The study examines nursing assessment in the context of questioning how nurses' encounters with patients become occasions for nursing. The focus of the study is on those occasions which constitute nursing assessment, in recognition that these occasions cannot be detached from other aspects of nurses' conduct. To undertake this examination of nursing assessment, I have drawn on the work of Michel Foucault, with an approach to field research and the analysis of discourse which has developed from contemporary writings on communication, anthropology, ethnomethodology and ethnography. With its focus on examining how power effects are constituted within an acute medical ward, the position developed in the thesis seeks to integrate critical thinking in ethnography with a post-structuralist problematising of 'detachment' as an everyday feature of social conduct. There are three parts to the study. The first part entails a textual analysis of how nursing assessment has been written in the literature. Nursing assessment has been conceptualised as a component of the nursing process; as a technical and cognitive activity. Representing nursing assessment in this way raises issues of knowledge and power. Writing nursing in terms of information processing, problem-solving 'models' is however less a representation of nursing reality and more a discursive practice, one with its own domain and locus of action. The nursing process detaches nursing assessment as a technology, separable from the organisation of patient care and autonomous from the social, but one designed to reconstitute the social through making nursing thinkable in a particular epistemic space. The second part of the study, a detailed examination of the care of old people in an acute medical ward, suggests the particular development of nursing assessment as a cognitive and technical activity overlooks the heterogenous conditions in which nursing is practised, in which it is being written and in which the conditions of detachment that the nursing process, once in process, helps produce and reproduce. These include involving an instrumentalrationalist approach to research on health services, a managerialist climate which seeks to make nursing 'visible' in relation to cost and time; the professionalisation of nursing, which impacts on nurses as a call for nurses to make nursing 'professional', rational and distinct from other practices; and, instituted through fashionable talk of customer care and the care of the subject, a heightening of persons as individuated, accountable, knowing subjects. The analysis shows how the disposal of elderly persons is effected by nurses through a 'constituting of classes' and explicates the motility of these classes in response to the aforementioned pressures. The final part of the thesis develops these themes. The nursing process appears to give the burden of knowing to the nurse as expert, always saving itself from appearing to be a congenitally failing technology through appeals for more and better training. Far from this being so, I illustrate how the burden of knowing falls upon the person; how as patient, persons must detach themselves from their everyday experience and seek modes of conduct appropriate to their disposal. By writing nurses as rational, scientific and professional practitioners, I suggest how the nursing process has been developed as a control technology which both disciplines patients to help accomplish their disposal and manage nurses through the institution of new forms of accountability and self-discipline.

Risk reduction processes in healthcare remain at the core of 21st century health care provision, though the continuing scale of the problem gives little room for complacency. While other areas of complex technological activity such as air transportation can demonstrate improvements in safety performance, comparable progress eludes modern healthcare. A review of risk reduction techniques within healthcare identifies that there exists a lack of tools involving simulation of risk. It has been necessary in the context of the research to establish many wholly original information structures representing healthcare activity and associated risk related interactions This Thesis describes a new risk simulation environment for the Critical Care Unit of University Hospital, Coventry which is a 1200 bed modern acute hospital which fully opened in 2006. Available sets of patient admission/discharge information and records of patient treatment records used for cost charging together with extensive direct observation of clinical activity are used to create simulated patient episodes within the Critical Care environment. Specific patient interventions are sub divided into a series of up to 7 sub tasks which are associated with sub competencies and a linked adverse effect. Such sub competencies can be coded to reflect three levels of task complexity. Separate codes can be allocated to identify sub competencies which are supervised and sub competencies for which additional competency can be requested from other team members. A fuzzy logic framework has been adopted to combine empirically derived mathematical functions which for a specific sub task, translate values of individual effectiveness, distraction, competency mismatch of individual/team together with the level of supervision to a specific risk value for each adverse effect. This fuzzy logic framework, referenced as the ‘risk engine’ has specific responses for levels of sub task complexity and can be modified by indicators relating to sub task supervision and competency sharing. In addition, each sub task/competency is associated with an adverse effect whose probability of occurrence can be reduced through identified safe working practices which are referenced as ‘preventive measures’. Individual effectiveness is identified as being influenced by cirdadian rhythm, physical effort, emotional/stress effort, intellectual effort, sleep deficit and long term factors. Organisational factors influencing individual effectiveness are identified as patient admission and shift handover. The risk simulation process is implemented within a 10 bed Critical Care Unit which utilises a specifically designed nurse rostering process for 12 hour shift periods. Sub grades of nurse skills (1 to 15) are used to structure skill mix within each rostered group and which are based on representative nurse grades (band 5, 6 and 7). Available competencies of nursing staff for a specific sub task are allocated on the basis of sub grade value and the parameter of individual competency mismatch is derived from values of required competency and available competency for each sub task. The team competency mismatch for a specific sub task linked to a specific individual is derived from the maximum available competency within the active nursing team. Nursing staff are allocated to patients on the basis of clinical need at the start of each shift. A novel feature of the model identifies modes of interaction between nursing individuals on a ‘bed to bed’ basis as relating to parameters of distraction, supervision and competency sharing and which are related to the physical layout of the active clinical area. A fuzzy logic sub system for determining values of such interaction coefficients and which uses the same design methodology as the ‘risk engine’ is described.

In this research, a model of teachers’ efficacy posed by Tschannen-Moran, Woolfolk-Hoy, and Hoy (1998) is considered with regard to teachers’ use of standardized assessment data. This study is timely because teachers are expected to utilize standardized test scores, but they are often underprepared for this task. As a result of minimal experiences, teachers require in-service opportunities that develop their efficacy and knowledge toward standardized assessment. This proposal provides an opportunity for such experiences, and assesses the impact of a professional development activities designed to foster teachers’ assessment efficacy and knowledge. Last, for considerations pertaining to program evaluation, this report will explore the relevance of using hierarchical linear modeling (HLM) as an alternative statistical procedure. / text

This study assessed the convergent validity of the Functional Assessment Informant Record for Teachers (FAIR-T; Edwards, 2002) with analog functional analyses (FAs). Participants were five teachers and students located at a specialized school serving individuals with disabilities. Teachers had worked with the student for a minimum of 1 month, and students displayed a variety of behavioral topographies. The FAIR-T was conducted by the researcher using telephone or video conferencing technology, and analog functional analyses were conducted in a clinic setting by trained therapists within the course of the student’s typical treatment plan. Results of the FAIR-T were coded according to function, and the results of the analog FAs were graphed and analyzed visually. Results of the FAIR-T and FAs indicated limited convergence between the two assessment methods, though results were somewhat inconclusive. Results are discussed in relation to the utility of the FAIR-T, particularly in the school setting. Directions for future research are discussed in light of the need to delineate efficient means with which to conduct functional behavior assessments within the schools.

No description available.

No description available.

Swallowing difficulties after acute stroke are common. Clinical bedside assessments are used frequently to detect acute dysphagia. Published studies which have assessed the natural history of swallowing using bedside assessments have only observed swallowing for a short period of time. The purpose of this investigation was to monitor the natural progression of dysphagic symptoms in stroke over three month using a clinical assessment. 26 patients consecutively admitted to the regional public hospital were assessed using a clinical assessment consisting of cranial nerve exam, observation of oral intake, water swallow test and inhalation cough challenge. The assessment was implemented within 72 hours post admission and then after one week, three weeks and three months. For this exploratory study, descriptive statistics were used to explore the data set. The results confirm that dysphagia after stroke is common and that there are improvements within three months.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Introduction: Patients who develop delirium while hospitalized are increasingly recognized as at risk for the development of long term cognitive impairment. We became interested in the contribution of delirium to the development of post-operative cognitive dysfunction (POCD) when we found that patients at Mayo Clinic in Arizona, compared to patients at the Mayo facilities in Rochester, MN, were 17 times more likely to receive the drug physostigmine (Antilirium®) for the treatment of delirium in the Post Anesthesia Care Unit (PACU). However, before we could examine the relationship between delirium and POCD we needed to validate a tool we could use to quickly assess the presence of delirium in patients emerging from anesthesia in the PACU. Hypothesis: The Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) can be used in the PACU to identify patients with delirium. Methods: Patients 65 years of age or greater who were going to have a standardized general anesthetic for a surgical procedure were identified on the day of surgery and consent to participate in the study was obtained. The CAM-ICU was used preoperatively to determine study eligibility (patients who scored less than 7 [scale of 1-10], indicating delirium, on the test were not followed further) and postoperatively, one hour after the patient was admitted to the PACU, to assess for delirium. The CAM-ICU was administered after we asked the patient’s nurse whether or not he or she had determined that the patient was delirious. Results: 168 patients, mean age 75 ± 7 (SD) with the majority of participants having urologic or orthopedic procedures were assessed pre- and post-operatively with the CAM-ICU, and post-operatively by a nursing assessment for delirium. The CAM-ICU took little time to administer and was easy for patients to understand and use. The nurse at the bedside identified 5 of 168 patients as delirious (prevalence of 2.98%). The CAM-ICU was positive for delirium in 11 of 168 (6.55%). The CAM-ICU had a sensitivity of 60% (3/5) and a specificity of 95% (155/163). Conclusion: In this investigation, the CAM-ICU was easy to use and had a high specificity for identifying post-operative delirium.

The growth in number and kind of online reference services has resulted in both new users consulting library research services as well as new patterns of service use. Staffing in person and virtual reference services adequately requires a systematic analysis of patterns of use across service points in order to successfully meet fluctuating patron needs. This article examines an assessment methodology for examining patron use of in person and virtual reference services, and designing variable staffing models which balance the observed needs of each mode of communication and patron type.

No description available.