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Community organizing has a rich tradition within the field of social work. Prevailing community practice models, approaches, and frameworks remain primarily based on practice wisdom, experience, and intuition. Difference, pervasive in various contemporary contexts of practice, largely mediates interactions at the community level. Although difference is addressed at various levels of the practice continuum and within the IFSW and NASW codes of ethics, few methodologically driven tools exist within the literature to guide practitioners. This grounded theory study initiates early development of a community practice model based on forging alliances across boundaries of difference. The Critical Difference Engagement model is based on local community leaders’ and organizers’ experiences working across dimensions of power, race, gender, age, sexual orientation, and socio-economic status, it provides practitioners with a framework for social change and building solidarity across difference in multiple contexts.

Background: Pelvic organ prolapse (POP) can be treated surgically or, more conservatively, with use of a pessary. Objective: To determine if the population of women treated for POP with the use of a pessary in one Nurse Practitioner's (NP) practice demonstrated health outcomes as better, same, or needing improvement through use of a data-based practice model from encounter data extracted from the electronic health record (EHR).Design: The project design was a quality improvement (QI) project, descriptive in nature. One Plan Do Study Act (PDSA) cycle was conducted for this QI project. Setting: NP managed specialty clinic in urban Southwestern Arizona that provides services to women with POP. Patients: Ten randomly selected women who had been treated conservatively for POP with use of a pessary were identified as two subpopulations and evaluated: women who received professional management of the pessary and women who were patient managed. Intervention: The intervention was the development of a data-based practice model, using patient profile data elements derived from the documented EHR encounters of the 10 women. Measurements: Twelve scales were developed to evaluate the patient profile data elements, generating numeric scores for each encounter. Two Decision Rules were then used to evaluate numeric scores by encounter, creating primary and secondary health outcomes. Limitations: Two limitations were identified. The QI project was limited by the small sample size of 10 patients. This is however, true to PDSA guidelines that recommend small scale cycles. The data were limited as only documented data were used. Conclusions: In general, the expected outcome was the outcome observed; the provider was unaware of any women in this QI Project who were not successfully treated with use of a pessary for treatment of POP. The value of this data-based practice model is that outcomes can be aggregated across populations rather than relying on recall of individual outcomes and therefore has potential to be used regularly and systematically as a quality feedback loop, as well as on a larger scale in future PDSA cycles to determine other outcomes beyond a single provider in this or other similar clinical populations.

Hospital administrators are being held accountable by patients, insurers, and other stakeholders in evaluating their overall hospital performance to reduce costs and improve efficiency. With the move to alternative payment models and value-based purchasing, hospital administrators must understand the economic viability and value that their specialty services bring to their facility. The purpose of this study was to identify the determinants New England acute care hospital administrators’ utilize in making the choice of anesthesia practice model for their facility. A quantitative, exploratory study of factors hospital administrators use when choosing an anesthesia practice model utilizing a non-experimental, correlational research design was completed. The research was descriptive in nature to determine the factors that influenced a hospital administrator when making decisions about the type of anesthesia practice model that would be the best for their hospital. This research examined seventeen independent variables that were hypothesized to determine hospital administrators’ choice of anesthesia practice model. After the final logistic regression analysis, it was determined that the presence of a hospital being located in a medically underserved area (MUA) alone was a predictor of type of anesthesia practice model utilized. In light of the study limitations and prior literature on the CRNA-only model being present in almost 100% of rural facilities, more exploration is necessary to come to more robust conclusions on predictors of choice of anesthesia practice model determined by hospital administrators. This study showed that there are definitive areas that hospital administrators identify as high importance to the healthy functioning of their facility. By addressing these needs, an anesthesia department could contribute to the overall stability of the hospital, while at the same time, making themselves a more valuable asset overall. Value-driven services offered by anesthesia departments may be the determining factor in choice of anesthesia practice model. By measuring and analyzing anesthesia provider and hospital demographics and hospital administrators’ perceptions of anesthesia services, the objective data collected may assist in defining the most appropriate practice model for a hospital.

Colorectal rectal cancer (CRC) is the 3rd most common cancer in men, the 2nd most common cancer in women, and the 4th leading cause of cancer death. Lack of screening or delayed screening for CRC is the major cause of undiagnosed cancers that become malignant and eventually become fatal. Nurses at the project site are not in compliance with CRC screening guidelines due to inadequate knowledge of the screening guidelines recommended by the American Cancer Society, which creates a gap in practice. The purpose of this project was to develop staff education on CRC screening guidelines. The practice focused question addressed if evidence-based education regarding CRC screening could be an effective means for nurse education, according to a panel of local experts. A pre-test evaluation of knowledge regarding CRC screening was administered to nursing staff from the site. The John Hopkins evidence-based practice model guided the development of the staff education program, using the results of the pre-test, evidence-based practice literature and guidelines. The project team, consisting of a physician and medical support staff, evaluated the education program, plan for delivery, and plan for evaluation of learning through an anonymous Likert-style evaluation survey. The 3 team members also completed program evaluation surveys, and 100% agreed or strongly agreed that the program objectives were met. The project was limited to planning only and the education program materials, along with plans for later implementation and evaluation of learning through pre- and post-tests, were handed over to the project site for delivery at a later date. The CRC screening education will become part of the yearly staff competencies, leading to appropriate screening of the site’s patient population. This education project has the potential to promote positive social change by saving lives and improving the quality of those lives.

In 2012, the U.S. Department of Health and Human Services reported an estimated 686,000 victims of child abuse and neglect. Forty-nine states reported a total of 1,593 fatalities. This quantitative research study examined the relationship between the variables: age of child, gender of child, age of parent/caregiver, prior substantiated reports of abuse, and incidents of abuse in Philadelphia at the Department of Human Services using risk practice model (RPM) and safety practice model (SPM). Although child welfare practitioners have examined the relationship between family and societal factors that affect child abuse; few researchers have examined the correlation between service delivery practice models and incidents of abuse. The findings of this quantitative study examined 34,761 components of variable data from the Department of Human Services revealed that the age of the child, age of the caregiver, and incidents of abuse are statistically significant predictors of abuse, whereas the gender of child had minimal effect on incidents of abuse. The most accurate predictor of child abuse is prior substantiated reports of abuse. The study shows that reports received in 2007 using the RPM were 9.6% more likely to have a valid report; likewise, every report received during the years 2007 and 2012 increases the probability of a valid report by 94.2%. Development of a comprehensive assessment tool that combines the principle tenets of both RPM and SPM is recommended. The implications for social change include developing a practice model that can increase safety probabilities while diminishing incidents of abuse by using a more comprehensive assessment tool.

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<p><strong>Abstract</strong></p> <p>Health care practice environments are central to the safety and quality of patient care. Hospitals often develop and implement a professional practice model (PPM) to improve practice environments. In the United States, magnet hospital designation is a driving force in PPM implementation. In Ontario, Canada, despite the lack of magnet hospital designation, many hospitals have implemented PPMs. There appear to be differences in how PPMs are implemented in Ontario.</p> <p>This phenomenographic study examined professional practice experts’ conceptions of PPM implementation and use in Ontario acute care hospitals. The findings indicate that PPM implementation is a dynamic and emergent phenomenon that occurs in cyclical phases of growth and reduced activity.</p> <p>Seven categories of PPM use are described (a) creating alignment/consistency, (b) supporting evidence-based practice, (c) enabling interprofessional practice, (d) enhancing professional accountability, (e) enabling patient-centred care, (f) creating/ strengthening linkages, and (g) strategic positioning of professional practice. Categories exhibited hierarchical relationships, with more foundational uses providing support for higher level uses.</p> <p>Three structural themes are identified (a) model design/structure, (b) professional practice leadership, and (c) organizational support. These themes work individually and synergistically, within and across the categories to influence use and potential impact of the PPM. Progressively fuller and more complex use of the PPM appears to occur under increasingly intense influence of the structural themes.</p> <p>The analysis provides unique information about relationships within and among categories of PPM use. This provides insight regarding how organizations might maximize return on investment with PPM implementation. Seven recommendations are identified.</p> / Master of Science (MSc)

Over the past decade, the healthcare landscape has shifted for Ontario’s family physicians as government policies changed the availability of practice and compensation models. The most impacted population are early career family physicians. Given this changing healthcare environment, the factors that drive early career family physicians practice choices are unclear and not well-studied. Therefore, this thesis sought to answer the following research questions: 1. What factors shape family physician choice of practice and compensation models in Ontario? a. How do early career family physicians perceive the availability of practice and compensation models in Ontario? 2. From the perspective of Ontario family medicine residency administrators, how does residency influence family physician practice choices? This study was a part of a broader, cross-provincial study examining family medicine resident and early career family physician practice patterns in British Columbia, Nova Scotia, and Ontario. Nineteen early career physicians and 7 family medicine residency administrators were interviewed for their perceptions and understanding of the factors and policies affecting their (or in the case of administrators, residents’) career choices. In this thesis, I used thematic analysis as described by Braun and Clarke to answer the research questions. Patton and McMahon’s Systems Theory Framework (STF) provided a systems perspective that was used to model and assess the interactions between emergent themes. The factors that shaped family physician choice of practice and compensation models were divided into micro- and macro-level factors as described by the STF. Micro-level factors were ‘gender’, ‘health’, ‘interests’, and ‘world of work knowledge.’ Macro-level factors included ‘educational institutions’, ‘geographical location’, ‘historical trends’, ‘peers’, ‘family’, ‘community groups’, ‘workplace’, and ‘employment market.’ Finally, two additional factors were found: ‘flexibility’, and ‘financial considerations.’ The interaction between these factors was complex, where many linked themes gave rise to career decisions made by family physicians. A second perspective in the form of residency administrators helped develop a holistic description of these factors. Furthermore, a gap between physician training and practice opportunities after graduation was identified.