L’analyse et la mise en œuvre du développement d’une communauté virtuelle de pratique pour les infirmières en santé scolaire au Québec

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières Option AdministrationLes infirmières en santé scolaire, sont des professionnelles qui travaillent dans le réseau de la santé communautaire et qui effectuent un travail auprès des jeunes et de leur famille dans les écoles. Ce domaine des soins infirmiers implique une pratique autonome, sans collègues à proximité, limitant ainsi l’accès consultatif à des collègues. L'isolement est une caractéristique du travail des infirmières scolaires. Ceci a des impacts sur leur possibilité de formation continue, ce qui rend la pratique dans cette branche professionnelle exigeante et difficile (Smith, 2004). Les barrières qui contribuent au sentiment d’isolement de l’infirmière en milieu scolaire sont d’ordre physique, social et organisationnel (Smith, 2004). De plus, les infirmières scolaires assument un rôle professionnel unique car elles se situent à la frontière entre les domaines de l'éducation et des soins de santé. Le succès de la pratique infirmière scolaire nécessite une compréhension des deux environnements ainsi qu’une négociation efficace avec les intervenants des deux secteurs. Ceci passe par l'autonomie de l’infirmière, une qualité qui peut être difficile à développer. L’autonomie, telle que décrite par Simmons (2002), est une source d’indépendance, de professionnalisme et d’innovation. Les perceptions qui teintent la pratique des soins infirmiers en milieu scolaire, varient en fonction de l’expertise de l’infirmière scolaire. Il y a donc une nécessité de réfléchir à des moyens efficaces et réalistes pour pallier aux barrières perçues, favoriser l’autonomie et faciliter le partage des savoirs. Au cours des dernières années les moyens de communication ont évolués dramatiquement et comme tous les professionnels, les infirmières doivent mettre à profit l'opportunité que cela constitue pour partager leurs idées et surtout leur expertise. Le développement d’une communauté virtuelle de pratique pour les infirmières en santé scolaire qui travaillent au Québec (CVP-ISSQ) m'est ainsi apparu comme un outil novateur pour venir répondre a ce besoin. J’ai donc développé et mis en œuvre une CVP en 2010 pour répondre aux besoins perçus de mes collègues infirmières scolaires. Le présent travail présente une recension et une analyse des différents concepts suivis du développement d’un cadre conceptuel pour soutenir le fonctionnement et assurer la pérennité de cette communauté virtuelle de pratique pour les infirmières en santé scolaire.School health nurses, are professionals working in health community network and who perform work with youth and their families in schools. This area of nursing involves an autonomous practice without colleagues nearby, thus limiting advisory access to colleagues. Isolation is a feature of the work of school nurses. This has an impact on their ability to continuing education, which makes this branch of industry demanding and difficult (Smith, 2004). Barriers that contribute to feelings of isolation from the school nurse are physical, social and organizational (Smith, 2004). Barriers that contribute to the sense of isolation of the nurse in the school environment are physical, social and organizational (Smith, 2004). In addition, school nurses have a unique professional role because they lie on the border between the areas of education and health care. The success of school nursing practice requires an understanding of the two environments and effective negotiation with stakeholders of the two sectors. This requires autonomy of the nurse, a quality that can be difficult to develop. Autonomy, as described by Simmons (2002), is a source of independence, professionalism and innovation. Perceptions that color the practice of school nursing vary depending on the expertise of the school nurse. So there is a need to consider realistic and effective ways to overcome the perceived barriers, promote independence and facilitate knowledge sharing. The development of a virtual community of practice for school health nurses who work in Quebec (CVP-ISSQ) proved to be an innovative tool to address a need. I've started this CVP in 2010 to meet the perceived needs and since no other study only became interested in it. This work presents a review and an analysis of the concepts followed by the development of a conceptual framework to support the operation and ensure the sustainability of a virtual community of practice for nurses in school health. A conclusion emerged to the effect that the modalities of communication have evolved dramatically in recent years and as all professionals, nurses must take advantage of this tool to share ideas and best expertise

Symbolic Interactionism Revisited: Potential Liabilities for the Self Constructed in the Crucible of Interpersonal Relationships

The contributions are reviewed of three symbolic interactionists, Baldwin, Cooley, and Mead, for whom the self was primarily a social construction, crafted through the linguistic exchanges (i.e., symbolic interactions) with significant others. Although the symbolic interactionists pointed to critical processes in the normative construction of the self, they did not alert us to the fact that self development dependent upon social interactions could go awry. Four potentia! liabilities of developing a self so dependent upon social processes are discussed: (a) the incorporation of unfavorable opinions about the self, (b) failure to internalize the opinions of others, (c) conflict betvveen socially-constructed multiple selves, and (d) the promotion of false-self behavior

Catheter-to-Vessel Ratio and Catheter-Related Thrombosis in Peripherally Inserted Central Catheters: A Retrospective Review of Records

Catheter-related thrombosis (CRT) is a potential complication of peripherally inserted central catheters (PICCs). With PICC use becoming more common, it is important to minimize this complication. Selection of an appropriately sized vessel can reduce the risk of catheter-related thrombosis. Research suggests that using a catheter-to-vessel-ratio (CVR) of 45% or less can minimize this risk. This quality improvement project was implemented to evaluate the impact of utilizing an ultrasound device that can measure catheter-to vessel ratio with peripherally inserted central catheter insertion by the vascular access team. Data was collected using a retrospective chart review looking at CRT rates before and after implementation of an ultrasound device that measures CVR to identify and use vessels with a CVR of 45% or less to insert PICCs. While there was no statistically significant difference, data suggests that using a CVR of 45% or less decreases the incidence of CRT. Results also reinforce previous research that cancer diagnosis as well as insertion of larger gauge PICCs were associated with deep vein thrombosis. Future studies that include larger sample sizes to validate this measurement are recommended. Keywords: Catheter-to-Vessel-Ratio (CVR), Peripherally Inserted Central Catheter (PICC), Catheter-Related-Thrombosis (CRT), Deep Vein Thrombosis (DVT

Folk Psychology Revisited: The Methodological Problem and the Autonomy of Psychology

'Folk psychology' is a term that refers to the way that ordinary people think and talk about minds. But over roughly the last four decades the term has come to be used in rather different ways by philosophers and psychologists engaged in technical projects in analytic philosophy of mind and empirical psychology, many of which are only indirectly related to the question of how ordinary people actually think about minds. The result is a sometimes puzzling body of academic literature, cobbled together loosely under that single heading, that contains a number of terminological inconsistencies, the clarification of which seems to reveal conceptual problems. This paper is an attempt to approach folk psychology more directly, to clarify the phenomenon of interest, and to examine the methods used to investigate it. Having identified some conceptual problems in the literature, I argue that those problems have occluded a particular methodological confound involved in the study of folk psychology, one associated with psychological language, that may well be intractable. Rather than attempt to solve that methodological problem, then, I suggest that we use the opportunity to rethink the relationship between folk psychology and its scientific counterpart. A careful look at the study of folk psychology may prove surprisingly helpful for clarifying the nature of psychological science and addressing the contentious question of its status as a potentially autonomous special science

Regulation of methanol utilisation pathway genes in yeasts

Methylotrophic yeasts such as Candida boidinii, Hansenula polymorpha, Pichia methanolica and Pichia pastoris are an emerging group of eukaryotic hosts for recombinant protein production with an ever increasing number of applications during the last 30 years. Their applications are linked to the use of strong methanol-inducible promoters derived from genes of the methanol utilisation pathway. These promoters are tightly regulated, highly repressed in presence of non-limiting concentrations of glucose in the medium and strongly induced if methanol is used as carbon source. Several factors involved in this tight control and their regulatory effects have been described so far. This review summarises available data about the regulation of promoters from methanol utilisation pathway genes. Furthermore, the role of cis and trans acting factors (e.g. transcription factors, glucose processing enzymes) in the expression of methanol utilisation pathway genes is reviewed both in the context of the native cell environment as well as in heterologous hosts