Literature on continuing education for members of the health professions has stressed that understanding of the diffusion process is fundamental to the development of sound educational programs. A review of the literature on diffusion suggests that the theoretical framework that has evolved concerning the transmission of information about new ideas and practices in other disciplines may be applied to nursing. The present study analyzes the process of diffusion as it functions in regard to changes in nursing practice in a selected segment of Canadian hospitals. Three aspects of diffusion are investigated: (1) the flow of new information in nursing through a network of hospitals; (2) factors affecting the adoption of new nursing practices; and (3) factors influencing delay in the adoption process, rejection of innovations, or their discontinuance following adoption. The population consisted of eighty-five public general hospitals in the province of British Columbia. An analytical survey method was used and the structured interview technique employed to gather data from the Director of Nursing of each hospital. Data relative to the flow of information were analyzed by calculating frequency and percentage distributions to assess the relative importance of sources of information used by the Directors of Nursing, and flow charts developed to illustrate the transmission of information through the network of hospitals. Characteristics of the hospitals, of the Directors of Nursing, of the hospital administrators, and of the nursing staffs, with emphasis on the first two, were studied relative to the adoption of nine new practices in nursing. The hospitals were divided into four categories, according to size. An adoption score for each hospital was computed, based on the stage in the adoption process reached by the nurses for each of the nine innovations. Using these scores, the hospitals were divided into four adopter categories and characteristics of the population related to these. Frequency and percentage distributions were again used to analyze factors influencing delay, rejection and discontinuance of innovations. Significant findings in regard to the sources of information used by nurses were (1) the importance of interpersonal communication with colleagues; (2) the high ranking of continuing education programs as an initial source of new knowledge; (3) the role of the hospital supply house salesman in disseminating information to nurses, and (4) the decreasing importance of impersonal sources in later stages of the adoption process. Two cycles of influence were shown to be operating in the flow of information to nurses in the province; the first deriving from the major teaching and research centers in Vancouver; the second, from the larger centrally located hospitals in districts of the province. Four sequential steps were identified in the transmission of information to nurses in British Columbia. The specific characteristics of the population which showed a relationship to adoption included: 1. Size , teaching status, geographic location, and accreditation of the hospital, 2. Age of the Director of Nursing, her marital status, academic preparation, professional nursing experience, extent of attendance at educational meetings, participation in professional nursing organizations, and subscription to nursing journals. 3. Professional preparation and prestige of the hospital administrator, 4. Relative age of the nursing staff. Factors influencing delay, rejection or discontinuance were shown to be related both to characteristics of the new practice and to characteristics of the individuals involved in making the decision to adopt innovations. From the findings of this study, it is evident that there is a serious problem in the communication of new information to nurses employed in public general hospitals in British Columbia. The problem is particularly acute in regard to the nurses in small hospitals. It is suggested that a step towards resolution of this problem might be the development of a 'systems' approach to continuing education for nurses. This approach could effectively utilize resources and facilities throughout the province and provide for coordination of all educational activities for nurses. An integral part of the system would be the development of information retrieval centers in nursing to supplement continuing education programs in the communication of scientific information to nursing practitioners. Areas suggested for further research include: an investigation of the flow of information through the social network of nurses within a hospital; an analysis of the in-service aspects of continuing education for nurses; a study of the role of change agents in nursing; the extent of the commercial salesman's influence on the adoption of nursing innovations; and research into various aspects of continuing education programs for nurses, such as an analysis of participants, the effectiveness of the short, continuing education course, and the design of effective methods of instruction. / Education, Faculty of / Graduate

by Chan Wai Han, Florence, Hui Wendy Wan Yee. / Thesis (M.B.A.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaf [44]).

According to the statistics from Department of Health, Executive Yuan, in 2007,brain attack has been listed as the third of the top ten reasons for death. In Taiwan, the occurrence rate of brain attack on population above 35-year-old is 3/1000. And the total amount of population above 35-year-old is nearly 10,000,000. Then the latest number of occurrence of brain attack is approximately 30,000¡COnce the stroke happens, under such a circumstance, not only the expense of acute care increases but also the long-term medical care expense, the family and social cost will become larger. In view of that, the long-term care plan for stroke patient has been in urgent need. This research, ¡¨Long-distance Community Health Care Nursing Service for Stroke Patients¡¨, which is originated from a plan conducted by a medical center in Southern Taiwan. Based on Andersen¡¦s¡]1968¡^health behavior model as the theoretical structure¡Awe studied 102 patients who had a stroke (including high stroke risk patients)within one year in Kaohsiung. In this study, we applied JMP V6.0¡]SAS Institute, Cary, NC, USA¡^to analyzing case characters¡Aconducting univariate analysis by £q2 analysis and ANOVA. Then we applied multivariate logistic regression analyses to significant variables. We hope to find out the predisposition, enabling factors and need factor from those important predictor variables in ¡§Long-distance Community Health Care and Nursing Service¡¨. We research the differences of stroke patients¡¦ behaviors, providing those research results as the reference materials for related business promotional strategy in future, hoping to advance the quality of long-term care and nursing for stroke patients. In this study, total 102 copies of the questionnaire were sent out and returned, with a return rate of 100%, and 100 copies of questionnaire were effective. The research results show that: 1. Predisposition¡GThere are significant differences on these items--¡§Number of Children¡¨(Demography), ¡§Buddhist¡¨(Religion) and ¡§Those who have a health check within nearly one year¡¨(Health Concept). 2.Enabling factors¡GThere are significant differences on these items--¡¨Monthly Family Income¡¨(Economical factor),¡¨Monthly Balance of Payment¡¨(Economical factor) and ¡§Commercial Insurance¡¨(Insurance resource). 3.Need factors¡GPeople (those who think their health state stay at the average level), Health State (¡§High Blood Pressure and Heart Attack¡¨,¡¨Eye Diseases¡¨, ¡¨Cancer¡¨,¡¨Bone and Muscle¡¨,¡¨Asthma¡¨,¡¨Ears Disease¡¨and ¡¨Neural Diseases¡¨are involved. The behavior research includes ¡§Number of Accepting Medical Treatment per month¡¨(1 to 2 times), ¡§Activity in Daily Life ¡¨¡]ADL¡BIADL-Shopping Ability¡^and ¡§Functional Behaviors¡¨. 4. To sum up, the predisposition, enabling and need factors in this research could partially influence using behaviors¡Ain accordance with Andersen¡¦s inference in health behavior model. In conclusion¡G1.¡¨Long-term Community Health Care and Nursing¡¨ can be applied to stroke patients, which can help patients to build up effective self-management and advance life quality; 2. This service combines Medical Service Chain established by Information-Telegraphic Technology. Currently, blood pressure checking and telephone consultation are most popular service among interviewees, and other kinds of service are under development; 3. Stroke patients with different demographical characters show a great difference on using behaviors; 4. To speak briefly, this service can meet the ideal long-term care and nursing standard for local aging population.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed June 30, 2007). Includes bibliographical references (p. 202-216).

The thesis compares funding of domiciliary services in the administration district of České Budějovice, the municipality with the extended scope of performance. In the theoretical part I focus on the history of the development of domiciliary social services provided on site and I define the social service at first. Then, I identify the different specifics of social services and their characteristics. Attention is also devoted to funding of social services in the Czech Republic and European countries. I also show the differences in management in the non-profit sector. The most important section of the thesis analyzes domiciliary service and gives its definition. Further, the thesis contains practical part, which compares the collected data on the domiciliary services. It specifies services provided within the domiciliary services, funds granted for the service, number of clients, basic information on providers and their pricelists. The data were collected as of the last quarter of 2011. The target of the thesis was to compare the income and expenditures of the domiciliary services provided in the administration district of České Budějovice, the municipality with the extended scope of performance. For the applied methodology I selected qualitative research and the secondary analysis of data as the applied method. The conducted research analysed four types of services provided in the administration district. The original hypothesis of the thesis that the assessed providers have identical average cost per 1 user proved to be invalid.

En 1960, après 40 années de professionnalisation, les infirmières françaises étaient dotées d’un modèle original de profession fortement structuré et témoignant d’une qualification qui avait indéniablement gagné en épaisseur. La Grande Guerre et ses prolongements avaient favorisé la pénétration en France du prototype professionnel anglo-américain. Même si cette influence fut limitée, en 1960 le modèle français était comparable en de nombreux points à l’historique modèle anglais et à son successeur américain. En revanche, les infirmières françaises ne connaissaient à cette date ni les perspectives de carrière de leurs collègues, ni le chemin de l’Université alors impensable. La création de l’EIEIS à Lyon en 1965 offrit cette possibilité à un petit nombre d’entre elles et constitua une extraordinaire opportunité pour le développement de la profession en France. L’élite très active formée grâce à cette institution œuvra à la modification des représentations de la profession chez les médecins, les universitaires, les directeurs d’hôpitaux et les politiques. Elle contribua aussi à changer les pratiques et le rapport au monde des infirmières françaises qui inventèrent même un mouvement revendicatif original à la fin des années 1980. Enfin, cette École établit les bases d’un développement disciplinaire des soins infirmiers en France. Unique en son genre, elle ferma en 1995, faute des moyens nécessaires au maintien de son activité. Le New public management, de plus en plus présent à l’hôpital, privilégia la rationalisation des organisations et leur gestion strictement comptable, au détriment des considérations sur le développement académique des soins infirmiers en France. / In 1960, after 40 years of vocational development, the French nurses were endowed with an original model of occupation strongly structured demonstrating that their qualification had undeniably gained in thickness. The Great War and its repercussions had furthered the penetration of the Anglo-American professional prototype in France. Even if this influence was limited, in 1960 the French model was comparable in numerous points to the historical English model and its American successor. On the other hand, the French nurses knew nothing about their colleagues’ career prospects and the way to University, which was unthinkable at the time. In 1965, the creation of the EIEIS in Lyon, gave to a small number of them this opportunity and established a tremendous occasion for the development of the nursing profession in France. The very active elite turned out thanks to this institution managed to change opinions about nursing profession among doctors, hospitals’ managers, academic people and public authorities. It also conduced to change French nurses’ practices and relationship to the world. Nurses even invented an original movement of protest at the end of 1980s. Finally, this School laid the foundations for an academic development of nursing in France. Though it was unrivalled in the country, it closed in 1995, due to the lack of necessary means to preserve its activity. “New public management”, more and more present in hospitals, promoted the rationalization of organizations and a strictly accounting management rather than an academic development of nursing in France.

The house is located in a quiet part of Strachotín. The plot itself is now used as agricultural land. The bio corridor belt creates a natural dominance around the area and ensures safe drainage of water during torrential rains. The concept is based on a wide range of services and care. The home for seniors will become part of the life of all seniors in the village and nearby. Supporting home-based autonomy allows seniors to live in their own home and only use the services that are available. Visits and social activities are a matter of course. Accommodation in the house itself will preferably be provided to seniors who require constant care. The operating standard of the home is designed to a very good standard. The home offers a barrier-free environment, single or double rooms. Meeting rooms are an important part of the house, along with a garden and bathing biotope. Separate living from operation guarantees a high level of privacy and allows direct contact with the garden.

Introdução: Os conflitos éticos na saúde, geralmente, ocorrem entre os atores envolvidos na ação assistencial. Essa ação, no entanto, é realizada em estruturas organizacionais, sofrendo implicações desse ambiente. Dependendo da organização do trabalho e das metas institucionais pode haver maior ou menor intensidade dessas interferências. Assim, não raro os enfermeiros atuantes no gerenciamento se deparam com situações que apresentam problemas éticos nessa área. Objetivos: Identificar conflitos éticos na percepção de enfermeiros com vivência no gerenciamento de Serviços de Enfermagem hospitalar e analisar como os enfermeiros com vivência no gerenciamento em enfermagem tomam decisões frente a conflitos éticos. Método: Trata-se de um estudo exploratório, descritivo de abordagem qualitativa. Para a coleta de dados do primeiro objetivo, após a aprovação do Comitê de Ética em Pesquisa, foram entrevistados 20 enfermeiros, com vivência profissional na área gerencial hospitalar, constituindo uma amostra intencional, através da técnica bola de neve\" (snow ball). As entrevistas gravadas foram realizadas através de uma pergunta norteadora: Conte-me a respeito de conflitos éticos que tenha vivido na sua atuação gerencial. A coleta de dados do segundo objetivo foi realizada através da técnica de grupo focal, sendo utilizado um caso fictício (caso-conflito), contendo uma situação gerencial hipotética para o debate sobre a decisão. No caso-conflito os dois valores éticos situaram-se nos cursos de ação extremos: prestar assistência de enfermagem segura e atender ordem institucional de redução de quadro de pessoal para viabilizar a sobrevivência financeira do hospital. Os discursos foram analisados segundo a análise de conteúdo proposta por Bardin, balizados pelo referencial metodológico-conceitual do procedimento da Teoria de Deliberação Moral de Diego Gracia. Resultados: Emergiram inicialmente três categorias: igualdade na distribuição da carga de trabalho; autonomia profissional nas decisões gerenciais e justiça e prudência nas decisões gerenciais. Evidenciou-se que os conflitos éticos no gerenciamento em enfermagem decorreram da percepção dos valores confrontados, presentes no problema ético. Os conflitos éticos materializam-se na gestão de recursos em saúde, nas relações de poder no ambiente de trabalho, nas relações interpessoais, na organização do trabalho e nas determinações da política institucional, como partes da conjuntura que constitui a assistência ao paciente, visando à proteção e manutenção de sua dignidade. Na decisão realizada coletivamente, em geral, os cursos de ação tendenciaram para o curso médio, considerados prudentes, indicando conciliar os valores em conflito do caso, ordem e cuidado. Entretanto, mesmo com tendência para o espaço da prudência, a maioria das argumentações dos cursos de ação, se situou privilegiando a preservação do cuidado de enfermagem. Conclusão: Os enfermeiros-gerentes, diante de fatos impositivos das determinações organizacionais, elegem a assistência de enfermagem como prioridade, mas tentam uma conciliação das partes. A prudência, como resultado do debate colegiado dos enfermeiros, revela a necessidade de investimentos em espaços grupais de discussão (bio)ética e na capacitação dos profissionais, expandido os diálogos éticos, inclusive interinstitucionalmente. Vislumbra-se um terreno fértil a ser explorado, que possibilite debates e deliberação sobre os problemas éticos que afligem os enfermeiros, contribuindo para amenizar momentos de angustia e, até, de sofrimento moral presentes nos conflitos de valores desses profissionais / Introduction: The ethical conflicts in health, generally, occur between the actors involved in care action. This action, however, is performed in organizational structures, suffering implications of this environment. Depending on work organization and institutional goals there may be greater or lesser intensity of these interference. So often the nurses working in management are faced with situations that present ethical problems in this area. Objectives: Identifying ethical conflicts in the perception of nurses with experience in hospital Nursing Services management and analyzing how nurses with experience in nursing management take decisions before the ethical conflicts. Method: This is an exploratory, descriptive study of qualitative approach. For collecting the data of the first objective, after the Research Ethics Committee approval, 20 nurses, with professional experience in hospital management area were interviewed, constituting an intentional sample, through \"snowball\" technique. Recorded interviews were conducted by a guiding question: \"Tell me about ethical conflicts that you have lived in your managerial acting.\" The data collection of the second objective was performed through the focus group technique, and used a fictitious case (case-conflict), containing a hypothetical managerial situation to the debate on the decision. In the case-conflict both ethical values stood in extreme \"courses of action\": provide safe nursing care and meet institutional order for staff reduction to enable the financial survival of the hospital. The speeches were analyzed according to content analysis proposed by Bardin, marked by methodological and conceptual framework of the Moral Deliberation Theory procedure of Diego Gracia. Results: First emerged three categories: equal in the distribution of the workload; professional autonomy in management decisions and justice and prudence in management decisions. It was evident that the ethical conflicts in nursing management resulted from the perception of values confronted, present in ethical problem. Ethical conflicts materialize in health resource management, in power relations in the workplace, in interpersonal relationships, work organization and in the determinations of institutional policy, as part of the environment that is patient care, aimed at protecting and maintaining its dignity. In the collectively held decision, in general, courses of action lean toward the middle course, considered prudent, indicating reconcile the conflicting values of the case, order and care. However, even with a tendency for the space of prudence, most of the arguments of \"courses of action\", stood favoring the preservation of nursing care. Conclusion: Nurses-managers, before impositions facts of organizational determinations, elect nursing care as a priority, but try a reconciliation of the parties. Prudence, as a result of collegiate debate of nurses, reveals the need for investment in group spaces for (bio)ethics discussion and professional training, expanded the ethical dialogue, including inter-institutionally. It glimpses a \"breeding ground\" to be exploited, which allow debates and deliberation on the ethical problems that afflict nurses, contributing to soften moments of anguish and even of moral suffering present in value conflicts of these professionals

This is the first monograph to be published on the work of the Queen Alexandra's Imperial Military Nursing Service (QAIMNS) in the Great War. The historiography of British military nursing during this period is scant, and research based monograph are negligible. What exists, does not focus specifically on the work of the Queen Alexandra's Imperial Military Nursing Service, (QAIMNS) the Reserve, (QAIMNSR) or the Territorial Force Nursing Service (TFNS) but tends to concentrate on the work of the volunteer, untrained, Voluntary Aid Detachment (VAD) nurses. Unfortunately, this has resulted in factually inaccurate representations of British WW1 nursing. The mass mobilisation of nurses by professional and voluntary nursing services led to rivalry between the different groups and my research addresses the relationship that develop between the trained and volunteer nurses. Also, my research examines the climatic and environmental conditions that impacted upon the effective delivery of nursing and casualty care and the mismanagement of services and supplies by the War Office and the Army Medical Services. Additionally, the political controversies and scandals over inadequate planning for the care, treatment and transportation of mass casualties is addressed. Furthermore, diseases and traumatic injuries sustained by nurses on active service are examined and, shell-shock, hitherto considered a combatants' condition is cited in relation to mental health issues of nurses on active service. Moreover, my research examines the deaths and disability rates within the ranks of nursing services. My research features individual awards for acts of bravery and mentioned in Dispatches. On the Home Front the politics of nursing are addressed. Nurses campaigned for professional recognition and many were supportive of universal suffrage and they argued for both professional and personal liberation. The struggle for professional recognition led to divisions within the civilian nursing leadership because they failed to arrive at a consensus on the content of the Nurse Registration Bill. Also, the supply of nurses for the war effort was consistently problematic and this led the Government to establish the Supply of Nurses Committee. Before it had its first sitting it had already become contentious and controversial. The issues are discussed. Using extensive primary sources, the monograph moves away from the myths, and uncritical and overly romanticised views of WW1 military nursing. It is hoped that by examining the personal, professional and political issues that impacted upon nurses the monograph will make a significant contribution to the historiography of WW1 military nursing and to the history of the Great War more generally.

Introdução: Os conflitos éticos na saúde, geralmente, ocorrem entre os atores envolvidos na ação assistencial. Essa ação, no entanto, é realizada em estruturas organizacionais, sofrendo implicações desse ambiente. Dependendo da organização do trabalho e das metas institucionais pode haver maior ou menor intensidade dessas interferências. Assim, não raro os enfermeiros atuantes no gerenciamento se deparam com situações que apresentam problemas éticos nessa área. Objetivos: Identificar conflitos éticos na percepção de enfermeiros com vivência no gerenciamento de Serviços de Enfermagem hospitalar e analisar como os enfermeiros com vivência no gerenciamento em enfermagem tomam decisões frente a conflitos éticos. Método: Trata-se de um estudo exploratório, descritivo de abordagem qualitativa. Para a coleta de dados do primeiro objetivo, após a aprovação do Comitê de Ética em Pesquisa, foram entrevistados 20 enfermeiros, com vivência profissional na área gerencial hospitalar, constituindo uma amostra intencional, através da técnica bola de neve\" (snow ball). As entrevistas gravadas foram realizadas através de uma pergunta norteadora: Conte-me a respeito de conflitos éticos que tenha vivido na sua atuação gerencial. A coleta de dados do segundo objetivo foi realizada através da técnica de grupo focal, sendo utilizado um caso fictício (caso-conflito), contendo uma situação gerencial hipotética para o debate sobre a decisão. No caso-conflito os dois valores éticos situaram-se nos cursos de ação extremos: prestar assistência de enfermagem segura e atender ordem institucional de redução de quadro de pessoal para viabilizar a sobrevivência financeira do hospital. Os discursos foram analisados segundo a análise de conteúdo proposta por Bardin, balizados pelo referencial metodológico-conceitual do procedimento da Teoria de Deliberação Moral de Diego Gracia. Resultados: Emergiram inicialmente três categorias: igualdade na distribuição da carga de trabalho; autonomia profissional nas decisões gerenciais e justiça e prudência nas decisões gerenciais. Evidenciou-se que os conflitos éticos no gerenciamento em enfermagem decorreram da percepção dos valores confrontados, presentes no problema ético. Os conflitos éticos materializam-se na gestão de recursos em saúde, nas relações de poder no ambiente de trabalho, nas relações interpessoais, na organização do trabalho e nas determinações da política institucional, como partes da conjuntura que constitui a assistência ao paciente, visando à proteção e manutenção de sua dignidade. Na decisão realizada coletivamente, em geral, os cursos de ação tendenciaram para o curso médio, considerados prudentes, indicando conciliar os valores em conflito do caso, ordem e cuidado. Entretanto, mesmo com tendência para o espaço da prudência, a maioria das argumentações dos cursos de ação, se situou privilegiando a preservação do cuidado de enfermagem. Conclusão: Os enfermeiros-gerentes, diante de fatos impositivos das determinações organizacionais, elegem a assistência de enfermagem como prioridade, mas tentam uma conciliação das partes. A prudência, como resultado do debate colegiado dos enfermeiros, revela a necessidade de investimentos em espaços grupais de discussão (bio)ética e na capacitação dos profissionais, expandido os diálogos éticos, inclusive interinstitucionalmente. Vislumbra-se um terreno fértil a ser explorado, que possibilite debates e deliberação sobre os problemas éticos que afligem os enfermeiros, contribuindo para amenizar momentos de angustia e, até, de sofrimento moral presentes nos conflitos de valores desses profissionais / Introduction: The ethical conflicts in health, generally, occur between the actors involved in care action. This action, however, is performed in organizational structures, suffering implications of this environment. Depending on work organization and institutional goals there may be greater or lesser intensity of these interference. So often the nurses working in management are faced with situations that present ethical problems in this area. Objectives: Identifying ethical conflicts in the perception of nurses with experience in hospital Nursing Services management and analyzing how nurses with experience in nursing management take decisions before the ethical conflicts. Method: This is an exploratory, descriptive study of qualitative approach. For collecting the data of the first objective, after the Research Ethics Committee approval, 20 nurses, with professional experience in hospital management area were interviewed, constituting an intentional sample, through \"snowball\" technique. Recorded interviews were conducted by a guiding question: \"Tell me about ethical conflicts that you have lived in your managerial acting.\" The data collection of the second objective was performed through the focus group technique, and used a fictitious case (case-conflict), containing a hypothetical managerial situation to the debate on the decision. In the case-conflict both ethical values stood in extreme \"courses of action\": provide safe nursing care and meet institutional order for staff reduction to enable the financial survival of the hospital. The speeches were analyzed according to content analysis proposed by Bardin, marked by methodological and conceptual framework of the Moral Deliberation Theory procedure of Diego Gracia. Results: First emerged three categories: equal in the distribution of the workload; professional autonomy in management decisions and justice and prudence in management decisions. It was evident that the ethical conflicts in nursing management resulted from the perception of values confronted, present in ethical problem. Ethical conflicts materialize in health resource management, in power relations in the workplace, in interpersonal relationships, work organization and in the determinations of institutional policy, as part of the environment that is patient care, aimed at protecting and maintaining its dignity. In the collectively held decision, in general, courses of action lean toward the middle course, considered prudent, indicating reconcile the conflicting values of the case, order and care. However, even with a tendency for the space of prudence, most of the arguments of \"courses of action\", stood favoring the preservation of nursing care. Conclusion: Nurses-managers, before impositions facts of organizational determinations, elect nursing care as a priority, but try a reconciliation of the parties. Prudence, as a result of collegiate debate of nurses, reveals the need for investment in group spaces for (bio)ethics discussion and professional training, expanded the ethical dialogue, including inter-institutionally. It glimpses a \"breeding ground\" to be exploited, which allow debates and deliberation on the ethical problems that afflict nurses, contributing to soften moments of anguish and even of moral suffering present in value conflicts of these professionals