Diss. Linköping : Univ., 2005. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Oregon, 2000. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 324-344). Also available for download via the World Wide Web; free to University of Oregon users. Address: http://wwwlib.umi.com/cr/uoregon/fullcit?p9963451.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 113-132). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

The feedback is a central component of medical education. Unfortunately, medical teachers often believe that provide adequate feedback to students. But several studies show confl icting results. The aim of this paper is to review the main concepts associated to feedback in clinical education as part of the teaching–learning process. / Revisión por pares

There is increasing concern that newly qualified registered nurses (RNs) find it difficult to make a smooth transition from completing their four-year nursing training to taking up their posts as first time RNs. In a constantly changing healthcare system, these newly qualified RNs are expected to work independently and be competent in applying the decision making and problem-solving skills gained during their training. While certain aspects of clinical incompetence may be ascribed to individual factors, the importance of the clinical learning environment and its influence on the development of clinical competence cannot be ignored. Nurses need support and guidance to effect a successful transition from being novice to competent nurse and the environment is regarded as important in developing technical competencies. The research study followed a positivistic, quantitative paradigm, where the hypothesized relationship between clinical learning environmental factors and clinical competence of newly qualified RNs were explored. Data was collected from the experienced RNs in the hospitals by means of a structured pre-existing questionnaire, namely the Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and inferential statistics were used to analyse data. The analysed data was used to describe the findings. Recommendations were made based on the findings. Results suggested that the development of clinical competence is dependent on both the individual and context. Positive relations were reported between clinical learning environmental factors and clinical competencies.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / With the growing need to prepare pharmacy students for clinical practice and ensure the quality of care, evaluation comes to play a essential role in graduation. However, there are little validated instruments to assessment of pharmacist´s clinical competencies and essential components for effective patient education. On the above, the aim of the present study was Cross-cultural adaptation of the "Global Competency Framework (GbCF)", making it an assessment tool of pharmacist clinical skills for the Portuguese of Brazil. Therefore, a systematic review was conducted to determine how the clinical competencies of pharmacists and/or pharmacy students are conceptualized and measured. A review was conducted into the databases, Scopus, Lilacs, Eric, and PubMed. With the keywords: "Clinical competence", "Pharmaceutical Care" and Pharmaceutical Education". The literature search identified 2,979 articles. After the exclusion process, 60 studies met the inclusion criteria. A total of 30 studies (50%) focused on general clinical skills, while the others examined specific clinical skills. Seventeen studies (28.3%) used the Objective Structured Clinical Examination (OSCE) as the method of clinical competence assessment. The instruments used in the studies varied greatly, with only eight studies (13.3%) using the same assessment instrument, which was the General Level Framework (GLF). This review concluded that there is a need for a validated assessment instrument to ensure that pharmacists´ competencies are globally applicable, transferable, accessible, and transparent. In addition, the cultural translation process GbCF instrument for Brazil started with the stages of translation and back translation. These were satisfactory to comply conceptual requirements, considering the linguistic aspects and the meaning of the content in the Brazilian reality. The combination of techniques Delphi and nominal group were employed to obtain a consensus on the items of the instrument is the most important aspects to be used in the evaluation of clinical skills of pharmacists. At this stage the judges proposed the modification of 65 items, including 41 textual changes, 22 exclusions, two groups and three reallocations of items in the four basic groups of skills that the instrument is divided. Version 3 generated was evaluated for semantic and idiomatic equivalence by the Judges Committee "A" formed by experts of this theme. The result showed that 31% of the items showed less than 80% agreement between judges and suffered semantic changes. Version 4 of the instrument was submitted to the cultural and conceptual equivalence by the expert committee "C" formed by experts of this theme, natives and / or residents of each of the five regions. According to the evaluation of this committee, there was need for modification of 29 items. The results showed concordance less than 80% to 80.60% of the items. The procedure resulted in the Portuguese version of the instrument entitled: General guidelines for assessment of pharmacist´s clinical competencies. / Com a crescente necessidade de preparar os estudantes de Farmácia para a prática clínica e assegurar a qualidade da atenção, a avaliação passou a ter um papel fundamental na graduação. No entanto, ainda há poucos instrumentos validados de avaliação de competências clínicas do farmacêutico e dos componentes essenciais para a orientação efetiva ao paciente. Diante do exposto, o objetivo do presente trabalho foi Adaptação transcultural do Global Competency Framework (GbCF) , tornando-o um instrumento de avaliação de competências clínicas do farmacêutico para o Português do Brasil. Para tanto, foi realizada uma revisão sistemática para investigar como estão sendo avaliadas as competências Clinicas do Farmacêutico. A busca de artigos foi realizada nas seguintes bases de dados: Scopus, Lilacs, Eric e PubMed. Com as palavras-chaves: Clinical competence , Pharmaceutical Care e Pharmaceutical Education . A pesquisa bibliográfica identificou 2,979 artigos. Após o processo de exclusão, 60 estudos preencheram os critérios de inclusão. Um total de 30 estudos (50%) estavam focados em competências clínicas gerais enquanto que os demais estavam relacionados à competências clínicas especificas. Destes, 17 estudos (28,3%) empregaram o exame clínico objetivo estruturado (OSCE) como metodologia de avaliação de competências clínicas. Os instrumentos utilizados nos estudos variaram muito com apenas oito estudos (13,3%), usando o mesmo instrumento de avaliação, o General Level framework (GLF). Essa revisão concluiu que há necessidade de instrumentos validados para avaliação de competências, de forma a garantir que as competências dos farmacêuticos sejam aplicáveis, transferíveis, acessíveis e transparentes globalmente. Ademais, o processo de tradução transcultural do instrumento GbCF para o Brasil foi iniciado com as etapas de tradução e retrotradução. Estas foram satisfatórias em cumprir exigências conceituais, considerando os aspectos linguísticos e o significado do conteúdo na realidade brasileira. A combinação das técnicas Delphi e grupo nominal foi empregada para obtenção de um consenso sobre os itens do instrumento que constituem os aspectos mais importantes para serem utilizados na avaliação de competências clínicas de farmacêuticos. Nesta etapa os juízes propuseram a modificação de 65 itens, incluindo 41 alterações textuais, 22 exclusões, dois agrupamentos e três realocações de itens nos quatro grupos básicos de competências que o instrumento está divido. A versão 3 gerada foi avaliada quanto à equivalência semântica e idiomática pelo comitê de Juízes A formado por experts desta temática. O resultado mostrou que 31% dos itens apresentaram menos que 80% de concordância entre os juízes e sofreram alterações semânticas. A versão 4 do instrumento foi submetida à avaliação da equivalência cultural e conceitual pelo comitê de juízes C formado por experts desta temática, nativos e/ou residentes de cada uma das cinco regiões brasileiras. De acordo com a avaliação deste comitê, houve necessidade de modificação de 29 itens. Os resultados revelaram concordância igual ou superior a 80% para 80,60% dos itens. O procedimento descrito resultou na versão em Português do instrumento intitulado: Diretrizes gerais de avaliação de competências clínicas do farmacêutico.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2017-09-13T19:10:07Z No. of bitstreams: 2 Dissertação - Priscilla de Souza Porto - 2017.pdf: 2399135 bytes, checksum: 1bc18dafa2f5bb006c770faf2cc511d6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-09-19T14:03:00Z (GMT) No. of bitstreams: 2 Dissertação - Priscilla de Souza Porto - 2017.pdf: 2399135 bytes, checksum: 1bc18dafa2f5bb006c770faf2cc511d6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-09-19T14:03:00Z (GMT). No. of bitstreams: 2 Dissertação - Priscilla de Souza Porto - 2017.pdf: 2399135 bytes, checksum: 1bc18dafa2f5bb006c770faf2cc511d6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-29 / INTRODUCTION: The insertion of the Central Peripheral Insertion Catheter (PICC) is a very common procedure in hospitalized patients and the nurse has the autonomy to indicate and perform the procedure, provided that she has received specific training. PURPOSE: to analyze the competence of nurses in relation to the use of PICC in hospitalized adult patients. METHODOLOGY: an exploratory descriptive study with a cross - sectional design and a qualitative approach carried out in a large public hospital, with 15 nurses working in hospitalization units of adult patients. The data were collected in an individual interview recorded on digital media or registered by the interviewer in writing at the time of its accomplishment and were analyzed by the content analysis of Bardin (2011). RESULTS: the results were presented in five categories: nurses' knowledge about the management of PICC, ability to use PICC, attitude/ adherence in the management of PICC, reasons for noncompliance with PICC use in adults, and suggestions for adherence to the use of PICC in adults. The majority of nurses do not have the competence to perform the PICC course. Nurses reported reasons for noncompliance with PICC and suggested ways to increase catheter use in adult patients outside intensive care units. FINAL CONSIDERATIONS: The majority of nurses still do not have competence to use the PICC. Very few have the necessary knowledge, the less they have developed the technical skill for their accomplishment, and none have demonstrated an attitude of acquiring that competence. It is necessary to invest in the training of health professionals and in the development of a more proactive attitude of nurses to increase their competencies to improve the quality of their care. / INTRODUÇÃO: a inserção do Cateter Central de Inserção Periférica (PICC) é um procedimento muito comum em pacientes internados e o enfermeiro tem autonomia para indicar e realizar o procedimento, desde que tenha recebido treinamento específico. OBJETIVO: analisar a competência dos enfermeiros em relação ao uso do PICC em pacientes adultos internados. METODOLOGIA: estudo descritivo exploratório com delineamento transversal e abordagem qualitativa realizado em um hospital público de grande porte, com 15 enfermeiros que trabalham em unidades de internação de pacientes adultos. Os dados foram colhidos em entrevista individual gravada em mídia digital ou registrada pela entrevistadora por escrito no momento de sua realização e foram submetidos à análise de conteúdos de Bardin (2011). RESULTADOS: os resultados são apresentados em cinco categorias: conhecimento do enfermeiro quanto ao manejo do PICC, habilidade para o uso do PICC, atitude/adesão ao manejo do PICC, motivos para não adesão ao uso do PICC em adultos e sugestões para adesão ao uso do PICC em adultos. A maioria dos enfermeiros não possui competência para realização da passagem do PICC. Os enfermeiros apresentaram motivos da não adesão ao uso do PICC e sugeriram diversas condutas para o aumento do uso do cateter em pacientes adultos fora das unidades de terapia intensiva. CONSIDERAÇÕES FINAIS: a maioria dos enfermeiros ainda não possuem competência para uso do PICC. Muito poucos possuem o conhecimento necessário, menos ainda desenvolveram a habilidade técnica para sua realização e nenhum demonstrou atitude de adquirir essa competência. É necessário investir na formação dos profissionais de saúde e no desenvolvimento de uma atitude mais proativa dos enfermeiros no sentido de incrementar suas competências para melhorar a qualidade de sua assistência.

Recente profusão de novos papéis profissionais do enfermeiro e mudanças nas práticas da enfermagem têm sido descritas mundialmente e exercem impacto no tipo de cuidado provido e nas formas de sua provisão. O interesse deste estudo é a ideia de papel clínico, que, apesar de ser uma expressão comumente usada no cotidiano, é pouco explorada em termos conceituais. Este estudo teve como objetivo desenvolver o conceito de papel clínico do enfermeiro. A Metodologia de Análise Qualitativa de Conceito foi aplicada em suas três fases: Identificação dos Atributos, Verificação dos Atributos e Identificação das Manifestações do Conceito. Na primeira fase, os atributos abstratos e universais do conceito foram identificados, utilizando-se a Análise Crítica da Literatura, que resultou no estudo de 24 publicações. Na segunda fase, aplicou-se a Teoria Fundamentada nos Dados para verificar os atributos do papel clínico na experiência do enfermeiro. Nessa fase, realizou-se estudo com sete enfermeiros assistenciais do Hospital Universitário da Universidade de São Paulo. Os dados foram coletados por entrevistas abertas, que foram analisadas e interpretadas em categorias inter-relacionadas, com a derivação de um modelo teórico da experiência do papel clínico do enfermeiro. Na terceira fase, os dados das fases anteriores foram comparados e integrados, possibilitando a proposição teórica do conceito. Os resultados da análise evidenciaram que papel clínico do enfermeiro é um processo psicossocial resultante da interação do enfermeiro com o paciente, com o contexto e consigo mesmo. Autonomia clínica configurou-se como elemento central da interação do enfermeiro com o paciente na experiência do papel clínico. O significado da experiência do papel clínico foi expresso no empoderamento do enfermeiro pelo exercício da autonomia clínica, que mostra o alcance de resultados manifestados na própria interação do enfermeiro com o paciente, consigo mesmo ou com o contexto. Os dados indicaram ter o paciente como o centro do cuidado, ter finalidades e intencionalidade como atributos principais do papel clínico. O desempenho do papel clínico requer que o enfermeiro tome posse da autonomia clínica, que a exerça nas interações e nas ações junto ao paciente e se perceba empoderado por esse exercício. Papel clínico é uma competência que se articula como uma forma de poder, mediado pela autonomia clínica. A autonomia clínica concede ao enfermeiro o poder de pensar, de imaginar, de planejar o cuidado e de influir na saúde do paciente. A análise do conceito do papel clínico contribuirá para reflexões sobre as dimensões envolvidas na prática e no ensino de enfermagem e para informar não só as políticas de ensino e de práticas profissionais, mas também as políticas de saúde. / Recent profusion of new professional roles of the nurse and changes in the practice of nursing have been worldwide described and have an impact on the type of care provided as well as on the forms of its provision. The interest of this study is the idea of the clinical role, which inspite of being a commonly used daily expression, is little explored in conceptual terms. This study has had as an objective the development of the concept of the clinical role of the nurse. The Methodology of Qualitative Analysis of Concept has been applied in its three phases: Identification of the Attributes, Verification of the Attributes and Identification of the Manifestations of the Concept. In the first phase, abstract and universal attributes of the concept have been identified using Critical Analysis of Literature, which resulted in the study of 24 publications. In the second phase, Grounded Theory has been applied to verify the attributes of the clinical role in the nurses experience. In this phase, a study has been carried out with seven assistential nurses from the São Paulo Universitys Hospital. Data has been collected by open interviews, which has been analysed and interpreted in interrelated categories, deriving to a theorical model of the nurses clinical roles experience. In the third phase, the data of the previous phases were compared and integrated, permitting the theorical proposition of the concept. The results of the analysis have proved that the nurses clinical role is a psychosocial process resulting from the interaction of the nurse with the patient, with the context and with himself. Clinical autonomy has configured as a central element in the interaction of the nurse with the patient in the clinical roles experience. The significance of the clinical roles experience has been expressed in the empowerment of the nurse through the exercise of clinical autonomy, which shows the range of achieved results shown in the nurses interaction with the patient, with himself or with the context. Data has indicated to have the patient as the center of attention, to have purposes and intentions as the main attributes of the clinical role. The performance of the clinical role requires that the nurse takes lead of the clinical autonomy, exercises it during interactions and actions with the patient and feels empowered by this exercise. The clinical role is an ability which, through clinical autonomy, is articulated as a form of power. Clinical autonomy concedes the nurse the power to think, to imagine, to make care plans and to influence the patients health. The analysis of the clinical roles concept will help to have reflections about the dimensions involved in the practice and teaching of nursing and to inform, not only the educational and professional practices politics, but health politics as well.

Philosophiae Doctor - PhD / Literature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments. / ICAP-NEPI Project Malawi

Syfte: Syftet med studien var att beskriva skötares uppfattningar av specialistsjuksköterskans kompetens i psykiatrisk vård. Metod: För att analysera detta fenomen gjordes en intervjustudie med kvalitativ design och en fenomenografisk analys tillämpades. Semistrukturerade intervjuer genomfördes där nio skötare verksamma i den psykiatriska vården vid tiden för intervjutillfället deltog. Med avsikt att finna variation bland uppfattningarna bearbetades och analyserades det transkriberade materialet i en analys omfattande sju steg. Resultat: Fyra kategorier av skötarnas uppfattningar identifierades: Osynlig kompetens, otydlig kompetens, synlig kompetens och tydlig kompetens. Relationen mellan dessa kategorier förhöll sig hierarkiskt i förhållande till i vilken grad specialistsjuksköterskans kompetens uppfattades. Slutsats: Skötarens uppfattningar ger uttryck för att det finns ett starkt behov av specialistsjuksköterskans kompetens samtidigt som man inte kan se hur den urskiljer sig från skötarens egen kompetens. Områden i specialistsjuksköterskans kompetens som har stor betydelse för och kompletterar skötarens egen kompetens värdesätts särskilt, såsom specialistsjuksköterskans arbetsledarroll, samarbetsförmåga, somatiska kunskap och helhetsbild av psykiatrin i övrigt. / Aim: The aim of this study was to describe how psychiatric aides’ understand the competence of specialist nurses in psychiatric care. Methods: In order to analyze this phenomenon, a phenomenographic interview study with qualitative design was carried out. Semi-structured interviews were conducted with nine psychiatric aides, working in psychiatric in-patient care at the time of the interview. In order to find the variation among the understandings, the transcribed material was processed and analyzed through an analyze method including seven steps. Results: Four categories of understandings were identified: invisible competence, unobvious competence, visible competence and obvious competence. The relationship between these different categories took a hierarchical structure in relation to the degree of which the specialist nurse competence was understood. Conclusions: The understandings of the psychiatric aides expresses the dependence of the specialist nurse's competence while at the same time one cannot see how it distinguishes itself from the psychiatric aides’ own competence. Areas of the specialist nurse competence that are of great importance for the psychiatric aides and complement their competence are especially valued, such as: the specialist nurse’s leadership, ability to cooperate, somatic knowledge and overall knowledge of psychiatry.