Ce sujet concerne avant tout les infirmières, les femmes « les plus louangées » de l’époque, mais aussi les femmes médecins, nouvellement arrivées, à la fin du siècle dernier, dans la profession. Les premières, très nombreuses, sont en quelque sorte évidente, connues par tous mais finalement invisibles, la surreprésentation les effaçant. Les secondes, en petit nombre, sont oubliées ou plus exactement ignorées. Ce sujet semble proche, presque familier, mais il est plus complexe qu’il n’y paraît, se situant à la croisée de plusieurs champs de recherche. L’histoire militaire d’abord, la femme évolue dans un monde d’hommes et dans un univers militarisé. L’histoire de la naissance des professions médicales au féminin, avec une réflexion sur les techniques médicales et sur l’approche de la douleur. L’histoire du genre, on assiste à la construction d’un sexe social, qui met en avant des rapports de domination masculine. Une histoire des représentations, ces femmes, vues à travers différents prismes, sont imaginées, construites par une société d’hommes. Enfin une histoire de l’intime à travers la parole des femmes. C’est celle d’une dominée, exclue des savoirs, du pouvoir, de la sphère guerrière, confinée dans un cadre surveillé, hier le foyer, ici l’hôpital, épinglée par des obligations de conduites, d’apprentissages, de hiérarchie. Le travail se décline à travers un triptyque : les femmes telles qu’on les veut, c’est le point de vue de l’institution masculine, puis les femmes telles qu’on les voit, à travers le prisme des représentations, enfin, ce sont les femmes telles qu’elles se disent, à travers leurs témoignages. / This subject mainly concerns female nurses, « the most praised » women at that time, but also female doctors who had newly arrived in that profession at the end of the last century. The former, very numerous, are « evident » in a way, well known by everybody, but finally « invisible » owing to an over-representation that outshines them. The latter, in small numbers, are forgotten or more precisely ignored. This subject seems close to us, almost familiar, but it is more complex than we think it is, being at the crossroads of several fields of research. First, it has to do with the military history, as women evolve in a man's world, a militarized universe. Then, it is also the history of women entering medical professions for the first time, with a reflexion on medical techniques and the treatment of pain. It is the history of gender, as we witness the building of a social gender gap which highlights man's domination in his relationship with women. The history of the representation of women through different prisms, imagined and built by a male society. Lastly, it is the history of privacy through women's words too. It is the history of women who were dominated, excluded from knowledge, power, the war sphere, women confined to a watched environment - yesterday the home, here the hospital. Women tied by behavioral duties, training and hierarchical obligations. The work comes in a triptych : women such as we want them – and this is men's view - then women as we see them, through the prism of representations and lastly, women as they tell themselves through their testimonies.

This qualitative case study examined the perceived effectiveness of executive leadership team processes at a community hospital in the southeastern U.S. in relation to the Value-Based Purchasing (VBP) requirements of the Patient Protection and Affordable Care Act (PPACA) through an analysis of documents and a repository database (http:www.hospitalcompare.hhs.gov) relating to service quality, patient satisfaction, and governmental reimbursements; and, structured interviews. Today, the PPACA or “Obamacare” continues to challenge the executive leadership teams at U.S. hospitals to effectively navigate the intricacies of the legislation in order to remain solvent in a volatile healthcare arena. The Plan-Do-Check-Act (PDCA) model was utilized to guide the theoretical framework for this qualitative case study in terms of process improvement. Hill’s (2010) team leadership model was also applied to examine the perceived effectiveness of the executive leadership team processes in terms of analyzing any change in core measures and patient satisfaction scores from the federal fiscal year (FFY) 2013 and 2014, respectively. The VBP data reflected consistent core measure scores in the 48th percentile and an increase in patient satisfaction scores from the 20th to 33rd percentile. The results revealed that the executive leadership team processes were perceived by the researcher as effective as evidenced by a strong collaboration among administration, the bord, and medical staff in implementing several strategies via a team oriented approach that impacted Medicare patients during the FFY of 2013-2014. This study offers a starting point in terms of generating more understanding of the importance of executive leadership team processes at a community hospital in relation to the VBP requirements of the PPACA which can be studied on a broader scale in the future.

Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C results accepted the invitation to attend group medical visits. Here surrounded by peers with the same diagnosis, they were able to learn and discuss methods to self manage their type 2 diabetes. At the conclusion post survey results indicate positive change in some lifestyle behaviors and improvement with hemoglobin A1C. However there was no improvement in weight management. A cost analysis reveals group medical visits may generate a small profit when compared to individual visits. Group medical visits may offer an effective means to motivate patients to make lifestyle change to reduce risk.

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase the use of disposable blades will be determined. Once Institutional Review Board (IRB) approval and written consent were obtained, anesthesia providers were asked to complete an anonymous one page questionnaire on their knowledge and practice regarding disposable laryngoscope blades. Immediately following the completion of the questionnaire, participants were given an investigator developed article to read. Participants completed the same anonymous questionnaire 3 months following the pre-intervention questionnaire. Inventory of the disposable laryngoscope blades were collected at the start of the project, at one month, and then again at three months. A total of 12 anesthesia providers participated in the evidence based practice project. An increased number of providers stated that they felt disposable laryngoscope blades were easy to use at the completion of the project and there was an increased use of disposable laryngoscope blades. At post-intervention, anesthesia providers described performance (25%) as their reason for not using the disposable laryngoscope blade which was down from the start of the project (60%). A single proportion Z-Test showed that the 23% increase in use of disposable laryngoscope blades after the intervention was statistically significant (Z=2.046, p=0.041). This evidence based project has shown that despite initial apprehension, a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades which should translate to improved patient outcomes.

The incidence and prevalence of overweight and obese children in the United States is a serious health concern since the complications of childhood obesity can have serious and long-term effects: cardiovascular disease, sleep apnea, type 2 diabetes, neurological disease, and pulmonary disease. Parental modeling and nutritional education focusing on the obese/overweight child’s parents has been shown as an effective strategy for improving nutritional outcomes of the recommended servings of fruits and vegetables in children from five to ten years of age. Outcomes of this study and targeted nutritional modeling included increasing vegetable and fruit consumption of the parent by at least one fruit and vegetable serving per day post-intervention through nutritional education. The project purpose was to measure the impact of a parent-focused nutritional educational intervention that increases fruit and vegetable consumption in the parents of obese and overweight children. While the study indirectly measured a nutrition education intervention aimed at children via their parents, no children were included in this project. Parents (N = 93) of obese/overweight children were provided nutritional and modeling education over three months. A participation rate of 14% (N = 13) was achieved. The majority of the parents were single African American mothers between 18 and 25 years old with one or two children living in the household, an average income less than $10,000 per year, and some college or technical education. This project used a pre-and post-test design to measure the effectiveness of a nutritional educational intervention. A descriptive analysis of the participants was computed. Differences in the pre-and post-test scores on the parental dietary modeling questionnaire and the food frequency questionnaire were analyzed. Results showed a significant increase in fruit and vegetable consumption (p < .05). The majority of the increase was due to improved fruit consumption. There was also an increase in parental modeling awareness. Parents’ understanding of the importance of parental modeling had an impact on nutritional selection of their own fruit and vegetable intake.

Quality of life in long term care (LTC) is a concern for many stakeholders. The elders who are living in LTC facilities, their families, the staff, and government and policy makers are all interested in providing quality care and quality of life to those persons living within the facility. Culture change is one way for LTC facilities to begin to give decision making to the residents, and to increase quality of life of these elders. There are different culture change models that embrace the concept of person-centered care. No matter which model is chosen, the essence of the change is moving from a medical care model to a person-centered care model. vi The purpose of this project was to evaluate the effectiveness of a culture change intervention, teaching person-centered care to certified nursing assistants (CNA), on the quality of life (QOL) of alert and oriented residents living in a LTC facility. The elders, identified as alert and oriented by a score of 25 or greater on the Mini Mental State Exam (MMSE), participated in a QOL questionnaire. Two one hour in-services on person centered care were presented to the CNAs. The QOL questionnaire was re-administered to the elder participants after three months. The results illustrated that teaching person-centered care to CNAs showed significant improvement in the areas of dignity and security, and marginal significance in the area of individuality. This suggests the elder's increased feeling of respect from the staff, as well as an increased sense of belonging and confidence in the availability and assistance of the staff members. It also suggests the elders felt that they were known as individual persons and that their preferences were honored.

Malgré son organisation d’inspiration libérale, la profession de médecin accepte depuis longtemps l’exercice sous forme illibérale. Ce mode d’exercice médical concerne tous les médecins, aujourd’hui nombreux, exerçant leur art au profit et pour le compte d’un employeur public ou privé. Il présente la particularité d’être organisé selon une bipartition théorique faisant la différence entre les médecins dont l’exercice est soumis au droit public, et ceux dont l’exercice relève du droit privé. L’organisation de l’exercice médical subordonné reprend en effet le schéma selon lequel les agents publics doivent être distingués des salariés de droit privé, conséquence de la dualité droit public/droit privé qui caractérise le système juridique français. Cependant, tout comme la différenciation entre les agents publics et les salariés de droit privé s’est affaiblie, celle existant en théorie entre les médecins illibéraux de droit public et les médecins illibéraux de droit privé a perdu de sa pertinence, tant ces deux catégories de professionnels se sont rapprochées, liées en pratique par une même notion : la subordination. Les différentes branches du droit applicables aux médecins illibéraux ont été réciproquement attirées les unes par les autres et ont évolué par des mécanismes d’emprunts mutuels. Ce mouvement d’attraction, dont le développement a fait naître un mode d’exercice médical illibéral uniformisé, marque l’abolition de la distinction entre médecine subordonnée de droit public et médecine subordonnée de droit privé / Despite being organized on a liberal inspiration, the medical profession can be practiced through a subordinate relationship. This way of practicing the medical profession includes every doctor who fulfills his professional duties in the profit and for a public or private employer. It is unique by its organization, according to a theoretical division making the difference between doctors ruled by public laws, and doctors who practice under private laws. It follows a particular scheme, in which civil servants are differenciated from salaried employees ruled by private laws, a direct result, typical of the french legal system, of the traditional duality between public and private law.However, like the differenciation between civil servants and salaried employees ruled by private laws, which has lost most of its strongness, the separation between subordinate doctors ruled by public laws and subordinate doctors ruled by private laws is not relevant anymore, because these two types of doctors, linked by one key concept, the subordination, have kept getting closer over time. The different rules that apply to the subordinate doctors have reach out to each other and have progressed with mutual borrowings. These attraction moves have created a homogeneous medical practice, by erasing the differences between subordinate doctors ruled by public laws and those who are governed by private laws

Ce travail est un portrait croisé de deux médecins modernes établis en milieux portuaires. D’un côté Paul-Victor Desèze (1754-1830) médecin catholique bordelais, de l’autre Benedetto Frizzi (1756-1844) médecin lombard de confession juive, installé dans le port de Trieste. Dans cette étude, il s’agit de comparer les pratiques de sociabilité des deux individus et d’identifier leurs principaux réseaux de relations afin de mettre en évidence la fonction centrale que tend à occuper le médecin dans les sociétés modernes et l’évolution de son statut. Pour ce faire, la première partie des recherches se concentrent sur la formation du médecin et son ancrage dans les sphères universitaires et scientifiques. Puis, la seconde phase du travail revient sur l’insertion et l’évolution du médecin dans la société civile et urbaine à travers sa fréquentation de lieux de sociabilité scientifiques, culturels ou politiques tels que les académies, les loges ou les sociétés. Ainsi, il est possible de constater que la figure du médecin devient un acteur protéiforme essentiel à la pérennité des sociétés modernes. A la fois actif et impliqué dans son environnement quotidien en étant très attaché à la diffusion de certains principes comme l’éducation, l’hygiène ou le progrès, il se fait aussi, à une plus grande échelle, le vecteur de notions plus universelles telles que la tolérance, la fraternité et le bonheur. Par conséquent, l’objectif final de ce travail est de reformuler et de repenser le concept de cosmopolitisme en donnant, à travers la figure du médecin, une nouvelle acceptation, concrète et effective de l’homme cosmopolite. / This study is a double portrait of 2 doctors settled in ports cities. In one hand Paul-Victor Desèze (1754-1830) a catholic doctor from Bordeaux, and, in an other hand Benedetto Frizzi (1756-1844) a jewish doctor from Lombardy, but living in Trieste. Our goal is to rebuild, to analyse the social practice of this 2 men and to identify their relationship networks in order to understand the central function of medicine end doctors in européen modern society. To tha end, the first part of the research focus on the medical training and the integration of the doctor in the academic and scientific areas. Then, the second part of the study focus on the doctor’s career development in modern society through their attendance to places like academies, club, salon, loge. So, we can state that the doctor is becoming an essential social player. He takes a really active part in his own social environment in order to fix daily issues and, at the same time, he convey new values like tolerance, brotherhood and happiness. To conclude, this comparative study has to show that, in the XVIIIe century, doctors develop a lifestyle that we could consider like an active demonstration of a cosmopolitan state of mind.

This study examined the leadership roles of secondary schools department heads at two government schools in Belize. Seven participants participated in the study and data regarding their perceptions of their leadership roles were collected through open-ended semi-structured interviews. Relevant sections from Belizean education documents were purposefully selected based on their relevance to the study. Documents were used to enrich the interview data. Three data analysis strategies—content analysis (Patton, 2002), inductive analysis (Hatch, 2002), and educational criticism (Eisner, 1998)—were used in the study. Discussion of the analysis was based on the following three themes: (a) build instructional capacity, (b) increase learning opportunities for students, and (c) provide technical and vocational teachers access to professional training and development in technical and vocational education. The themes are perspectives from which to view and understand the leadership roles of secondary school department heads at two government schools in Belize. Three major conclusions resulted from this study. One, secondary school department heads at the two government schools in Belize are school leaders whose multifaceted role includes myriad duties, responsibilities, and obligations. Two, department heads are street-level bureaucrats who implement and enforce policies and regulations through their classroom routines and the decisions they make. Three, policymakers, school management, and department heads need to invest in sustained professional training and development activities that are specifically designed for department heads. Implications for policy and practice include the need to establish minimum professional selection criteria for the role of department heads, expand the capacity of teacher training institutions, and foster a culture that supports and nurtures shared instructional leadership and learning among department heads.

The central focus of the present study was to examine the relationship between student personal factors (i.e., gender, race, academic performance, career awareness, and socio-economic factors) and the perceptions of secondary school students regarding vocational education. In recent years, traditional vocational programs have not done well throughout the nation. Enrollment within vocational education has dropped to approximately 10%, while enrollment in college preparation courses has increased to over 50%. The subjects of this study were secondary school students enrolled in the Duval County Public School system. The research was conducted using a two-part survey instrument containing 24 demographic questions and 76 questions related to vocational education. The survey instrument was subjected to content validity analysis by a panel of experts from various universities. Additionally, a validation panel, consisting of 12 vocational education teacher interns, critiqued the instrument. This study was helpful in illuminating the contradictions in commonly held perceptions of vocational educators, guidance counselors, school administrators and political decision makers towards secondary students and their declining interest in vocational education. Five hypotheses were tested relative to the relationship between student personal factors and perceptions of vocational education. The five hypotheses sampled were statistically significant, and R squared values indicate that an appreciable amount of variation in perceptions can be accounted for by student background. Demographic factors are related to students' perceptions of vocational education, with socio-economic status most appreciable among the several predictors.