The practice of obtaining blood as part of the placement of a new peripheral venous access device (p-VAD) is a frequent practice in the emergency department (ED). Of the concerns related to this practice is the possibility of laboratory specimen rejection due to p-VAD catheter size, use of the wrong collection device, and the absence of a standardized collection process. The objective of this study, therefore, was to examine the effect of the use of evidence-based venipuncture and p-VAD blood collection protocols on the rejection rate of blood specimens drawn by staff in the adult areas of an urban academic medical center ED. A convenience sample of 28 ED nurses and 39 ED technicians (51.94% of all eligible ED employees) consented to using these evidence based protocols when they collected blood from adult ED patients. Blood specimen rejections rates were measured for four consecutive weeks prior to and at weeks 1-4, 5-8, 9-12, and 1-12 after the evidence-based blood collection practices training intervention. Laboratory analysis of all specimens was automated with rejection results provided in the form of computerized reports. There was a significant decrease in the 12-week rejection rates for two of the three ED adult care areas, with the overall ED adult area rejection rate significantly decreased from 3.19% to 2.38% (X2at Df1, p < .05). The most common reasons for rejection were hemolysis (65.39%) and clotting (10.68%) followed by specimen mis-labeling, tube missing, insufficient quantity for testing, incorrect packaging, specimen contamination or dilution, and label missing, Though the use of theses evidence based blood collection protocols significantly decreased the overall rejection rate, the high percent of rejections due to hemolysis may further be reduced by having all ED staff use these protocols, and by exploring other collection techniques in the literature that have been found to significantly decrease rejection rates.

The purpose of this study was to examine how teachers describe instructional coaching. Instructional coaching has become a leading form of professional development in educational settings, yet there is a lack of empirical evidence that explains and clarifies it. One aspect of instructional coaching that is not known is how teachers perceive it. In order to gain understanding about instructional coaching, the perspectives of the teachers could provide valuable insight to benefit those involved in the practice. Instructional coaching and the schools where coaching takes place are complex in nature. Through the use of one-on-one interviews, an in-depth look at teachers’ perspectives provided insight into some of these complexities. Fifteen teachers in six child care centers participated in this study. Two qualitative strategies—inductive analysis (Hatch, 2002) and educational criticism (Eisner, 1998)—were used to analyze interview data from which three themes were formed: (a) instructional coaching is a means of building instructional capacity, (b) instructional coaching requires a supportive environment, and (c) instructional coaching increases children’s learning opportunities. The themes are perspectives from which to view and understand instructional coaching in preschool classrooms. One conclusion in this study was that all three themes were substantially supported by extant literature and empirical research. The implication for policy and practice is that instructional coaching is contingent upon change and change is difficult due to resistance by teachers and systemic issues. Five recommendations are highlighted in this study: (a) instructional coaches should demonstrate a high level of proficiency in educational knowledge and practice, (b) coaches should be involved in on-going professional development that includes communication training, (c) teacher supervisors should be involved in instructional coaching as instructional leaders, (d) instructional coaching should be intentional, and (e) instructional coaching should have child learning as its primary focus. Further research is needed to better understand the perspective of teachers in the field of early childhood education; the perspectives of instructional coaches in the field of early childhood education; and how to effectively involve teacher supervisors in the coaching process to develop teacher leaders and support them to assume the duties and responsibilities of highly effective instructional leaders who influence deep, sustained learning facilitated by problem-solving- and creativity-focused instruction

The purpose of this study was to identify and describe from an ecological perspective the characteristics contributing to collaboration, empowerment and effectiveness of federally mandated Ryan White Title I and Title II planning councils and consortia within the State of Florida. A case study approach within two (2) community health planning partnerships, specifically those related to. HIV/AIDS consortia, was used to gather data over one and a half years. The methodology included a combination of qualitative and quantitative approaches, utilizing documents, administering several survey instruments, observing meetings, and conducting individual interviews. The interviews and surveys provided the primary sources of data, with the documents and observations providing supportive secondary sources of data. The data were analyzed to develop an ecological perspective of the collaboration, empowerment, and effectiveness of the partnerships. The findings indicate that both partnerships were collaborative, empowering, and effective in their fulfilling their responsibilities. Significant findings include those related to members' perceptions about the leader and the group, decision making, and conflict as well as the structure, processes, and outcomes of the partnerships. Suggestions were made for the improvement of each partnership and areas for further research and practical implications were identified.

Each student receiving special education services in the public school system, roughly 6.4 million students, has an Individualized Education Program (IEP) that is mandated by the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). IDEA dictates that a team of people familiar with the student, including the parents, should create the IEP. Unfortunately, research indicates that many parents believe their participation is not welcome. While only a small percentage of parents may actually be dissatisfied with the IEP process, the cost of dissatisfaction is high, further stretching already limited resources that could be better used in the classroom. The purpose of this study was to investigate parents’ and school personnel’s beliefs about and experiences with collaborative activities that took place prior to the annual IEP or 504 plan meeting. Participant perceptions and suggestions about improving the special education process were also explored. In-depth interviews were conducted with an assistant principal, a self-contained ESE teacher, a resource ESE teacher, a regular education inclusion teacher, and three parents whose children were receiving special education services. All participants were involved in the special education process at the elementary school level. The study’s findings indicated that while school personnel perceive that they are providing opportunities for parents to be involved in a collaborative manner, parents do not perceive that a fully open and transparent collaboration exists. The school made an effort to generate a comfortable environment inviting collaboration during formal meetings; however, parents expressed frustration with the more informal aspects of the special education process including initiation of services. Teachers and parents identified similar concerns and frustrations with the IEP process and suggested similar ideas for improvement. Both school personnel and parents identified scarcity of resources within the school, which seemed to create a barrier to open communication and collaboration. Suggestions for improvement included access to outside support and advocacy groups to increase parent understanding of the special education process and facilitate its process. It is concluded that, ultimately, policy makers should become more involved at the classroom level in order to understand the implications of policy change.

Glass particle contamination of medication occurs when opening ampules which may cause patient harm. The use of filter needles reduces this risk. Many anesthesia providers use ampules daily, but do not use filter needles when aspirating medications from ampules. In addition, filter needles may not be readily available at the anesthesia medication preparation site. Not using filter needles or having them available for use can increase the risk of patient harm by glass particle contamination. The purpose of this project was to increase anesthesia provider’s knowledge thereby improving compliance with evidence-based standards when preparing medications from ampules. The goal is to increase filter needle use when medication is aspirated from an ampule in order to decrease the risk of glass particle contamination to the patient. This project consisted of a one-group pre/post intervention design using a piloted self-developed survey, an education intervention, and tracking of filter needle use. The convenience sample of eighty-three recruited anesthesia providers included anesthesiologists, nurse anesthetists, and anesthesiologist assistants that consented to participate. The filter needle inventory was tracked via an existing software program to determine filter needle use three months prior and three months after the intervention. Data were collected and analyzed using descriptive statistics. The results of this project found greater awareness among participants of standards and organizations regarding filter needle use with ampules, greater awareness of availability of filter needles on anesthesia carts, and a five-fold increase in filter needle usage by participants three months following the intervention as compared to three months prior to the intervention.

This quantitative study analyzed the influence of individual factors and institutional context on faculty participation in online teaching at public higher education institutions in the United States. Through an ex post facto design, cause and effect relationships were explored using statistical analysis of a large national data set. Variables in the data set directly related to the areas of interest in this study included interest in teaching, student-centered pedagogy, autonomy and control, instructional support, and institutional climate. Factors related to interest in teaching and institutional reward were statistically significant (p

The intent of this study was to establish and validate criteria for use to assess the quality of a library and information sciences (LIS) Ph.D. program. The Ph.D. student-centric topology for quality Ph.D. programs was developed from a 2001 position statement by the American Association of Colleges of Nursing (AACN) regarding the quality indicators in research-focused doctoral programs in nursing. Topology components were tested using a survey instrument to establish their importance to the community of practice and their potential use to assess a Ph.D. program. Survey participants were asked to rank terms or concepts in a balanced incomplete block (BIB) design then rate, on a Likert-type scale, statements about the applicability of these terms or concepts to assessing a quality LIS Ph.D. program. Survey participants were from the Association for Library and Information Science Education (ALISE) Open Lib/Info Sci Education Forum jESSE Listserv. Of 225 survey participants affiliated with universities or schools from North America who submitted usable surveys, slightly less than two-thirds (64.4 %) were female while 35.5 % were male. Ninety-eight participants (43.6 %) were faculty, 114 (50.7 %) were Ph.D. students or candidates, and 13 (5.8 %) were in other roles. Statistical analysis of survey responses showed consistent results between the different demographic groups. The topology was validated by the results of the statistical analysis of the research data. Every component of the topology was acknowledged as very important to assess the quality of a LIS Ph.D. program. Faculty was the highest ranked item in the BIB analysis with a statistically significant difference (p < .0001) in the mean rank order from the next highest ranked item, Ph.D. students. The rank order from the BIB analysis was as follows: faculty, Ph.D. students, programs (courses) of study, teaching, learning environment, resources, and evaluation. Faculty was also the highest rated item in the Likert-type statement analysis.

Made available in DSpace on 2017-06-01T18:18:15Z (GMT). No. of bitstreams: 1 dissertacao_vinicius_calado.pdf: 2034952 bytes, checksum: db6e33bde714285cc19cf574592b5918 (MD5) Previous issue date: 2012-04-11 / The object of this dissertation - informational medical negligence - locates itself in the sphere of medical liability, restricting the scope at the private sector, where is mostly understood, both by doctrine and case law, as a consumer relationship. The empirical research raises the decisions of the Superior Court of Justice - STJ from their website. From the lexical filtering, is constituted a corpus consisting of eight judgments, analyzed from the epistemic axis of Critical Discourse Analysis - ACD. The literature review seeks dogmatic support to understand the medical liability for violating the duty to inform. It studies the nature and content of medical obligation, and then analyzes the subjective right of consumers to information and the duty to inform of the physician contained in its Code of Medical Ethics. Investigates the importance of Informed Consent - TCI to concrete autonomy and free and conscious choice of the patient-consumer. The qualitative analysis of the corpus enabled the characterization of the violation of the physician&#8223;s duty to inform as a informational negligence / O objeto de estudo da presente dissertação - negligência informacional médica - situa-se na esfera da responsabilidade civil médica, restringindo-se o escopo à esfera privada, que é compreendida majoritariamente, tanto pela doutrina como pela jurisprudência, como uma relação de consumo. A pesquisa empírica levanta as decisões do Superior Tribunal de Justiça STJ em seu site na internet. A partir da filtragem lexical, é constituído um corpus constituído de oito julgados analisados a partir do eixo epistêmico da Análise Crítica do Discurso ACD. Para tanto a revisão de literatura busca na dogmática jurídica suporte para compreender a responsabilidade civil médica pela violação do dever de informar. Estuda-se a natureza e o conteúdo da obrigação médica, além de analisar o direito subjetivo do consumidor à informação, bem como o dever de informar do médico contido em seu Código de Ética Médica. Investiga-se a importância do Termo de Consentimento Informado TCI para a concreta autonomia e escolha livre e consciente do pacienteconsumidor. A análise qualitativa do corpus viabilizou a caracterização da violação do dever de informar médico como uma negligência informacional

Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

This study explored the influences on Doctor of Education (Ed.D.) students who have completed all required coursework for their degree, but have not finished their dissertation, in an effort to identify factors influencing degree completion. Past research documents an increased time-to-degree (TTD) for Ed.D. students, which has a negative impact on K-12 and higher education, as well as on business, government, and society. This study examined Ed.D. students enrolled at a private teaching college in northern California by use of a survey built upon the framework of Bean’s nine themes of college student retention. It analyzed demographic indicators as well as the professional and personal priorities and how these characteristics interface with the demands of completing a doctoral dissertation. The results highlight key differences between Ed.D. students and other graduate and undergraduate students to understand the reasons behind their increased TTD.