There is a recognized nursing shortage in Canada, including specialty areas such as critical care (CC). Nursing shortages impact health care delivery, including economic, patient, and nursing outcomes. Job satisfaction is one of the most significant outcomes affected by the nursing shortage. Recruitment of inexperienced nurses in CC is a relatively new hiring practice and has resulted in a more diverse level of clinical expertise among CC nurses. Little is known about how differences in level of clinical expertise affect job satisfaction. The purpose of this study was to explore the relationship between CC nurses’ self -reported level of clinical expertise and job satisfaction. Interrelationships between additional influencing factors, such as organizational climate and personal factors were also explored. Utilizing a web based online survey, a cross-sectional survey was sent to all 788 Manitoba hospital based CC nurses, via the College of Registered Nurses of Manitoba. Respondents (N = 188) completed the Critical Care Nurse Retention Survey, which operationalized the key study variables. Sixty-five percent of the sample reported overall job satisfaction. Based on multivariate analysis, the most influential factors affecting CC nurses’ job satisfaction were nursing management, control over practice, and level of clinical expertise. Nursing management plays a vital role in facilitating optimal nursing practice. Control and autonomy may reflect a sense of satisfaction in the achievement of the knowledge and skills necessary for effective decision-making in CC. Finally, this study provides pioneering data on the importance of advancing clinical expertise to improve job satisfaction in CC nurses.

Research in decision making has identified the importance of prior knowledge and heuristics on decision making behaviour. These develop with experience in a fashion similar to how domain experts develop specialized knowledge structures and heuristic reasoning patterns. This research is extended to the domain of health and lay decision making in a series of studies characterizing conceptualizations of health and illness, information-seeking strategies, and the impact of medical information on lay decision making. Lay subjects included those with diabetes, heart disease, and no identified ongoing medical diagnosis. / Semi-structured interviews and think aloud methodology were employed. Interviews focused on understanding of health and illness, prior knowledge and beliefs, and decision making. In Study One, subjects were presented with health-related problem scenarios and instructed to think aloud as they reasoned through them to make decisions. In Study Two, subjects (lay and medical) were presented with a telecommunications device and scenarios of data to enter into the system. All data were audiorecorded, transcribed, and analyzed for factors and strategies related to information-seeking and decision making behaviours. / Lay understanding of health and illness was characterized as feeling well and functioning in everyday life. The knowledge used in making decisions was based on experience and socio-cultural tradition. Knowledge about disease was found to be decoupled from decisions to act related to illness. Additional information was sought using four criteria grounded in common experience: accessibility, familiarity, complexity, and credibility. These characteristics influenced interactions between lay people and domain experts, such as health care providers, and with technology designed by experts for lay users. / Both technical and lay people make decisions with incomplete information and uncertain outcomes. For lay people making decisions about health-related issues, this incomplete knowledge is filled in based on everyday life rather than medical and scientific facts.

Drawing from a still-life is a complex visuomotor task. Nevertheless, experts depict three-dimensional subjects convincingly with two-dimensional images. Drawing research has previously been limited by its general dependence on qualitative assessment of drawings by human critics and on retrospective self-report of expertise by drawers. Accuracy measures cannot hope to encompass all the properties of “goodness” in a drawing but this thesis will show that they are consistent with the expertise of the drawers and with the quality ratings of human critics, they are robust enough to support analysis of ecologically valid drawing tasks from complex three-dimensional stimuli, and they are sensitive enough to study global and local properties of drawings. Drawing expertise may depend to some extent on more accurate internal models of 3D space. To explore this possibility we had adults with a range of drawing experience draw a still life. We measured the angles at intersecting edges in the drawings to calculate each person's mean percentage magnitude error across angles in the still life. This gave a continuous objective measure of drawing accuracy which correlated well with years of art experience. Participants also made perceptual judgements of still lifes, both from direct observation and from an imagined side view. A conventional mental rotation task failed to differentiate drawing expertise. However, those who drew angles more accurately were also significantly better judges of slant, i.e., the pitch of edges in the still life. Those with the most drawing experience were significantly better judges of spatial extent, i.e., which landmarks were leftmost, rightmost, nearest, farthest etc.. The ability to visualize in three dimensions the orientation and relationships of components of a still life is related to drawing accuracy and expertise. In our second study, we set out to extend our understanding of drawing accuracy and to develop measures that would support more complex research questions about both drawing and visual perception. We developed and applied novel objective geometric measures of accuracy to analyze a perspective drawing task. We measured the deformation of shapes in drawings relative to the ground truth of a reference photograph and validated these measures by showing that they discriminate appropriately between experts and novices. On all measures—orientation, proportionality, scale and position of shapes—experts outperformed novices. However, error is not uniform across the image. Participants were better at capturing the proportions and positions of objects (the “positive space”) than of the spaces between those objects (the “negative space”) and worse at orienting those objects than shapes in the negative space, but scale error did not differ significantly between positive and negative space. We have demonstrated that objective geometric measures of drawing accuracy are consistent with expertise and that they can be applied to new levels of analysis, not merely to support the conventional wisdom of art educators but to develop new, evidence-based means of training this fundamental skill. Most or all prior research into drawing was based on human ratings of drawing quality, but we cannot take for granted that the “goodness” of a drawing is related to its accuracy. In order to determine whether our objective measures of accuracy are consistent with drawing quality, we invited more than one hundred participants to grade the quality of all of the drawings we had collected and measured. We showed participants photographs of the still lifes on which the drawings were based and asked them to grade the quality of each drawing on a scale from 1 (“Poor”) to 10 (“Excellent”). People's quality ratings were consistent with one another. People without drawing experience rated drawings slightly more highly than the drawing experts did, but the ratings of both groups correlated well. As we predicted, the more drawing experience the artist had, the more highly rated the drawing was, and the more accurate the drawing was, the more highly rated it was. Furthermore, scaling error (but not proportionality, orientation or position) also predicted drawing quality. In perspective drawing, accuracy—as measured by angle error or polygon error—is related to drawing quality. If drawing practice strengthens an artist's model of 3D space, we would expect the three-dimensionality of drawings to be disrupted by damage to the dorsal stream or the connection between the dorsal and ventral streams. A former illustrator and animator, DM, who had suffered a right hemisphere stroke and presented with spatial neglect, performed modified versions of the angle judgement, spatial judgement and indirect drawing tasks of our second study. Despite his previous experience, he showed weaknesses in his mental model of 3D space, weaknesses that were not evident in his drawings before the stroke. Taken together, the thesis has developed and validated two objective measures of drawing accuracy that both capture expert/novice differences well and provide superior measures when contrasted with self-reported expertise. The performance of a single patient with neglect highlights the potential involvement of the dorsal stream in drawing. The novel quantitative measures developed here allow for testable hypotheses concerning the cognitive and neural mechanisms that support the complex skill of drawing to be objectively measured.

Thesis (Ph. D.)--University of Washington, 1988. / Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Toronto, 2007. / Source: Dissertation Abstracts International, Volume: 68-05, Section: A, page: 1816. Includes bibliographical references (leaves 86-89).

Thesis (Ph. D.)--Open University. BLDSC no. DX199046.

Diss. Univ. Bielefeld, 2008.

The prescribing rights of non-medical healthcare professionals in the United Kingdom (UK) are some of the most extensive in western medical practice. Nurses, pharmacists, physiotherapists, optometrists, chiropodists, podiatrists, therapeutic and diagnostic radiographers and dieticians, with appropriate training have the authority to prescribe. They are often referred to as non-medical prescribers (NMPs). These non-medical healthcare professionals should have a specified number of years of post-registration experience in order to undertake specific training in prescribing. There has been a limited amount of research exploring how non-medical healthcare professionals acquire their expertise during the prescribing programme. In addition, there is a gap in the literature on how NMPs apply their acquired expertise during the process of making clinical prescribing decisions. A programme of research was conducted to explore the learning processes and decision-making skills of pharmacist and nurse independent prescribers working in secondary care. The research used current literature on pharmacist and nurse independent prescribing by conducting a systematic review to assess how their expertise development is reported in the literature. In addition, the learning experiences of secondary care pharmacists and nurses undertaking the independent prescribing programme was explored by employing a novel audio-diary technique followed by semi-structured interviews on 7 nurses and 6 pharmacists. Students were mainly recruited via their non-medical prescribing programme leaders at a number of accredited universities across the UK. There was little opportunity in this study to explore the clinical reasoning processes of students as they were learning to prescribe. Therefore, the final study aimed to explore how secondary care pharmacist and nurse independent prescribers make clinical prescribing decisions. A total of 21 independent prescribers working in secondary care took part in this study, mainly recruited via their non-medical prescribing lead and social media. This study employed a think-aloud protocol method using validated clinical vignettes followed by semi-structured interviews. Students and NMPs occupied a wide range of roles. Ethical approval from the University of Manchester Research Ethics Committee (UREC) and governance approvals from a number of National Health Service (NHS) hospitals were obtained before conducting the research. NMPs were influenced by a number of intrinsic and extrinsic factors during the process of learning to prescribe and when making prescribing decisions. Students also experienced an affective phase of transition in which students became highly metacognitive as they began to form their identities as prescribers and reflect on their confidence and competence. There were notable differences between how pharmacists and nurses learned to prescribe, which were also seen during the process of clinical decision-making as independent prescribers. Despite this, pharmacists and nurses revealed a similar pattern in their decision-making processes as prescribers. Findings from this programme of research provide further insight into the specific training and support requirements of these healthcare professionals. Additional research with NMPs would be beneficial to contribute to the currently limited understanding of the learning and clinical reasoning processes of NMPs.

Dans les industries de hautes technologies, le rythme contemporain de l’innovation se caractérise aujourd’hui par un renouvellement accéléré des produits et par une déstabilisation des dominant designs. Dans ce contexte d’innovation intensive, les organisations industrielles se doivent de se doter de nouvelles capacités d’innovation de rupture pour organiser l’émergence de nouvelles expertises technologiques afin de permettre la conception innovante de nouveaux produits et technologies.Paradoxalement, les enjeux d’expertise et de conception innovante peuvent parfois sembler en opposition ou du moins en tension. L’expertise semble préserver les dominant designs, mais c’est aussi elle qui permet la génération d’expansion conceptuelle. Derrière cette aporie, se posent des questions cruciales sur le management contemporain de l’émergence de l’expertise dans les organisations industrielles en situation d’innovation intensive.A partir d’une démarche exploratoire basée sur une étude de cas longitudinale chez STMicroelectronics, cette thèse s’intéresse aux modèles de gouvernance de l’émergence de l’expertise dans les organisations industrielles. A partir d’une analyse empirique chez STMicroelectronics, ces travaux mettent en évidence que l’émergence de nouvelles expertises s’effectue par une réorganisation et une restructuration profonde des structures d’expertise. Autrement dit, les nouveaux domaines d’expertise émergent à partir de la recomposition des relations d’interdépendance entre les domaines d’expertises existants.Par ailleurs, ces travaux de recherche proposent un modèle formel de l’émergence de l’expertise dans les organisations industrielles. Ce modèle permet d’identifier de nouveaux enjeux managériaux et de mettre en évidence des modèles organisationnels permettant de supporter ces formes d’émergence d’expertise. De nouvelles solutions managériales sont ensuite expérimentées et analysées chez STMicroelectronics. Enfin, la thèse propose une analyse des rôles et missions des experts scientifiques dans les stratégies d’exploration et d’innovation au sein des organisations industrielles. / In science-based industries, the pace of innovation is characterized by accelerated renewal of products and the destabilization of dominant designs. In this context of intensive innovation, industrial organizations have to develop new breakthrough innovation capabilities to organize the emergence of new technological expertise allowing the innovative design of new products and technologies.Paradoxically, expertise and innovation issues can sometimes seem to be in opposition or at least in tension. Expertise seems to preserve the dominant designs, but it also allows the generation of conceptual expansion. Behind this aporia, there are crucial questions about the contemporary management of the emergence of expertise in science-based organizations in a situation of intensive innovation.From on an exploratory approach based on a longitudinal case study at STMicroelectronics, this thesis focuses on governance models for the emergence of expertise in science-based organizations. Based on an empirical analysis carried out by STMicroelectronics, this work shows that the emergence of new expertise is effected by a reorganization and a profound restructuring of the expertise structures. In other words, new areas of expertise emerge from the reconfiguration of interdependent relationships between existing areas of expertise.Moreover, this research suggests a formal model for the emergence of expertise in science-based organizations. This model allows to identify new managerial challenges and to highlight organizational models to support these expertise emergence forms. Then, new management solutions are tested and analyzed at STMicroelectronics. Finally, the thesis analyses scientific experts’ roles and missions in the innovation strategies within science- based organizations.

Orientadora: Karina Anhezini de Araujo / Banca: Rebeca Gontijo Teixeira / Banca: Wilton Carlos Lima da Silva / Resumo: Compreender os fundamentos do ofício de Rodolfo Augusto de Amorim Garcia (1873-1949), especialmente, naquilo que diz respeito às problemáticas próprias da escrita da história desse autor, sua atuação na coleta, seleção e divulgação de documentos históricos, assim como na organização de acervos, entre os anos de 1932 e 1945, é a questão que norteia esta dissertação. Tendo em vista a tensão entre a figura do erudito e do intelectual identificada naquele período, algumas inquietações perpassam a investigação das relações estabelecidas nos principais locais de sociabilidade e produção do conhecimento em que circulou: Que atividades os chamados eruditos desenvolviam? Quais as motivações dos que se referiam a Rodolfo Garcia como intelectual? Tais indagações servirão como fio condutor na investigação das possibilidades de escritas de vida por meio de correspondências e prefácios, bem como de sua dedicação na validação do conhecimento histórico através dos procedimentos metódicos praticados na edição documental e na promoção de cursos de especialização em um período de investimentos na formação de profissionais / Abstract: Comprehending the métier fundamentals of Rodolfo Augusto de Amorim Garcia (1873-1949), especially, about the own issues on his writing of history, his collecting, selecting and disclosing procedures of historic documents, even as on collection organization, between 1932 and 1945, is the main question of this dissertation. Taking in account the tension between erudite and intellectual figure at that period, some concerns pervade the investigation about the relationships established on the main sociability and production places of knowledge where he has been: What activities did the so-called erudite develop? Which were the motivations of those who referred Rodolfo Garcia as intellectual? Such inquiries will be used as conducting wire in investigation about the possibilities of writing of life by means of correspondences and forewords, as well as his dedication on history knowledge validation by methodical proceedings used in documental edition and promoting specialization courses during a period of investments on professional formation / Mestre