Controle Local na era de responsabilidades: Um caso de estudo de pré-escola infantil (preK) em Wisconsin

The opposing principles of local control and increased standardization are a prominent tension in the United States’ education system. Since at least the early 1990s, this tension has taken shape around the accountability movement, defined by educational reforms that hold schools, teachers, and students accountable for performance on new standards, assessments, and curricula. While many scholars have examined the manifestations of the current accountability movement, few have looked at this phenomenon within the growing public preK movement. Drawing from interviews with state policymakers and district-level actors, this paper describes how the seemingly contradictory principles of local control and increased state and national standards (what we refer to simply as standardization) are shaping the policy and practice of Wisconsin’s preK system, known as 4K. We argue that rational models of policy making fail to explain the coexistence and blending of the strands of local control and standardization we found in our data, and suggest that Deborah Stone’s (2001) policy paradox provides a better theoretical framework for our findings.Los principios opuestos al control local y el aumentado de exámenes estandarizados han causado bastante tensión en el sistema de educación en los Estados Unidos. Desde el inicio del 1990, esta tensión ha tomado forma alrededor del movimiento de responsabilidad, que se distingue por las reformas educativas que tratan de asumir la responsabilidad a las escuelas, los profesores y estudiantes sobre las nuevas normas, evaluaciones y planes de estudio. Mientras muchos han examinado las manifestaciones del movimiento de la responsabilidad actual, pocos han observado este fenómeno que va creciendo dentro del movimiento preescolar (preK). Usando entrevistas con diseñadores de políticas de estado y autores a nivel del distrito, en este artículo se describe cómo aparentemente se contradicen los principios de control local y se aumentan las pólices estándares, nacionales y estatales (las que nos referimos simplemente como la estandarización) son mol-da la política y la práctica del sistema de pre-escolar (preK) de Wisconsin, conocido como "4K". Nuestro argumento es que los modelos racionales de la formulación de políticas fallan al explicar la convivencia y la mezcla de aspectos de control local y la paradoja política que encontramos en nuestros datos, sugieren que la política de Deborah Stone (2011) proporciona una mejor estructura teórico para nuestras recomendaciones.Os princípios opostos de controle local e o aumento na padronização são uma tensão proeminente no sistema de ensino dos Estados Unidos. Pelo menos desde o início dos anos 1990, essa tensão tem tomado forma em torno do movimento de responsabilidade, definido por reformas educacionais que sustentam escolas, professores, e estudantes responsáveis pelo desempenho de novos padrões, avaliações e currículos. Enquanto muitos estudiosos têm examinado as manifestações do atual movimento de responsabilização, poucos têm olhado para esse fenômeno dentro do crescimento público do movimento pré-escolar infantil (preK). Tomando de entrevistas com formuladores de políticas estatais e autores de nível distrital, este artigo descreve como princípios aparentemente contraditórios de controle local e o aumento de padrões nacionais e estatais (o que nos referimos simplesmente como padronização) estão moldando a política e a prática do sistema de pré-escola infantil (preK) de Wisconsin, conhecido como “4K”. Defendemos que os modelos racionais de formulação de políticas falham em explicar a coexistência e mistura dos fios de controle local e padronização que encontramos em nossos dados, e sugerem que o paradoxo da política de Deborah Stone (2011) proporciona uma melhor estrutura teórica para as nossas descobertas

Telemedicine in diabetes foot care delivery: health care professionals’ experience

Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants’ attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult

Conditions for success in introducing telemedicine in diabetes foot care: a qualitative inquiry

Background: The uptake of various telehealth technologies to deliver health care services at a distance is expanding; however more knowledge is needed to help understand vital components for success in using telehealth in different work settings. This study was part of a larger trial designed to investigate the effect of an interactive telemedicine platform. The platform consisted of a web based ulcer record linked to a mobile phone to provide care for people with diabetic foot ulcers in outpatient clinics in specialist hospital care in collaboration with primary health care. The aim of this qualitative study was to identify perceptions of health care professionals in different working settings with respect to facilitators to engagement and participation in the application of telemedicine. Methods: Ten focus groups were conducted with health care professionals and leaders in Western Norway between January 2014 and June 2015 using Interpretive Description, an applied qualitative research strategy. Results: Four key conditions for success in using telemedicine as a new technology in diabetes foot care were identified: technology and training that were user-friendly; having a telemedicine champion in the work setting; the support of committed and responsible leaders; and effective communication channels at the organizational level. Conclusions: Successful larger scale implementation of telemedicine must involve consideration of complex contextual and organizational factors associated with different work settings. This form of new care technology in diabetes foot care often involves health care professionals working across different settings with different management systems and organizational cultures. Therefore, attention to the distinct needs of each staff group seems an essential condition for effective implementation.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult