OBJECTIVE: This study investigated how upper limb post-operative patients defined quality care. We specifically assessed the following three aims: (1) determining patient expectations following upper limb surgery, (2) identifying patient recognized barriers to receiving quality care, and (3) analyzing patient identified areas of improvement in patient education. METHOD: In total, 52 patients, aged 19 – 89 years (mean age: 48 years) who received upper limb surgery were surveyed with an open-ended questionnaire during their six to eight week post-operative visit at Stanford Medicine Outpatient Center in Redwood City or Stanford Orthopaedic Surgery Clinic in Los Gatos. Responses were electronically transcribed to REDcap, Research Electronic Data Capture System, for analysis of responses to demographic questions. Open-ended questions were evaluated by thematic analysis until data saturation was reached. RESULTS: Thematic analysis of open-ended responses revealed three main themes: (1) Pain, (2) Function; and (3) Patient Unpreparedness. Both pain and function involved pre- and post-operative factors. Of our three identified themes, elimination of pain and regaining function were the two main health-outcomes that upper limb patients identified as successful treatments of their condition. Patient unpreparedness was recognized as a main barrier in patients receiving quality care and an important area to improve patient education about their problem and treatment. CONCLUSION: By understanding the desired health outcomes and limitations in achieving those outcomes for post-operative upper limb patients, we can improve how medical care is practiced. Our results highlighted that both process and outcome domains of care are important elements in patients’ definition of quality care when seeking medical treatment for their upper limb problems. Specifically, patients identified that elimination of pain and regaining function were important health outcomes during their care. In order to achieve those desired health-outcomes, we recognized that improvements need to be made with regard to patient education about their health condition and treatment process, in order to foster better physician-patient communication. Overall, our findings support the need for continued focus on patient-centered care to ensure the delivery of quality healthcare to all patients.

Geography, more than other subjects in the curriculum, plays a central role in general education in equipping learners with skills and competencies needed for modern living and global citizenship. A learner-centred education in Namibia was adopted to provide more opportunities for learners to develop the required skills and competencies irrespective of their different cultural background. This small-scale case study investigated three Grade 10 geography teachers' understanding and implementation ofa learner-centred approach to gain insights into how leamer-centred education is being implemented in the context of Geography. The research design adopted a qualitative approach within an interpretative orientation. Data were collected through interviews, classroom observations and documentary analysis. The research was conducted at three selected schools in Oshikoto Region with three Grade 10 geography teachers The findings revealed, firstly, that teachers have a limited understanding of the key ideas ofLCE, such as, prior knowledge, role of questioning, and social interaction in learning; use of resources and the types of assessment activities which comply with the aims of LCE. Seconclly, the findings revealed that the policy documents, such as syllabuses, that are being used by the participants are not in line with the tenets ofLCE. Thirdly, teachers appeared to have limited subject knowledge, as revealed by their lack of understanding of how to translate the aims and assessment objectives into their daily lessons. The study therefore raises some possibilities for improving the implementation of LCE in the selected schools if the gaps as identified by this study are reduced.

Previous literature discussing Japanese women's language (JWL) has shown that it is an ideal more than an existing genderlect (Inoue 2006; Nakamura 2007). As a social construct, it has been rendered a powerful truth through institutionalized practices and representations as well as individual negotiations. JWL, a cultural knowledge about how women speak, has been dynamically constructed in certain spatio-temporal intersections (Inoue 2003, 2004a, 2004b, 2006; Washi 2004). Mass media have served as one of the influential sites of production and reproduction of the discourses that naturalize indexical orders of JWL of the given temporality. The purpose of this study was to reveal how modern female speakers of Japanese negotiate the presented media discourses and contribute to recontextualization of JWL discourses through metapragmatic narratives. Three participants were asked to analyze the speech styles of two female characters from a TV drama in terms of linguistic femininity, and to discuss what it means to speak feminine to them. The participants' written scene analysis data, individual interviews, and the focus group discussion were triangulated in order to effectively uncover and denaturalize the intertwined discourses of feminine speech and JWL. The participants' metapragmatic narratives were examined based on the principles of the discourse centered approach (Sherzer 1987), shedding light on their dynamic articulations of JWL discourses. The participants' scene analyses in terms of femininity and generalization of what consists of femininity showed both interpersonal and intrapersonal similarities and differences. Simultaneously, the participants' metadiscursive narratives revealed some contradictory discourses around JWL: discourse of JWL in the contemporary Japanese society and discourse of JWL as cultural heritage. In the articulation of these discourses, the imagined continuity of JWL is romanticized as a cultural heritage, so the semiotic value of JWL is that of an icon of an ideal woman. However, the participants also acknowledged the structural transformation of Japanese society and the higher socioeconomic status of modern women, which naturalizes the masculinization of women's speech to keep up with men. These two contrastive discourses make JWL a vicarious language, through which the participants appreciate the continuity of JWL in the future.

Background: There are around 150.000 people with dementia in Sweden. It is common to suffer from BPSD sometime during the course of the disease, which adversely affects the quality of life. Symptoms cause impairment to varying degrees, making everyday life difficult to handle independently. Person-centered care means seeing the person behind the disease and it is necessary to find the cause of behavior and to compensate for loss of function. Knowledge of experience of working person-centered is a prerequisite for being able to provide staff with necessary support. Aim: To highlight healthcare professionals' experiences of person-centered care in BPSD. Method: This is a qualitative literature study based on 12 scientific articles. Result: The main themes that emerged were: Own conditions and obstacles, External conditions and obstacles and Contradictory feelings at work. With associated subthemes: Seeing the person behind the disease, To balance between strategies and routines,To take personal responsibility, To have knowledge and experience, Being in need of support and cooperation, To meet organizational / environmental factors, To have access to background information, To feel success and satisfaction and To feel insufficient and powerless. Conclusion: Several conditions that favor dementia care emerged from the results, but there were also factors and obstacles that hampered nursing work. Person-centered work practices increase the possibility of well-being for all involved. In order to care for people with dementia with a person-centered approach, more research in the subject, more resources and in-depth education is required. / Demenssjukdom är ett växande problem inom såväl hälso- och sjukvården som för samhället i stort. Det finns tillgång till symtomlindrande behandling men demenssjukdomar går idag inte att bota utan kan innebära ett stort livslångt lidande för de drabbade men även för deras anhöriga samt en ständig utmaning för vårdpersonal. De flesta drabbas någon gång under sin sjukdomsperiod av beteendemässiga eller psykiska symptom, som till exempel utmanande eller avvikande beteende. Det är viktigt att komma på vad som orsakar symtomen för att kunna lindra, förebygga eller minska lidandet. Syftet med denna studie är att beskriva vårdpersonalens erfarenheter av personcentrerad vård vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom (BPSD) och studiens resultat baseras på en sammanställning av 12 kvalitativa artiklar. Resultatet visade att vårdpersonal beskrev egna och yttre förutsättningar och hinder och motstridiga känslor i arbetet. Att ha helhetssyn, förståelse och kunskap gentemot personer med demenssjukdom underlättar omvårdnaden. Vårdpersonal strävar efter att behandla personer med demenssjukdom utifrån det som passar personen och situationen bäst. Att anpassa mötet och se människan bortom sjukdomen är en viktig utgångspunkt som resulterar i bättre vårdkvalitet. Kunskap och kännedom om tidigare livshistoria är en förutsättning för att lära känna och förstå personen och arbeta personcentrerat vid BPSD. Olika strategier och rutiner används som redskap för att skapa kontakt och tillgodose behov. Vårdpersonal har erfarenhet och medvetenhet om att omvårdnaden av personer med demenssjukdom är komplex och kräver kunskap och tålamod. Det ställs stora krav på vårdpersonalens anpassningsförmåga då det som fungerar ena gången, kanske inte fungerar gången därpå. Vårdpersonalens erfarenheter handlade även om behovet av stöd och samarbete, att möta organisatoriska miljöfaktorer och ha tillgång till bakgrundsinformation om patienten. Samarbete mellan kollegor främjar personcentreringen och bidrar till en förbättrad arbetssituation. Svårigheten i att påverka organisatoriska beslut är märkbar och brist på resurser, samarbete och förståelse från organisationens sida bidrar till att vårdpersonal får svårt att arbeta personcentrerat. Detta tillsammans med vårdpersonalens erfarenheter av hur välfungerande personcentrerad vård gynnar arbetet med personer med BPSD skapar motstridiga känslor i arbetet. Vårdpersonalen kände sig ibland otillräcklig och maktlös men kunde även känna framgång och tillfredsställelse

Abstract Keywords: elderly people, dementia, person-centered care and relatives. Title: To visit someone who is no longer there Author: Ulrika Stenmarck As the number of elderly people increase, the amount of people suffering from age-related illnesses is growing. Such a disease is dementia, which today is a priority research area, both nationally and internationally. It has been found that working in a person-centered way and involving the patient’s relative’s is important for the people cared for by the dementia departments. Despite this, research has shown that the support for relatives is inadequate. The purpose of this study is to identify how individual support, in the field of nursing for dementia patients, can be better adapted to support relatives. By interviewing five relatives and four staff members in a nursing home for dementia patients, answers were sought for regarding; what kind of support the relatives need and how staff work to support relatives. The relatives´ responses were analyzed based on the theories concerning crisis processing related to their relatives´ dementia diagnoses. The answers given from the staff were analyzed based on the theories concerning organizational culture The analysis indicates that the goal of crisis processing for relatives should be to “create their new life”, which seems to be a challenge for a staff that is already carrying a large workload. The results indicate that the staff have succeeded in creating a foundation of values that relatives seem to experience as a safe atmosphere. This atmosphere can be interpreted as the most important support for relatives and a necessity for progress in their crisis processing. As a complement to the unit’s staff, external support for the families can be a solution.

Made available in DSpace on 2014-06-11T19:26:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-07Bitstream added on 2014-06-13T18:29:18Z : No. of bitstreams: 1 mendes_cct_me_prud.pdf: 446057 bytes, checksum: 251d3fdf0fe496ddfe3b18f7339f9aba (MD5) / O presente estudo foi desenvolvido no âmbito dos trabalhos do Grupo de Pesquisa “Políticas Públicas, Organização Escolar e Formação de Professores” e teve como objetivo analisar e compreender as representações sociais construídas pelos professores do Ensino Fundamental (Ciclo I) da Rede Municipal de Presidente Prudente-SP sobre a Hora de Trabalho Pedagógico Coletivo tendo como aporte teórico a Teoria das Representações Sociais de Serge Moscovici. É uma pesquisa com traços de pesquisa participante, pois como professora, faço parte do grupo de profissionais desta Rede. Foram utilizadas técnicas tais como o questionário aplicado junto a 170 professores; a entrevista semi-estruturada com 10 professores e um grupo de discussão com 9 Orientadores Pedagógicos, profissionais responsáveis pela organização da HTPC, momento de formação na escola. Os dados coletados foram tratados com base na análise de conteúdo, mais precisamente no processo de categorização dos dados tendo como ponto de partida o grau de aprovação dos professores a este momento de formação. Os resultados obtidos revelam que os profissionais representam a HTPC como Hora de Tempo perdido, ou seja, que esse momento apesar de ser importante não tem atingido seus objetivos tendo em vista a sua forma de organização. Os profissionais apontam que a forma de gestão, a condução do Orientador Pedagógico e a participação do professor não têm contribuído para que mudanças significativas ocorram na prática dos professores com reflexos positivos na aprendizagem dos alunos... / The present study was developed current to the Research Group “Public policy, scholar organization and teachers’ formation”. Its objective was to analyze and understand the social representations of the teachers from the Primary School (Circle I) of the municipal schools of Presidente Prudente – SP about the Collective Pedagogic Work Time (HTPC). The theoretical support was the Theory of Social Representations by Serge Moscovici. This study has some characteristics of participative research, since as a researcher I am a constituent of the group of teachers who work at the municipal schools. In order to do so we used questionnaires applied to 170 teachers; semi-structured interview with 10 teachers and a discussion group with 9 Pedagogic Coordinators, who were responsible for the HTPC organization, which is a moment for teachers’ development in school. The data collected were treated according to the content analysis, more precisely to the process of data categorization from the level of teachers’ approval about the HTPC. The results showed that the teachers think the HTPC is waste of time, what means that despite the fact that it is an important moment, it has not reached their objectives because of the way it is organized. The teachers assert that the way it is conducted by the Pedagogic Coordinator and the teachers’ participation has not contributed to effective changes in teachers’ practice with positive reflections in students’ learning...(Complete abstract, click electronic access below)

Este trabalho tem por objetivo apresentar uma pesquisa-ação sobre a implantação da metodologia Manutenção Centrada em Confiabilidade (MCC) integrada à Gestão de Manutenção em uma linha de produção de misturas negras de uma fábrica de pneus localizada na região sudeste do Brasil que em virtude da crise financeira global deflagrada em 2008, foi obrigada a realizar o cancelamento de contratos, cortes drásticos nos investimentos em processos e nas verbas disponíveis de manutenção. Tais ações contribuíram para o pior resultado de disponibilidade fabril média da década atual. Diante destes fatos, a unidade de negócio de manutenção decidiu a partir de uma análise de cenários realizada e pelo uso do Mapeamento de Processo que é uma ferramenta gerencial analítica, pela aplicação efetiva e disciplinar da metodologia MCC. Esta aplicação permitiu a construção de uma plataforma robusta que propiciou o balanceamento e a melhoria qualitativa e quantitativa dos planos de manutenção existentes e conseqüentemente dos resultados de disponibilidade fabril média que alcançaram o desempenho proposto pela alta direção ao longo dos anos de 2009 e 2010, sendo este superior aos índices alcançados dos últimos seis anos. Portanto os resultados alcançados convergem para as necessidades de um cenário organizacional que necessita de taxas consistentes e contínuas de disponibilidade fabril e custos reduzidos de produção. / The objective of this paper is to present an action research on the deployment of the methodology Reliability-Centered Maintenance (RCM) integrated Management Maintenance in a blacks mixtures production group of a tire plant located in the southeastern region of Brazil that because the global financial crisis in 2008, was forced to cancel the contracts, cuts in investment processes and maintenance costs. These actions contributed to the worst result of the average plant availability of the current decade. Due to these facts, the business unit maintenance decided to do a scenario analysis performed and the use of Process Mapping that is an analytical management tool, for the effective application of the methodology and discipline RCM. This application allowed the construction of a robust platform that provided the balance and the qualitative and quantitative improvement of the existing maintenance plans and therefore the results of which reached an average plant availability performance proposed by senior management over the years 2009 and 2010, and this result was higher than the rates achieved over the last six years. Therefore, the reached results converge into the needs of an organizational which requires consistent and sustained rates of plant availability and reduced costs of production.

According to a study made at Linköping University, there are few options besides self-catered food and buying food at a restaurant. According to the same survey, a majority of the students seek further options in the market. A proposed solution, tested here, is to develop a platform for selling and buying homemade food through a web application. Development takes place in iterations where design and functionality are supported by scientific theory. Changes are based on qualitative opinions from user tests at the end of each iteration. The work is specifically aimed at creating a design with associated features that allow quick navigation to the desired transaction while the user experiences a good navigability. The balance between navigability and time aspects has been central to the report and influenced all aspects of the web application's design. The report shows that it is possible to develop a web application according to the above criteria and identify what is essential for the users. / Enligt en undersökning vid Linköpings universitet finns det få alternativ till egenlagad mat och att köpa mat på restaurang. Enligt samma undersökning eftersträvar en majoritet av studenterna ett ytterligare alternativ på marknaden. En föreslagen lösning, som testas här, är att genom utvecklingen av en webbapplikation skapa en plattform för försäljning och köp av hemlagad mat. Utveckling sker i iterationer där design och funktionalitet underbyggs med vetenskaplig teori. Förändringar baseras på kvalitativa åsikter från användartester i slutet av varje iteration. Arbetet är speciellt inriktat på att skapa en design med tillhörande funktioner som tillåter en snabb navigering till den önskade transaktionen samtidigt som användaren upplever en god navigerbarhet. Avvägningen mellan navigerbarhet och tidsaspekter har varit centralt i rapporten och påverkat samtliga delar av webbapplikationens utformning. Rapporten visar att det är möjligt att utveckla en webbapplikation efter ovan nämnda kriterier och identifierar vad som upplevs centralt för användarna.

The purpose of this study is to explore the relationships among Chinese college students’ attitudes toward online games and online game advertising, their perceived influence of online game advertising on themselves and others, and their attitude toward restrictions on online game advertising. The growing popularity of online games and the frequent use of advertising in promoting online gaming activities make it necessary to examine empirically the relationships among these variables. Based on a survey among 518 Chinese college students, the study found support for the mediating role of the third-person effect. It also found evidence for the first-person effect through the mechanism of looking glass perception.

The purpose of this DNP project was to determine the feasibility of implementing a nurse practitioner led interprofessional collaborative management model of caring for patients with complex medical conditions who are at high risk for ED and hospital readmission. The target of the feasibility study was an accountable care organization (ACO) in Idaho. The ACO assumes greater financial risk for providing care to a population that includes Medicare Advantage patients - dual insured Medicare/Medicaid patients. The care management teams are currently led by physicians. The members of the population that suffer most from multiple chronic conditions often encounter barriers to accessing high quality primary care, in particular when transitioning between different levels of care. Interprofessional collaborative team based care coordination can address medical and social issues that can affect a patient’s ability to achieve/maintain wellness. The literature suggests that nurse practitioners are ideally suited to lead those teams Approval was given by leadership in the ACO to accomplish a study to determine the feasibility of successfully implementing an innovative NP led interprofessional collaborative care management model: the AEIØOU Bundle of Care Practices. Principles of qualitative descriptive methodology, using content analysis, were applied to explore the responses provided at individual interviews by thirteen key stakeholders. The data collected were not intended to be generalized, but rather to evaluate the potential for implementation of a new model of interprofessional collaborative care within the ACO. Findings suggest that implementation of this model is feasible within the ACO. Common themes uncovered include: (a) change is challenging, (b) coordinated patient care aligns with organizational goals, (c) success requires cost analysis, a comprehensive business plan, buy-in from primary care physicians, and a pilot program, and (d) strong support among all participants for NP and RN home visits was notable.