Doctor of Philosophy

dissertationThe cost of medication errors is burdensome to patients, institutions, and frontline providers. Nurses are accountable for and vulnerable to institutional safe medication practices and make this responsibility their highest priority; yet, contextual factors relevant to nurses' work encompassing medication administration are not well understood. The aim of this ethnographic study was to identify and describe nurses' work in the context of medication administration, errors, and organizational safety. Using nonparticipant observation (92 hours) and 37 unstructured interviews with nurses, administrators, and pharmacist in a mid-sized hospital in the United States, I found the nature of nurses' work characterized by: 1) chasing a standard of care, 2) prioritizing practice , and 3) renegotiating routines. These characteristics were inextricably linked to organizational structures, the medication management system, competing obligations, and shifting of priorities. Data were divided into two articles: 1) Nurses' Work in the Context of Medication Administration: Untenable Expectations provides a thick description of everyday experiences on the unit, medication administration, and the potential for errors. From these data, I present an emerging theoretical model. 2) The Paradox of Safety in Medication Management is a microanalysis of the medication use process with a specific focus on patterns of medication errors in the hospital, and the role of the pharmacists as a "stop-gap" between the physicians and patients in the recognition and interception of medication errors. These results enhance our understanding of why present efforts targeting the reduction of medication errors may be ineffective

From Common Operational Picture to Common Situational Understanding : A Framework for Information Sharing in Multi-Organizational Emergency Management

Complex emergencies such as natural disasters are increasing in frequency and scope, in all regions of the world. These emergencies have devastating impacts on people, property, and the environment. Responding to these events and reducing their impact requires that emergency management organizations (EMOs) collaborate in their operations. Complex emergencies require extraordinary efforts from EMOs and often should be handled beyond ordinary routines and structures. Such operations involving multiple stakeholders are typically characterized by inadequate information sharing, decision-making problems, limited situational awareness (SA), and lack of common situational understanding. Despite a high volume of research on these challenges, evaluations from complex disasters and large-scale exercises document that there are still several unsolved issues related to information sharing and the development of common situational understanding. Examples here include fulfillment of heterogeneous information needs, employment of different communication tools and processes with limited interoperability, and information overload resulting from a lack of mechanisms for filtering irrelevant information. Multi-organizational emergency management is an established area of research focusing on how to successfully collaborate and share information for developing common situational understanding. However, the level of complexity and situational dependencies between the involved EMOs create challenges for researchers. An important element for efficient collaboration and information sharing is building and maintaining a common operational picture (COP). Sharing important information is a key element in emergency management involving several EMOs, and both static and dynamic information must be accessible to perform tasks effectively during emergency response. To be proactive and mitigate the emergency impacts requires up-to-date information, both factual information via the COP and the ability to share interpretations and implications through using a communication system for rapid verbal negotiation. The overall research objective is to investigate how stakeholders perceive and develop SA and COP, and to explore and understand key requirements for stakeholders to develop a common situational understanding in complex multi-organizational emergency management.publishedVersio

A Middleware framework for self-adaptive large scale distributed services

Modern service-oriented applications demand the ability to adapt to changing conditions and unexpected situations while maintaining a required QoS. Existing self-adaptation approaches seem inadequate to address this challenge because many of their assumptions are not met on the large-scale, highly dynamic infrastructures where these applications are generally deployed on. The main motivation of our research is to devise principles that guide the construction of large scale self-adaptive distributed services. We aim to provide sound modeling abstractions based on a clear conceptual background, and their realization as a middleware framework that supports the development of such services. Taking the inspiration from the concepts of decentralized markets in economics, we propose a solution based on three principles: emergent self-organization, utility driven behavior and model-less adaptation. Based on these principles, we designed Collectives, a middleware framework which provides a comprehensive solution for the diverse adaptation concerns that rise in the development of distributed systems. We tested the soundness and comprehensiveness of the Collectives framework by implementing eUDON, a middleware for self-adaptive web services, which we then evaluated extensively by means of a simulation model to analyze its adaptation capabilities in diverse settings. We found that eUDON exhibits the intended properties: it adapts to diverse conditions like peaks in the workload and massive failures, maintaining its QoS and using efficiently the available resources; it is highly scalable and robust; can be implemented on existing services in a non-intrusive way; and do not require any performance model of the services, their workload or the resources they use. We can conclude that our work proposes a solution for the requirements of self-adaptation in demanding usage scenarios without introducing additional complexity. In that sense, we believe we make a significant contribution towards the development of future generation service-oriented applications.Las Aplicaciones Orientadas a Servicios modernas demandan la capacidad de adaptarse a condiciones variables y situaciones inesperadas mientras mantienen un cierto nivel de servio esperado (QoS). Los enfoques de auto-adaptación existentes parecen no ser adacuados debido a sus supuestos no se cumplen en infrastructuras compartidas de gran escala. La principal motivación de nuestra investigación es inerir un conjunto de principios para guiar el desarrollo de servicios auto-adaptativos de gran escala. Nuesto objetivo es proveer abstraciones de modelaje apropiadas, basadas en un marco conceptual claro, y su implemetnacion en un middleware que soporte el desarrollo de estos servicios. Tomando como inspiración conceptos económicos de mercados decentralizados, hemos propuesto una solución basada en tres principios: auto-organización emergente, comportamiento guiado por la utilidad y adaptación sin modelos. Basados en estos principios diseñamos Collectives, un middleware que proveer una solución exhaustiva para los diversos aspectos de adaptación que surgen en el desarrollo de sistemas distribuidos. La adecuación y completitud de Collectives ha sido provada por medio de la implementación de eUDON, un middleware para servicios auto-adaptativos, el ha sido evaluado de manera exhaustiva por medio de un modelo de simulación, analizando sus propiedades de adaptación en diversos escenarios de uso. Hemos encontrado que eUDON exhibe las propiedades esperadas: se adapta a diversas condiciones como picos en la carga de trabajo o fallos masivos, mateniendo su calidad de servicio y haciendo un uso eficiente de los recusos disponibles. Es altamente escalable y robusto; puedeoo ser implementado en servicios existentes de manera no intrusiva; y no requiere la obtención de un modelo de desempeño para los servicios. Podemos concluir que nuestro trabajo nos ha permitido desarrollar una solucion que aborda los requerimientos de auto-adaptacion en escenarios de uso exigentes sin introducir complejidad adicional. En este sentido, consideramos que nuestra propuesta hace una contribución significativa hacia el desarrollo de la futura generación de aplicaciones orientadas a servicios.Postprint (published version

Librarians and the emerging research library: A case study of complex individual and organizational development.

The purpose of this case study was to increase the knowledge base of how research librarians experience and cope with the turbulence of change within their library system. This research also examined the issues that surround the organizational structures and leadership of transformative change in one research library. A library belonging to the Association of Research Libraries was selected for case study investigation. Seventeen librarians participated in on-site interviews, utilizing a protocol composed of a clustering technique and semi-structured interviewing. Instrumental case studies of each individual were then developed through a collective case method to present the intrinsic case study of the library system as an organization. Data were analyzed primarily through a complex systems theoretical framework while at the same time were grounded in a broad literature base of organizational, leadership, individual change, and library organizational development theories. The findings of the study include: the competing tensions between the physical and virtual environments, the search for professional meaning, coping with the experiences of professional change, the evolution of the organizational structure, and leadership as a shared experience. Analysis of the findings suggest: the emergence of a hypercritical state, the limiting nature of negative feedback, a complex systems framework for professional thinking, coping in the hypercritical organization, the emergence of disorder in the complex system, the blending of self-organizing systems with structural feedback mechanisms, and the complexity of leadership in the new research library

Leadership in a Changing World

Leadership in a Changing World - A Multidimensional Perspective investigates the multi-dimensional aspect of leadership by exploring different perspectives and practices as well as existing theories of effective leadership in a changing world. Chapters address such topics as the connection between leadership, innovation, and creativity, venture leadership, e-leadership, digital leadership, and more. Beyond understanding the nature of effective leadership, this book examines the nature of leadership focusing on what we know and how we know it

Persona

Dementia shows us human existence without any decoration. We see it is heartbreaking, fragile, and delicate in all details. And we see more similarities than differences in our lives than we might imagine. We are all familiar with sadness, joy, fear, despair, depression, and happiness. People who have dementia feel the same way. Sadly, emotions confuse them and us. Formal and informal caregivers play a major role in caring for people who have dementia. These caregivers, however, frequently face great strain from care, stress, and have an increased risk of depression and anxiety. Their psychological distress is mostly caused by the shifting nature of dementia and its complexity. Despite the growing global impact, a lack of understanding of dementia leads to fears and to stigmatization. For those living with dementia (both the person and their family), the stigma gives rise to social isolation and to delays in looking for diagnosis and help. Therefore, there is an urgent need to raise awareness and understanding of dementia in all strata of society as a move towards enhancing the quality of life of people who have dementia and their caregivers and to adequately prepare formal and informal caregivers. ‘Persona’ is an artistic research project that adopts multiple design strategies to convey a better understanding of dementia to (in)formal caregivers and the public. Centered around scientific studies, and insights from primary caregivers, specialists, designers, and in collaboration with artists, this project aims to create an immersive experience to cultivate empathy, improve competence and alleviate psychological distress, and in doing so, humanize the disease and embrace the fragility of the human mind.Master of Design, Visual CommunicationMAV

Purposeful Nurse Hourly Rounding: Plan to Decrease Patient Falls During a Pandemic

Problem: Patient falls remain a critical and persistent safety problem in healthcare today. The prolonged impact of the COVID-19 pandemic raises leadership concerns regarding the safe care of high-risk COVID patients and mitigating the increased stress and potential risks of infection to clinical staff. Context: This Doctor of Nursing Practice (DNP) scholarly project details implementation of an evidence-based purposeful nurse hourly rounding (PNHR) pilot project designed to decrease the incidence of patient falls on a designated COVID-19 unit. Measure: A modified PNHR rounding tool was implemented to guide focused elements for key nurse/patient interactions. Interventions: PNHR strategies were further augmented by innovative quantum caring healthcare leadership (QCHL) principles intended to support team engagement and enhance a culture of safety. The transformational leadership approach and theoretical foundations of QCHL were viewed as pivotal enculturation tactics and were aligned to sustainability goals. The project aim was to decrease the incidence of adult patient falls by 10% over baseline data during a four-month pilot on a designated COVID-19 nursing unit. Results: The post-implementation outcomes highlight a 58% reduction in patient falls from 4.29 to 1.79 falls per 1,000 patient days. Conclusions: Quantitative and qualitative findings support a proactive leadership approach to patient safety and staff engagement that utilizes an evidence-based, structured, timely, and sustainable nurse hourly rounding strategy. Dissemination: Low costs, improved clinical outcomes, and positive impact on patient safety and employee engagement increase the potential for spread of this scholarly project to non-COVID care units across the organization and to other systems

Team improvised adaptation: team performance in contexts of uncertainty and time scarcity

The main goal of this thesis is to propose, validate, and analyse the team improvised adaptation construct. It comprises one theoretical study and four empirical studies. Team improvised adaptation is the process of team adaptation when design and execution merge. Study 1 deconstructs and recombines team adaptation and team improvisation, proposing the team constructs of purposive improvisation, improvised adaptation and preemptive adaptation. Study 2 validates team improvised- and preemptive adaptation, revealing the moderation role of team learning behaviours on the mediation of improvised adaptation between shared temporal cognitions and team performance. Study 3 suggests that in-action and transitional reflexivity moderate the relationship between shared mental models similarity and improvised adaptive performance, and that transitional reflexivity moderates the relationship between shared mental models similarity and improvised adaptation learning. Study 4 uncovers the mediation effect of team improvised adaptation between future-orientation elevation and team performance. The findings also show that futureorientation diversity has a positive impact on team improvised adaptation learning. However, future-orientation elevation and future-orientation diversity have negative impacts on improvised adaptation learning and team performance, respectively. Finally, study 5 takes an inductive approach revealing two tensions of team improvised adaptation: a deployment tension between routine inertia and improvisation pressures, and a development tension between the need to plan and the need to act immediately. The resolution of these tensions unravels a process that ultimately leads to team learning outcomes. The thesis contributes to the understanding of teamwork, in particular when teams have to adapt to unexpected circumstances under conditions of extreme time scarcity.O objetivo principal desta tese é propor, validar e analisar o construto de adaptação improvisada em equipa. Compreende um estudo teórico e quatro estudos empíricos. A adaptação improvisada em equipa é o processo de adaptação da equipa quando o plano e a execução são simultâneos. O estudo 1 desconstrói e recombina a adaptação e a improvisação em equipa, propondo os construtos de improvisação premeditada, adaptação improvisada e adaptação preparada. O estudo 2 valida a adaptação improvisada e a preparada, revelando o papel de moderação dos comportamentos de aprendizagem em equipa, na mediação da adaptação improvisada entre as cognições temporais partilhadas e o desempenho da equipa. O estudo 3 sugere que as reflexividades em ação e transicional moderam a relação entre a semelhança dos modelos mentais partilhados e o desempenho adaptativo improvisado, e que a reflexividade transicional modera a relação entre a semelhança dos modelos mentais partilhados e a aprendizagem de adaptação improvisada. O estudo 4 expõe o efeito de mediação da adaptação improvisada em equipa entre a orientação futura da equipa e o seu desempenho. Os resultados também revelam que a diversidade na orientação futura da equipa tem um impacto positivo na aprendizagem de adaptação improvisada. No entanto, o construto de orientação para o futuro, composto para o nível da equipa através da elevação e através da diversidade, têm impactos negativos na aprendizagem de adaptação improvisada e no desempenho da equipa, respetivamente. Finalmente, o estudo 5 faz uma abordagem indutiva que revela duas tensões de adaptação improvisada em equipa: uma tensão inicial entre a inércia de rotina e as pressões de improvisação, e uma tensão de desenvolvimento entre a necessidade de planear e a necessidade de agir imediatamente. A resolução destas tensões despoleta um processo que, em última análise, leva à aprendizagem em equipa. Esta tese contribui para a compreensão do trabalho em equipa, em particular quando as equipas precisam de se adaptar a circunstâncias inesperadas em condições extremas de escassez de tempo