Thesis advisor: Christopher Maxwell / Though much research has been done on the subject of substituting nurse practitioners for physicians as health care providers, both analytic methods and results have been inconsistent. Various studies have shown nurse practitioners to provide equivalent or improved care especially in primary care settings. However, no consensus has been reached on whether or not and under what conditions this substitution is economically efficient. Because of variation in productivity and substitution rates, the economic viability of nurse practitioners must be assessed on a department specific basis, taking into account differences in nurse practitioners’ job descriptions.One specific area this economic efficiency could be assessed in is in the diagnosis of ear infections. A study conducted through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey showed that 15% of pediatric visits included a diagnosis of middle ear infection (Freid, 1998). If employed properly, nurse practitioners could be used to achieve significant cost savings in this area.This thesis is intended to address the economic efficiency of nurse practitioners as compared to physicians in diagnosing ear infections. First nurse practitioner quality in this specific area will be assessed by comparing nurse practitioner diagnosis error rates to physician error rates based on surveys asking both types of providers to provide diagnoses based on tympanic membrane images collected through previous telemedicine visits. Next the economic practicality of employing nurse practitioners in this field will be assessed in terms of the relative costs of these errors, measured as the cost of unnecessary prescriptions in the case of overdiagnosis and the cost of an unnecessary follow-up visit in the case of underdiagnosis. / Thesis (BA) — Boston College, 2012. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: Economics Honors Program. / Discipline: Economics.

Ceasing tobacco use benefits smokers regardless of age; therefore, it is essential for health care providers to consistently identify smokers and offer evidence-based cessation treatments to those wanting to stop smoking as a proactive approach towards tobacco abstinence. The purpose of this doctoral project, which was underpinned by the knowledge-to-action framework, was to educate nurse practitioners about evidence-based tobacco cessation interventions and assess the impact of the education on their knowledge base, skills, and self-confidence in implementing tobacco-cessation protocols. Participants (n = 14) completed a knowledge-based questionnaire and the Skills and Confidence for Smoking Cessation Tool before and after an education intervention based on the Rx for Change program. Paired sample t-tests were completed to analyze the pretest and posttest results. The results indicated a statistically significant increase (p < .05) in perceived knowledge, skills, and confidence among nurse practitioners related to tobacco cessation education. These findings support the use of tobacco cessation education for nurse practitioners to improve this aspect of care and provide patients with effective interventions to improve quit rates. The impact of this project on positive social change includes fostering a healthier lifestyle for tobacco users that extends to family and community.

Due to under intense competitions and uneven resource allotments, many medical institutes are not only being pushed ahead with their medical technology but also constantly improving their medical management and efficiency for achieving higher medical quality. In Taiwan, it takes ten years to train a doctor; however, it is possible to have a NP (Nursing Practitioner) to substitute partial capacity of a resident; as long as the NP has equivalent working experiences, a short-term training and also to pass exams as well. Therefore, using a qualified NP in medical institutes is a more economical and practical way of utilizing human resource benefits; as far as for the medial caring services it also has a substantive significance. This study is a research that is based on a certain southern teaching medical hospital¡¦s doctors, nurses, patients, medical services and other medical related people.It is divided into two parts to proceed: first, collect information from quality based researching interviews of targeting people in order to study their perspectives toward to the system of NP. Then, a quantifiable survey is being designed according to the result of the interviews and some other verified literature content; therefore, the merit of NP can be proven by the medical hospital¡¦s human resource efficiency trend.Further discussion on whether medical professional personnel attributes can affect theperception of NP; to anticipate an establishment of independent NP system in the future medical system. According to the research results: (1) 51.8% participants of the interviews think that the establishment of independent NP system is not only a demand from hospitals, doctors as well as the patients. It may even promote overall hospitals management efficiency. The demand 28.4% accounts come from doctors; to a certain extent that many participants believe to establish an independent NP system can possible to share an appropriate amount of doctors¡¦ workloads. 47.2% participants believed that the act of NPs in medical system is ¡§Physician Assistant¡¨. In addition, about 50% participant thought that the NPs can substitute residents and they can cut down cost,be economized the use of manpower training time, improve efficiency, promote medical service quality and so on. (2) A remarkable difference in ¡§Expanding System Construction Interface¡¨¡]F=3.495¡Ap=.018¡^is found because the participants come from different age groups. The younger participants are, the lower they score. Thus, it is possibly to say when come to develop nursing care network and community medical caring Expanding System Construction Interface that the younger medical professionals are, the lower understanding and less recognizing they are. (3) According to different seniority of every single interface variance analysis; the differences of seniority medical professionals in ¡§Expanding System Construction Interface¡¨¡]F=4.153¡Ap=.008¡^, after comparing with Scheffe¡¦s method,has scored above an average: above five years > 3-5. In comparison, one who has more seniority has obtained a higher score. (4) Monthly income in the SubstitutionConstruction Interface (F=3.174, p=.046) has a remarkable difference. According to the description of personnel attributes; doctors who have the average monthly income above 120,000NTD have occupied the majority (38.2%). However, in comparing with other categories; to provide resident's immediate supports, as well as others¡¦ understanding and recognizing of the NPs have obtained a lower score. The purpose of this research is to believe that there should be more explicit direction and further related implementation in all the future hospital policy, in order to enable the NPs to make full use of their ability. At the moment, there is a rather vague definition of NPs¡¦ job in Taiwan; in fact, the establishment of NPs¡¦ system has not much explication either. Therefore, while evaluating overseas¡¦ system, method and training, it may not be approved by the present medical professionals without envisaging a thoughtful systematic construction first. However, according to the findings of this research; it is necessary to have a further discussion. It is to suggesting a future specific and comprehensive plan: expanding case acceptance throughout all level of hospitals in Taiwan to promote the result of inference; designing a further discussion survey of focusing on NPs¡¦ beneficial results as for the future research foundation.

This is a study of the constitution of adolescents' identity through authentic assessment experiences in my Grade 8 homeroom English class in a rural school in Nova Scotia, Canada. It combines postructuralist theory with practitioner research and examines how young people, through authentic assessment, constitutioned identities in my classroom to be assessed.

In this study, I consider the status of the academic discipline of entrepreneurship as represented in refereed journal articles and citations in the Web of Science database within a broad philosophical framework, developed for this investigative purpose. This dissertation firstly explores an understanding of knowledge as offered by French social theorist, Michael Foucault, identifying two forms of knowledge. Using Foucault’s distinctions, I develop models that position savoir and connaissance knowledge, which I define as practical applications of understanding and academic orientations of explaining, in relation to disciplines and discourses. The strategic apparatus of the episteme is included in my models as a discipline-based method of determining the acceptability of knowledge into the discipline, incorporating the varied roles of gate-keepers, intellectuals and other participants into the models. The roles of epistemology and ontology are discussed and included in the models. Further, drawing on the works of German philosopher, Martin Heidegger, I introduce the concept of an ontological test as a possible means to consider whether an academic discipline clearly understands its ‘meaning of being’ or, alternatively, could be considered to have passed Foucault’s point of epistemologization and be termed a ‘dubious discipline’. Academic thinking on entrepreneurship has come under an array of criticism from within the discipline, including criticism as to a perceived lack of objectivity. The models developed in this dissertation are applied to the discipline of entrepreneurship in order to better understand the development of the discipline of entrepreneurship and the reasons for this criticism. Using the episteme of the Web of Science database, I apply citation analysis to identify those articles and texts which are considered within the entrepreneurship discipline to have the highest gravitas. These high gravitas articles are used to create an archaeological representation or aliran that illustrates the development of the discipline over time and the ontological development of sub-aliran. This aliran is a phenomenological representation of the discipline based upon the episteme to depict the episteme ‘as it is’. This representation is hermeneutically interpreted to discern the development of various sub-aliran, and identify the possible influence of gate keepers with high gravitas in such development. Based upon my survey of high gravitas articles from the aliran, I found there was a general exclusion of practitioner both as an audience for and as a source of savoir knowledge. Admittedly this finding could well be attributed to the nature of the episteme selected for the research. The exception to this general finding was in the Venture Capital sub-aliran. Further findings indicated an apparent feature of the aliran was a higher than expected level of demarcation between the organization and the firm. This demarcation had several features including an increasing trend towards learning by the organization as applied to entrepreneurship. Firms were not perceived to engage in learning but did engage in new ventures and undertook innovation. These functions were not indicated within the aliran to be part of the functions of the organization. Innovation was also not shown to be an activity conducted by individuals but was a preserve of the firm. These findings are consistent with the political structure of the Academy of Management’s Entrepreneurship Division and indicate the influence this body likely has on the discipline. In some instances, as might be expected, there was an overt level of construction of some sub-aliran by those with high gravitas in the discipline. This was most apparent in endeavours to add ‘corporate’ nominations to entrepreneurship, innovation and venturing. In the case of corporate entrepreneurship, such overt construction was perceived to be less than successful. However, the changing orientation offered by such construction is seen to offer a new direction to entrepreneurship which may be realized in the fledgling Strategic Entrepreneurship sub-aliran. Some sub-aliran observed was considered to be more introverted due to restraints imposed by the political structuring of the discipline. While the discipline of entrepreneurship may not to be able to pass Heidegger’s ontological test and could be considered a dubious discipline (doubtless like so many others), this finding should not be deemed to be unduly negative. As with Gadamer’s rehabilitation of prejudice, the term dubious could be rehabilitated to be positive and encourage moves towards greater objectivity, or at least greater rigour, within the discipline of entrepreneurship.

In this study, I consider the status of the academic discipline of entrepreneurship as represented in refereed journal articles and citations in the Web of Science database within a broad philosophical framework, developed for this investigative purpose. This dissertation firstly explores an understanding of knowledge as offered by French social theorist, Michael Foucault, identifying two forms of knowledge. Using Foucault’s distinctions, I develop models that position savoir and connaissance knowledge, which I define as practical applications of understanding and academic orientations of explaining, in relation to disciplines and discourses. The strategic apparatus of the episteme is included in my models as a discipline-based method of determining the acceptability of knowledge into the discipline, incorporating the varied roles of gate-keepers, intellectuals and other participants into the models. The roles of epistemology and ontology are discussed and included in the models. Further, drawing on the works of German philosopher, Martin Heidegger, I introduce the concept of an ontological test as a possible means to consider whether an academic discipline clearly understands its ‘meaning of being’ or, alternatively, could be considered to have passed Foucault’s point of epistemologization and be termed a ‘dubious discipline’. Academic thinking on entrepreneurship has come under an array of criticism from within the discipline, including criticism as to a perceived lack of objectivity. The models developed in this dissertation are applied to the discipline of entrepreneurship in order to better understand the development of the discipline of entrepreneurship and the reasons for this criticism. Using the episteme of the Web of Science database, I apply citation analysis to identify those articles and texts which are considered within the entrepreneurship discipline to have the highest gravitas. These high gravitas articles are used to create an archaeological representation or aliran that illustrates the development of the discipline over time and the ontological development of sub-aliran. This aliran is a phenomenological representation of the discipline based upon the episteme to depict the episteme ‘as it is’. This representation is hermeneutically interpreted to discern the development of various sub-aliran, and identify the possible influence of gate keepers with high gravitas in such development. Based upon my survey of high gravitas articles from the aliran, I found there was a general exclusion of practitioner both as an audience for and as a source of savoir knowledge. Admittedly this finding could well be attributed to the nature of the episteme selected for the research. The exception to this general finding was in the Venture Capital sub-aliran. Further findings indicated an apparent feature of the aliran was a higher than expected level of demarcation between the organization and the firm. This demarcation had several features including an increasing trend towards learning by the organization as applied to entrepreneurship. Firms were not perceived to engage in learning but did engage in new ventures and undertook innovation. These functions were not indicated within the aliran to be part of the functions of the organization. Innovation was also not shown to be an activity conducted by individuals but was a preserve of the firm. These findings are consistent with the political structure of the Academy of Management’s Entrepreneurship Division and indicate the influence this body likely has on the discipline. In some instances, as might be expected, there was an overt level of construction of some sub-aliran by those with high gravitas in the discipline. This was most apparent in endeavours to add ‘corporate’ nominations to entrepreneurship, innovation and venturing. In the case of corporate entrepreneurship, such overt construction was perceived to be less than successful. However, the changing orientation offered by such construction is seen to offer a new direction to entrepreneurship which may be realized in the fledgling Strategic Entrepreneurship sub-aliran. Some sub-aliran observed was considered to be more introverted due to restraints imposed by the political structuring of the discipline. While the discipline of entrepreneurship may not to be able to pass Heidegger’s ontological test and could be considered a dubious discipline (doubtless like so many others), this finding should not be deemed to be unduly negative. As with Gadamer’s rehabilitation of prejudice, the term dubious could be rehabilitated to be positive and encourage moves towards greater objectivity, or at least greater rigour, within the discipline of entrepreneurship.

This thesis explores the newly established role of midwife practitioner (MP) and its impact on midwives and obstetricians in a maternity unit in Wales. MPs manage the care of women at high obstetric risk and carry out aspects of care, such as assessment, diagnosis and the development of management plans, which in the past were predominantly performed by obstetricians. This qualitative study employs a focused ethnographic approach and uses a purposive sample. Phase one consisted of seven focus groups, which were held between May and August 2004, with midwives (n=48) from maternity units in Mid and South Wales. In Phase two, participant observation was undertaken with MPs (n=3) over a two-week period encompassing eight 12-hour night shifts, during November and December 2004. For Phase three, semi-structured interviews were conducted with midwives (n=10), clients (n=10) and obstetricians (n=7), between July and December 2005. Phases two and three were carried out in a maternity unit in South Wales. The key findings of this study demonstrate that the lack of planning for the MP role inadvertently resulted in the creation of a distinct health care role, which encompasses positive aspects of both midwives' and obstetricians' work to provide safe and acceptable care for clients. The MPs in this study are committed to providing holistic care that takes into consideration the emotional and social needs of women and their families. In addition, these MPs are developing confidence and analytical skills, normally demonstrated by medical staff. However, further initiatives such as allowing MPs to prescribe, or to refer to other specialties, have not yet been adapted to support these new roles. It is too early to see the full impact of this role, but it is argued that it will have no significant effect on the work of the other midwives. MPs, however, do have the potential to impact upon the work of the obstetricians. This study contributes to the current body of knowledge concerning policy and practice for maternity care by examining a new role early in its genesis. This study makes a number of recommendations, including extending the number of MPs employed in Wales, the need for careful planning of future extensions to the midwives' role and further research into the safety and effectiveness of the MP role.

The Affordable Care Act has changed the face of health care provision and services in this country, expanding access to more than 30 million people (Buerhaus et al., 2012). With increased coverage comes increased use of health care systems, in a system already saddled with a deficient number of providers (HIS Inc., 2016). The solution to this has been the inclusion of advanced practice nurses (APNs) into both primary and specialty care services. Within cardiovascular medicine, there has been a surge in the recruitment of APNs to care teams (Virani et al., 2015). With this increased need comes the recognition that generalist education and preparation does not prepare an APN to be a competent cardiovascular medicine provider. Advanced practice nurse training has long left specialization to the postgraduate orientation period (Kells, Dunn, Melchiono, & Burke, 2015), and the demands of the healthcare system outweigh the current training models. This has opened the door for the creation of postgraduate fellowship programs for APNs (Taylor, Boryhill, Burris, & Wilcox, 2017). This project focused on the evaluation of existing cardiovascular APN fellowships and proposed the creation of a postgraduate APN fellowship in cardiovascular medicine at Oregon Health and Science University (OHSU).

As the baby boomer population continues to age, the number of older adults in the United States continues to rise as well, which has and will continue to result in an ongoing increase in the nursing home population. Challenges in nursing home care include assuring the provision of comprehensive quality care, person centered care, and continuity of care. This DNP project evaluated a comprehensive template for nurse practitioners to use when completing monthly nursing home visits that would help address these challenges. The purpose of this project was to evaluate nurse practitioner satisfaction regarding the effectiveness of the tool in assuring comprehensive, quality and patient centered care when completing monthly nursing home visits. This was accomplished via a descriptive analysis of 10 nurse practitioners providing care in nursing homes. A Likert scale questionnaire was used before and after the nurse practitioners used the tool for a period of two months. All 10 participants agreed or strongly agreed that they would recommend the tool for use by nurse practitioners when completing monthly nursing home visits. Seven of the participants agreed or strongly agreed that the tool helped improve overall quality of the visit. The results demonstrated that the monthly nursing home assessment tool was beneficial in improving the quality of the visits and that there are future implications for use of the tool by not only nurse practitioners who practice in this setting but also for nurse practitioner students and physicians.

Thesis advisor: Jean M. Bartunek / This dissertation examines the knowledge translation from one professional community to another that has distinct priorities, values, and commutation styles: management academia to practice. More specifically, I examined knowledge translation in the form of converting peer-reviewed management research papers into practitioner-oriented research highlights. Drawing from archival and interview data, I conducted three interrelated empirical studies to investigate this phenomenon. In the first study, using the framework of Gatekeeping Theory (Lewin, 1947; Shoemaker, 1991), I examine the process and norms of how knowledge translators select from the vast amount of management research and decide which ones deserve to be translated toward practitioners. In the second study, I build on Communication Accommodation Theory (Giles, Coupland, & Coupland, 1991) to examine the processes, underlying motivations, and translation strategies of how knowledge translators conduct the knowledge conversion, especially how they manage the often conflicting demands between source knowledge producers and recipients of translated knowledge. In the third study, drawing on insights from the cross-cultural psychology literature, I examine how knowledge translators’ strategies may differ systematically when they write in two different languages toward audiences in two different cultures. This dissertation contributes to the knowledge translation literature, the academic-practitioner knowledge transfer literature, and the communication literature with insights on the micro-processes and strategies underlying knowledge translation, the generative tensions in this multi-party process, and the perceptions of and relationships between the academic and practitioner communities. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Carroll School of Management. / Discipline: Management and Organization.