The policy and practice of RPL (Recognition of Prior Learning) remains a contested area in the higher education sector. While a growing body of research on RPL has become available, little is known about the quality assurance dimensions of this policy and its current expression in higher education practice. Accordingly, this study seeks to provide a comprehensive and detailed portrait of the manner in which RPL is implemented in the Faculty of Education at the University of Pretoria. The central question is does the RPL system that is in place at this institution meet national and international requirements for quality and quality assurance? If not, what are the reasons and how can the faculty improve its RPL practice? The research sub-questions addressed are the following: <ul> <li> What is the quality of the inputs used to design the RPL that is in place in the Faculty of Education at the University of Pretoria?</li> <li> How does the Faculty of Education at the University of Pretoria assess RPL candidates for their prior learning? </li> <li> What is the effect of the output of the RPL system on client satisfaction?</li></ul> A mixed methods research design was used for this study. A single Faculty (Education) was selected as the data collection site, to reveal the deeper and nuanced impact of the process of implementation of the RPL programme. A semi-structured interview schedule administered to the senior managers of the faculty was to elicit information on how the RPL system was conceptualised and designed. This process included the Dean (Faculty of Education); Head of Department (Curriculum Studies); Head of Department (Educational Management, Law and Policy Studies); Director (Centre for Evaluation and Assessment) and the Director (Centre for Joint Science, Mathematics and Technology Education). To determine whether there is a link between what the Quality Assurance Unit of the university promotes and application of such principles and procedures at service delivery level, an interview with the Director of the QA Unit was done. Other interviews involved students (undergraduates and postgraduates); the non-academic staff and lecturers within all the departments of the faculty, to determine whether they knew or were aware of RPL related activities in the faculty. An observation tool was constructed to examine the quality of the assessment process, which involved RPL learners, assessors, evidence facilitators, verifiers, moderators and RPL administrators. A questionnaire was administered to RPL learners involved in the assessment process to determine their satisfaction with the output of the RPL programme. Lecturers who participated in the RPL assessment process were interviewed to determine their experiences. Finally, an observational checklist was used to determine quality indicators at macro (administrative) and micro (academic) levels. The data was analysed using pattern matching, discrepancy, content and interpretational analyses methods. The research findings presented are in the form of a “thick” narrative on the quality of RPL implementation, that is, what the faculty should do to improve or strengthen the current system, and a portrayal of how the RPL programme truly operates. The findings indicate that a relatively good system of RPL provisioning is in place in the Faculty of Education, with a few areas of concern (weaknesses). The major problem is that this system is not benefiting the majority of people it was intended for. The system is “selective” and “exclusionary” in nature. There are clear procedures and processes for RPL assessment, which are adhered to strictly by faculty assessors. The RPL system that is currently in place is satisfactory to those who were assessed for prior learning during the period 2003-2006 and unsatisfactory at the level of the lecturers who participated in the assessment process. Most of them indicated that RPL is an add-on activity to their workloads, with very little incentives from management. To those who were not part of the assessment process, but were assumed to have received information from the faculty, the findings indicated that they knew very little about RPL and how it is being assessed in the faculty. From the client’s perspective, most (eighty four percent) said if they knew how this system operates in the faculty, they would want to be assessed for their prior learning. An extensive examination of the RPL practice in the Faculty of Education gave useful insights on the quality of RPL provisioning. Future research needs to concentrate on evaluations on how RPL is implemented in the other faculties of the university. Second to this, is to begin to provide answers as to what causes full-scale implementation of RPL problematic in the higher education sector, to provide empirical data to policy makers for decision-making purposes. Thirdly, to provide solutions towards the sustainability of the RPL system in the higher education sector, there is a need to do studies on the cost-effectiveness of RPL implementation. / Thesis (PhD (Assessment and Quality Assurance in Education and Training))--University of Pretoria, 2007. / Curriculum Studies / PhD / unrestricted

Introduction: Falls are the leading cause of death due to injury among the elderly. Every 24 minutes an older adult dies from a fall related injury. Studies using 3 different methods were performed at a large urban, academic medical center in the US. Aim #1: Understand the advantages and disadvantages of QI methodologies (Lean and Six Sigma) and HFE when applied to fall prevention in the acute care setting: o Evaluate the contribution of QI and HFE to fall prevention with a focus on reducing falls with serious injury. o Use studies with different methodologies (Lean, Six Sigma) to develop and implement an intervention with the goal of decreasing total falls and falls with injury. o Compare methodologies (Lean, Six Sigma and HFE) to understand their benefits and limitations. Aim #2: Develop recommendations for fall prevention: o Investigate interventions and assess success of fall prevention. o Develop an understanding of interventions that prevent falls resulting in injury. Methodology and Results: Study #1 (Method = Lean, Intervention = Standard Work): Study #1 used Lean techniques such as standard work to improve fall risk assessment and intervention selection. Total falls decreased by 22%. At first glance this appears successful but a deeper evaluation of the serious injuries revealed more improvement is needed. There were still 15 falls with serious injuries that occurred among the three oncology divisions. These rare but serious injuries result in a longer hospital stay and increased cost of treatment that is not reimbursed. Due to a climate of increasing financial pressure further reduction of serious injury was desired. Study #2 (Method = Six Sigma, Intervention = Patient Partnering: Study #2 used Six Sigma tools to investigate root causes of falls. An intervention called Patient Partnering was developed to encourage patients to call for help and participate in preventing their own falls. There were no falls with serious injury for over 14 consecutive months. However, the intervention was difficult to sustain due to resistance from nurses and patients. Falls with injuries resumed as the intervention ceased. Study #3 (Method = Qualitative HFE, Intervention = Patient Interview): Study #3 was a qualitative study based on Human Factors principles to understand patient s perception of fall risk. It was found that patients did not think they would fall and felt particularly safe and protected while in hospital. They found it difficult to get around with IV tubes and crowed spaces. They wanted information and assistance when they need it, in the format they prefer (customized for each individual patient). Impact on society: Falls prevention interventions need to be designed for all the stakeholders (patients and staff). Patients think nurses will keep them safe and are willing to participate with fall prevention if they feel it is tailored to their needs. Until all perspectives are taken into account it is unlikely that there will be sustained and embedded improvements. Key message: Falls with injury are rare events with complex root causes that require agile solutions with constant revision to align with rapidly changing conditions and interactions. Reducing injury will take a balance between safe environment, organization, processes, tasks and behaviors from staff and patients.

The work purpose is to analyze the flow and implement 5S in one of the sections in the production at Gotlands Gummifabrik AB. The implementation is based on 5S theory that stands for sort, set in order, shine, standardize and sustain. A line diagram has been used to structure quantitative data in form of order logs where reportedtime is compared to planed time for an article. To identify reasons why planned time are not achieved interviews has been made with coworkers and management. The reasons has been structure in a cause-effect diagram in relation to how many who pointed out the same cause. A process flow analysis has been made together withlayout flow chart to provide a clear picture of the flow and transportation. After the implementation an evaluation discuss has been conducted with the staff that’s been working with the 5S program. The key theory’s that’s been used in the report are lean, overlap of operations, “hörnstensmodellen” which is a part of TQM and culture.The result shows that 50 % of the planned times for an article are not achieved because of different factors such as paint templates, humans, unforeseen stops, wrong times, washing machine and blasting. The result also show that the causes vary depending on the article. To improve the flow, new realistic times must be developedand the flow needs to be more technical, but also the organization needs to work with mental aspects such as leadership, communication, motivation, employees etc. The result of implementing 5S has contributed to more efficient work where employees feel motivated and participation in work, also management has shown greater commitment to their process. / Syftet med arbetet är att analysera flödet och implementera 5S i metall-förberedningen hos Gotland Gummifabrik AB. Implementering har genomförts med hjälp av 5S teori som står för sortera, strukturera, städa, standardisera och skapa vana. Ett linjediagram har används för att strukturera kvantitativ data i form av orderlogg där rapporterade tider jämförs med planerade tider. Intervjuer med anställda och ledningen har utförts för att identifiera orsaker till varför planerade tider inte uppnås. Orsakerna har strukturerats i ett orsaks-verkan-diagram med koppling till hur många som påpekat samma orsak. En processflödesanalys har gjorts tillsammans med ett layoutflödesschema för att ge en överskådlig bild av flödet och dess transportsträckor. Efter implementering har en utvärderingsdiskussion skett med personalen som arbetat med 5S programmet. Huvudsakliga teorier som används i arbetet är lean, överlappning av operationer, hörnstensmodellen och kultur. Resultatet av flödet visar att 50 % av de planerade tiderna för en artikel inte uppnås på grund av flertalet olika faktorer som lackmallar, människan, oförutsedda stopp, felaktiga tider, tvättmaskin och blästring. Resultatet redogör också att orsaker varierar beroende på artikel. För att förbättra flödet måste nya realistiska tider tas fram och flödet behöver bli mer tekniskt samt att organisationen behöver arbeta med mentala aspekter som kommunikation, ledarskap, motivation, medarbetare m.m. Resultatet för implementering av 5S har bidragit till ett mer effektivt arbete där medarbetarna känner sig motiverade och delaktiga till arbetet och att ledningen visat ett större engagemang för deras process.

Vårdrelaterade infektioner (VRI) är ett av de största hoten mot patientsäkerheten. Handhygien är den viktigaste komponenten vid prevention av vårdrelaterade infektioner. Följsamhetsmätningar av de basala hygienrutinerna är betydelsefulla för följsamheten till de basala hygienrutinerna och klädreglerna. Ett förbättringsarbete gentemot hygienobservatörerna i Region Jönköpings län har genomförts där tre aulaträffar ersattes av 17 möten med färre deltagare.  Syftet med förbättringsarbetet är att öka andelen mätande enheter. Syftet med studien av förbättringsarbetet är att beskriva hygienobservatörernas upplevelser kring brister i de basala hygienrutinerna och den nya mötesstrukturen samt att urskilja faktorer som påverkar i vilken utsträckning mätningar kommer att utföras. Metod: PDSA, Nolans förbättringsmodell, enkät, kvalitativ dataanalys i form av fokusgruppsintervjuer. Resultatet av förbättringsarbetet visar en viss ökning av andelen mätande enheter. Resultat för studien av förbättringsarbetet visar brist på ledningsstöd och en otillräcklig kunskap bland personalen om hur smitta sprids. Moment som brister är framförallt handsprit före patientnära arbete, överanvändning av handskar och dålig följsamhet till klädreglerna inom primärvården. Hygienobservatörerna upplevde att den nya mötesstrukturen gav erfarenhetsutbyte och verksamhetsnära diskussioner med kollegor. Slutsatser: För att följsamhetsmätningar ska bli utförda och det vårdhygieniska arbetet prioriteras är ledningsstödet helt avgörande. En ökad andel mätande enheter skulle minska antal VRI, kostander och patienters lidande. / Healthcare associated infections (HAIs) are one of the greatest threats to patient safety. Hand hygiene is the most important component in the prevention efforts. Measurements to standard precautions are important for adherence to the basic rules of hygiene and clothing.  An improvement work focused on hygiene observers in Region Jönköping County, was implemented in which three hall gatherings was replaced by 17 meetings with fewer participants.   The aim of the improvement work is to increase the number of measuring devices.  The purpose of the study of the improvement work is to describe the hygiene observers experiences concerning deficiencies in the basic hygiene practices and the new meeting structure and to identify factors that influence the extent to which measurements will be carried out.  Method: PDSA, Nolan's improvement model, survey, qualitative data analysis in the form of focus group interviews. The result of the improvement work indicates more units performing measurements. Results of the study of the improvement work shows lack of management support and inadequate knowledge among staff about how infections spread. Other factors are lack of disinfection before patient care, overuse of gloves and poor adherence to dress rules. Conclusions: Management support is crucial for adherence to measurement. Improvements in number of HAI, costs and patients ' suffering increases as hygiene measurements are carried out.

Objectif : Comprendre les tensions identitaires vécus par les professionnels de la santé, lorsque ceux-ci travaillent en partenariat avec des patients sur un comité d’amélioration continue. Devis : Étude qualitative ethnographique participative. Terrain de recherche : Une clinique de médecine de famille qui a décidé de former un nouveau comité d’amélioration de la qualité (CAQ) interdisciplinaire et d’y inclure des patients partenaires. Participants : Le CAQ était composé de deux patients partenaires, deux médecins de famille, deux résidents de médecine de famille, une pharmacienne, une infirmière clinicienne, un infirmier praticien spécialisé, une secrétaire, une réceptionniste, une agente de communication et une gestionnaire. Tous les participants ont été invités à participer à l’étude. Collecte des données : La collecte des données a commencé à l’automne 2017 et s’est terminé à l’été 2018. Elle comprenait des observations participatives, la tenue d’un journal de bord et des entrevues semi-dirigées. Résultats: À partir du cadre conceptuel développé par Ghadiri sur les menaces identitaires, notre étude met en lumière que le passage de la relation “soignant-soigné” à une relation “collègue-collègue” génère différentes tensions identitaires chez les professionnels, tant au plan de l’idéal du “bon” professionnel, de l’étanchéité des catégories patient-professionnel, du métissage des symboles associés à l’une ou l’autre de ces identités, et de l’équilibre intérieur entre les rôles de soignant et de collègue. Conclusion : Nos résultats offrent une grille de lecture originale et différente par rapport à la littérature scientifique existante, permettant de comprendre certains enjeux fréquemment rencontrés sur le terrain. Travailler en partenariat avec des patients n’implique pas, pour le professionnel, une relation de simple « collègue de travail », mais plutôt la construction d’un nouveau cadre relationnel, flexible et dynamique, prenant en compte une coexistence identitaire de plusieurs identités. / Objectives: To understand the identity tensions experienced by health professionals during a partnership relationship with patients on a quality improvement committee. Design: Qualitative ethnographic study based on participatory observation. Setting: Family medicine clinic in Montreal who decided to create a new interdisciplinary quality improvement committee (QIC) and to include PP for the first time. Participants: The QIC consisted of two patient partners, two family physicians, two family medicine residents, one pharmacist, one nurse clinician, one specialized nurse practitioner, one secretary, one receptionist, and one manager. All members of the QIC were invited to participate in the study. Data collection: Data collection began in the winter of 2017, when the committee was created, and ended in summer 2018. It consisted of participatory observations, logbook notes, and semistructured interviews. Results: Through Ghadiri's theoretical framework on identity threats, health professionals experienced significant identity tensions. Transforming the “caregiver–patient” relationship into a “colleague-colleague” relationship generated identity upheavals among the professionals, relating to the “good professional” ideal, the impermeability of the patient and professional categories, the interweaving of the symbols associated with one or the other of these identities, and the inner balance between the roles of carer and colleague. Conclusion: our results provide an interpretive reading that is original and different from the current literature, shedding light on certain issues frequently encountered in the field. Working with patients does not, for the professional, imply a purely “collegial” relationship, but rather the construction of a new relational framework, flexible and dynamic, that takes into account the coexistence of multiple identities.

Background: To date, little attention has focused on what the factors are and how Best Practice Guidelines (BPGs) are sustained in acute care over time. Problem: For ten years, a multi-site acute care center supported the use of a Pain Assessment and Management Policy and Protocol (Pain P/P), placing the decision to use it with point of care nurses. Despite early implementation success, the nursing department identified an evidence-based gap on Medicine care units. Purpose: To (i) identify factors influencing nurses’ use (or not) of the Pain P/P over time, and ten years post-implementation; (ii) examine related knowledge translation interventions (KTIs) used over time, and ten years post-implementation; (iii) validate unit nurses’ use of the Pain P/P ten years post-implementation; and (iv) identify relevant sustainability frameworks/models/theories (F/M/Ts), constructs and factors for sustained use of BPGs in acute care. Methodology: A case study of an organization-wide nursing BPG was conducted ten years following initial implementation using mixed methods guided by the Dynamic Sustainability Framework (Chambers, 2013). The case study setting was a 1122 bed acute care center in Canada. I examined BPG sustainability at the (corporate) department and unit levels (two embedded subcases). Data sources included 19 informant interviews (3-corporate, 16-unit level), 200 chart audits (100/subcase), and 29 documents. I concurrently conducted a systematic review to identify sustainability concepts and factors for use in acute care to compare case study results. Results: I identified 7 constructs, 49 factors, and 29 KTIs influencing sustained use of evidence-base practices (EBPs) in acute care. Three factors and eight KTIs had a continuous influence during implementation and sustained use phases. Findings confirm the concept of sustainability is a dynamic ‘process’ or ‘ongoing phase’. Conclusions: This thesis provides a novel resource to support future practice and research aimed at sustaining EBPs to improve nursing practice and related patient outcomes. Attention to the level of application and changing conditions over time impacting factors that influence EBP use is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and link KTIs to target behaviors that incrementally address low adherence rates promotes sustainability.

Patienter med kronisk hjärtsvikt står för hälften av alla internmedicinska slutenvårdstillfällen på Södertälje sjukhus. Då ett av symtomen är andnöd söker patienterna ofta vården i ett akut skede med oro och ångest. Genom att ge förutsättningar för patienter att lära känna, och vara delaktiga i vården av, sin hjärtsvikt, kan försämring förebyggas vilket minskar behovet av att söka vård akut. Dessa förutsättningar kan skapas med hjälp av teknik där patienter själva mäter blodtryck, vikt etc. och sätta dessa mätresultat i relation till sina levnadsvanor. Egenmonitorering förväntas minska behovet av inneliggande sjukhusvård, minska fysiska vårdbesök, förbättra hälsoutfall och ge ökad trygghet för personer med hjärtsvikt och deras närstående. För att ytterligare stärka patientens egenvård, genom support, finns personal på mottagningen som kan se patientens mätvärden via en teknisk plattform där kommunikationen också sker. Det övergripande syftet med aktuellt förbättringsarbete var att testa ny teknik och nya arbetssätt för patienter med hjärtsvikt och samla insikter samt erfarenheter inför ett eventuellt breddinförande. Målet var att 10 patienter med hjärtsvikt före 2021-03-31 hade medverkat i pilottest av egenmonitorering. Examensarbetet syftar till att med stöd av ett teoretiskt ramverk klarlägga vilka förhållanden som påverkar övergången från traditionell slutenvård till egenmonitorering för personer med hjärtsvikt. Förbättringsarbetet resulterade i att åtta patienter från två olika verksamhetsområden inkluderades. Studien visade bland annat att innan en organisation ska införa egenmonitorering bör hänsyn tas till komplexiteten i hälso- och sjukvården. Goda infrastrukturer för IT är avgörande och tekniken behöver bli mer flexibel för att patienter som inte har svenska som språk ska kunna få ta del av egenmonitorering / Patients with chronic heart failure account for half of all internal medicine diagnoses at Södertälje Hospital. As one of the symptoms is shortness of breath, patients often seek care in an acute stage with worry and anxiety. By enabling patients to get to know, and be involved, in their wellbeing, relapses with symptoms such as shortness of breath may be prevented and reduce the need to seek emergency care. To accomplish this, digital technology is used to enable patients to take and monitor their own health measurements and put these in relation to their wellbeing and lifestyle. To further strengthen the patient's self-care, the clinic is monitoring the patient's vital functions through a communicationsplatform. The purpose of the improvement work is to reduce patients with heart failure’s need of hospital care and instead allow them to stay at home with self-monitoring and receive care at home. The goal is that before 2021-03-31, 10 patients in need of hospital care at Södertälje Hospital heart failure will participate in a pilot test with self-monitoring and report safety and increased sense of safety with selfmonitoring.This study aims to clarify which conditions that affect the transition from traditional inpatient care to self-monitoring for people with heart failure. The improvement work resulted in eight patients being included. The study shown that before an organization introduces self-monitoring, the complexity of healthcare should be considered. Good infrastructures for IT are crucial and the technology needs to be more flexible so that patients who do not have Swedish as a language can take part in self-monitoring.

No description available.

Bakgrund: Kvaliteten på sjuksköterskans omvårdnadsjournal kan återspegla den vårdkvalitet som tillhandahålls patienter. Patienter med en höftfraktur har ofta ett omfattande vårdbehov där omvårdnadsjournalen har en viktig funktion att strukturera dokumentation av vårdinsatser genom patientens vårdförlopp. Patienter med höftfraktur har ofta en komplex sjukdomsbild, där omvårdnadsdokumentationens kvalitet kan bidra till en säkrare vård för patienten. Kvaliteten på dokumentationen ökar vid en strukturerad journal och framförallt när ett standardiserat språk används. Journalgranskning är ett sätt att göra kvalitetskontroll av dokumentation. Motiv: Att drabbas av en höftfraktur innebär stora hälsorisker för en ofta redan skör person. Omvårdnadsdokumentationens kvalitet vid höftfraktur kan bidra till att patienten får bättre förutsättningar för att undvika komplikationer och till kortare vårdtid. Syfte: Att undersöka kvaliteten av omvårdnadsdokumentation för patienter med höftfraktur.Metod: En retrospektiv, deskriptiv och jämförande design där granskning av omvårdnadsjournaler användes för att besvara studiens syfte. Ett konsekutivt urval har gjorts av omvårdnadsdokumentation från 40 vårdtillfällen med patienter över 60 år som vårdats för en höftfraktur på en akutortopedisk avdelning. För granskningen användes journalgranskningsinstrumentet Cat-ch-ing. Resultat: De granskade omvårdnadsjournalernas kvalitet var varierande; ingen av journalerna hade en komplett dokumentation. Dokumentation av vårdplan och resultat av omvårdnadsåtgärder saknades i en majoritet av journalerna. Dokumentationen var av bättre kvalitet i gruppen yngre äldre patienter vid jämförelse med gruppen äldre äldre patienter. Ingen skillnad av kvalitet i dokumentationen kunde urskiljas utifrån vårdtidens längd då patienter som vårdats mindre än sju dygn eller sju dygn eller mer jämfördes. Konklusion: Kvaliteten av omvårdnadsdokumentationen var inte komplett. Det krävs ytterligare kunskap om förbättringsåtgärder i den kliniskas verksamheten för att säkerställa en omvårdnadsdokumentation av god kvalitet där patienter med höftfraktur vårdas. / Background: The quality of the nursing record can reflect the quality of nursing care provided to patients. Patients with a hip fracture often have an extensive need for care. The nursing record has an important function of describing the nursing process, nursing diagnoses and interventions. Patients with hip fractures often have complex health care needs and the nursing documentation can contribute to patient safety. The quality of the documentation increases with a structured journal. Furthermore, it should be written in a standardized language. Audit of nursing documentation can contribute to quality of care. Motive: Great health risks is a fact when suffering from a hip fracture, especially an already fragile person. The quality of the nursing documentation can contribute to better outcome in patient safety and the length of stay. Aim: To explore the quality of nursing documentation for patients with hip fractures. Methods: A retrospective descriptive and comparative design where audit of nursing records was used to attain the study's aim. A consecutive sample was used, where 40 patients’ health care records of nursing documentation for patients over the age of 60 with a hip fracture in an emergency orthopedic ward were included. The audit instrument Cat-ch-Ing was used. Result: The result showed that the quality was variable; none of the records had a complete documentation. Documentation of care plans were missing in a majority of the records. The documentation was of better quality in the group of younger elderly patients compared to that of older elderly patients. No quality differences were seen based on the length of stay. Conclusion: None of the records had a complete documentation. Further knowledge of how good quality nursing documentation on hip fractur patients can be implement for a sustainable result in clinical activities.

The thesis deals with implementing of statistical process control (SPC) on CNC cut center into the mechanic production. One part of the project is engaged in theoretical information gathering, process monitoring and data collection. Second part deals with stabilization, regulation and improvement of the process using right statistical instruments. As a result is implementing measuring station from where will be the process data transferred to a server and evaluated. On the basis of that is possible to implement a correction in the right time if the process isn´t stabilized. The main objectives of the thesiss are cost reduction, scrap reduction and modernization of the process.