-tests, an independent t-test and correlation methods. Participants’ CCEF scores significantly improved from the training (t = -25.970, df = 84, ES = 3.67, p < 0.001). Participants’ CFCCM scores significantly improved as well (t = -21.693, df = 84, ES = 2.78, p < 0.001). Participants’ scores also significantly improved with their perceptions about case conceptualization (t = -30.828, df =84, ES = 5.47 p < 0.001), for items 1-5. Item 6 resulted in values of (t = -13.295, df = 84, ES = 2.14, p < 0.001). The level of cognitive complexity as measured by the CCQ did not have a significant effect on the quality of the counselors in training case conceptualizations. Compared to the CFCCM, the CCEF is a much shorter and easier instrument for evaluating a case conceptualization. Overall, results of this study provide support that counselors in training can improve their quality of case conceptualization skills in as little as 2 hours. This can aid in understanding and explaining their client’s situation better, which may significantly improve the treatment process and client. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Introdução: O ser humano na sua condição social, precisa necessariamente da intervenção de outro ser nas suas funções. Na área da saúde, o profissional, vivencia situações e diante do acúmulo de informações recuperadas na Internet, necessita de um mediador que torne possível transformar essa informação em conhecimento. Nos últimos 20 anos, temos verificado um aumento gradativo e descontrolado na quantidade de documentos bibliográficos em todas as áreas do conhecimento, mas especialmente na biomédica. Objetivo: Considerando que a internet e a tecnologia da informação são amplamente disponíveis atualmente, alguns estudos sugerem que as bibliotecas e os bibliotecários podem vir a se tornar instituições obsoletas no cenário acadêmico. O objetivo do presente estudo foi analisar o perfil de usuários da biblioteca em nossa instituição, além de tentar verificar o papel da mediação informal desempenhada pelos bibliotecários neste contexto. Métodos: 570 usuários da Biblioteca da FMUSP, que visitaram nossa biblioteca no período de dezembro de 2012 a Abril de 2013, foram convidados a responder um breve questionário, sobre seus hábitos de busca de conhecimentos na literatura. O questionário foi mandado e respondido por e-mail. O perfil destes usuários foi analisado e a seguir, os participantes foram divididos em 2 grupos. Grupo 1 (n=190): receberam qualquer auxilio do bibliotecário durante suas buscas, grupo 2 (n= 52): acessaram a informação de maneira independente, sem a mediação do bibliotecário. Analisamos algumas características destes dois grupos. Resultados e conclusões: O presente estudo permitiu caracterizar que a maioria dos usuários que compareceu à biblioteca era do sexo feminino e que estão na faixa etária entre trinta e quarenta anos, sendo na maioria médicos jovens e estudantes de medicina, habituados a usar as bases de dados. A maioria recebeu algum tipo de mediação formal ou informal dos bibliotecários no acesso à informação. Sendo que este auxílio pode ter influenciado no uso de descritores em suas buscas. Com esta pesquisa, foi possível avaliar algumas das necessidades informacionais dos respondentes. Tais informações aliadas à extensa revisão da literatura podem ser úteis para balizar futuras intervenções dos profissionais da biblioteca para otimizar seu papel na mediação. Não foram observadas diferenças entre os grupos / Introduction: Human beings in their social condition necessarily need the intervention of another being in his duties. In healthcare, professional, experiences and situations before the accumulation of information retrieved on the Internet, you need a broker that makes it possible to transform this information into knowledge. Over the past 20 years, we have seen a gradual and uncontrolled increase in the amount of bibliographic documents in all areas of knowledge, but especially in biomedical. AIMS: Considering that the internet and the information technology are widely available nowadays, some studies suggest that libraries and librarians may become obsolete in the academic scenery. The purpose of the present study was to access the profile of library users in our institution, as well as to evaluate the need for mediation by the librarians in a Medical School. METHODS: 570 individuals that visited our library from December 2012 to April 2013 were invited to respond to a brief questionnaire addressing their habits when pursuing scientific information. The questionnaire was sent and responded by email. 419 participants were post graduate students and the others were physicians from our institution. The population was divided in two groups. Group 1 (n= 190): submitted to library training in searching information, group 2 (n= 52): accessed information by themselves without mediation. We analyzed the differences in behavior between those two groups. RESULTS AND CONCLUSIONS: The majority of individuals that used our library were, females, with a mean age of 39 years and most of them physicians or medical students. The great majority were frequent users and had personal experience in the library before. No differences in behavior were observed between groups in terms of frequency, data base, or use of key words. The present work has inumerous limitations, but may useful inhelping librarians improve their technique facing the new era of information

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT. / Increased frequency of RRT activation has been linked in the literature with decreased patient mortality rates. The significance of the findings from this study is that the use of analytic decision making has the potential to reduce the incidence of the number one patient safety indicator, failure to rescue. / by Carlo G. Parker. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018. / For emergency medical care (EMC), clinical mentorship can be thought of as the relationship between the EMC students and qualified emergency care personnel. Through this relationship, students may be guided, supported and provided with information to develop knowledge, skills, and professional attributes needed for delivering quality clinical emergency care. However, this relationship is poorly understood and the focus of this research was to explore how this relationship enabled or constrained learning. Through having experienced mentorship, first as a student in EMC, then as an operational paramedic, mentoring students, I was privy to an insider perspective of clinical mentorship, and the experiences of fellow students‘. Through this experience the practices I observed may not have promoted learning. This is when my interest in pre-hospital clinical mentorship in relation to learning began. The aim of this research was to present a qualitative analysis of the clinical mentorship relationship in pre-hospital EMC involving the qualified pre-hospital emergency care practitioner (ECP) and the EMC student. The objectives included gaining an understanding of what enabled and/or constrained learning EMC, exploring clinical mentorship and learning in the pre-hospital EMC context, and gaining understanding of the role and scope of community members in the clinical mentorship activity system. The purpose of this study was to qualitatively document, by means of a thematic analysis, the pre-hospital clinical mentorship relationship, as well as document, by means of a Cultural Historical Activity Theory (CHAT) analysis, the clinical mentorship activity system. The focus of this qualitative documentation was the enablements and constraints to learning during clinical mentorship. This research also made possible recommendations for EMC clinical mentorship and education and may also inform (PBEC) policy, as well as work integrated learning (WIL) policy. Data collection included the use of diaries and focus group interviews. Analysis involved a two-part analysis, where data was reduced and understood with thematic analysis guided by Braun and Clarke (2006) six phase thematic analysis process (explained in Chapter three, Section 3.6). Thereafter, a CHAT analysis was conducted to uncover contradictions within the clinical mentorship activity system that made working on the object of activity difficult, thereby also uncovering constraints to learning. Inductive reasoning was applied to the thematic analysis to reduce data and identify themes and subthemes which provided insight into the enablements and constraints to learning in the pre-hospital EMC clinical mentorship relationship. The CHAT analysis of the data collected and analysed brought to surface the affordances, tensions as well as the primary-level and secondary-level contradictions of the clinical mentorship activity system. The thematic analysis of the clinical mentorship relationship provided limited understanding of the enablements and constraints to learning, and thus further motivated deeper analysis with CHAT. The results of this research included primary and secondary-level contradictions for almost all elements of the clinical mentorship activity system. Contradictions amongst the Division of Labour (DoL), the rules of the activity system, and the tools/resources of the activity system existed in that it constrained the interaction and activity of the subject and the community while working on the object of the activity system possibly achieving a lesser or undesired outcome of clinical mentorship.

Adams et al. was the first to demonstrate an association between improved outcomes and provider experience in a 1973 study examining complication rates from coronary arteriograms.[1] In this study, a questionnaire was mailed to the directors of coronary arteriography laboratories throughout the US. They found that mortality was eight times higher in institutions performing fewer than 200 examinations per two-year period compared to institutions performing more than 800 examinations per two-year period. It was not until 1979, however, that efforts to systematically study outcomes in surgery were made by Luft and colleagues.[2] They demonstrated lower mortality rates at high-volume centers compared with low-volume centers for several high risk procedures, such as coronary artery bypass graft surgery (CABG) and vascular surgery. This landmark study set the stage for outcomes research in surgery. Over the past decade, additional studies have continued to show higher surgeon or hospital volumes to be associated with improved patient outcomes. [3-13] To what degree surgeon versus hospital volume each contribute to outcomes is controversial and depends on the procedure examined. Nevertheless, formal recommendations encouraging certain high-risk procedures be performed at high-volume hospitals began as early as 2000 by the Leapfrog group and other policy initiatives.[14, 15] Formal recommendations for surgeon volume, on the other hand, have been lacking. There has been mounting evidence, particularly in the last decade, that surgeon volume is associated with improved patient outcomes, independent of hospital volume. To what measure these data have influenced referral patterns from low- to high-volume surgeons is unknown.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 241-258). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 241-258). Also available on the Internet.