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<p>This thesis explores the Cognitive Load Theory (CLT) framework with health professions education research, and applies the principles of CLT to one specific area of health professions education: the acquisition of cardiac and respiratory auscultation and physical assessment skill in undergraduate nursing students. The first study evaluates context-based learning environments on the acquisition of auscultation skill and physical assessment performance. Results suggest that for novice level students, high-context-based learning environments may contribute to extraneous cognitive load and may not be beneficial for learning. The next cluster of studies evaluates auscultation test performance following manipulation of cognitive load variables. The interleaving approach instruction was found to be most helpful for auscultation test performance. The series of studies conducted in this thesis demonstrate a useful direction for health professions research and promotes the use of cognitive load theory as a framework for instructional design and evaluation.</p> / Doctor of Philosophy (PhD)

In recent years the complexity and integrated nature of health care has increased. It has become accepted that the needs of patients are often greater than one single health profession can address and requires collaboration on the part of health care providers (Freeth, 2001). Interprofessional health education (IPHE) is the interactive educational process and cooperation among various health care professions. It is a valuable pedagogical approach for teaching health care students that they cannot work effectively without the use of a team, and is thought to be the first step in the direction of changing health care practice in the clinical setting. Using a two phase mixed methods approach, this dissertation investigated changes in student attitudes and measured interprofessional readiness as a result of a longitudinal interprofessional educational experience at Thomas Jefferson University called Health Mentors. The health care professions included in this program are: medicine, nursing, physical therapy, occupational therapy, and pharmacy. Together, these students visit an individual living in the greater Philadelphia, PA region with one or more chronic health conditions four times during the year. Of the five hundred and seventy-six students participating in the Health Mentors program, four hundred and ninety-six completed two surveys in September 2008 and again in April 2009. These were the Interprofessional Education Perception Scale (IEPS) and the Readiness for Interprofessional Learning Scale (RIPLS) which measured their attitudes and readiness toward interprofessional education. Analysis revealed slight significant differences in the means of the health programs and showed small significant decreases in attitudes and readiness over time. Two focus groups were conducted to better understand the quantitative results. Using grounded theory, the following themes emerged: preparation for future professional experience, personal enjoyment from working with their Mentor, logistical conflicts, unknown roles, and program assignments seen as an `add on' or `busy work'. The results from both the qualitative and quantitative methods indicate that students have a high opinion of the theory of IPHE but find the application difficult in practice. / Educational Psychology

This qualitative study explores the facilitators, barriers, benefits, and limitations of the mentoring relationship between recently graduated nurse mentees and their mentors. These nurses participated in a seven-week New Nurse Internship Mentoring Program in an urban hospital. The study sample consisted of twenty inexperienced and nineteen experienced registered nurses who represented diverse racial, cultural, and clinical nursing specialties. Focus group and open-ended personal interviews were used to gather data. Findings were reported by open coding, domain and thematic analyses. Major findings of the study were related to four research questions accompanied by important information regarding the mentoring experience in general. Four research questions which guided the study included: (1) What are the facilitators of the mentoring relationship? (2) What are the barriers to the mentoring relationship? (3) What are the benefits of the mentoring relationship? and (4) What are the limitations of the mentoring relationship? Findings suggested the relationships were viewed as good to excellent. The transition from student nurse to graduate nurse was seen as both difficult and smooth. Mentoring was defined in relation to mentor characteristics. positive mentor traits were identified as patient, supportive and knowledgeable. Facilitators to mentoring were identified as factors which were helpful including mentor and mentee personality characteristics and institutional factors. Barriers to mentoring were identified based on debilitating factors, personality conflicts, scheduling conflicts, mentor dislike for the job and mentor lack of knowledge. Means to overcoming barriers included matching team schedules I rewarding the mentor and increasing mentor training. Benefits were defined as advantages to the mentor, mentee, institution and profession. Respondents were reluctant to identify limitations. Findings verified that a nurse mentoring relationship is an important factor in assisting the transition of graduates into the nursing profession. Findings offer implications for nursing education and professionals responsible for providing a work environment supportive to developing clinically competent nurses. / Ph. D.

Yes / The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.

Ce mémoire vise à retracer les carrières des escortes indépendantes montréalaises et les tensions qui les traversent, afin de rendre compte de la complexité du « drame social » que constitue cette activité. Nos résultats montrent que cette profession présente de nombreuses similarités avec d’autres professions, en même temps que sa position particulière dans une matrice sociale stigmatisante et dans une relation de service intime lui confère toute sa singularité. Partie de la question « Comment commence-t-on et poursuit-on dans l’activité d’escorte, alors que celle-ci est stigmatisée ? », nous avons réalisé une enquête de terrain auprès d’escortes indépendantes, composée essentiellement de sept entrevues approfondies et de l’observation de leur environnement professionnel informatisé. Nous avons décidé de nous écarter du débat actuel, tant scientifique que militant, qui divise sur le sujet du travail du sexe. Notre cadre conceptuel est, dans un perspective interactionniste, à la croisée des sociologies des professions, de la déviance et du stigmate. Nous rendons compte de nos résultats sous la forme de quatre actes, afin de poursuivre la métaphore théâtrale engagée par Hughes, qui suivent les étapes d’une carrière d’escorte et qui mettent l’accent sur leur complexité intrinsèque. Ces étapes sont ancrées dans une ambivalence entre un effort de professionnalisation de leur pratique et une tentative de rester dans la norme en se distanciant de cette activité. Cette ambivalence, causée par la matrice sociale dans laquelle évoluent ces escortes et à l’intimité des relations de service, contribue à la pérennité de la stigmatisation de cette activité. / This master’s thesis aims to recount the careers of Montreal independent escorts and the tensions they encountered to expose the complexity of the "social drama" of this occupation. Our results show how the profession of escort presents numerous similarities with other professions while having a particular position on a stigmatizing social matrix and being characterised by an intimate relation of service that confers it its peculiarity. The question: "how do we begin and pursue the escorting occupation despite its propensity for stigmatization?" as a starting point, we carried out a field survey with independent escorts. Seven in-depth interviews were conducted and their computerized professional environment was observed. We decided to stay away from the current scientific and militant debate on sex work. Our theoretical frame is a fine balance between the sociologies of the professions, deviance and stigma, in an interactionist perspective. We report our results in four acts to pursue the theatrical metaphor brought by Hughes. The acts retrace the stages of the escorting career and emphasize on their intrinsic complexity. The escorts are caught in an ambivalence between an effort of professionalization of their occupation and an attempt to stay in the norm by distance themselves from this practice. This ambivalence is caused by the stigmatization that characterizes the social matrix where the escorts evolve and by the intimacy of their professional relationship. It contributes to a certain extent to the continued stigmatization of their own occupation.

Engagée à l’occasion de l’introduction en France de contrats de commande publique de type "partenariat public-privé" [PPP] – elle fut initiée peu après la promulgation de l’Ordonnance du 17 juin 2004 créant les « Contrats de Partenariat » – notre recherche explore les PPP, modalités de commande publique complexe à caractéristiques financières, en tant qu’ils constituent un marché émergent pour des acteurs financiers, fournisseurs de capitaux et de techniques de financement, potentiellement porteurs de valeurs, modes de raisonnement, et logiques économiques, exogènes au monde de la commande publique. Aiguillonné par notre désir de participer aux débats disciplinaires des mondes de la sociologie économique, des études sociales de la finance, et d’autres approches hétérodoxes des phénomènes économiques, par notre souci de contribuer à la compréhension des formes d’organisation des services publics et des infrastructures urbaines, stimulé également par notre curiosité à l’égard des mutations des économies occidentales, interpellé évidemment par l’actualité incontournable de la grande crise financière, puis économique, entamée en 2007-08, notre travail prend prétexte de ce "phénomène" – l’immixtion, par l’entremise des PPP, de nouveaux acteurs financiers dans une partie de la commande publique de grands équipements – pour nous inscrire dans le programme de recherche qui vise à caractériser le mouvement socio-économique plus large parfois qualifié de "financiarisation". Ce terme recouvre, sans grande précision ni définition consacrée et indiscutable, un ensemble d’évolutions liées à l’extension du domaine de la finance, que ce soit au niveau macroéconomique, sectoriel, ou cognitif, dans l’ordre de la connexion de pans entiers de la vie économique et sociale aux "marchés" financiers et à leurs exigences. Notre ambition est donc, à partir d’un sujet particulier et technique, non réductible à sa seule dimension financière4, de considérer la valeur heuristique du cas des PPP pour interroger plusieurs dimensions caractéristiques de ce mouvement de "financiarisation" – voire essayer d’en identifier les principaux éléments constitutifs. Ce dessein passe par une analyse en termes de sociologie économique menée à plusieurs niveaux / Committed (Hired) on the occasion of the introduction in France of contracts of state commission of type(chap) "Public Private Partnership" [ PPP] - She (it) was introduced shortly after the promulgation of the Prescription of June 17th, 2004 creating "Partnership agreements" - our search (research) explores the PPP, the modalities(methods) of complex state commission with financial characteristics, as they establish (constitute) an emerging market for financial actors, suppliers of capital and techniques of financing, potentially valuable carriers, ways of reasoning, and economic, exogenous logics to the world of the state commission

Cette recherche en sociologie du genre vise à comprendre la rareté de femmes arbitres à la Fédération Malgache de Volley-Ball (FMVB). Elle a pour problématique l'articulation entre pratiques professionnelles d'arbitrage et normes des identités sexuées de la société malgache. Faute de travaux existant portant sur genre et sport à Madagascar, la démarche procède d'une enquête exploratoire. L'approche institutionnelle et statistique met en évidence un double plafond de verre, bloquant la formation des femmes à l'arbitrage, puis leur promotion de carrière. L'approche qualitative interroge sur ces faits des arbitres femmes (8) et des cadres ou dirigeants sportifs (17 dont 14 hommes) par entretien, des volleyeuses de Tananarive (222) par questionnaire. Toutes les réponses convergent sur les faits mais les interprétations divergent : les arbitres femmes dénoncent des procédés discriminatoires et la domination masculine qu'elles affrontent ; les dirigeants légitiment leur gestion en se prévalant des normes et valeurs patriarcales de la société malgache ; d'autres cadres hommes se dissocient de ces positions et d'autres Fédérations favorisent l'arbitrage féminin, jusqu'à l’international. Les réponses des volleyeuses viennent prouver leur disponibilité pour le sport, expriment en majorité une conception égalitaire de l'arbitrage et un quart déclarent souhaiter devenir arbitre. Bien que la fin des discriminations de la gestion arbitrale à la FMVB semble dépendre de rapports de pouvoir internes, l'enquête montre l'émergence de mobilités de genre dans le milieu sportif malgache, les femmes arbitres y ayant notamment conquis de nouvelles prérogatives publiques et démocratiques. / This research in the field of sociology of gender aims at understanding the rarity of female referees in the Malagasy Federation of Volleyball (MFVB). The issue concerns the link between the professional practice of arbitration and the norms of sexual identities in the Malagasy society. Due to the lack of existing work on gender and sport in Madagascar, our approach proceeds from an exploratory investigation. The institutional and statistical approach reveals the existence of a double glass ceiling, blocking women's arbitration training, and then, their career promotion. Interviews were conducted, in a qualitative approach, with female referees (8), leaders or managers (17 with 14 men), and a questionnaire was filled in by female volleyball players from Antananarivo (222). All answers point towards the facts but the interpretations vary: the female referees denounce discriminatory processes and the male domination they are facing, leaders legitimize their management practice, relying on the patriarchal norms and values of the Malagasy society, while other male managers do not abide by these positions and other federations promote female arbitration on an international scale. The female volleyball players' responses prove that they are available for the sport and generally express an egalitarian conception of arbitration, a quarter of the women even said they would like to become referee. Although the end of discrimination in the arbitral management of the MFVB seems to depend on internal power relations, the survey shows the emergence of gender mobility in the Malagasy sport community, women referees have actually conquered new public and democratic prerogatives.

Aoki Yumiko. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 51-53). / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.v / ACKNOWLEDGMENTS --- p.vi / Chapter CHAPTER I --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.5 / Career Commitment --- p.5 / Female Stereotype --- p.11 / Chapter CHAPTER 3 --- HYPOTHESES --- p.17 / Sex difference of usage of career strategy --- p.17 / Situation in Hons Kong --- p.18 / Chapter CHAPTER 4 --- METHODOLOGY --- p.20 / Sample --- p.20 / Method --- p.20 / Chapter CHAPTER 5 --- RESULTS --- p.23 / Sex difference of usage of career strategy --- p.23 / Situation in Hong Kong --- p.26 / Chapter CHAPTER 6 --- DISCUSSION --- p.30 / Implication --- p.30 / Limitation --- p.35 / APPENDIX --- p.48 / QUESTIONNAIRE* Indented sentence were not written in actual questionnaire --- p.48 / BIBLIOGRAPHY --- p.51