The school to post-school transition has been identified as a time when young people with Additional Support Needs (ASN) need extra support. This thesis focuses on the school to post-school transition planning and preparation process for young people with ASN in Scotland. In particular, the author scrutinised the collaborative planning and preparation that takes place amongst professionals to support young people with ASN and their families during this transition. The author also examined the influence of the Education (Additional Support for Learning) (Scotland) Act 2004 upon the process. A mixed-methods research design was used to undertake three studies. Study 1 was a national on-line survey of professionals involved in post-school transition planning and preparation. Study 2 was a longitudinal study in which professionals involved in transition planning and preparations from one local authority were interviewed at 2 time periods (2004 before the implementation of the Education (Additional Support for Learning) (Scotland) Act 2004 and 2010). Minutes of transition meetings from both periods were also examined. Study 3 was a case study of a further education college undertaken in the same local authority as Study 2, to understand the experiences of transition planning and preparation from the perspectives of the young people with ASN who had experienced post-school transition and their families, along with school and college professionals. Participants (young people, parents and professionals) were interviewed. Visual resources were developed by the author to support the interviews with the young people. Data in all the studies were analysed using a thematic analysis approach. Finally, the findings of the three studies are presented and discussed. These include the perception that transition planning and preparation has become more young person centred since the Act was introduced. Implications for policy makers, practitioners, and future research are also discussed.

Government policy for economic development across Scotland and the UK is driving an increasing number of strategic alliances in higher education to achieve economies of scale and economies of experience. Higher education institutions have been encouraged through strategic funding to further develop externally facing university-business engagement. Effective collaboration could theoretically produce the advantage of a better student experience and, at the same time, make the market for higher education more competitive. Collaborative structures are complex including the interaction between the people or agents who work within and between them. The challenge is how such collaboration can best be organised to deliver across organisation boundaries. The purpose of the study was to explore and report on a causal story of collaborative practice by examining the insider perspectives of the people engaged in collaborative strategic projects in higher education. Collaboration is defined as a relationship which is mutually beneficial to organisations to achieve common aims, including the structure, roles and relationships within collaborations. The study considered one such strategic project, the Scottish HE Employability Forum,in particular, the lived experience of the members of its project management group and was informed by the evidence based literature. The interpretivist qualitative approach to the study, with semi-structured interviews, represented one specific time interval of the participant voice considering the set-up, implementation and evaluation of the strategic project. The data analysis and findings confirmed a priori themes, for example, the need for trust building, effective leadership and strategic planning. A principle emergent theme was that the notions of agency and reciprocity were not mutually exclusive and impacted on the causal mechanisms and explanation of observed behaviours and relationships of the participant members. A conceptual framework from the current study is presented suggesting themes of collaborative activity being comprised of a broader pattern requiring relational behaviour, expert and champion roles for successful collaboration. A series of recommendations is given for collaborative practice; for project management, effectiveness and sustainability along with key messages of knowledge transfer and learning.

The task of ensuring Patient Safety is, more than ever, central in Healthcare. The report “To Err is Human” [Kohn et al. 2000], was revealing alarming numbers of incidents, injuries and deaths caused by deficiencies in healthcare activities. The book initiated assessment and change of Healthcare methods and procedures. In addition, numerous reports to Swedish HSAN (Medical Responsibility Board) have shown a high rate of information and communication deficiencies in Healthcare has a direct or indirect cause of incidents, injuries and deaths. Despite numerous of new sophisticated tools for information management in recent years, e.g., tools such as Electronic Health Records (EHR) and Clinical Decision Support Systems (CDSS), the threats to Patient Safety have not been redeemed. Rather to the contrary. Underlying reasons for this paradox are twofold. Firstly, advancements in diagnosing techniques have given rise to increasing volumes of data at the same time as the number of patients has increased due to demographic changes and advancements in treatments. Secondly, the information processing systems are far from aligned to related workflow processes. In short, we do not at present have interoperability in our Healthcare systems. In this doctoral dissertation, we present an in-depth analysis of two different “HSAN-typical” cases, where Patient Safety was jeopardized by incomplete information flows and/or information breakdowns. The cases are mirroring the apprehension of Simplicity, that is, Occam´s Razor of Diagnostic Parsimony. A well-known protocol used in Healthcare and implemented in most (knowledge based) CDSS. This rule of thumb is the foundation for the well-known adage: “when you hear hoof beats, think horses, not zebras”. Hickam´s Dictum is one well known objection to the simplifications of Occam´s Razor stating "Patients can have as many diseases as they damn well please". Of course, this Dictum is harder to implement effectively! In the thesis we suggest a visualization tool Visual Incidence Anamneses (VIA) to provide middle out compromise between Ockham and Hickam but providing means to increase Patient Safety. The findings of our Study for the thesis have resulted in a number of Aspects and Principles as well as Core-principles for future CDSS design, That is, tools and methodologies that will support designing and validating Interoperability of Healthcare systems across patient-centric workflows. The VIA tool should be used as the initiating point in a patient (individual) centered workflow, quickly visualizing vital information such as symptoms, incidents and diagnoses, occurring earlier in the medical history, at different times, to ground further vital decisions on. The visualization will enable analysis of timelines and earlier diagnoses of the patient, using visually salient nodes for visualization of causalities in context. Furthermore, support for customization of the tool to the views of stakeholders, members of healthcare teams and empowerments of the patient, is crucial.

Este estudo analisa como o estágio em cursos de licenciatura, que utiliza a reflexão como estratégia metodológica, contribui para a construção de saberes pedagógicos; pesquisa a potencialidade do estágio colaborativo em relação às concepções produzidas por estagiários, a partir da reflexão sobre a própria atividade docente realizada em escolas públicas; formula possibilidades para que o estágio possa auxiliar na formação do futuro professor, de modo a fortalecer sua identidade profissional por meio da reflexão sobre a práxis docente. Os sujeitos da pesquisa são estudantes do curso de Licenciatura Plena em Educação Física do Centro Universitário Vila Velha, estado do Espírito Santo, que, no contexto de um trabalho colaborativo com a escola-campo e acompanhamento de supervisores, atuaram em escolas de ensino público infantil e fundamental. A pesquisa é qualitativa e apresenta semelhanças com os procedimentos pautados no estudo de caso etnográfico. Na coleta do material para análise, baseia-se em dois tipos de fontes: a primeira relaciona-se a informações obtidas por meio de entrevista individual aplicada a 18 estagiários em 2007, e aos 12 estagiários, que constituíram o grupo focal, em 2008; a segunda refere-se à análise documental do projeto de estágio da instituição pesquisada e de relatórios produzidos pelos sujeitos da pesquisa nos anos de 2007 e 2008, alunos finalistas que aderiram voluntariamente à pesquisa. Leva em consideração um quadro de referências teóricas preocupado com a teoria crítica, que tem contribuído para esclarecer os problemas relacionados à prática pedagógica, as concepções ligadas à discussão sobre os saberes docentes, a formação inicial e, especialmente, o estágio e a docência. Procede à análise com base em quatro eixos: (1) as possibilidades para um estágio que fortaleça a identidade profissional e propicie a reflexão da prática docente; (2) as concepções que os estagiários julgam ter produzido a partir da reflexão sobre a própria atividade docente realizada em escolas públicas de Vila Velha-ES; (3) a realização do estágio e o resultado da colaboração entre supervisor, aluno e professor da escola; e (4) o estágio e a produção de saberes que os estagiários professores elaboram sobre esse processo formativo. Os resultados do estudo indicam, entre outros aspectos, que o ambiente de colaboração e de busca da superação de práticas conservadoras no ensino escolar pode ancorar a produção de saberes pedagógicos, principalmente em relação aos processos de planejamento de ensino e às atitudes comunicativas entre pares, no sentido de transpor situações-problema e dilemas por meios das reflexões coletivas. A partir da triangulação de dados e análise do conteúdo, conclui que os saberes que os futuros professores produzem num estágio de integração entre universidade e escola são processuais, daí sua temporalidade e constantes transformações durante o processo de estágio. / This study aims to examine how the stage of graduate courses, which uses the reflection and methodological strategy, contributes to the construction to know pedagogical; research the potential of the collaborative stage in relation to the conceptions produced by trainees, from the reflection of their own teaching held in public schools; and give opportunities to the stage to assist in the training of future teachers, to strengthen their professional identity through reflection on practice teaching. The research subjects are students of the course of Full Degree in Physical Education at the University of Vila Velha, state of the Espírito Santo who, in a collaborative work with the school field and monitoring of supervisors, worked in schools of public education and basic infant. The research is qualitative and presents similarities with procedures based on ethnographic case study. The collection of material for analysis was based on two types of sources. The first is related to information obtained by individual interview, applied to 18 trainees in 2007, with a focus group consisting of 12 trainees held in year 2008. The second refers to the documentary analysis of the draft stage and searched the imposition of probation reports produced by the subjects of research in the years 2007 and 2008. The students are finalists and voluntarily joined the search. Was considered a theoretical frame of reference concerned with the critical theory, which has helped clarify the issues related to teaching, concepts related to the discussion on the knowledge and training teachers, especially on the training and teaching. Four were the axes of analysis: (1) possibilities for an internship that strengthens professional identity and provides a reflection of teaching practice, (2) The concepts that trainees feel they have produced from the reflection of their own teaching in public schools de Vila Velha-ES, (3) The process of conducting training and appearance of collaboration between supervisor, student and teacher of the school, and (4) The production of knowledge and training that prepare teachers-trainees on the training process. The results indicate, among other things, that the environment of cooperation and search for overcoming conservative practices in school education can anchor the production of educational knowledge, especially in relation to the planning processes of teaching and attitudes in communication between pairs to cross-problem situations and dilemmas by means of collective thinking. From the triangulation of data and analysis of the content we find that the knowledge that future teachers produce a stage of integration between university and school, are procedural, and therefore its temporality and constant change during the stage.

Patient centred collaborative practice between nurses and physicians is currently being promoted worldwide. There is increasing evidence that post licensure interprofessional educational interventions improve patient outcomes but similar evidence for pre-licensure interprofessional learning is lacking. The impact of contemporary nursing and medical education on graduates’ ability to collaborate in the workplace is also unclear. To address this gap, an interview based qualitative study underpinned by hermeneutic phenomenology and informed by the theoretical lens of social identity was designed. Eleven junior registered nurses and eleven junior residents from a single healthcare jurisdiction each, in Canada and the United Kingdom (UK) were interviewed to explore how the processes that lead to socialization, professional identification and identity formation in professional schools are perceived to influence collaborative teamwork upon graduation. Data were as analyzed through iterative naive and thematic interpretations aligned with the hermeneutic process, to arrive at a comprehensive understanding. The impact of contemporary undergraduate nursing and medical education on the ability to practice collaboratively was found to be obfuscated by internal contradictions and overshadowed by the contingencies and demands of the workplace, during residency and early nursing practice in both locations. In medical schools, the intense socialization described in literature was replaced by individual reflection and a struggle to maintain work-life balance. Values internalized were of a sense of responsibility and hard work. Students espoused an attitude of collaboration but lacked training in enabling competencies and practical application. Exposure to interprofessional learning and its impact was variable and inconsistent and formal assertions of collaboration were not consistently modeled by faculty. In nursing schools, the value of caring, self-awareness and assertiveness was promoted. Training for collaboration with physicians was largely transactional and teaching about the status of the nurse vis-à-vis the physician was mired in contradictions. Residents and the nurses could not rely on their experience of professional school as they transited to the workplace. Initiation was frequently precipitous and contingencies of the workplace determined how they acted. For residents the community of clinical practice was fluid and repeatedly new. Both residents and nurses were overwhelmed by unpreparedness, workload, and responsibility and acted to get by and get the job done. Residents learned to preface doing the best for the patient and not compromising patient care, while nurses became proficient at routine tasks and found fulfilment as the patient’s advocate. There was a propensity for conflict when uniprofessional roles and values collided. In busy wards each group had interdependent but competing priorities which lead to adversarial expressions of uniprofessional identity and consequent derogatory out-group stereotyping. In contrast situations demanding urgent focused attention, such as a cardiac arrest, lead to the spontaneous formation of a collaborative team which briefly expressed an interprofessional identity. Complex cross-generational and gender based interactions were sometimes adversarial and provoked resentment. Consequently junior nurses retreated to derive fulfilment as the patient`s advocate while residents looked forward to collaborating with other health professionals on their own terms, in the future. Neither contemporary professional education nor the hospital environment sustained consistent collaborative practice. / Graduate

Este estudo analisa como o estágio em cursos de licenciatura, que utiliza a reflexão como estratégia metodológica, contribui para a construção de saberes pedagógicos; pesquisa a potencialidade do estágio colaborativo em relação às concepções produzidas por estagiários, a partir da reflexão sobre a própria atividade docente realizada em escolas públicas; formula possibilidades para que o estágio possa auxiliar na formação do futuro professor, de modo a fortalecer sua identidade profissional por meio da reflexão sobre a práxis docente. Os sujeitos da pesquisa são estudantes do curso de Licenciatura Plena em Educação Física do Centro Universitário Vila Velha, estado do Espírito Santo, que, no contexto de um trabalho colaborativo com a escola-campo e acompanhamento de supervisores, atuaram em escolas de ensino público infantil e fundamental. A pesquisa é qualitativa e apresenta semelhanças com os procedimentos pautados no estudo de caso etnográfico. Na coleta do material para análise, baseia-se em dois tipos de fontes: a primeira relaciona-se a informações obtidas por meio de entrevista individual aplicada a 18 estagiários em 2007, e aos 12 estagiários, que constituíram o grupo focal, em 2008; a segunda refere-se à análise documental do projeto de estágio da instituição pesquisada e de relatórios produzidos pelos sujeitos da pesquisa nos anos de 2007 e 2008, alunos finalistas que aderiram voluntariamente à pesquisa. Leva em consideração um quadro de referências teóricas preocupado com a teoria crítica, que tem contribuído para esclarecer os problemas relacionados à prática pedagógica, as concepções ligadas à discussão sobre os saberes docentes, a formação inicial e, especialmente, o estágio e a docência. Procede à análise com base em quatro eixos: (1) as possibilidades para um estágio que fortaleça a identidade profissional e propicie a reflexão da prática docente; (2) as concepções que os estagiários julgam ter produzido a partir da reflexão sobre a própria atividade docente realizada em escolas públicas de Vila Velha-ES; (3) a realização do estágio e o resultado da colaboração entre supervisor, aluno e professor da escola; e (4) o estágio e a produção de saberes que os estagiários professores elaboram sobre esse processo formativo. Os resultados do estudo indicam, entre outros aspectos, que o ambiente de colaboração e de busca da superação de práticas conservadoras no ensino escolar pode ancorar a produção de saberes pedagógicos, principalmente em relação aos processos de planejamento de ensino e às atitudes comunicativas entre pares, no sentido de transpor situações-problema e dilemas por meios das reflexões coletivas. A partir da triangulação de dados e análise do conteúdo, conclui que os saberes que os futuros professores produzem num estágio de integração entre universidade e escola são processuais, daí sua temporalidade e constantes transformações durante o processo de estágio. / This study aims to examine how the stage of graduate courses, which uses the reflection and methodological strategy, contributes to the construction to know pedagogical; research the potential of the collaborative stage in relation to the conceptions produced by trainees, from the reflection of their own teaching held in public schools; and give opportunities to the stage to assist in the training of future teachers, to strengthen their professional identity through reflection on practice teaching. The research subjects are students of the course of Full Degree in Physical Education at the University of Vila Velha, state of the Espírito Santo who, in a collaborative work with the school field and monitoring of supervisors, worked in schools of public education and basic infant. The research is qualitative and presents similarities with procedures based on ethnographic case study. The collection of material for analysis was based on two types of sources. The first is related to information obtained by individual interview, applied to 18 trainees in 2007, with a focus group consisting of 12 trainees held in year 2008. The second refers to the documentary analysis of the draft stage and searched the imposition of probation reports produced by the subjects of research in the years 2007 and 2008. The students are finalists and voluntarily joined the search. Was considered a theoretical frame of reference concerned with the critical theory, which has helped clarify the issues related to teaching, concepts related to the discussion on the knowledge and training teachers, especially on the training and teaching. Four were the axes of analysis: (1) possibilities for an internship that strengthens professional identity and provides a reflection of teaching practice, (2) The concepts that trainees feel they have produced from the reflection of their own teaching in public schools de Vila Velha-ES, (3) The process of conducting training and appearance of collaboration between supervisor, student and teacher of the school, and (4) The production of knowledge and training that prepare teachers-trainees on the training process. The results indicate, among other things, that the environment of cooperation and search for overcoming conservative practices in school education can anchor the production of educational knowledge, especially in relation to the planning processes of teaching and attitudes in communication between pairs to cross-problem situations and dilemmas by means of collective thinking. From the triangulation of data and analysis of the content we find that the knowledge that future teachers produce a stage of integration between university and school, are procedural, and therefore its temporality and constant change during the stage.

Collaborative practice in the healthcare system is of global interest to become cost-efficient and adaptable towards health care needs due to more complex challenges and shortages in qualified health workers. Health-sciences education should provide interprofessional education to promote learning for collaborative practice in their curricula. The interprofessional training ward is one form of interprofessional education in the clinical setting. Previous studies in the field of interprofessional education focused on self-reports by students. The focus on students leads to a lack of the supervisor´s perspective in interprofessional education. The aim of this study is to get insides of the supervisor´s perspective on how they perceive their work. This study was conducted with a qualitative methods approach with semi-structured interviews. Main results of this study were in different areas. Power relations between managers, supervisors, and students show a big impact about supervisor´s work satisfaction from appreciation from the managers. Supervisors usually feel appreciated by students but lack of appreciation from managers can lead to distress and decreased satisfaction. Supervisors go through different stages during their work period: First they have low confidence in their job role, after a period of time they are confident, but after a long period of time they can get tired of their work. The conclusion is even though the interprofessional training wards have already a lot of positive aspects, the managers should always remember themselves to support this kind of setting. Without the support of the managers, the whole project decreases its quality and the supervisor’s satisfaction.

Objectives Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Methods Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. Results On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. Conclusions The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

Anticoagulation risks in older adult, long-term care patients are known to be high, especially in those with frequent transitions between care environments. Introduction of collaborative practice agreements (CPA) in specific settings is encouraged in the United States and has provided an additional option for the care of medically challenging patients. The aim of this study was to investigate the time in therapeutic range (TTR) in a Medicare Part A sponsored long-term care environment managed by pharmacists through a collaborative practice agreement in South-Central Appalachia. A retrospective review of all warfarin patient admissions from a large long-term care pharmacy’s anticoagulant clinic was conducted for residents over an 18-month period. For all patients (n = 104), the overall TTR was 46.7% (INR 43% in range). Average management duration was 19.5 days per patient. Further studies are required to optimize CPA and transition strategies for complex, advanced age warfarin patients.

Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment.