As newly licensed registered nurses enter their first nursing role, their perceived preparation for practice may vary. This descriptive study addressed the education-practice gap that exists as nurses transition into nursing practice. The use of Benner's skill acquisition model offers a structure for connecting theory to practice. New graduate nurses responded to the Casey-Fink Graduate Nurse Experience Survey-© to identify gaps in preparedness for novice practice. A convenience sample of nurses within the first 12 months of hire (n = 35) was sent the survey link by educators from the chosen sites. Anonymity was maintained with 18 total responses and 5 respondents completing the entire 25-question survey. Responses were analyzed via descriptive statistics. New graduate nurses either strongly agreed or agreed that they were prepared for their new role and received positive support from preceptors and staff. However, nurses disagreed or strongly disagreed that they were prepared for transition from student to nurse in the areas of workload, unit integration, system, and interpersonal concerns. Thirty percent also felt uncomfortable with independent performance of some technical skills, such as emergency management and blood administration. None of the new graduate nurses felt unprepared in professional skills related to leadership, communication, and decision making, a finding which contrasts with the literature, which indicates that these are areas of difficulty for new graduates. These findings can be used to structure curriculum and educational strategies to address the perceptions of preparedness and transition-to-practice concerns discovered in this project. This project may lead to social change in its attempt to close the education-practice gap with a stronger population of new graduate nurses.

Evidence-based policy and practice (EBPP) in population health in Australia has been promoted largely without sound research. In response, this thesis presents a series of studies undertaken to assess and inform enhancement of capacity for EBPP in Australia. It comprises linked studies designed to examine different yet complementary aspects of capacity for EBPP. Research was conducted at various levels of Australian health care system, from local to national, in order to better understand EBPP and to make a series of recommendations about effective and synergistic response.

Constructed Isolation investigates the development of a collection of architectural devices and operations that respond to and have evolved from the specific nature of residential suburban Perth, Western Australia. These devices explore the potential for ambiguity to create space that transforms the occupant from being a passive observer into a dynamic participant. It collates a collection of projects by iredale pedersen hook architects and examines the devices under the thematic concerns of geometry, place, time and craft. The Masters Thesis identifies the potential for Perth's geographic isolation to manifest as a positive construct, developing a unique architecture that opportunistically reinterprets past traditions to create individual environments. 'Constructed Isolation' is an ambitious idea where identity may begin with the individual dwelling and collectively evolve to create a constellation of considerable influence. It demonstrates how these devices may result in new propositions for suburbia, how big ideas with small-scale projects and a little irrational joyousness may contribute to or at least aspire to create change. These small projects will be viewed as a continuation of Perth's 'Heroic Period of Modernism', the fertile and ambitious but incomplete project from the 1950s and '60s. This will also focus on the development and change that occurred as a result of the reflective practice process, while identifying potential opportunities for the future.

Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.

Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician’s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. A phenomenological methodology was used to study the structure of clinical attention in relation to holistic competence. Fourteen clinicians, all of whom met the criteria for attaining expertise in the use of attention in their clinical work, participated in an explicitation interview. Data analysis followed a modified phenomenological methodology in a series of steps as the data were grouped in invariant constituents, reduced to emergent themes and analyzed for a textural structural description from which a structural description was constructed. From the structural description was distilled the essence of clinical attention. Clinical attention was seen to consist of a dynamic and iterative process of intention and intuition. Intention and intuition were seen to be based in different attentional levels, both of which were recursively and iteratively related to attention’s construction as a process grounded in inner awareness providing the potential abilities to reflect on experience and regulate affective experience. The study concluded with a discussion of the relationship of the skill of clinical attention to a holistic competence based in levels of procedural capability focused on concrete behavioural action and meta competence focused on clinical judgment, self-awareness and self-reflection on the actions taken. The implications of the study’s findings for training clinicians in attention were discussed.

Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.

Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician’s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. A phenomenological methodology was used to study the structure of clinical attention in relation to holistic competence. Fourteen clinicians, all of whom met the criteria for attaining expertise in the use of attention in their clinical work, participated in an explicitation interview. Data analysis followed a modified phenomenological methodology in a series of steps as the data were grouped in invariant constituents, reduced to emergent themes and analyzed for a textural structural description from which a structural description was constructed. From the structural description was distilled the essence of clinical attention. Clinical attention was seen to consist of a dynamic and iterative process of intention and intuition. Intention and intuition were seen to be based in different attentional levels, both of which were recursively and iteratively related to attention’s construction as a process grounded in inner awareness providing the potential abilities to reflect on experience and regulate affective experience. The study concluded with a discussion of the relationship of the skill of clinical attention to a holistic competence based in levels of procedural capability focused on concrete behavioural action and meta competence focused on clinical judgment, self-awareness and self-reflection on the actions taken. The implications of the study’s findings for training clinicians in attention were discussed.

Abstract The unstable policies of both pubic health and payment by National Health Insurance¡]NHI¡^in Taiwan cause great difficulties in the management of clinics since the separation of dispensing practice from medical practice since 1997.In order to survival from the tough circumstance, the managers of clinics must adapt different strategies to increasing income, enlarging size of organization, or gaining the competition advantage. One of the most important strategies is the institution of clinic pharmacies by themselves or cooperating with another pharmacist. Right now the theses about the clinic pharmacies was few. But the name, so called ¡¨ doorway drugstore ¡§, which was considered to against the spirit of the policies of separation of dispensing practice from medical practice and global budget is called by some scholars and the NHI. In order to reducing the payment for the clinic pharmacies, the NIH is planning to set up 3 criteria for further management of the ¡§doorway drugstores¡¨. And if the new rules come true in the future, the managers of clinic pharmacies and the owners of clinics will meet more challenges. In this study, main focus would be the 6 clinic pharmacies at Kaohsiung city and by the means of face to face interview with the managers of these drugstores in order to gathering the primary data about the motivation for selling OTC merchandise, and the situations of merchandise profile, pricing strategy, promotion activity and the situations of human resource etc. The study result revealed that there are two clinic pharmacies have no selling of OTC merchandise because of small space, lack of salesman, or worry about the conflict between the doctor and the pharmacist. The percentage of the OTC income at another four clinic pharmacies is below the level of 20%, and the reasons of difficulties for selling these products were too expensive, not famous, and lack of in job training for salesmen. Further analysis of the needs of the main consumers , whom were the patients of the clinics, of these drugstores were the treatments for their disease and the maintenance of their health. So the health food or function food will play the import roles of OTC merchandise profile. The reasons of success of selling OTC products in the clinic pharmacies were choosing proper merchandies, which were good for these patients` health or some help for control their disease, and were recommoned by the doctor, and with reasonable price. The weakness of the management of clinic pharmacies were lack of salesmen and few investment of I.T. equipments, lack of promotion activity and in job training. According the primary data from the interview with the managers of clinical pharmacies and biotech functional food suppliers, there are some important conclusions from this study¡G¡]1¡^clinical pharmacies now are selling some OTC merchandise and functional food¡]2¡^clinical pharmacies provide the service for the patients whom came from not only one clinic¡]3¡^the owners of the clinical pharmacies would be the physician of clinic or the pharmacist and the ownership status could be sole or partnership¡]4¡^the percentage of income from selling OTC merchandise is still low in these pharmacies¡]5¡^the managers of clinical pharmacies wish to joint chain pharmacy in the future ,but right now they are not urgent ¡]6¡^the major reason of joint chain pharmacy is cost down and the clinical pharmacies managers will share the management data and use the logo of chain pharmacy, but there are tremendous disagreements between them about the franchising fee¡]7¡^clinical pharmacies had the potential of transforming to become retail channels of biotech functional food because of patients may need them to keep their health and they trust their physician and pharmacist, and the successful selling for biotech functional foods need professional explain ,which can provided by the doctor and pharmacist both are available in clinical pharmacies.

Playing is a common part of children’s leisure time, and with children spending an increasing amount of this time in school-age childcare, in both Sweden and England, staff have the responsibility to facilitate play. The way play is conceptualised by staff may lead to different aspects of play being facilitated. These play practices are enabled and constrained by the arrangements of what this dissertation calls the school’s play practice architecture, i.e. where play practices are intertwined with a school’s practice architecture. The aim of the research was to explore how staff talked about play and how to facilitate it, how concepts of play contributed to different play practices and how it might be possible to transform play practice architectures. The research draws on conversations with staff in school-age childcare settings in two Swedish and one English school during an action research project. Just as action research was used to disturb and change practice in order to understand it, concepts from Deleuze and Guattari’s philosophy (1980/2004) were put to work to disturb taken-for-granted concepts of play in order to explore how play works. Article I explores what the staff talked about in relation to play and its facilitation. The conclusion is that the ability of staff to interpret children’s play as children exploring their agency is crucial when facilitating play in a learning institution. Article II examines some discursive orders about play in school-age childcare and goes beyond them by conceptualising playing as becoming-different. The article argues that when foregrounding play, staff recognised children and themselves as becoming-players. Article III investigates how to think practice as constant change. For any practice, planning is required, and yet the unexpected keeps happening. When playing was conceptualised as a “What If? As If” approach, which allowed for potentialities to become actualised, then this approach was also useful as an approach in practice. The analysis suggests that when engaging in a playing practice, practitioners develop new knowledge and simultaneously change social situations. The practice of playing, whether intentional or unintentional, can not only disturb but also transform play practice architectures. The practice of playing is sensitised to the disturbances caused by playing and also puts itself “in play”. This opens up for a continuous de- and reterritorialisation of play and playing in school-age childcare practice.

Nurse practitioners (NPs) have been undergoing a rapid transition in their entry-level degree, from Master of Science in Nursing (MSN) to Doctor of Nursing Practice (DNP). At this time, it is important to establish research evidence on the effects of doctoral education on NP practice. Therefore, a qualitative study of practicing NPs that have returned for the DNP degree was conducted. The purpose was to describe NPs' perceptions of their DNP education, and particularly its influence on their professionalism and patient care. A literature review and evidence synthesis process showed that the available body of research provides little insight into the question of how DNP education affects NP practice; therefore, qualitative description methodology was used to describe this phenomenon. The research questions that guided the study were: 1) What changes do practicing NPs describe about their clinical practice after the experience of completing a DNP?; and, 2) What are the NPs' perceptions of and concerns about the influences of their DNP educational experience on their clinical practice? Two published models and the DNP Essentials (AACN, 2006) informed and guided the data collection and analysis process. Purposive sampling and analyses continued concurrently until data saturation was achieved. Ten DNP prepared NPs were interviewed, and there was wide variation in the sample. The overarching theme Growth into DNP Practice summarizes the participants' perceptions of the changes that have occurred as a result of their DNP educational experience. Four major themes that support the overarching theme are: (a) Broader Thinking and Work Focus; (b) New Knowledge and Interests; (c) New Opportunities; and, (d) "Doctor" Title an Asset. Conceptual categories under each major theme are described. Participants were overwhelmingly positive about the influences of their DNP education on their practice, but the role of the DNP graduate in knowledge translation has yet to be fully operationalized.