Hearing disclosures of childhood sexual abuse (CSA) is a clinical reality for many therapists. Psychologists within mental health services are working increasingly with clients who have traumatic histories, including the presence of CSA. Recently there has been a drive towards improving services for adult survivors of CSA, with an emphasis on asking health and social care service-users about abuse. Recent research has demonstrated that the experience of talking about CSA in psychological therapy can be a complex experience for client and clinician with varied consequences for both parties. The research into psychologists‟ experiences of CSA disclosure has been limited to surveys of psychologists‟ practice and knowledge and has lacked a scientific approach. This study aimed to expand on the scientific research into CSA disclosure with a Constructivist Grounded Theory approach (CGT). CGT was used to explore psychologists‟ experiences of CSA disclosure from clients in Adult Mental Health. Eight psychologists took part in the current study and were recruited from a large Clinical Psychology service in Scotland. Data was collected through semi-structured interviews. Core categories constructed in this study contributed to a model of psychologists‟ experiences of disclosure in AMH clinical practice. Core categories referred to “Negotiating the Dance of Disclosure” and “Nurturing the Pre-conditions to Disclosure”, which occur in parallel to the therapeutic relationship; whereas “Growing Personally and Professionally” and “Carrying the Weight of the Work” refer to the impact of hearing disclosures and talking about CSA with clients. Research findings are discussed and the implications of this model in relation to theory and areas of development for research and clinical practice are considered.

The aim of this thesis is to study whether the Swedish state’s efforts to govern the professional practice of social workers (SWs) by knowledge to achieve an evidence-based practice, address the difficulties that SWs encounter in their practice. The Swedish state’s ambition is to govern the practice of social work by ideas and methods originating from medicine. The thesis therefore compares, through four different studies, the professional practice of SWs with general practitioners (GPs) as the most comparable sub-profession in medicine. The research questions that the thesis seeks to answer are: What situations are perceived as problematic and non-problematic by SWs and GPs? How does the professionals’ relationship with clients affect the performative aspects of these occupations’ enactment of their practice? How do SW and GPs experience the state’s efforts to govern their professional practice by knowledge? What problems can arise when the Swedish state builds its knowledge governance of social work practice on a comparison with medicine, even though these professional fields exhibit a number of important differences? The empirical material in the first and second studies consists of 52 narratives, written by SWs and GPs on problematic and non-problematic situations. The third study is based on vignette-based focus group interviews with 25 SWs and GPs. And the fourth study is based on a literature review, consisting of 54 articles about SWs’ and GPs’ practice. A first finding is that professionals rarely describe lack of knowledge or difficulties with knowledge use as problematic. A second finding is that non-problematic situations are connected to professionals’ control of the intervention process. SWs gained control of the relationship with the client either by use of coercive means or by the client’s active co-operation. GPs gained control of the intervention process by the use of professional knowledge. A third finding is that an understanding of professional practice as a linear process consisting of diagnosis, inference and treatment reflects GPs’ practice but not all aspects of SWs’ practice. A fourth finding is that both professions hold ambivalent positions towards evidence-based risk reductions technologies. The responses towards organisational risk reductions technologies differ in that GPs are sceptical, whilst SWs take a more pragmatic view. A main conclusion is that the Swedish state’s efforts to govern the performative aspects of SWs’ practice by knowledge, runs the risk of becoming a insufficient strategy since they tend to exhibit two main blind spots. The first is that these efforts tend to ignore that the relationship with the client has a crucial affect on and conditions SWs’ and in problematic situations also GPs’ knowledge use. The second is that the efforts also tend to ignore that control of the intervention process is not always maintained through control of knowledge use. For SWs control of the relationship with clients represents another mode of professional control of the intervention process. / Hur använder socialarbetare och allmänläkare kunskap i praktiken?, FAS/FORTE dnr 2009-0251

Context of this research: The construction industry has a history of client dissatisfaction in the UK. In response, framework agreements have been developed to create relationships between suppliers and clients in order to improve project performance. This research aims to assess whether use of framework agreements can result in significant improvement for performance outcomes without a significant increase in costs when compared with traditional discrete methods, and if so, develop a procurement performance model for realisation and continuous improvement in performance. Research methodology: A literal review of UK Government reports with economic and performance management theories precede a case study set within Hampshire County Council, a major public sector authority, allowing analysis of data from 164 highway maintenance projects by independent samples t-tests. Projects are divided into discrete and framework groups using critical success factors to measure performance differences. In addition to project outcomes, a review of economic performance was undertaken to advance a current ‘gap in professional knowledge’ concerning cost effectiveness of framework agreements. A performance management model is proposed representing impact of operational measures and sociological behaviour factors on suppliers’ performance, tested by qualitative views of experienced practitioners collected through a questionnaire survey and in-depth interviews. Key findings: Independent-samples t-tests proved that there were significant improvements in performance with use of framework agreements, but that no significant additional costs were incurred. Factor analysis and central tendency statistics from questionnaires and node values from interview transcripts confirmed long-term relationships, financial and non–financial incentives and stronger communication were sociological behaviour factors driving performance for framework agreements. Conclusions from the evidence and findings: As framework agreements can achieve significant performance improvements without a significant increase in costs, this study supports use of framework agreements for Hampshire County Council and professional practice. Value of this research is recognised by both central government and case study organisation alike. In respect of the latter context, case study findings have been included within a regional framework for use by South East authorities until 2016. It is recommended further studies should be conducted on civil and building projects in wider public and private sectors so that construction clients can make informed decisions based upon generalised findings.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Jessica Canfield / Landscape architecture is embarking on a new design frontier, one where its practitioners are increasingly being asked by clients to design using credible evidence and to ensure design performance. As design disciplines follow in the footsteps of other evidence-based practices, like medicine and engineering, landscape architecture is poised to become a more scholarly profession – a profession of evidence-based landscape architecture. Evidence-based landscape architecture was first coined and defined in 2011 by Brown and Corry as “the deliberate and explicit use of scholarly evidence in making decisions about the use and shaping of land” (Brown and Corry 2011, 328). Current literature explains the benefits of practicing evidence-based design (EBD). These include ensuring design performance, justifying client investment, quantifying the value of design, systematically managing complex projects, marketing the firm to clients, attracting the most innovative designers to the firm, and adding to the knowledge base of the landscape architecture field. However, little is known about how landscape architecture firms are engaging evidence-based design in daily practice. This thesis examines how four leading landscape architecture firms (Design Workshop, Mithun, Sasaki Associates, and OLIN) have developed unique EBD approaches to integrate, apply, and propagate evidence-based design in professional practice. In order to study and analyze the four firms’ EBD approaches, individual comprehensive case studies were conducted. Qualitative data was collected through: focused interviews with directors and leaders of evidence-based design at each firm; casual observations made during office visits; and, a review of firm literature. A case study framework for EBD approaches in professional practice was developed based on discussion topics that consistently emerged from the interviews. The framework was used to organize, analyze, and present the findings into four major themes. A cross-case analysis was conducted to compare the development, implementation, and effects of EBD approaches at each firm. Findings reveal that each firm has developed an EBD approach to meet the need for engaging complex problems and meeting increasing client expectations for performance. While each firm’s EBD approach is unique, similarities and characteristics emerged between the case studies. The most consistent factors identified across cases include: having academic founders of the firm; the implementation of EBD- or research-specific roles and responsibilities; the creation of tools to organize and understand data; cultivating design cultures to support the EBD approach vision; the communication and transparency of relationships with clients and consultants; and, the reporting of findings for the advancement of the profession. Although any landscape architecture firm is likely to employ at least one of these concepts, the developed integration, application, and propagation of a majority of these concepts is what makes these firms unique and successful in applying EBD in professional practice. It was also found that the design processes themselves vary dramatically across the firms. EBD in practice is therefore not prescriptive and does not always look the same. The findings and case study framework developed in the study are useful primarily for landscape architecture firms looking to develop, integrate, apply, and propagate their own EBD approach.

RESUME THE SIX-MONTH TRAINEESHIP IN THE PHARMACY FROM THE STUDENTS' POINT OF VIEW Author: Jana Najmanová Tutor: RNDr. Jana Kotlářová, Ph. D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic Introduction: The six-month traineeship at a pharmacy is an obligatory course for the final year students who have been studying Pharmacy at FAF UK in Hradec Kralove. The purpose of this course is to fix the theory and let the students transform their knowledge into practical skills while preparing them to work at a pharmacy. Aim of the thesis: The evaluation of the questionnaire survey from two academical years. The summary and comparison of the opinion of final year students at FAF UK on their six-month traineeship, the pharmacy where they had been completing their practice and assessing the feasibility of the students' change proposals. The theoretical part is focused on the issue of the six- month traineeship at a pharmacy mainly in the term of legislation and current requirements. Methodology: A questionnaire survey which was created at the Department of Social and Clinical Pharmacy, Faculty of Pharmacy at the Charles University in 2007 took place to collect the data. All the respondents were the final year students of Pharmacy. The...

Thesis advisor: Dorothy A. Jones / Thesis advisor: Pamela J. Grace / The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. <bold>Background:</bold> Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. <bold>Methodology:</bold> The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. <bold>Findings: </bold>The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Dorothy A. Jones / In Taiwan, the ability to measure the changing of health care reform and the improvement in nursing practice environment is hindered by the lack of a valid, reliable, and culture-sensitive instrument for measuring nursing practice environment. The purposes of this two-phase study were to translate and psychometrically validate the Chinese versions of the PPE Scale (CPPE). Phase I focused on translating and adapting the 38-item PPE into CPPE and evaluating the semantic and content equivalency. Semantic equivalence of the CPPE was secured using Translation Validity Indices as judged by American and bilingual experts. The content equivalence of the CPPE was supported by the satisfactory Content validity Indices. To increase the cultural sensitivity and comprehensiveness of the CPPE, 27 items were added at the suggestion of Taiwanese experts following content validation. A 66-item CPPE including 38 PPE items, 1 adapted item and 27 new items was produced for psychometric evaluation. Phase II focused on establishing the psychometric properties of the CPPE. A cross-sectional survey was conducted to test the 66-item CPPE on 977 Taiwanese nurses working in acute care settings. PCA with Varimax rotation on the 38 PPE items produced an eight-component solution for the 36-item CPPE after deleting two items. Cronbach's alpha was .90 for the total 36-item CPPE and .68 - .87 for the eight subscales. PCA with Varimax rotation on 66 items of the CPPE produced an eleven-component solution for the 58-item CPPE after deleting 8 items. Cronbach's alpha was .95 for the total 58-item CPPE and .71 - .87 for the eleven subscales. Both the 36-item CPPE and the 58-item CPPE demonstrated satisfactory test-retest reliability and concurrent validity. The psychometric structures of the 36-item CPPE and the 58-item CPPE were different from the original PPE. Both the 36-item CPPE and the 58-item CPPE were reliable and valid, but the 58-item CPPE is culturally sensitive to the Taiwanese nurses. The 58-item CPPE is useful for measuring Taiwanese nursing practice environment. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Student Number : 9201253K - MEd research report - School of Adult Education - Faculty of Education / This research report investigates the relationship between critical self-evaluation and improved teaching practice. A sample of nine lecturers at the University of the Witwatersrand were identified, and, by means of a questionnaire and semi-structured interviews, participants were asked to disclose their attitudes towards performance evaluation as a practice at the University, and their personal views in relation to critical self reflection. Critical reflection involves an appraisal of that which is being reflected upon. When such appraisal involves assumption or presupposition, it “holds major potential for effecting change in one’s established frame of reference (Mezirow, 1998). This reflection leads to improved teaching practice. Lecturers at the University all support the notion of self-evaluation, but in practice only one of the nine participants actively and critically reflected upon his teaching. Most of the subjects sanction self-evaluation as a concept, do not practise critical reflection. The reasons for this are numerous as the conclusions to the study reveal, but most significant is that lecturers do not see any reason to reflect upon their own performance, nor see any benefit in doing so.

INTRODUÇÃO: O agir profissional do enfermeiro corresponde ao conjunto de saberes adquiridos no período de formação, mas, que só adquire status de ação profissional quando o graduando (aprendiz) o experiencia na realidade prática. Isso, acontece porque o vivido durante o ensino de graduação, em muitos momentos, projeta-se como disposição para a ação prospectiva em enfermagem, no cenário de prática. A conjunção entre o vivido no curso na forma de aulas teórico-práticas e as experiências nos estágios curriculares, materializam-se, então, como um conjunto de práticas. OBJETIVOS: O objetivo do estudo foi compreender como a formação acadêmica orienta o processo didático-pedagógico para o desenvolvimento do agir profissional prospectivo do enfermeiro e, ainda, como o processo de formação em enfermagem e a realidade prática participam do desenvolvimento da disposição para a ação prospectiva, no agir profissional do egresso de enfermagem. MÉTODO: Trata-se de uma pesquisa exploratória, de caráter qualitativo que privilegiou a perspectiva fenomenológica. O cenário do estudo foi o Curso de Bacharelado de Graduação em Enfermagem da Escola de Enfermagem da Universidade de São Paulo (EEUSP). Participaram do estudo 19 egressos de enfermagem que concluíram o curso, com base na última reformulação curricular da instituição (2010/2013) e, já se encontravam inseridos no mundo do trabalho. A coleta de dados aconteceu por meio de entrevistas gravadas. O referencial teórico-metodológico para análise dos resultados utilizado foi a Teoria da Interpretação do filósofo Paul Ricoeur. Este método de análise fundamenta-se na compreensão dos resultados pela aplicação de uma matriz interpretativa nas narrativas, obtidas após a transcrição das entrevistas. Esse método contempla três fases interpretativas: a primeira, denominada de Teoria do Discurso que, corresponde a uma leitura inicial da narrativa e sua organização, com a síntese do evento e significação relacionadas à vivência, que possibilita a primeira interpretação ou pé-compreensão. A segunda fase, nomeada de Teoria do Texto, na qual acontece a análise estrutural do resultado da pé-compreensão, de forma a obter-se ao final desta fase a análise crítica das inferências, na forma de unidades de significado denominadas de Temas/Subtemas. E, por fim, a última fase, a Teoria da Leitura que possibilita uma interpretação mais profunda do material em avaliação, de modo que se possa validar a primeira conjectura, obtida no final da segunda fase, por meio de uma compreensão crítica. Todas estas fases apresentam, em sua estrutura, a dialética tricordiana. RESULTADOS: Após a análise dos resultados, emergiram duas categorias temáticas: a primeira foi O Mundo do Curso, que tratava da expressão do agir do egresso, considerando suas intermediações com a vivência acadêmica. Esta categoria suscitou a divisão em três subcategorias: Proposta Pedagógica, na qual a expressão mais ativa do agir acadêmico foram a postura humanística, a postura investigativa e a capacidade de desenvolver o pensamento crítico-reflexivo. A segunda subcategoria foi a Organização Curricular, que evidenciou a complexa rede de inter-relações presentes nas atividades disciplinares, práticas e relacionais e, por fim, a última subcategoria Prática Docente que trouxe à luz questões relativas ao preparo para a ação pedagógica, apresentada pelo docente e, ainda, o inter-relacionamento docente-discente. A segunda categoria temática foi nomeada de O Mundo do Trabalho, esta representou a expressão do agir do egresso, considerando-se as influências da realidade prática sobre seu agir profissional, tal categoria também foi dividida em duas subcategorias: ressignificação do agir profissional, que teve como resultado expressões e caminhos da ressignificação que sofreu o agir acadêmico e, a segunda subcategoria, disposição para a ação prospectiva, desvelou as percepções dos egressos sobre seu agir no contexto da realidade prática. CONSIDERAÇÕES FINAIS: Ao final do estudo, foi possível observar que a formação acadêmica no ensino de enfermagem apresenta-se como estrutura processual que a depender de sua proposta pedagógica, organização curricular e prática docente é capaz de colaborar com o desenvolvimento da disposição para a ação prospectiva no agir profissional do egresso de enfermagem, mas, é preciso dizer que a incorporação dos atos de disposição para a ação prospectiva só aconteceu de fato quando o egresso contrapôs o arcabouço de conhecimentos e vivências formativas com a realidade prática do mundo do trabalho. / INTRODUCTION: The professional action of the nurse corresponds to the set of knowledge acquired during the training period, but, that only acquires professional action status when the graduating (apprentice) experience in practical reality. This is because the experience during undergraduate education, in many moments, is projected as a provision for prospective action in nursing, in the practice scenario. The conjunction between the lived in the course in the form of theoretical-practical classes and the experiences in the curricular stages, materialize then as a set of practices. OBJECTIVES: The objective of the study was to understand how the academic formation guides the didactic-pedagogical process for the development of professional career prospective of the nurse and also how the nursing training process and the practical reality participate in the development of the disposition for the prospective action, In the professional act of nursing egress. METHOD: It is an exploratory research, of qualitative character that privileged the phenomenological perspective. The study scenario was the Undergraduate Nursing Course of the Nursing School of the University of São Paulo (EEUSP). The study was attended by 19 nursing graduates who completed the course based on the last curricular reformulation of the institution (2010/2013) and were already included in the world of work. Data collection took place through recorded interviews. The theoretical-methodological reference for the analysis of the results used was the Theory of Interpretation of the philosopher Paul Ricoeur. This method of analysis is based on the understanding of the results by the application of an interpretative matrix in the narratives, obtained after the transcription of the interviews. This method contemplates 03 interpretative phases: the first called Discourse Theory, which corresponds to an initial reading of the narrative and its organization, with a synthesis of the event and meaning related to the experience, which makes possible the first interpretation or pre-comprehension. The second phase, named Text Theory, in which the structural analysis of the result of pre-comprehension takes place, so as to obtain at the end of this phase the critical analysis of inferences, in the form of units of meaning called Themes / Subtopics. And finally, the last phase, the Reading Theory, which allows a deeper interpretation of the material under evaluation, so that the first conjecture, obtained at the end of the second phase, can be validated through a critical understanding. All these phases present, in their structure, the Ricorian dialectic. RESULTS: After analyzing the results, two thematic categories emerged: the first was \"The World of the Course\", which dealt with the expression of the action of the egress, considering their intermediation with the academic experience. This category raised the division into 03 subcategories: Pedagogical Proposal, in which the most active expression of academic action was the humanistic posture, the investigative stance and the capacity to develop critical-reflexive thinking. The second subcategory was the Curriculum Organization, which showed the complex network of interrelationships present in the disciplinary, practical and relational activities and, finally, the last subcategory Teaching Practice that brought to light questions related to the preparation for the pedagogical action presented by the teacher and , The teacher-student interrelationship. The second thematic category was named \"The World of Work\", this represented the expression of the action of the egress considering the influences of practical reality on his professional action, this category, too, was divided into 02 subcategories: resignification of the act Which resulted in expressions and paths of resignification that underwent academic action, and the second subcategory, a provision for prospective action, revealed the students\' perceptions about their action in the context of practical reality. FINAL THOUGTHS: At the end of the study, it was possible to observe that the academic formation in nursing teaching is presented as a procedural structure that, depending on its pedagogical proposal, curricular organization and teaching practice, is able to collaborate with the development of the disposition to The prospective action, in the professional act of the nursing egress, but it must be said that the incorporation of the acts of disposition for the prospective action, only happened in fact when the egress contrasted the framework of knowledge and formative experiences with the practical reality of the world Of work.

A punção venosa periférica representa um procedimento invasivo de alta ocorrência no cotidiano laboral dos profissionais de enfermagem. Este estudo de natureza comparativa, inferencial tem como propósito avaliar o desempenho dos profissionais de enfermagem na execução do procedimento de punção venosa periférica, com vistas a verificar as convergências, e, identificar os fatores de riscos que podem predispor ocorrência de complicações. Um formulário do tipo \"Lista de Verificação\" foi usado para proporcionar a observação estruturada. O grupo em estudo constitui-se de 55 profissionais de enfermagem os quais foram observados executando o procedimento de punção venosa periférica por três vezes e em dias alternados. Utilizou-se a média aritimética dessas observações. Obtivemos como resultados 78% para a mediana de acertos global para todas as categorias; sendo que especificamente, a mediana global para cada categoria correspondeu: 82% enfermeiros, 80% técnicos e 77% auxiliares de enfermagem. Para a comparação entre o número de acertos nas três categorias profissionais foi utilizado o teste estatístico não paramétrico Kruskal-Wallis com nível de significância &#945; = 5%. Nos casos onde houve diferença foi procedido o teste de comparações múltiplas apropriado. Em relação, aos 25 itens do procedimento de punção venosa, 10 apresentaram erros significativos, sendo que 4 destes com diferenças estatisticamente significantes entre as categorias profissionais. Concluímos que as atividades educativas e de treinamento profissional periódico, constituem a linha mestra para a formação de uma equipe de enfermagem, crítica e consciente do seu papel na prevenção e controle das complicações associadas aos procedimentos invasivos, dentre eles, a punção venosa periférica. / Peripheral venipuncture is an invasive procedure that frequently occurs in the daily work of nursing professionals. This descriptive and exploratory study aimed at evaluating the performance of nursing professionals during the execution of the peripheral venipuncture procedure with the purpose to verify convergences and identify risk factors that can predispose to the occurrence of complications. In order to evaluate the average number of correct performances in the three professional categories, the KrusKal-Wallis non-parametric statistical test was used with significance level of &#945; = 5%. In the cases where a difference was found, the multiple-comparison tests were carried out. Structured observation was the resource used for data collection. Therefore, a check-list type form was used to guide the respective observation. The sample consisted of 55 nursing professionals who were observed while performing the respective procedure three times every other day. An average of 78% of globally correct performances was found for all the categories. However, the specific global average for each category corresponded to: 82% for nurses, 80% for nursing technicians and 77% for nursing auxiliaries. In relation to the 25 items concerning the venipuncture procedure, 10 presented significant errors and four of them presented p < 0.05. It was concluded that educational activities and periodical professional training constitute the guiding line for the education of a nursing team comprising individuals who are critical and conscious with regard to the role that they play in the prevention and control of complications associated with invasive procedures, among which is peripheral venipuncture.