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Grounded Theory Approach (grounded + theory_approach)
Selected AbstractsKeeping the spirit high: why trauma team training is (sometimes) implementedACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2008T. WISBORG Background: Systematic and multiprofessional trauma team training using simulation was introduced in Norway in 1997. The concept was developed out of necessity in two district general hospitals and one university hospital but gradually spread to 45 of Norway's 50 acute-care hospitals over the next decade. Implementation in the hospitals has varied from being a single training experience to becoming a regular training and part of quality improvement. The aim of this study was to better understand why only some hospitals achieved implementation of regular trauma team training, despite the intentions of all hospitals to do so. Methods: Focus group interviews were conducted with multiprofessional respondents in seven hospitals, including small and large hospitals and hospitals with and without regular team training. Interviews were transcribed and analyzed using a Grounded Theory approach. Results: ,Keeping the spirit high' appeared to be the way to achieve implementation. This was achieved through ,enthusiasm,',strategies and alliances,' and ,using spin-offs.' It seems that the combination of enthusiasts, managerial support, and strategic planning are key factors for professionals trying to implement new activities. Conclusions: Committed health professionals planning to implement new methods for training and preparedness in hospitals should have one or more enthusiasts, secure support at the administrative level, and plan the implementation taking all stakeholders into consideration. [source] Wide Awake to the World: The Arts and Urban Schools,Conflicts and Contributions of an After-School ProgramCURRICULUM INQUIRY, Issue 1 2001Therese Quinn While the benefits of arts involvement are increasingly clear, policies and practices consistent with this recognition are not proceeding apace. Nearly half the schools in the United States have no full-time arts teachers and emphases on "standards" have led to the elimination of the arts in many urban schools. This case study of a multi-year after-school arts program in urban public schools explores challenges and tensions that emerged during the program's implementation. Focusing on understanding the place and purpose of an arts program in a specific community, we employed a grounded theory approach and used multiple data-gathering methods, ranging from observations and interviews to surveys. We found that in serving hundreds of students, employing dozens of staff, and aiming to meet several complex goals, this arts program faced technical challenges that undermined its effectiveness. The arts program also suffered from unaddressed conflicts regarding norms and values. Artists attempted to provide students opportunities for creative exploration, while school staff emphasized control, order, and academic goals. We discuss these tensions and the ways they undermined the arts program. [source] Young people at risk of psychosis: a user-led exploration of interpersonal relationships and communication of psychological difficultiesEARLY INTERVENTION IN PSYCHIATRY, Issue 2 2010Rory Byrne Abstract Aim: The aim of the present study was to qualitatively explore experiences and perceptions of interpersonal relationships and interpersonal communication among young people at risk of psychosis. Method: Semi-structured interviews were conducted using a qualitative grounded theory approach. Participants had entered into a service providing psychological interventions for young people assessed to be at a high risk of developing psychosis (Northwest UK). Our sample comprised one female and seven male participants (n = 8), ranging in age from 16 to 28 years, with a mean age of 22.4 years. Results: Analyses identified three central themes: difficulty with interpersonal relationships and reduced opportunities for helpful communication, difficulty talking to others about psychological problems, and experiences of talking to others about psychological problems. Conclusions: Individuals at risk of psychosis may have experienced significant difficulties with interpersonal relationships. Such difficulties may contribute directly to the development of unusual psychological experiences, and to an inability or reluctance to communicate these to others. In addition, commonly held stigmatizing ideas associated with unusual psychological experiences may contribute to a fear among at-risk individuals that they are ,going mad', and this may lead to concealment of their difficulties, and to delayed help-seeking. For at-risk individuals, helpful communication of psychological distress offers significant benefits, including improved psychological and emotional well-being and reduced risk of psychosis. Thus, while concealment of distress may directly impact on the development of unusual psychological difficulties, communication of such difficulties may be central to recovery. [source] Stigma and treatment delay in first-episode psychosis: a grounded theory studyEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2010Lauren Franz Abstract Aim: A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP. Methods: Qualitative interviews were conducted with 12 African American family members directly involved in treatment initiation for a relative with first-episode psychosis. Data analysis relied on a grounded theory approach. A testable model informed by constructs of Link's modified labelling theory was developed. Results: Four main themes were identified, including: (i) society's beliefs about mental illnesses; (ii) families' beliefs about mental illnesses; (iii) fear of the label of a mental illness; and (iv) a raised threshold for the initiation of treatment. A grounded theory model was developed as a schematic representation of the themes and subthemes uncovered in the family members' narratives. Conclusions: The findings suggest that due to fear of the official label of a mental illness, certain coping mechanisms may be adopted by families, which may result in a raised threshold for treatment initiation, and ultimately treatment delay. If the relationships within the grounded theory model are confirmed by further qualitative and quantitative research, public educational programs could be developed with the aim of reducing this threshold, ultimately decreasing DUP. [source] Experience and meaning of user involvement: some explorations from a community mental health projectHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2002Carole Truman Abstract With an increased interest in and policy commitment to involving service users in the planning and delivery of health service provision, there is a clear need to explore both the rhetoric and realities of what user involvement entails. In the present paper, by drawing upon an evaluation of a community-based exercise facility for people with mental health problems, the authors explore ways in which the reality of user involvement is subject to a range of configurations within health services. The paper describes a piece of qualitative research that was undertaken within a participatory framework to explore the nature of user involvement within the facility. The data have been analysed using a grounded theory approach to provide insights into: the organisational context in which user involvement takes place; factors which encourage meaningful participation on the part of service users; perceived barriers to user involvement; and issues of sustainability and continuity. This research approach has enabled the authors to explore the views and experiences of users, service providers and referral agencies in relation to the nature and potential for user involvement. The findings illustrate ways in which user involvement may take place under both flexible and formal arrangements across a variety of activities. The present paper provides an account of some of the meanings and experiences of what ,successful' user participation may involve and the conditions which underpin ,success'. The authors conclude that successful and meaningful user involvement should enable and support users to recognise their existing skills, and to develop new ones, at a pace that suits their particular circumstances and personal resources. This process may require adaptation not only by organisations, but also by service providers and non-involved users. [source] Auditor,client Interaction and Client Usefulness , A Swedish Case StudyINTERNATIONAL JOURNAL OF AUDITING, Issue 2 2006Niclas Hellman This paper investigates the usefulness of the external audit to a listed client company. The research questions focus on what the auditors discovered, the subsequent auditor,client interaction, and the ways in which this was useful to the client company. The study proceeds from the management letters produced by the auditors in the period 1999,2001. On the basis of these reports, interviews were conducted with financial managers at different organisational levels. The data collection and analysis of the data follows a grounded theory approach. The results suggest that the usefulness of the audit to the client company was primarily linked to the way the management letters, and the auditor,client interaction related to the management letters, supported the client's management control system. Improved management control was achieved as a result of co-operation between the audit firm and the client company's central accounting and finance department, that put pressure on the subordinate units. The reported benefits for the client company must be weighed against potential threats to auditor independence, and the paper also includes empirical results that indicate risks of auditor dependency on the client's accounting and finance department. [source] Professional socialization: The key to survival as a newly qualified nurseINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 2 2007Higher DiplomaArticle first published online: 29 MAR 200, MSc (Nursing), Mary Mooney RGN The impact and prevalence of professional socialization in nursing has been written about extensively. Despite the many positive developments that have taken place in nursing within the past decade, the role of professional socialization remains heavily weighted and is of particular significance to those nurses who are newly qualified. The account given by newly registered nurses in this study demonstrates that their ability and willingness to become professionally socialized determines their ease of survival at clinical level. Twelve newly qualified Irish nurses, from two separate cohorts, were interviewed to ascertain their perceptions of becoming newly qualified nurses. A grounded theory approach was used and data were analysed using thematic analysis. A category that emerged was linked very strongly with professional socialization. The respondents did not refer to professional socialization per se, but through the coding process this emerged as the linchpin of the discussion. [source] Life experiences after stroke among Iranian stroke survivorsINTERNATIONAL NURSING REVIEW, Issue 2 2010A. Dalvandi phd DALVANDI A., HEIKKILÄ K., MADDAH S.S.B., KHANKEH H.R. & EKMAN S.L. (2010) Life experiences after stroke among Iranian stroke survivors. International Nursing Review57, 247,253 Background:, Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. Aim:, To illuminate how stroke survivors experience and perceive life after stroke. Method:, A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors. Findings:, The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances. Conclusions:, The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families. [source] From east to west: Nepalese women's experiencesINTERNATIONAL NURSING REVIEW, Issue 3 2004C. Rolls rn Abstract Background:, Nepal is a small mountainous South Asian country located between the nations of India and China. Forty-two per cent of the 22 million Nepalese people live in poverty. As a result, immigration to a developed country is the dream of many but available to few. Some immigrants from Nepal have arrived in Australia in recent years entering the ,Skill' stream of eligibility categories. Nepalese immigrants to Australia are predominantly young married couples with professional education qualifications. Aim:, To generate knowledge of the childbirth and early experiences of Nepalese women in their mother country and in Australia. The aspect presented here is the immigration experiences of Nepalese women to Australia. Method:, An ethnographic, grounded theory approach was used to observe and analyse the experiences of 11 Nepalese participants. Findings:, Analysis of data suggests that Nepalese female immigrants with the ability to comprehend and speak English and a level of education and skill required by Australia can successfully negotiate the change of culture and adapt to their new society. Major benefits of immigration for the women were the opportunities to work, become independent and to share in decision making for their family. Conclusion and implications for nursing practice:, Severance from the Nepalese joint family, a male dominant hierarchical society, and a new way of life allow a Nepalese woman to become an individual rather than a member of a collective. This study has produced transcultural information from the perspective of the educated professional Nepalese female immigrant that will assist in the provision of midwifery and nursing care. [source] Evidence-Based Practice in Healthcare: An Exploratory Cross-Discipline Comparison of Enhancers and BarriersJOURNAL FOR HEALTHCARE QUALITY, Issue 3 2010Joanna Asadoorian Abstract: In order to improve health outcomes, healthcare providers need to base practice on current evidence. The purpose of this qualitative study was to explore and compare the understanding and experiences with evidence-based practice (EBP) in three different disciplines. Researchers conducted individual interviews with psychiatrists, nurses, and dental hygienists. The majority of study participants demonstrated an understanding of EBP and were able to identify enhancers and barriers to implementing EBP. Using a grounded theory approach, several major themes acting as enhancers and barriers to EBP emerged and revealed both differences and similarities within and across the three health disciplines. While saturation was not attempted, this exploratory research is important in contributing to understanding the cultural practice milieu in relation to individual characteristics in implementing evidence into practice with the overall aim of improving healthcare delivery and outcomes. [source] Healthcare professionals' perceptions of existential distress in patients with advanced cancerJOURNAL OF ADVANCED NURSING, Issue 7 2010Esther Mok mok e., lau k-p., lam w-m., chan l-n., ng j.s.c. & chan k-s. (2010) Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Journal of Advanced Nursing,66(7), 1510,1522. Abstract Title.,Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Aim., This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals. Background., Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care. Method., Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants. Findings., We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients' openness and readiness; healthcare professionals' self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions. Conclusion., This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals' views, and further studies from the perspectives of patients and their families are needed. [source] Supervising medication administration by undergraduate nursing students: influencing factorsJOURNAL OF CLINICAL NURSING, Issue 5-6 2010Kerry Reid-Searl Background., The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required. Aims and objectives., The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting. Design., A grounded theory approach was used with constant comparative analysis to identify categories from the data. Methods., The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia. Results., Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time. Conclusions., The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment. Relevance to clinical practice., The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented. [source] Never-ending making sense: towards a substantive theory of the information-seeking behaviour of newly diagnosed cancer patientsJOURNAL OF CLINICAL NURSING, Issue 11 2007Eilis McCaughan BSc Aim., The aim of this paper was to report a study which explored the information-seeking behaviour of patients newly diagnosed with cancer in the immediate postdiagnosis period. Background., Information is an important tool for cancer patients. There is evidence that patients' information needs are not being adequately met and, in many cases, patients often do not recall much information at the time of diagnosis. Method., Using a grounded theory approach, a theoretical sample of 27 newly diagnosed patients was interviewed in their own homes. Data were analysed using grounded theory analysis procedures. Results., A substantive theory describing the transitions from ,being traumatized' by the diagnosis, through a phase of trying to ,take it on', through to ,taking control' is tentatively offered. It provides a theoretical framework to understand newly diagnosed cancer patients' changing, varied and continuing needs and their efforts to regain some control over their lives. Their information-seeking behaviour seemed a journey of ,never-ending making sense' with ongoing discovery and new information needs as they struggled with the effects of the disease and treatments. Conclusions., The processes and stages identified in this study provide nurses with a framework to assess the readiness of patients to receive information and to assist them in their efforts to regain some control over their disease and their lives. Relevance to clinical practice., Health professionals need to be aware of these stages, to be equipped to assess the need of individuals for information and support. [source] Patients and nurses' perceptions of ward environmental factors and support systems in the care of suicidal patientsJOURNAL OF CLINICAL NURSING, Issue 1 2006Fan-Ko Sun PhD Aims., The aims of this paper are to present and discuss the findings that emerged from a qualitative study exploring nurses and patients' views of the acute psychiatric ward (the context) and the type of care received (the intervening conditions). Background., The phenomenon of suicide and the nursing care of people who are suicidal have previously been investigated. However, literature demonstrates that there is a dearth of information exploring the importance of the ward context in the care of suicidal patients and the intervening conditions that are used by professionals in the care of suicidal patients. Method., Qualitative research using the grounded theory approach. Data collection and analysis., Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding. Findings., A substantive theory of suicide-nursing care was developed. For the purpose of this paper, the two categories that emerged in the ,context' element of the paradigm model are explored. They were: team working and the psychiatric ward environment. In addition, the four categories from the ,intervening conditions' are discussed. They were: nurses' attitudes and beliefs have an effect on caring, barriers to caring, patients' negative thoughts and feelings about the care provided and support systems. Conclusion., The findings indicated that the context of the ward environment and the intervening conditions used by nurses in the nursing care of suicidal patients helped to define some of the complex dynamics that impacted on the development of a therapeutic relationship within the practice of suicide-nursing care. Relevance to clinical practice., Environmental factors as well as the nurses' knowledge and skills and the type of support patients receive impact on the care of suicidal patients. These findings could help to enhance and advance suicide-nursing care. [source] Lecturer practitioners in six professions: combining culturesJOURNAL OF CLINICAL NURSING, Issue 5 2004Pat Fairbrother BA Background., Whilst research has been undertaken in relation to the lecturer practitioner role in nursing, there have been no cross-professional studies. There is an explicit political agenda in the United Kingdom on interprofessional education and enhancing the status of those who provide practice-based teaching. Aim., This paper reports a study to investigate the commonalities and differences between lecturer practitioners across professions and to generate hypotheses about the role, which follows different models of practice in the different professions. Methods., An exploratory research design was adopted, using semi-structured interviews with a purposive sample of lecturer practitioners from six professions (architecture, clinical psychology, law, medicine, nursing and social work). A grounded theory approach was used. Findings., All lecturer practitioners perceived a clear dichotomy between their professional practice role and their university role. All used similar strategies to adapt to and deal with combining two very differently perceived cultures. There were striking similarities in response to the consequences of serving ,two masters' in the areas of time management and role identity/definition. Conclusions., The role not only bridges theory and practice, but has to operate within very different organizational cultures. Further research is needed to test the generalizability of the findings. Relevance to clinical practice., This investigation aims to inform higher education and health service policy on lecturer practitioners, and also provide support for those undertaking this challenging role. The study poses challenging questions for policymakers in the current climate of interprofessional learning, which need to be addressed if future initiatives in this area are to be successful. [source] Social Network Profiles as Taste PerformancesJOURNAL OF COMPUTER-MEDIATED COMMUNICATION, Issue 1 2008Hugo Liu This study examines how a social network profile's lists of interests,music, books, movies, television shows, etc.,can function as an expressive arena for taste performance. By composing interest tokens around a theme, profile users craft their "taste statements." First, socioeconomic and aesthetic influences on taste are considered, and the expressivity of interest tokens is analyzed using a semiotic framework. Then, a grounded theory approach is taken to identify four types of taste statements,those that convey prestige, differentiation, authenticity, and theatrical persona. The semantics of taste and taste statements are further investigated through a statistical analysis of 127,477 profiles collected from the MySpace social network site between November 2006 and January 2007. The major findings of the analysis include statistical evidence for prestige and differentiation taste statements and an interpretation of the taste semantics underlying the MySpace community,its motifs, paradigms, and demographic structures. [source] Work stress: an exploratory study of the practices and perceptions of female junior healthcare managersJOURNAL OF NURSING MANAGEMENT, Issue 1 2002K. Rodham BSc(HONS) Aim:, This exploratory study set out to investigate the perceptions and practices of junior healthcare managers with regard to stress at work. Background:, It has been suggested that cultural change is needed to accommodate a shift towards recognition of organizational responsibility for stress (Schulz et al. 1985). Logically, it can be argued that junior healthcare managers, as potential future senior managers, are best placed to facilitate this change. Junior healthcare managers' current thinking about stress had not yet been explored in depth. Method:, A combination of critical incident diaries and semistructured interviews was conducted with six junior healthcare managers. The data were analysed and transcribed using a grounded theory approach. Findings:, The main themes to emerge were that junior healthcare managers were generally unaware of (a) potential work stressors and (b) the effect of work stressors on their own health and performance and that of their staff. Conclusions:, The perceptions and practices of junior healthcare managers suggest that there is a culture of acceptance and expectation of work stress, combined with a lack of awareness to effectively and proactively manage it. [source] Toward a Theory of Self-Reconciliation Following Mistakes in Nursing PracticeJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2007Nancy J. Crigger Purpose: To explore nurses' responses to making mistakes in hospital-based practice in the US. Methods: A grounded theory approach was used to explore the process that occurs after nurses perceive that they have made mistakes in practice. Theoretical sampling was used and data were collected until saturation occurred. Ten participants, who were registered nurses, described 17 personal mistakes. The mistakes they described occurred in hospitals. All participants were practicing nursing either in hospitals or in other work settings. Findings: A process of "Self-Reconciliation After Making Mistakes in Hospital Practice" was identified, with four distinct categories: reality hitting, weighing in, acting, and reconciling. The core category was reconciliation of the self, personally and professionally. Conclusions: This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested. [source] Egalitarian consultation meetings: an alternative to received wisdom about clinical supervision in psychiatric nursing practiceJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2000C. Stevenson RMN BA (HONS) PhD Clinical supervision (CS) has become a watchword for psychiatric nursing. Yet, there are contradictions and controversies in academic and professional discourse in relation to the nature of CS, both structure and process, its effectiveness and how this is ascertained, the preparation of supervisor and supervisee, and the quality of the supervisory relationship. The perception of such discord encouraged the authors of this paper to step outside the debate and enact a different kind of CS, which came to be known as egalitarian consultation (EC). Egalitarian consultation meetings (ECMs) were established with the postmodern turn in psychiatric nursing as a reference point. A space was created in which participants could construct their particular version of CS. The authors and six G-grade community psychiatric nurses engaged with each other for six videotaped meetings. The data from the recordings were analysed using a hermeneutic grounded theory approach (Strauss & Corbin 1994), in keeping with the style of the research, which combined the roles of researcher and practitioner for the authors. The aim was to produce local knowledge of CS. The ECMs were characterized by a sense of freedom in relation to existing rules about hierarchy and truth. The participants, each as expert in her/his own case world, produced engrossing narratives about and for practice. The group developed a cohesiveness based in closeness and this encouraged radical talk and action , a questioning of practice systems. However, for some group members, radical equated to dangerous in terms of the watchful organization and a return to ,real' work (case supervision) was observed. Innovation in relation to CS may benefit from a change in institutional culture. [source] The Meaning of Good Parent,Child Relationships for Mexican American AdolescentsJOURNAL OF RESEARCH ON ADOLESCENCE, Issue 4 2007Lisa J. Crockett Perceptions of good parent,adolescent relationships were explored among 19 Mexican American high school students aged 14,17 who participated in focus group interviews on what it means for Mexican American teenagers to have good relationships with parents. Using a grounded theory approach, five general themes emerged in the responses, corresponding to open communication, instrumental and emotional support, indirect expressions of caring, parental control, and valued relationship qualities. Both genders described distinct relationships with mothers and fathers. Relationships with mothers were closer and more open than relationships with fathers, and mothers were seen as being more affectionate, lenient, and emotionally supportive, whereas fathers tended to express caring indirectly by providing instrumental and financial support and by just being there. Parental upbringing, culture, gender, and parental role expectations emerged as explanations for parents' behavior. Theoretical, methodological, and practical implications are discussed. [source] A PROCESS ANALYSIS OF GLOBAL TRADE MANAGEMENT: AN INDUCTIVE APPROACH,JOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 2 2010WARREN H. HAUSMAN This paper describes a new, detailed process model for Global Trade Management (GTM) that contains sufficient detail on cross-border trade processes to estimate the benefits of Information Technology-Enabled Global Trade Management (IT-GTM). Our methodology combines a grounded theory approach with data analysis and analytical modeling. GTM describes the processes required to support cross-border transactions between importers, exporters, their trading partners and governments. IT-GTM is the set of information technologies and software solutions that can be used by companies to carry out their global trading processes in a streamlined manner. We collect data on time reductions for individual trade process steps using IT-GTM and use Critical Path Analysis to calculate the resulting improvements in key metrics such as the Manufacture to Invoice Cycle and Days Sales Outstanding for exporters, and the Order to Receipt Cycle for importers. Under reasonably conservative scenarios the gross savings from IT-GTM amount to 1.7 percent and 0.6 percent of annual sales for exporters and importers, respectively. [source] ,You're judged all the time!' Students' views on professionalism: a multicentre studyMEDICAL EDUCATION, Issue 8 2010Gabrielle Finn Medical Education 2010: 44: 814,825 Objectives, This study describes how medical students perceive professionalism and the context in which it is relevant to them. An understanding of how Phase 1 students perceive professionalism will help us to teach this subject more effectively. Phase 1 medical students are those in the first 2 years of a 5-year medical degree. Methods, Seventy-two undergraduate students from two UK medical schools participated in 13 semi-structured focus groups. Focus groups, carried out until thematic saturation occurred, were recorded and transcribed verbatim. Data were analysed and coded using NVivo 8, using a grounded theory approach with constant comparison. Results, From the analysis, seven themes regarding professionalism emerged: the context of professionalism; role-modelling; scrutiny of behaviour; professional identity; ,switching on' professionalism; leniency (for students with regard to professional standards), and sacrifice (of freedom as an individual). Students regarded professionalism as being relevant in three contexts: the clinical, the university and the virtual. Students called for leniency during their undergraduate course, opposing the guidance from Good Medical Practice. Unique findings were the impact of clothing and the online social networking site Facebook on professional behaviour and identity. Changing clothing was described as a mechanism by which students ,switch on' their professional identity. Students perceived society to be struggling with the distinction between doctors as individuals and professionals. This extended to the students' online identities on Facebook. Institutions' expectations of high standards of professionalism were associated with a feeling of sacrifice by students caused by the perception of constantly ,being watched'; this perception was coupled with resentment of this intrusion. Students described the significant impact that role-modelling had on their professional attitudes. Conclusions, This research offers valuable insight into how Phase 1 medical students construct their personal and professional identities in both the offline and online environments. Acknowledging these learning mechanisms will enhance the development of a genuinely student-focused professionalism curriculum. [source] Medical students' first clinical experiences of deathMEDICAL EDUCATION, Issue 4 2010Emily Kelly Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source] How residents learn: qualitative evidence for the pivotal role of clinical activitiesMEDICAL EDUCATION, Issue 8 2007P W Teunissen Objectives, Medical councils worldwide have outlined new standards for postgraduate medical education. This means that residency programmes will have to integrate modern educational views into the clinical workplace. Postgraduate medical education is often characterised as a process of learning from experience. However, empirical evidence regarding the learning processes of residents in the clinical workplace is lacking. This qualitative study sought insight into the intricate process of how residents learn in the clinical workplace. Methods, We carried out a qualitative study using focus groups. A grounded theory approach was used to analyse the transcribed tape recordings. A total of 51 obstetrics and gynaecology residents from teaching hospitals and affiliated general hospitals participated in 7 focus group discussions. Participants discussed how they learn and what factors influence their learning. Results, An underlying theoretical framework emerged from the data, which clarified what happens when residents learn by doing in the clinical workplace. This framework shows that work-related activities are the starting point for learning. The subsequent processes of ,interpretation' and ,construction of meaning' lead to refinement and expansion of residents' knowledge and skills. Interaction plays an important role in the learning process. This is in line with both cognitivist and sociocultural views on learning. Conclusions, The presented theoretical framework of residents' learning provides much needed empirical evidence for the actual learning processes of residents in the clinical workplace. The insights it offers can be used to exploit the full educational potential of the clinical workplace. [source] Forming professional identities on the health care team: discursive constructions of the ,other' in the operating roomMEDICAL EDUCATION, Issue 8 2002L Lingard Background, Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the,talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). Methods, The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded and transcribed. Using a grounded theory approach, three researchers individually analysed sample transcripts, after which group discussions were held to resolve discrepancies and confirm a coding structure. Using the confirmed code, the complete data set was coded using the ,NVivo' qualitative data analysis software program. Results, There were substantial differences in surgeons', nurses', anaesthetists', and trainees' interpretations of the communication scenarios. Interpretations were accompanied by subjects' depictions of disciplinary roles on the team. Subjects' constructions of other professions' roles, values and motivations were often dissonant with those professions' constructions of themselves. Conclusions, Team members, particularly novices, tend to simplify and distort others' roles and motivations as they interpret tense communication. We suggest that such simplifications may be rhetorical, reflecting professional rivalries on the OR team. In addition, we theorise that novices' echoing of role simplification has implications for their professional identity formation. [source] The nature of touch therapy related to Ki: Practitioners' perspectiveNURSING & HEALTH SCIENCES, Issue 2 2003Sung Ok Chang PhD Abstract Touch therapy related to Ki, a type of healing touch, has been regarded as one of the distinct therapeutic modalities in traditional oriental medicine. The present study attempted to develop a substantive theory about helping patients using touch therapy related to Ki, by exploring the views of practitioners who are using this therapeutic modality within the context of the Korean society. A grounded theory approach was applied during the collection and analyses of data. The core category, main categories and trajectory of helping patients during the use of touch therapy related to Ki was delineated. Helping patients while using touch therapy related to Ki was found to be a dynamic process with each participant actively engaged in increasing the activating, potential power of the human being. These findings have value in understanding the embedded meaning of the healing process through touch therapy within the context of Ki. [source] Attitudes towards prenatal diagnosis and termination of pregnancy for thalassaemia in pregnant Pakistani women in the North of EnglandPRENATAL DIAGNOSIS, Issue 3 2006Shenaz Ahmed Abstract Objectives Most births of children affected with ,-thalassaemia major in the United Kingdom are to parents of Pakistani origin. A popular explanation for this is that Pakistanis decline termination of pregnancy on religious grounds. However, various factors influence people's attitudes towards prenatal diagnosis and termination of pregnancy, which have not been investigated in a UK Pakistani sample. This study is aimed at exploring the attitudes of pregnant Pakistani women towards prenatal diagnosis and termination of pregnancy for ,-thalassaemia major in the North of England. Methods Forty-three pregnant women tested for thalassaemia carrier status were interviewed following receipt of their test results. Interviews were analysed using the grounded theory approach. Results Findings showed: (1) women's awareness of and attitudes towards prenatal diagnosis; (2) the relationship between attitudes towards prenatal diagnosis and termination of an affected foetus; (3) the relationship between attitudes towards termination of pregnancy and religious beliefs, perceptions of severity of the condition, influence of significant others, and (4) the impact of gestational age at the time of the offer of termination of pregnancy. Conclusions Pakistani women's attitudes towards prenatal diagnosis and termination of pregnancy are influenced by various factors, and therefore their religion should not be taken as a proxy for their attitudes either for or against termination of pregnancy. Copyright © 2006 John Wiley & Sons, Ltd. [source] ,A little bitty spot and I'm a big man': patients' perspectives on refusing diagnosis or treatment for lung cancerPSYCHO-ONCOLOGY, Issue 8 2005Barbara F. Sharf Abstract Patient refusal of physicians' recommendations may partially account for variations in lung cancer treatment affecting survival. Reasons for refusal have not been well researched, and patients who refuse are often labeled derogatorily as irrational or enigmatically non-compliant. This study explored why patients refused recommendations for further diagnosis or treatment of lung cancer. We conducted in-depth interviews with nine patients, identified and recruited over a 2-year period, with documented refusal of doctors' recommendations. Recruiting was hampered by deaths, logistics, and refusal to participate. Questions focused on participants' understanding of disease, medical recommendations, and perceptions of decision-making. Transcripts were analyzed using a grounded theory approach. Participants emphasized self-efficacy, minimizing threat, fatalism or faith, and distrust of medical authority; explanations were often multi-dimensional. Comments included complaints about communication with physicians, health system discontinuities, and impact of social support. Explanations of participants' decisions reflected several ways of coping with an undesirable situation, including strategies for reducing, sustaining, and increasing uncertainty. Problematic Integration Theory helps to explain patients' difficulties in managing uncertainty when assessments of disease outcomes and treatment recommendations diverge. Implications for clinical communication include increasing trust while delivering bad news, understanding the source of resistance to recommendations, and discussing palliative care. Copyright © 2005 John Wiley & Sons, Ltd. [source] Effective casework practice with adolescents: perspectives of statutory child protection practitionersCHILD & FAMILY SOCIAL WORK, Issue 2 2010Virginia Schmied ABSTRACT Many child protection practitioners struggle with the complexity of problems and the limited casework time for adolescent cases. However, there is little research on child protection practice or case management that can guide a practitioner working with adolescents in the child protection system. The aim of this study was to explore and describe the nature of effective child protection practice with adolescents from the perspective of statutory child protection practitioners in one state in Australia. Data were collected through focus group discussions and interviews with child protection practitioners and managers currently working with adolescents (n= 44). A grounded theory approach was used to identify the dominant themes or categories and form linkages and relationships through constant comparison techniques. Seven key categories emerged from this analysis: characteristics of the young person and their family; ,walking it together', the centrality of relationships; ,looking back/looking forward', practice strategies; practitioner attributes and skills; ,walking a fine line', working with the families of adolescents; ,walking with services', effective inter-agency work; and organizational context in effective child protection practice with adolescents. Key implications for practice and areas for further research were discussed. [source] | |||||||||||||||||||