Abstract The purpose of this study was to describe and explain nurse mentors’ competence in mentoring nursing students and to evaluate the effects of an educational intervention on nurse mentors’ competence in mentoring. The purpose was to also evaluate the reliability of an instrument measuring competence in mentoring nursing students. The study aimed to develop new knowledge on nurse mentors’ competence that can be used to improve mentoring education. This study included four phases. In the first phase, nurse mentors’ experiences of mentoring nursing students were described using a systematic review. Data were collected from seven electronic databases and were selected by titles, abstracts and full-texts. The quality of the included studies (n=21) was evaluated and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) extraction tool was used to extract and synthesize the studies. In the second phase, the psychometric properties of Mentor Competence Instrument (MCI) were tested. Data were collected from mentors (n=3355) at five university hospitals in Finland using an electronic version of the MCI. The construct validity and reliability of the instrument were tested using exploratory factor analysis (EFA) and Cronbach’s alpha. In the third phase, mentors’ level of competence in mentoring and distinct mentor profiles were identified using a cross-sectional study. The same data were used as in the second phase of this study and analyzed using multivariate statistical methods. In the fourth phase, the effect of mentoring education on nurse mentors’ competence in mentoring nursing students was evaluated using a quasi-experimental study. Data were collected from nurses (n=150) using the MCI instrument before and after mentoring education. Data were analyzed using statistical methods. According to the systematic review, nurse mentors' competence in mentoring nursing students contained eight competence areas. The MCI instrument exhibited acceptable psychometric properties. Nurse mentors evaluated their level of competence in various categories from satisfactory to good. Three distinct profiles of mentor competence were identified from skilled developer, competent adapter and beginner. Mentoring education had an effect on mentoring competence. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää sairaanhoitajien opiskelijaohjausosaamista sekä arvioida ohjaajakoulutuksen vaikutuksia sairaanhoitajien opiskelijaohjausosaamiseen. Lisäksi tarkoituksena oli arvioida opiskelijaohjausosaamisen mittarin luotettavuutta. Tavoitteena oli vahvistaa hoitotieteen tietoperustaa ja tuottaa uutta tietoa opiskelijaohjaajien osaamisesta ohjaajakoulutuksen kehittämiseksi. Tutkimus oli nelivaiheinen. Ensimmäisessä vaiheessa kuvailtiin järjestelmällisen katsauksen avulla sairaanhoitajien kokemuksia opiskelijoiden ohjaamisessa tarvittavasta osaamisesta ammattitaitoa edistävän harjoittelun aikana. Tiedonhaku toteutettiin seitsemästä tietokannasta. Aineisto valittiin otsikoiden, tiivistelmien ja koko tekstien perusteella. Mukaan otettujen alkuperäistutkimusten (n=21) laatu arvioitiin sekä tulosten yhdistämisessä ja analyysissä käytettiin apuna Joanna Briggs Instituutin JBI-QARI -uuttamismenetelmää. Toisessa vaiheessa arvioitiin opiskelijaohjausosaamista arvioivan mittarin luotettavuutta. Aineisto kerättiin poikkileikkaustutkimuksena Suomen viidessä yliopistollisessa sairaalassa työskenteleviltä sairaanhoitajilta (n=3355) sähköisesti opiskelijaohjausosaamisen mittarilla. Mittarin rakennevaliditeettia arvioitiin eksploratiivisella faktorianalyysillä ja sisäistä johdonmukaisuutta Cronbachin Alfa -kertoimella. Kolmannessa vaiheessa kuvattiin sairaanhoitajien opiskelijaohjausosaamisen tasoa ja selitettiin profiileita poikkileikkaustutkimuksella. Aineisto oli sama kuin tutkimuksen toisessa vaiheessa. Aineisto analysoitiin tilastollisilla monimuuttujamenetelmillä. Neljännessä vaiheessa arvioitiin ohjaajakoulutuksen vaikutuksia sairaanhoitajien opiskelijaohjausosaamiseen kvasikokeellisella tutkimusasetelmalla. Aineisto kerättiin sairaanhoitajilta (n=150) Opiskelijaohjausosaaminen -mittarilla ennen ja jälkeen koulutuksen. Aineisto analysoitiin tilastollisin menetelmin. Järjestelmällisen katsauksen mukaan sairaanhoitajien opiskelijaohjausosaaminen muodostui seitsemästä osaamisen alueesta. Opiskelijaohjausosaamisen mittarin psykometriset ominaisuudet todettiin hyviksi. Sairaanhoitajat arvioivat opiskelijaohjausosaamisen tason tyydyttäväksi tai hyväksi. Sairaanhoitajat profiloituivat ohjausosaamisensa osalta taitavaan kehittäjään, osaavaan soveltajaan ja aloittelijaan. Ohjaajakoulutus edisti ohjausosaamista.

A tese trata dos lugares da psicanálise na clínica e na cultura. O conceito de lugar é emprestado do autor pós-colonialista Homi Bhabha, para quem os lugares da cultura são marcados pelo hibridismo, fazendo com que o pensamento crítico seja tal que habite o limite e a cesura; além de Bhabha, recorre-se a Derrida e à própria psicanálise como aportes na constituição da estratégia de pensamento que mobiliza a tese. A partir desses aportes tratou-se da forma como a psicanálise se inscreve nos textos em que se faz ativa, na cultura que a acolhe, nas instituições através das quais se transmite e na práxis clínica dos psicanalistas. Dois pontos críticos marcam a discussão: 1. questiona-se a ideia de que a psicanálise é intrinsecamente excepcional: seja essa excepcionalidade suposta em termos históricos, epistemológicos, clínicos e/ou políticos, em todos esses âmbitos tenta-se demonstrar a impertinência desse tipo de julgamento apriorístico. Sustenta-se, como alternativa, uma compreensão do lugar da psicanálise como marcado pelo jogo, pela abertura e pela indeterminação, lugar a ser definido e reiteradamente sustentado em função da inscrição que se pleiteia para ela. 2. Discute-se também o lugar dos autores canônicos no entendimento do devir histórico, institucional e clínico da psicanálise diferentemente das compreensões onde tal ou qual autor funda ou garante tal ou qual clínica ou modo de pensamento, sustenta-se que os autores canônicos estabelecem entre si parâmetros de jogos de poder no interior da psicanálise, de forma que o recurso a um dado autor não configura por si garantia ou apoio para nada, configurando, isso sim, a escolha de uma determinada plataforma estratégica a partir da qual as questões terão de ser distribuídas, enfrentadas e encaminhadas em vista do que se pretende. Nota-se através dessas análises um mote comum: às formas de compreender e localizar a psicanálise como modo de estabilização há de se opor outras, pensadas e propostas de forma a induzir a habitação dos limites a partir de onde a psicanálise, ao ser acionada, opera. Pretende-se, com essa discussão, contribuir tanto para a pesquisa em psicanálise (nos campos da história da psicanálise e da transmissão da psicanálise em função de suas instituições) como para a práxis clínica dos psicanalistas / The research focuses on the locations of psychoanalysis in clinical practice and in culture. The concept of location is borrowed from postcolonial thinker Homi Bhabha, for whom the locations of culture are determined by hybridism and interpenetration, which means that critical thinking has to inhabit borders, limits and (as Bhabha names it) the caesura. Derrida and psychoanalysis itself are also mobilized as constituents for the theoretical framework, which aimed to discuss the means through which psychoanalysis inscribes itself in the texts in which it operates, the culture with which it intertwines, the institutions through which it transmits itself and the clinical praxises that embody it in everyday life. Two main critical points have been issued: 1. the idea that psychoanalysis is intrinsically exceptional whether such exceptionality be stated in historical, epistemological, clinical or political terms, in any case the argument is that such exceptionality cannot be stated as an a priori: be it desired, it has to be constantly put under suspicion and scrutiny, has to be constantly fought for, conquered and (re)established, every time anew. 2. The location of canonical authors within psychoanalytical tradition the recurrent notion that canonical authors confer rigor and stability to the psychoanalytical endeavour (be it theoretical, political or clinical) has been put into question; in its place the author argues for the notion that canonical authors arrange the strategical battlefield within the psychoanalytical community which means they do not confer rigour: what they do is to establish the critical terms for the politics of authorization which set up the starting points for psychoanalytical practice. Throughout the text a red thread signals the main critical argument: psychoanalytical locations in text, in culture and in clinical practice cannot be taken for granted, but have to be thought anew, systematically questioned and fundamentally (re)established, time and time again

Introdução: apesar das recomendações de todas as diretrizes sobre a doença arterial coronária e das evidências científicas de que o tratamento medicamentoso otimizado acrescido de intervenção sobre os fatores de risco e a melhoria do estilo de vida reduzem eventos cardiovasculares fatais não-fatais, essa terapêutica de prevenção secundária continua a ser subutilizada na prática clínica. Objetivos: Primário: demonstrar que a utilização de um programa de otimização da prática clínica em pacientes com doença arterial coronária estável aumenta a prescrição de medicamentos comprovadamente eficazes na prevenção secundária desta doença. Secundários: a) documentar a prática clínica vigente em termos de terapia medicamentosa e de medidas para a mudança do estilo de vida b) identificar as ferramentas utilizadas na estratégia para a otimização da prática clínica quanto à eficácia e aderência à medicação prescrita. Métodos: trata-se de um estudo de corte transversal para documentar a prática clínica vigente, seguido de componente longitudinal em que a utilização das ferramentas para a otimização da prática clínica foi avaliada por meio de novo corte transversal, com nova coleta de dados. Foram identificados retrospectivamente através dos prontuários, 710 pacientes consecutivos portadores de doença arterial coronária (Fase 1). Após a aplicação das ferramentas, foram incluídos 705 pacientes consecutivos atendidos no serviço com a coleta dos mesmos dados, para a análise comparativa. Além disso, foram selecionados do primeiro grupo, de forma aleatória, 318 prontuários de seis a doze meses após a primeira avaliação, para a coleta dos mesmos dados, que foram comparados com as informações iniciais destes mesmos pacientes. (Fase 3). Resultados: comparação entre Fase 1 e Fase 2: as características demográficas eram comparáveis entre os dois grupos. Quanto aos fatores de risco, houve melhora com diferença significativa para o tabagismo (p=0,019), dislipidemia (p<0,001) hipertensão arterial e atividade física regular (p<0,001). Quanto aos exames laboratoriais, não houve diferença estatisticamente significativa entre as duas populações. Comparando a prescrição dos fármacos recomendados, houve diferença significativa para IECA (67,2% versus 56,8%, p<0,001); ARA II (25,4% versus 32,9%, p=0,002) e betabloqueador (88,7% versus 91,9%, p=0,047). Comparação entre Fase 1 e Fase 3: os dados demográficos foram semelhantes, assim como as características clínicas, com exceção da doença arterial periférica obstrutiva: 31 pacientes (9,7%) e 42 (13,3%), p=0,007. Em relação aos fatores de risco, consideramos apenas os modificáveis tabagismo e atividade física. Para o tabagismo, considerando três categorias (nunca, ex-fumante e atual), não houve diferença significativa entre as duas fases. Para a atividade física, a proporção de pacientes sem informação para esta variável era elevada, 83,9% na primeira fase e 72,8% na terceira fase, dificultando a análise estatística. Quanto às medidas de exame físico, houve redução significativa do peso, p=0,044, pressão arterial sistólica e diastólica, p<0,001. Os exames laboratoriais não mostraram diferenças significativas entre as duas fases. Em relação à prescrição de medicamentos recomendados, houve diferença para IECA (64,8% versus 61,6%, p=0,011) e ARA II (27,0% versus 31,3%, p=0,035). Conclusão: com base nos resultados obtidos, o presente estudo permite concluir: não houve mudança significativa na utilização de medicamentos comprovadamente eficazes na prevenção secundária da DAC entre o período pré- e pós-intervenção; houve melhora significativa em relação ao tabagismo e atividade física na Fase 2; melhora substancial nos níveis de pressão arterial, tanto sistólica como diastólica na comparação tanto entre a Fase 1 e 2 como entre a Fase 1 e 3; a inclusão de enfermeiro treinado para gerenciar o processo é fundamental para a eficácia do programa; programas abrangentes de melhoria de qualidade assistencial em hospitais terciários e acadêmicos, provavelmente devem ser continuados por período de seguimento superior a um ano. / Background: despite guidelines recommendations on coronary artery disease treatment and scientific evidence confirming that optimal medical therapy added to risk factors and lifestyle management, reduce both fatal and non-fatal cardiovascular events, these secondary prevention strategies have been underutilized in clinical practice. Objectives: Primary: to demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients would increase the evidence-proved treatment prescription in secondary prevention. Secondaries: a) to describe the ongoing clinical practice on medical therapy and lifestyle change counseling b) to identify tools to be utilized in the strategy to improve clinical practice, assessing efficacy and adherence to prescribed treatment. Methods: cross-sectional study to describe the ongoing clinical practice, followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional crosssectional data collection. 710 consecutive coronary artery disease patients were included after chart review following eligibility criteria (Phase 1). After tools implementation, within 6-month period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3). Results: Phase 1 to Phase 2 comparison: demography was comparable. Concerning to risk factors, there were improvement on smoking (p=0,019), dyslipidemia (p<0,001), hypertension and physical activity (p<0,001). There were no statistical significant differences on laboratory results. By comparing the proven pharmacological treatment prescription, there was significant difference on ACEI (67,2% versus 56,8%, p<0,001); ARB II (25,4% versus 32,9%, p=0,002) and beta-blocker (88,7% versus 91,9%, p=0,047). Phase 1 to Phase 3 comparison: demography was comparable, as well as clinical characteristics, except peripheral artery disease: 31 patients (9,7%) and 42 (13,3%), p=0,007. Regarding risk factors, smoking and physical activity were considered. There was no significant difference on smoking rates taking into account three categories (never, ex-smoker and smoker). The proportion of patients without available data for physical activity was high, 83,9% (Phase 1) and 72,8% (Phase 3), making the data analysis not appropriated. Anthropometric measurement showed significant on weight reduction, p=0,044, both systolic and diastolic blood pressure, p<0,001. Laboratory results did not show significant differences. There was statistical significant difference on ACEI (64,8% versus 61,6%, p=0,011) and ARB II (27,0% versus 31,3%, p=0,035). Conclusion: based upon study results the following might be concluded: there was no significant change on the evidence-based pharmacological treatment utilization on secondary prevention coronary artery disease patients between pre and post-intervention Phases; there was significant improvement concerning smoking and physical activity in Phase 2; substantial improvement on blood pressure levels, both systolic and diastolic in both comparisons (Phase 1 to 2 and Phase 1 to 3); the inclusion of a case-manager for the process management is crucial for program efficacy; comprehensive programs for clinical practice improvement in tertiary academic hospitals should be pursued for longer follow-up period.

Masters of Science - Msc (Physiotherapy) / The roles of doctors and nurses in clinical supervision and clinical education are well defined in literature. However, the role of the physiotherapist in clinical education has not been clearly defined. This could be because the understanding of a clinical supervisor varies from discipline to discipline.

A depressão é um dos maiores problemas de saúde pública do século XXI. Guias de prática clínica (GPCs) estão disponíveis para o tratamento da depressão e têm como objetivo fornecer a melhor e mais recente evidência disponível para os cuidados dos pacientes. Visando reduzir a duplicação de esforços e realizar a adequação de GPC ao contexto local o objetivo desta pesquisa é sintetizar as recomendações de GPCs de alta qualidade sobre o tratamento farmacológico da depressão em adultos na atenção primária. Foram realizadas as etapas busca sistemática dos GPCs, avaliação e seleção dos GPCs de melhor qualidade, e elaboração da síntese de recomendações de acordo com o preconizado no método ADAPTE. Foram considerados os GPCs com recomendações para o tratamento farmacológico da depressão em adultos em atenção primária, em língua inglesa, portuguesa ou espanhola, publicados a partir de 2011. Para a avaliação da qualidade dos GPCs, foi utilizado o Appraisal of Guidelines for Research & Evaluation II (AGREE II) sendo considerados de alta qualidade os GPCs com 80% ou mais no domínio \"rigor metodológico\". As características associadas à alta qualidade dos GPCs foram analisadas por meio do teste estatístico de Fisher. A extração das recomendações foi realizada de modo independente por dois avaliadores e estas foram organizadas em tópicos. Dos 28 GPC avaliados apenas cinco (18%) foram considerados de alta qualidade. A realização de revisão sistemática e da revisão externa e a aplicação de consenso formal foram características associadas à alta qualidade. Na síntese, além dos GPCs de alta qualidade, foram incluídos 2 GPCs muito empregados na prática clínica. Constatou-se que a maioria dos GPCs traz recomendações concordantes e complementares. Quase todos os GPCs recomendam o uso de inibidores seletivos de recaptação de serotonina como primeira escolha de tratamento. Uma das principais divergências é a recomendação de agomelatina, milnaciprano e mianserina por um dos GPCs como opção de primeira linha de tratamento. A pesquisa demonstra que a qualidade dos GPCs está aquém do desejável, tal qual evidenciado em outros estudos. A elaboração da síntese de recomendações permitiu evidenciar que há um GPC que se destacou por recomendar o uso de medicamentos considerados pouco eficazes na depressão. Considerando que a maioria das recomendações eram concordantes e os GPCs complementavam-se, essa síntese pode contribuir para que sejam realizadas discussões e adaptações locais, favorecendo a elaboração de novos GPCs que possam atender às necessidades de distintos grupos de usuários e demandas regionais. / Depression is one of the most significant public health problems of the 21st century. Clinical practice guidelines (CPGs) are available for treating depression and are used for providing the best and latest evidence available for patient care. To avoid the duplication of effort and allow the adequacy of CPGs to regional healthcare networks, the objective of this study is to summarise the recommendations of high-quality CPGs on the pharmacological treatment of depression in adults in the primary healthcare network. The stages of this study were the systematic search of CPGs, analysis and selection of high-quality CPGs, and summarisation of the recommendations according to the ADAPTE guidelines. The CPGs published in English, Portuguese, and Spanish since 2011 with recommendations for the pharmacological treatment of depression in adults in the primary healthcare network were considered. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) was used to evaluate the quality of CPGs. CPGs with a score of >=80% in the domain \'methodological rigour\' were considered high-quality. The factors associated with high quality were analysed using Fisher\'s exact test. The recommendations were extracted independently by two evaluators and organised into topics. Of the 28 evaluated CPGs, five (18%) were considered high-quality. The inclusion of systematic reviews and external reviews and the application of formal consensus were associated with high quality. In addition to high-quality CPGs, two CPGs commonly used in clinical practice were included in the summary. The recommendations provided by most CPGs were consistent and complementary. Almost all CPGs recommended using selective serotonin reuptake inhibitors as the first choice of treatment. One of the main divergences was the recommendation of agomelatine, milnacipran, and mianserin by one CPG as a first-line treatment option. The quality of CPGs was below desirable, and this result was corroborated by other studies. The analysis of the recommendations indicated that one CPG advised using medications with low efficacy in treating depression. Provided that most suggestions were concordant and the CPGs were complementary, this summary may contribute to local discussions and adaptations and promote the development of new CPGs that meet the needs of different user groups and regional demands.

A depressão é um dos maiores problemas de saúde pública do século XXI. Guias de prática clínica (GPCs) estão disponíveis para o tratamento da depressão e têm como objetivo fornecer a melhor e mais recente evidência disponível para os cuidados dos pacientes. Visando reduzir a duplicação de esforços e realizar a adequação de GPC ao contexto local o objetivo desta pesquisa é sintetizar as recomendações de GPCs de alta qualidade sobre o tratamento farmacológico da depressão em adultos na atenção primária. Foram realizadas as etapas busca sistemática dos GPCs, avaliação e seleção dos GPCs de melhor qualidade, e elaboração da síntese de recomendações de acordo com o preconizado no método ADAPTE. Foram considerados os GPCs com recomendações para o tratamento farmacológico da depressão em adultos em atenção primária, em língua inglesa, portuguesa ou espanhola, publicados a partir de 2011. Para a avaliação da qualidade dos GPCs, foi utilizado o Appraisal of Guidelines for Research & Evaluation II (AGREE II) sendo considerados de alta qualidade os GPCs com 80% ou mais no domínio \"rigor metodológico\". As características associadas à alta qualidade dos GPCs foram analisadas por meio do teste estatístico de Fisher. A extração das recomendações foi realizada de modo independente por dois avaliadores e estas foram organizadas em tópicos. Dos 28 GPC avaliados apenas cinco (18%) foram considerados de alta qualidade. A realização de revisão sistemática e da revisão externa e a aplicação de consenso formal foram características associadas à alta qualidade. Na síntese, além dos GPCs de alta qualidade, foram incluídos 2 GPCs muito empregados na prática clínica. Constatou-se que a maioria dos GPCs traz recomendações concordantes e complementares. Quase todos os GPCs recomendam o uso de inibidores seletivos de recaptação de serotonina como primeira escolha de tratamento. Uma das principais divergências é a recomendação de agomelatina, milnaciprano e mianserina por um dos GPCs como opção de primeira linha de tratamento. A pesquisa demonstra que a qualidade dos GPCs está aquém do desejável, tal qual evidenciado em outros estudos. A elaboração da síntese de recomendações permitiu evidenciar que há um GPC que se destacou por recomendar o uso de medicamentos considerados pouco eficazes na depressão. Considerando que a maioria das recomendações eram concordantes e os GPCs complementavam-se, essa síntese pode contribuir para que sejam realizadas discussões e adaptações locais, favorecendo a elaboração de novos GPCs que possam atender às necessidades de distintos grupos de usuários e demandas regionais. / Depression is one of the most significant public health problems of the 21st century. Clinical practice guidelines (CPGs) are available for treating depression and are used for providing the best and latest evidence available for patient care. To avoid the duplication of effort and allow the adequacy of CPGs to regional healthcare networks, the objective of this study is to summarise the recommendations of high-quality CPGs on the pharmacological treatment of depression in adults in the primary healthcare network. The stages of this study were the systematic search of CPGs, analysis and selection of high-quality CPGs, and summarisation of the recommendations according to the ADAPTE guidelines. The CPGs published in English, Portuguese, and Spanish since 2011 with recommendations for the pharmacological treatment of depression in adults in the primary healthcare network were considered. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) was used to evaluate the quality of CPGs. CPGs with a score of >=80% in the domain \'methodological rigour\' were considered high-quality. The factors associated with high quality were analysed using Fisher\'s exact test. The recommendations were extracted independently by two evaluators and organised into topics. Of the 28 evaluated CPGs, five (18%) were considered high-quality. The inclusion of systematic reviews and external reviews and the application of formal consensus were associated with high quality. In addition to high-quality CPGs, two CPGs commonly used in clinical practice were included in the summary. The recommendations provided by most CPGs were consistent and complementary. Almost all CPGs recommended using selective serotonin reuptake inhibitors as the first choice of treatment. One of the main divergences was the recommendation of agomelatine, milnacipran, and mianserin by one CPG as a first-line treatment option. The quality of CPGs was below desirable, and this result was corroborated by other studies. The analysis of the recommendations indicated that one CPG advised using medications with low efficacy in treating depression. Provided that most suggestions were concordant and the CPGs were complementary, this summary may contribute to local discussions and adaptations and promote the development of new CPGs that meet the needs of different user groups and regional demands.

This research was undertaken to study the impact of single and multicomponent knowledge translation interventions (KTIs) on barriers to the integration of Clinical Practice Guidelines (CPG) into Clinical Decision Making (CDM) in the context of physical therapists (PTs) and find out which of the two KTIs was more effective. A literature review showed that research knowledge (e.g. CPG) in the field of PT (Physical Therapy) is not being integrated in to clinical practice (e.g. CDM), thus leading to a research-practice (R-P) gap in other words CPG-CDM gap. It is suggested in the literature that the management and behavioural aspects of PTs might be acting as barriers hindering the integration of the research knowledge into clinical practice consequently affecting the delivery of optimum patientcare. Remedial measures, namely KTIs, are suggested to address those barriers and to bridge the R-P gap. However, the phenomenon of the R-P gap, the causes of it and the possible interventions are not well understood concepts in the literature, particularly in the context of PTs. CPG for Venous Thromboembolism (VTE) in PT was chosen as the example of research knowledge. It was argued that barriers have the potential to affect CDM which in turn can affect the CPG-CDM gap. Lack of knowledge about CPG-CDM gap is a major limitation in the literature that is affecting the integration of CPG into CDM. Other gaps found in the literature that have the potential to affect CPG-CDM gap include management and behavioural variables as probable causes of CPG-CDM gap (or barriers), use of KTIs to bridge the CPG-CDM gap and, KTIs. Furthermore, lack of knowledge about relationship between barriers and CPG-CDM gap, KTIs and barriers, KTIs and CPG-CDM gap and the impact of KTIs (effectiveness) in bridging CPG-CDM gap were the other gaps found in the literature that had potential implications to CPG-CDM gap. These gaps were addressed in this research to some extent. Relationships between the independent variables (lack of knowledge of PTs in CPG, lack of favourable attitude of PTs towards CPG and lack of self-efficacy and motivation of PTs to integrate CPG into CDM) and the dependent variables (CDM and CPG-CDM gap) were defined and models were proposed. Further, it was posited that KTIs could impact barriers based on theories and models found in the literature that provided some basis to create the linkage between KTIs and management and behavioural barriers. Education material (EM) and virtual communities of practice (VCoP) were chosen as of the KTIs in this study. The models of Cabana et al. (1999) and Fischer et al. (2016), primarily, were used to ground the conceptual models represented by figures and equations. Methodologically, a positivist approach with an objective ontological stance was employed and a deductive approach and quantitative research method were used to address the research gaps. The research design included a longitudinal element and survey questionnaire. The target population was licensed PTs in the USA. Random sampling was used. Two groups of PTs were identified namely EM-group and VCoP group. Data was collected from the groups before and after administering the KTIs. The results showed that single and multicomponent KTIs impacted barriers in different ways. EM impacted lack of favourable attitude of PTs towards CPG, and lack of self-efficacy and motivation of PTs to integrate CPG into CDM as barriers and narrow the CPG-CDM gap. VCoP was found to impact the combination of four barriers and narrow CPG-CDM gap. In addition, barriers in groups of two were also impacted by VCoP and narrowed the CPG-CDM gap. Furthermore, a CPG knowledge score card and a corresponding CDM score card developed by the researcher were used to test the change behaviour of PTs in integrating CPG into CDM. This experiment showed that barriers existed and caused CPG-CDM gap and KTIs could narrow the CPG-CDM gap. The findings indicate that this research has contributed to knowledge in many ways, including unearthing the relationship between CPG-CDM gap and barriers, better understanding of KTIs, their relationship with CPG-CDM gap and barriers, gaining knowledge about the impact of single and multicomponent KTIs on single and multiple barriers and identification of methods to bridge the CPG-CDM gap.

The prescription rate of antipsychotics in patients with dementia varies between 20% and 50% for the common and troubling neuropsychiatric symptoms experienced by patients with dementia. The use of these antipsychotic medications has been linked with increased risk of morbidity and mortality due to associated Parkinsonism, over sedation, gait disturbances, cognitive decline, and cardiovascular adverse events. The purpose of this project was to assess whether development of an evidence-based clinical practice guideline (CPG) for a long-term care facility would increase awareness about issues that govern the safe use of antipsychotic medications. The conceptual framework for the project was Watson's model of caring. The Fineout-Overholt tool was used to rank and score information retrieved following an extensive literature review. An expert panel made up of 2 medical doctors and 4 nurse practitioners had 100% agreement that objectives were clear; content was relevant and easy to understand; the CPG was well-organized and easy to follow; and knowledge learned would be used in practice. From 66.6% to 83.3% agreed that the CGP led to an improved understanding of dementia, neuropsychiatric symptoms, medication adverse events, and nonpharmacologic interventions. The expert panel agreed to launch the CPG upon implementation of an educational program for frontline nursing staff and a behavioral log to track occurrence and frequency of behaviors and the use of nonpharmacologic interventions and their effectiveness in managing behaviors. Safe implementation of this CPG might be adapted to other long-term facilities to optimize dementia care, which would bring about a positive social change.

This dissertation presents findings from a qualitative discourse analysis study of three pre-service teachers enrolled in the Urban Teacher Residency Partnership Program (UTRPP); a clinical teacher preparation setting at a major southeastern university. UTRPP is a full-time teacher preparation program that focuses on university student achievement through embedded coursework and provides preservice teachers (PSTs) with the opportunity to work with a content coach. Through coaching cycles, these PSTs work one-on-one with a literacy content coaches to enrich their teaching experiences and connect theory to practice through content coaching cycles. A content coaching cycle consists of a pre-conference, video-recorded observation of a teaching event, individualized video coding sessions of that teaching video, and post-conference reflections (Gelfuso & Dennis, 2014). In this study, I focus specifically on the PSTs’ literacy content coaching experiences. The purposeful support and unique structure of UTRPP provide a rich opportunity to study literacy teacher identity construction since PSTs are contracted as full-time teacher residents in urban schools and work one on one with a literacy professional to develop their literacy practices through coaching cycles. This research was guided by the following research question: In what ways do three PSTs develop literacy teacher identity? Data was only collected during literacy coaching cycles where literacy was explicitly taught, and not during any other content area coaching cycle or subsequent lesson reflection that was not literacy based. The findings showed evidence of: (a) the plurality of identity, in that each participant drew on multiple identity characteristics when reflecting on their literacy practice, (b) connections between participants core sense-of-self and literacy teacher characteristics, (c) participants deployment of front and backstage dramaturgy to conceal their beliefs and feelings from the literacy coach and children, and (d) connections to student-centered teaching practices. These findings offer insights into how PSTs construct their literacy teacher identities in both a clinical preparation program and through literacy content coaching.

<p>Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities.</p><p>Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study.</p><p>The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies.</p><p>Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented.</p><p>Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented.</p><p>The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved.</p><p>There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.</p>