<p>Chronic low back pain is the second most prevalent chronic condition in Canadian primary care settings. The treatment and diagnosis of chronic pain is challenging for primary care clinicians. Their main challenges are lack of knowledge and their approach toward assessing and treating pain. Evidence based guidelines have been developed for neuropathic pain and low back pain.</p> <p>CDSSs for chronic diseases are becoming popular in primary care settings as a mean to implement CPGs. A CDSS prototype for diagnosis and treatment of chronic, non-cancer pain in primary care was developed at McMaster University. It is evident that poor usability can hinder the uptake of health information technologies.</p> <p>The objective of this study was to test the usability of Pain Assistant using think aloud protocols with SUS scores in 2 iterations. In this study 13 primary care providers including family physicians, nurse practitioners and residents used Pain Assistant to complete 3 different patient case scenarios. Participants were asked to comment on both barriers and facilitators of usability of Pain Assistant. Additionally time to complete patient case scenarios was calculated for each participant. A comparison questionnaire gathered user preference between introducing CPGs in paper format and computerized decision support system.</p> <p>This study showed that iterative usability testing of the Pain Assistant with participation of real-end users has the potential to uncover usability issues of the Pain Assistant. Problems of user interface were the main usability barrier in first testing iteration following by problems of content. Changes were made to system design for second round based on the issues came up in the first iteration. However, because of time constrains not all the changes were implemented for second round of testing. Most of the refinements were to resolve user interface issues. In the second iteration, the problems with the content of Pain Assistant were the major barrier. The changes to the system design were successful in resolving user interface problems since the changed issues did not come up again in second round. Pain Assistant had an above the average usability score however no significant changes seen in SUS score. The time needed to complete tasks remained identical in both iterations. In addition, participants preferred to have CPGs in electronic formats than paper. Further study after implementing all the system changes needed to determine the effectiveness of system refinements.</p> / Master of Science (MSc)

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Cette thèse doctorale porte sur l’apprentissage du raisonnement clinique infirmier (RCI) par une stratégie éducative numérique qui s’appuie sur la notion de la concordance de scripts. Elle repose sur un devis de recherche multiméthode visant le développement, la mise à l’essai et l’évaluation de la stratégie éducative auprès d’étudiants au premier cycle de formation universitaire en sciences infirmières à l’Université de Montréal. La thèse, qui comporte cinq chapitres, est rédigée selon le mode de présentation par articles. L’étude a été orientée par un cadre de référence incluant la théorie des scripts relevant des sciences cognitives de l’apprentissage et l’approche pédagogique de compagnonnage cognitif. Un devis de recherche multiméthode intégrant un devis de recherche-développement, une étude descriptive qualitative et une étude de cas multiples a été privilégié. Des experts collaborateurs (n = 5), des experts-panélistes (n = 12) et des étudiants (n = 45) ont participé à l’étude. Les résultats montrent que l’approche de recherche-développement a contribué à bonifier l’élaboration de la stratégie éducative numérique basée sur la concordance de scripts (SENBCS) et à assurer sa validation. Globalement, les étudiants ont apprécié la SENBCS, notamment la rétroaction variée et formative d’experts et l’opportunité d’apprendre la priorisation des hypothèses infirmières. L’intégration d’un devis descriptif a soutenu l’identification des stratégies d’apprentissage chez les étudiants lors de l’utilisation de la SENBCS. Les résultats montrent que les étudiants ont sollicité certaines stratégies d’apprentissage cognitives de traitement et d’exécution des données ainsi que des stratégies métacognitives d’autorégulation. Les résultats de l’étude de cas multiples montrent que les étudiants mettent en évidence certains processus cognitifs du RCI, à l’aide des vignettes du test de concordance de scripts (TCS) et de la pensée à voix haute, notamment : la représentation précoce d’une situation clinique, la transformation sémantique des données et la confrontation d’hypothèses. La SENBCS améliore la visibilité des savoirs d’experts, lesquels sont absents dans une classe traditionnelle ou même en stage clinique. Cela constitue une avancée certaine que de considérer l’apport des stratégies éducatives numériques dans les programmes de formation universitaire en sciences infirmières ou dans d’autres programmes pour soutenir le développement du raisonnement clinique. L’étude a permis de mettre à profit une riche documentation scientifique entourant l’élaboration de la SENBCS. Les résultats informent au regard de son utilisation efficiente afin qu’elle soit complémentaire à d’autres stratégies éducatives pour soutenir plus globalement la complexité de l’apprentissage du RCI. Des retombées pour les cinq domaines de la pratique infirmière sont générées par cette étude, elles offrent certaines pistes qui pourraient favoriser l’apprentissage du RCI. L’une d’elles vise à favoriser l’articulation des connaissances et de solliciter fréquemment des microjugements pour confronter et différencier des hypothèses relevant de l’incertitude de la pratique clinique, sous-entendant des apprentissages par couches successives. / This doctoral thesis focuses on learning clinical reasoning in nursing using a digital educational strategy based on the notion of script concordance. The thesis is based on a multi-method research design aimed at developing, testing and evaluating an educational strategy for undergraduate students in nursing at the University of Montreal. The thesis, which has five chapters, is written according to the mode of presentation by journal articles. This study was guided by a framework based on script theory, from cognitive science, and the pedagogical approach of cognitive companionship. A multi-method research design integrating a research-development approach, a descriptive qualitative study and a multiple case study was used. Collaborative experts (n=5), expert panellists (n=12) and students (n=45) participated in the study. The results show that the research-development approach enriched the development of a digital education strategy based on script concordance (DESBCS) while ensuring its validation. Overall, students appreciated the DESBCS, especially the varied and formative feedback received from experts while learning how to prioritize nursing hypotheses. A descriptive qualitative study design facilitated the identification of student learning strategies. Results demonstrate that when using a DESBCS, students used certain cognitive apprenticeship strategies for data processing and execution as well as for metacognitive self-monitoring. The results from the multiple case study show that students practised certain cognitive processes of clinical reasoning in nursing, using the vignettes from the script concordance test (SCT) and a think aloud approach, in particular: the early representation of a clinical situation, the semantic transformation of data and the confrontation of hypotheses. The DESBCS improves the visibility of expert knowledge usually absent in a traditional class or even in clinical training. It is a definite advancement to consider the contribution of digital educational strategies in university nursing education programs, or in other programs, to support the development of clinical reasoning. This study highlights the use of a wealth of scientific documentation surrounding the development of DESBCS. Study results inform instructors about effective DESBSC use to make it complementary to other educational strategies by supporting the complexities of learning clinical reasoning in nursing. Implications for the five domains of nursing practice emerge from this study and offer avenues to promote learning and development of clinical reasoning in nursing. One of these aims to promote knowledge articulation and the frequent solicitation of microjudgments to confront and differentiate hypotheses that arise from the uncertainty of clinical practice, implying learning in successive layers.

(English) The dissertation presents the findings of a mixed method research project aimed at analysing the process of reading in Modern Standard Arabic. Think aloud method represents the main instrument for collecting qualitative data in the form of verbal reports that the students produce while taking a test of reading comprehension. The test is used as an instrument for distinguishing good and poor readers whose reading strategies are analysed using protocol analyses. The resulting codes of reading strategies are then categorized and their specificities are discussed at length. Key words: Modern Standard Arabic, Arabic as a second language, construct of reading, reading comprehension, proficiency testing, reading aloud, reading strategies, think aloud, verbal protocols, validity.

This diploma thesis discusses a modern concept of information retrieval and search engines for libraries and other academic institutions. The concept named "web scale discovery" comprises of search engines, whose main characteristics lie in simplicity and user friendliness for the end users while maintaining all functional qualities of traditional research databases. Users can search in a wide variety of international research databases, and also in local sources of an institution that are combined within a large central index. The theoretical section presents definitions of web scale discovery, which conceptually set the new method of information retrieval within the field of information and library science. A graphic scheme of the basic functionality of a web scale discovery system is presented. Also discussed are requirements for a modern discovery system, an overview of the current situation in the Czech Republic, and a short characteristic of commercially available discovery systems. The theoretical part concludes with a literature review of selected foreign research, studying user satisfaction with the new solution, the impact on electronic and print resources in libraries, and usability testing. The practical part presents an original research study - usability testing of EBSCO Discovery...