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This thesis examines a middle manager’s response to strategic directives on integrated care in a National Health Service (NHS) organisation and the development of an awareness of prejudice that acknowledges its relationship to the process of understanding. The research focuses on an integration of two community NHS trusts and an NHS hospital trust into one integrated care organisation (ICO). A change programme was initiated and promulgated on an assumption that integrating the three organisations would facilitate integrated care. However, despite the use of organisational change approaches (such as communication plans and systematic approaches to staff engagement), implementing the strategy directives in practice remained problematic. What emerged during the integration process was resistance to change and a clear division in the different ways of working in the community NHS trusts versus the community and hospital trusts – differences that became apparent from the prejudices of individuals and staff groups. The proposition is that prejudice is an important aspect of relationships whose significance in processes of change is often overlooked. I argue that prejudice is a phenomenon that emerges in the processes of particularisation, which I describe as an ongoing exploration and negotiation in our day-to-day activities of relating to one another. Our pejorative understanding of the term ‘prejudice’ has overshadowed more subtle connotations, which I propose are unhelpful in understanding change in organisations. However, I suggest a different way of thinking about prejudice – namely as a process that should be acknowledged as a characteristic of human beings relating to one another, which has the potential to generate and enhance understanding. The research is a narrative-based inquiry and describes critical incidents during the integration process of the three organisations and focusing on interactions between key staff members within the organisation. In paying attention to our ongoing relationships, there has been a growing awareness of disconnection from traditional management practices, which advocate systematic approaches and staff engagement techniques that are designed to encourage cooperation and reduce resistance to proposed change. This thesis challenges assumptions surrounding prejudice and how middle managers traditionally manage organisational change in practice in their attempts to apply deterministic approaches (which assume a linear causality) to control and influence human behaviour. I have taken into consideration a hermeneutic perspective on prejudice, drawing on the work of Hans Georg Gadamer, and have argued from the viewpoint of the theory of complex responsive processes. This offers an alternative way of thinking about management as social processes that are emergent in our daily interactions with one another, that are not based on linear causality, or on locating leadership and management with individuals. It provides a way of taking seriously the relationships between individuals by paying attention to what emerges from the interplay of our expectations and intentions. This leads to a different way of thinking about the relationship between prejudice and strategic directives, which I argue are not fixed instructions but unpredictable articulations of our gestures and responses that emanate from social interaction and continually iterate our thinking over time. This paradoxically influences how we make generalisations and particularise them in reflecting on and revising our expectation of meaning I suggest that it is not possible to predetermine a strategic outcome; and that traditional management practice, which locates change with individuals – and reduces aspects of organisational life, such as resistance, into a problem to be fixed – obscures our capacity to understand the processes of organisational change in the context of a much wider social phenomenon. I therefore conclude that my original and significant contribution to the theory of complex responsive processes and to practice is encouraging a different way of thinking about prejudice – as a process that can be productive and generate understanding, when considered as encompassing our expectations of meaning, linked to our own self-interests. This then opens up possibilities for transforming ourselves in relation to others – and, through this process, to transform the organisations in which we work.

Water protection and quality management in the European Union and Lithuania Summary Key words: water protection, strategic planning, integrated protection, sustainable development, financial instruments, water directives, transference of legislation, legislation on water protection. The major objective of this master thesis is to examine how water protection policy is implemented in the EU and Lithuania, to analyze possibilities of water policy financing, and to discuss the process of harmonizing EU’s and Lithuania’s legislation on water protection issues. The hypothesis raised in this thesis states that successful implementation of water policy is being highly influenced by the integrated water management, which covers policy agenda setting, legislation scope, institutional capabilities and financing efficiency. The thesis consists of six parts. In the first part of this thesis author examines three different stages of water policy implementation in the EU in a chronological order. The development of policy formation is discussed and features of every stage are defined. In the second part of the thesis water directives of different stages of EU water policy are presented and examined. The third part of this thesis is targeted to examine the development of water policy in Lithuania and at the same time to determine the changes of water legislation in Lithuania prior to its membership in the European Union and after its entry. The fourth part of the thesis aims to... [to full text]

The present master paper investigates the challenges which are met while trying to implement the provisions of the directives on professional qualifications into national law. Despite the fact that the directives regulating the recognition of professional qualifications have already been implemented into the national law of the Republic of Lithuania after the new European Parliament and Council directive 2005/36/EC codifying all the existed directives on the recognition of professional qualifications, has been adopted, the competent authorities face new challenges trying to implement the provisions of new directives. Due to this fact, several stages of the implementation of the directives of European Union are distinguished.: the obligations Lithuania had to fulfil before the accession to EU and after the new Directive 2005/36/EC was adopted. The main objective of this paper is to analyse problematical issues regarding the transposition of directives on recognition of regulated professional qualifications into national law. The attempt was made to disclose the main features of the systems regarding recognition of regulated professional qualifications. A great deal of attention is alloted to the analysis of the process of recognition, the presumptions and the development of General system of recognition and Sectoral directives. The main legal documents on professional qualifications as well as provisions of the new law are widely discussed. Currently more and more emphasis... [to full text]

Esta dissertação reflete sobre as possibilidades da escola no cumprimento das determinações da atual Lei de Diretrizes e Bases da Educação Nacional (LDB) nº 9394/96, que a reconhece como núcleo gestor responsável pelo seu próprio projeto político-pedagógico. Problematiza em que medida essa prática escolar tem influenciado os resultados obtidos pelas escolas públicas e viabilizado, localmente, a implementação das políticas educacionais desenvolvidas no âmbito dos sistemas de ensino. Caracteriza as concepções estruturantes sobre projeto político-pedagógico por meio de uma análise bibliográfica, discutindo o alcance que tais teorizações têm alcançado no cotidiano escolar. Apresenta os resultados de uma pesquisa, realizada junto a uma rede pública de ensino, apontando potenciais evidências da crise de sentido e de método que tal prática revela. Recupera ainda o processo histórico que marcou a tramitação da atual LDB, demonstrando que a referida crise deve ser entendida primeiro como crise congênita, herdada da própria lei que a concebeu. No contexto do sistema educacional, essa crise também é caracterizada ao reunir elementoschaves presentes no pensamento pedagógico contemporâneo, que exploram o conceito de sistema e a sua relação com a unidade escolar. Finaliza a pesquisa problematizando princípios fundamentais para se pensar o projeto políticopedagógico na perspectiva do movimento da educação cidadã, com vista à superação da crise de sentido e de método que essa prática escolar tem demonstrado. / This paper reflects on the possibilities of the school in compliance of the determinations of the current Law of Directives and Bases of National Education (LDB) nº 9394/96, which recognizes it as the core manager responsible for its own political and pedagogical project. It questions the extent to which this educational practice has influenced the results obtained by the public schools and facilitated, locally, the implementation of educational policies developed within the education systems. It characterizes the structural concepts of political and pedagogical project through a literature review, discussing the scope that these theories have reached in the school day. Presents the results of a survey, carried out with a public school system, pointing out potential evidences of the crisis of meaning and method that this practice reveals. Recovers even the historical process that marked the course of the current LDB, demonstrating that the crisis must be understood first as a crisis congenital, inherited from the law that has conceived it. In the context of the educational system, this crisis is also characterized by bringing together key elements present in contemporary pedagogical thinking, exploring the system concept and its relationship with the school unit. Ends the research questioning the fundamental principles for thinking about the political and pedagogical project in view of the civil and educational movement, with a view to overcoming the crisis of meaning and method of the educational practice has shown.

Hand hygiene (HH) is not only an effective prime precaution in reducing adverse events but also a major challenge in different fields of care practice and scientific research. The present study aimed at assessing the knowledge and adoption of health professional regarding hand hygiene in emergency room unit. This research comprehends a prospective longitudinal study with quantitative approach. The study was developed at the emergency room of the University Hospital of Santa Maria (HUSM), with 69 health professionals (residentes, nurses, nursing technicians and physiotherapists) who maintained direct contact with a clinically stable patient. The data collection was made between March and July of 2015, using instruments validated by the World Health Organization (WHO), in two stages. On the first stage, the non-participant direct observation tehcnique was applied, with an Observation form being filled in by the researcher. During the observation the five moments recommended for HH were accompanied, taking into account the concepts of Opportunity, Indication and Action. Each professional was observed in three different moments, with an average interval of 15 days (SD=9) between sessions. The time interval between the first and the last observations consisted of an average 28 days difference (SD=9). On the second stage, the subjects answered the Test of knowledge regarding hand hygiene for health professionals questionnaire, composed of right and wrong questions. The data organization was made using the Epi-info® software, version 6.4, with double independent typing. After verifying the errors and inconsistancies, the data analysis was made using the PASW Statistics® (Predictive Analytics Software, by SPSS Inc., Chicago, USA) 18.0 software, by means of descriptive analytical statistics. 59 out of the 69 health professional were accompanied during three observation sessions. 53 out of the 59 answered the questionnaire. In 111 days of observation, 166 sessions were made, with an average 11 minutes duration each (SD=50s). On such sessions 166 oportunities for HH were observed, however HH took place in 90. The global rate of adoption was 54,2%; 50,8% during the first observation and 59,6% during the last. Nurses and physiotherapists were the professional with the highest rates of adoption (66,6%; p<0,05). When comparing the rate of adoption between professional categories, nurses were found to have a larger adoption of HH than nursing technicians (OR: 2,83; IC: 95% [1,08 7,4]). The other categories presented no statistic difference. Regarding the knowledge questionnaire, the largest percentage of correct answers, over 90%, referred to route of transmission, technique, products and transmission to the health professional. Conclusion: The low adoption and restricted knowledge regarding the benefits of using alcohol for HH lead to the necessity of additional investment in capacitations for the health professional about safe practices relating to HH, aiming to increase the safety culture for the patient in emergency room. / A higienização das mãos (HM) é uma precaução primordial eficaz na redução dos eventos adversos, além de um grande desafio nos diferentes campos de prática assistencial e da pesquisa científica. Este estudo objetivou avaliar o conhecimento e a adesão dos profissionais de saúde a respeito da higienização das mãos em unidade de pronto-socorro. Trata-se de um estudo com delineamento longitudinal prospectivo, com abordagem quantitativa. Foi desenvolvido no Pronto-Socorro do Hospital Universitário de Santa Maria (HUSM), com 69 profissionais de saúde (residentes, enfermeiros, técnicos de enfermagem e fisioterapeutas) que mantiveram contato direto com paciente clinicamente estável. A coleta de dados foi realizada entre março e julho de 2015, utilizando instrumentos validados pela Organização Mundial da Saúde (OMS), em duas etapas. Na primeira, aplicou-se a técnica de observação direta não participante, com preenchimento do Formulário de observação . Durante o acompanhamento foram observados os cinco momentos preconizados para HM, levando-se em conta os conceitos de Oportunidade, Indicação e Ação. Cada profissional foi observado em três momentos diferentes, com intervalo médio de 15 dias (DP= 9) entre as sessões. O intervalo de tempo entre a primeira sessão de acompanhamento e a última teve em média 28 dias de diferença (DP= 9). Na segunda etapa, foi aplicado o questionário Teste de conhecimento a respeito da higienização das mãos para profissionais de saúde , com questões classificadas em certo e errado . A organização dos dados foi realizada no programa Epi-info®, versão 6.4, com dupla digitação independente. Após a verificação de erros e inconsistências, a análise dos dados foi realizada no programa PASW Statistics® (Predictive Analytics Software, da SPSS Inc., Chicago, USA) 18.0, por meio da estatística descritiva e analítica. Dos 69 participantes, 59 foram acompanhados durante três sessões de observação. Destes, 53 responderam ao questionário de conhecimento. Em 111 dias de acompanhamento, foram realizadas 166 sessões, com duração média de 11 min. (DP= 50s) cada. Nelas, observaram-se 166 oportunidades para HM; porém em 90 delas a HM foi realizada. A taxa de adesão global foi de 54,2%; no primeiro acompanhamento foi de 50,8% e no último, 59,6%. Os enfermeiros e os fisioterapeutas foram os que obtiveram maiores percentuais de adesão (66,6%; p< 0,05). Ao ser comparada a adesão entre as categorias profissionais, verificou-se que os enfermeiros tiveram maior aderência à HM do que os técnicos de enfermagem (RC: 2,83; IC: 95% [1,08 7,4]). Com as demais categorias não houve diferença estatística. No que se refere ao teste de conhecimento, os maiores percentuais de acertos, acima de 90%, foram referentes a via de transmissão, técnica, produtos e transmissão ao profissional de saúde. Conclusão: A baixa adesão e conhecimento restrito sobre os benefícios da utilização do álcool para a HM remetem à necessidade de investimento adicional em capacitações para os profissionais de saúde sobre as práticas seguras relacionadas à HM, com vistas a elevar a cultura de segurança do paciente no pronto-socorro.

The objective of my thesis is to outline the evolution of accounting regulation. The thesis describes development of accounting, first regulation forms, emergence of double entry and present globally accepted accounting standards. In my work I enlarge the development of two well known accounting standards GAAP and IAS and their regulation. The convergence project between standard setters' bodies is elaborated as part of present development of accounting regulation. One of next titles in my thesis is the accounting harmonization process in EU as part of accounting regulation and the adoption of IAS standards by EU Commission

The theoretical part of the graduation theses describes the theoretical basis of the exist broad issue and involves the basic processes and methods of bookkeeping and creating of the final accounts at accounting period of the year 2009 in accordance with actual legislation. The practical part of the graduation theses includes practical application of the theoretical basis onto the concrete company. The output of the graduation theses will be the methodology of accounting and creating of the final accounts at accounting period of the year 2009 for the concrete company.

The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ. For this study, data were collected using semi-structured, in-depth interviews with an open interview guide. These interviews were conducted in a two-tiered format. Tier 1 included ten leading experts in various areas of end-of-life healthcare and aging in Tennessee. Tier 2 included nine legislators who were members of the health committees of either the Tennessee House of Representatives or the Tennessee Senate. Qualitative data were organized into numerous categories, and an initial phase of open coding was completed. From this phase of coding, emergent themes and focuses were discovered. This was followed by focused coding on all nineteen interviews using coding software to organize subtleties. Findings of the Tier 1 interviews indicated that there are many areas of end-of-life healthcare that need improvement including increased funding, expanded caregiver support, improved doctor-patient communication, and increased use of advance directives. Emergent themes included the influence of money, having difficult conversations, the stigma of death and dying, and supporting the caregiver. Tier 2 findings highlighted the motivations behind voting decisions and the level of awareness legislators have in areas of end-of-life healthcare policy. Both tiers also explored the support and opposition of physician-assisted death. The findings of this dissertation are intended to inform health professionals and state legislators. The data gathered through this exploratory research and the knowledge gained will lead to a greater understanding of end-of-life healthcare in Tennessee, and what needs to be done to improve its quality. This will allow individuals and families faced with end-of-life decisions to navigate the process with expanded options, access, and support.

This thesis defines the issue of financial management of a construction contract and its application in practical analysis of the financial management of the real costs of real construction contracts. The aim is to analyze the model of financial management and analysis of building contract cost management and financing on selected construction contract.