Crafting a System of Profound Knowledge Management in Long-Term Care

The paradigm shift to a knowledge economy, predicted by Drucker, is currently reflected in a knowing-to-doing gap in healthcare, potentially threatening the lives of long-term care (LTC) residents and sustainability of LTC organizations. The purpose of this grounded theory study was to seek a substantive conceptual theory to explain how LTC uses knowledge management (KM) to improve performance by probing the a priori views and lived experiences of 11 LTC knowledge creators, managers, and users. Data were collected via semi structured interviews that were transcribed and coded. The research questions guided by the conceptual concentrated on how KM is used in LTC, what KM processes enhance or inhibit performance in LTC, the nature of knowledge in LTC, and the potential impact of Deming\u27s theory of profound knowledge on KM in LTC. Data analysis included coding, categorizing, constant comparison, conceptualizing, and theorizing to reveal a tentative unified theory of crafting a system of KM in LTC that theoretically extends Deming\u27s organizational theory of profound knowledge to integrate the individual knower within Deming\u27s organizational perspectives. Findings included participant use of sentinel data and bridging decisions in response to emergent knowledge needs, risk management versus quality management performance drivers, and participant perceptions of resource dependence in response to emergent knowledge needs. Findings also include social change implications for LTC facilities, residents, and staff driven by systematic KM to facilitate clinical best practices, lessons learned, and resourcing the use of knowledge to enhance LTC performance capabilities. Study conclusions include a call for future research related to study findings across the healthcare continuum

The Healthy Incentive for Pre-schools (HIP) Project: The Development, Validation, Evaluation and Implementation of an Healthy Incentive Scheme in the Irish Full Day Care Pre-school Setting.

While many children are now cared for outside the home, inadequate nutrition and physical activity practices in pre-schools have been reported. This study aimed to develop a validated nutrition and health related evaluation tool and an education information resource for pre-schools, and determine whether their use can promote improved food service and nutrition and physical activity practices in this setting. Following a pilot phase undertaken in Co. Wicklow (n 12), pre-schools providing a full day care service in the Midland Area of Ireland were invited to participate in the study (n, 100). Direct observation was used to collect data (food and fluid provision; physical activity; outdoor time; staff practices and availability of nutrition and health resources) in each pre-school during one full day both prior to, and 6-9 months following the training period, using the specifically developed data collection tool, the Pre-school Health Promotion Activity Scored Evaluation Form. Post-intervention, self-assessment data were also collected using the same evaluation tool. All foods offered were recorded using household measures, and a photographic food atlas developed specifically for this project. A Delphi investigation was undertaken to identify pre-schools’ most favoured incentives for project inclusion. Of 76 services that registered interest in participating, pre-intervention data were collected in 58 facilities. Pre-schools were randomised into 2 training intervention groups: a ‘manager only trained’ group (n, 27); and a ‘staff and manager trained’ group (n, 18). Pre-intervention, poor nutrition and health practices were observed. Significant improvement (P\u3c 0.05) in nutrition and health related practice was observed within both intervention delivery groups in all areas evaluated; training of staff had no significant impact on overall practice. Scores assigned by direct independent observation were lower than pre-school self-assessment scores. Grant aid for food and physical activity, and project participation recognition, were the incentives most favoured by pre-schools. This intervention was the first in Irish pre-schools to demonstrate that Pre-school Health Promotion Activity Scored Evaluation Form use supported by education improved practice with no significant additional effect of staff education

Health psychology: it's not what you do, it's the way that you do it

Despite the growth in theoretical understandings of health behaviour and standardised approaches to health interventions (e.g. behaviour change taxonomies), health psychology has paid comparatively less attention to the importance of the implementation processes – ‘how to’ rather than ‘what to’ of such interventions. The clinical and interpersonal skills that often reflect these implementation processes are poorly defined within the health psychology literature. The level of proficiency in such skills expected of Health and Care Professions Council registered practitioner health psychologists is unclear and poorly documented within the UK training requirements. This article explores the potential impact of this and offers some pragmatic solutions

Temporal order judgements of dynamic gaze stimuli reveal a postdictive prioritisation of averted over direct shifts

We studied temporal order judgements (TOJs) of gaze shift behaviours and evaluated the impact of gaze direction (direct and averted gaze) and face context information (both eyes set within a single face or each eye within two adjacent hemifaces) on TOJ performance measures. Avatar faces initially gazed leftwards or rightwards (Starting Gaze Direction). This was followed by sequential and independent left and right eye gaze shifts with various amounts of stimulus onset asynchrony. Gaze shifts could be either Matching (both eyes end up pointing direct or averted) or Mismatching (one eye ends up pointing direct, the other averted). Matching shifts revealed an attentional cueing mechanism, where TOJs were biased in favour of the eye lying in the hemispace cued by the avatar’s Starting Gaze Direction. For example, the left eye was more likely to be judged as shifting first when the avatar initially gazed toward the left side of the screen. Mismatching shifts showed biased TOJs in favour of the eye performing the averted shift, but only in the context of two separate hemifaces that does not violate expectations of directional gaze shift congruency. This suggests a postdictive inferential strategy that prioritises eye movements based on the type of gaze shift, independently of where attention is initially allocated. Averted shifts are prioritised over direct, as these might signal the presence of behaviourally relevant information in the environment

Construction of adolescent perfectionism and its relevance for clinical contexts

This thesis explored conceptual and pathological issues of perfectionism within the developmental period of adolescence. Quantitative and qualitative methodological approaches were utilised in the study of both general and clinical adolescent populations. Overall, the thesis aimed to provide an empirically driven account of adolescent perfectionism within a clinical context. Introductory chapters discuss adolescent development and mental health, developmental theories of perfectionism, and adolescent expressions of perfectionism. Historical and conceptual developments in perfectionism theory are critically discussed before the current conceptualisations used in adolescent research are identified and considered. The findings of a systematic review examining associations between perfectionism, mental illness, and treatment outcomes in clinical adolescent populations are reported. PRISMA guidelines and pre-specified qualitative assessment criteria were utilised. Sixteen studies were included in the review. Good quality research indicates that socially-prescribed perfectionism relates to suicide and depression. Lower quality research suggests that self-oriented perfectionism has a role in eating disorders. Studies of eating disorder, depression, and chronic fatigue syndrome treatment all indicate that perfectionism negatively impacts on outcomes for these adolescent groups but the effect is less consistent in suicidal adolescents A questionnaire-based survey of 507 Scottish adolescents (272 females, 233 males; age range: 12.24-15.50 years) was conducted to explore the relationships of perfectionism and clinical perfectionism to mental health risk in the general adolescent population. Exploratory and confirmatory factor analyses were performed on the Child-Adolescent Perfectionism Scale (CAPS) and the Clinical Perfectionism Questionnaire (CPQ). The identified factor structures of these measures were then used to examine risk for depression, anxiety, and eating disorders in adolescents. Path analyses using structural equation modelling identified unique paths between varied facets of adolescent perfectionism and mental health disorders. Perfectionistic concerns, measured by the CPQ, was found to be transdiagnostic for all three disorders in adolescents. A focus group study of clinician perspectives of adolescent perfectionism was conducted and analysed through thematic analysis. The results highlighted similarities and differences between clinician-perspectives and published conceptual models. The study also revealed some of the issues clinicians face in their clinical work with clinical adolescent perfectionists. The study provided a reference framework to inform the development of the final study. With the aim of developing a novel conceptualisation of perfectionism in adolescent clinical populations, a grounded theory study of sixteen adolescents diagnosed with an eating disorder was conducted. Semi-structured, individual interviews were conducted and methodically analysed according to grounded theory methodology to explore the young peoples’ experiences of perfectionism. A novel framework for adolescent clinical perfectionism is proposed based on the findings of this study. The framework encapsulates a developmentally relevant construction of perfectionism as it is experienced by these young people. The thesis findings are related to associated literature regarding mental health problems in adolescents and conceptualisations of perfectionism. Implications for clinical intervention are suggested. Future directions for the field of adolescent clinical perfectionism are proposed. The unique contribution of this thesis to the wider adolescent perfectionism literature is discussed

Personality Traits Do Not Predict How We Look at Faces

International audienceWhile personality has typically been considered to influence gaze behaviour, literature relating to the topic is mixed. Previously, we found no evidence of self-reported personality traits on preferred gaze duration between a participant and a person looking at them via a video. In this study, 77 of the original participants answered an in-depth follow-up survey containing a more comprehensive assessment of personality traits (Big Five Inventory) than was initially used, to check whether earlier findings were caused by the personality measure being too coarse. In addition to preferred mutual gaze duration, we also examined two other factors linked to personality traits: number of blinks and total fixation duration in the eye region of observed faces. No significant correlations were found between any of these measures and participant personality traits. We suggest that effects previously reported in the literature may stem from contextual differences or modulation of arousal

Healthy Incentive Scheme in the Irish Full-day-care Pre-school Setting

A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 hid. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years\u27 setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guide­ lines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day­ care pre-school setting

Motivators of adult women enrolled in a community college

The goal of this study was to describe what motivates adult women enrolled in a community college to pursue higher education. Utilizing profile analysis and multiple regression analyses, this study investigated the extent to which gender, English as a first language, and age predicted the seven factors of the Education Participation Scale (A- form) comprised of (1) Communication Improvement, (2) Social Contact, (3) Educational Preparation, (4) Professional Advancement, (5) Family Togetherness, (6) Social Stimulation, and (7) Cognitive Interest (Boshier, 1991). Data collection involved administering an online survey to 367 students enrolled in a large urban community college in the Southeastern United States. Twenty-eight percent were males and 72% were females. The majority of students were in their early 30s (M=33.7, SD=12.1). Ethnicity of the group varied with 47% White/Caucasian (N=173), 36% African-American/Black (N=133), 10% Latino/Hispanic (N=38), 6% Asian-American/Asian (N=21), and 1% Native American/ Alaskan (N=2). Fifteen percent of the participants indicated they speak a language other than English as their first language. The results indicated that females were most motivated by Professional Advancement, followed by Cognitive Interest, Educational Preparation, Communication Improvement, Family Togetherness, Social Contact, and finally Social Stimulation. In short, females seem to be less motivated by social reasons (i.e. Social Contact, Social Stimulation, Family Togetherness), and more motivated by practical reasons (i.e. Professional Advancement, Cognitive Interest, Educational Preparation). A profile analysis demonstrated that the motivational profiles for males and females can be considered coincident with similar profiles for the genders. Multiple regression results indicated that gender was not a significant predictor of motivation, but age of respondent and students who spoke English as their first language were predictors of several motivational factors. In general, older students place less importance on social reasons to attend school, such as Communication Improvement, Social Contact, and Social Stimulation. Students who speak English as a second language are more likely to value Communication Improvement, Social Contact, Family Togetherness, Social Stimulation and Cognitive Interest than students who speak English as their first language. The current findings seem to indicate that most females (and males) value attending college in order to obtain better employment options and to prepare to take even higher level classes later. The research implies incorporating course content related to a student’s career goals would assist with student motivation, such as using examples related to career interests in developmental classes. This strategy would also tap into Cognitive Interest, which is the second most important motivator for females