Building the Clinical Bridge to Advance Education, Research, and Practice Excellence

The University of Michigan School of Nursing and the Health System partnered to develop an undergraduate clinical education model as part of a larger project to advance clinical education, practice, and scholarship with education serving as the clinical bridge that anchors all three areas. The clinical model includes clusters of clinical units as the clinical home for four years of a student's education, clinical instruction through team mentorship, clinical immersion, special skills preparation, and student portfolio. The model was examined during a one-year pilot with junior students. Stakeholders were largely positive. Findings showed that Clinical Faculty engaged in more role modeling of teaching strategies as Mentors assumed more direct teaching used more clinical reasoning strategies. Students reported increased confidence and competence in clinical care by being integrated into the team and the Mentor's assignment. Two new full time faculty roles in the Health System support education, practice, and research

Effects of positive practices on organizational effectiveness

Effects of Positive Practices on Organizational Effectiveness Increasing attention is being given to the term -positive‖ in organizational studies, and positivity has become a popular topic with consultants, self-help advocates, and change agents. This term, however, has created controversy among organizational scholars and has spawned skeptics as well as advocates. The term -positive‖ is accused of a potentially restrictive connotation and values bias The field of Positive Organizational Scholarship (POS) was developed to study positive outcomes, practices, and attributes of organizations and their members. POS aims to reveal positive capabilities and activities that lead to flourishing in organizations . The importance and credibility of this field of study, however, at least partly depends on the relationships between positive practices and organizational performance and change. POS researchers advocate for including positive phenomena in organizational science because, ostensibly, they account for variance in performance that may otherwise be overlooked This study addresses the dearth of research on the impact of positive practices on organizational effectiveness and change. It aims to examine directly the criticism that, thus far, empirical evidence that positivity is advantageous is lacking To be sure, ample research has been conducted on positive factors such as positive affect, subject well-being, organizational citizenship and prosocial behavior, positive identity, engagement, psychological capital, and satisfaction Positive Practices In order to find evidence that positive practices impact organizational outcomes, the meaning of the term -positive‖ must be clarified. In fact, the tentativeness regarding the link between positive practices and organization performance exists at least partly because of the ambiguity surrounding this term. Past literature converges around three connotations of the concept of positive in organizational science. One focuses on extraordinarily positive outcomes, or positively deviant performance A second area of convergence focuses on an affirmative bias, or on strengths, capabilities, and possibilities rather than problems, threats, and weakness. This focus emphasizes positive energy, positive climate, positive relationships, positive communication, and positive meaning in organizations A third area of convergence relates to the concepts of virtuousness and eudemonism Virtuousness is inherently valuable, aside from any benefit that may accrue, so its association with other outcomes may be considered superfluous. Nevertheless, studies of virtuousness and its impact on individual and organizational performance have begun to appear in the scholarly literature The investigations reported here attempted to incorporate all three connotations of positive in that they sought to examine organizational practices-i.e., behaviors, techniques, routines-that represent positively deviant (i.e., unusual) practices, practices with an affirmative bias, and practices that connote virtuousness and eudemonism in organizations. The intent is to examine empirically the link between positive practices and organizational effectiveness as depicted in Two Investigations This paper reports two studies that explore the relationships between positive practices Health care, on the other hand, is stereotypically concerned with compassionate care and human service. The question of interest was whether positive practices could be identified and investigated in these markedly different industry types. Assessing Positive Practices Unfortunately, no assessment instrument available claims to capture positively deviant, affirming, and virtuous practices at the organization level of analysis (Chun, 2005; Wright & Goldstein, 2007). Numerous lists of virtuous behaviors have been published, but all of them were derived from lists of personality factors and individual traits (e. g., No overarching theory was used to derive this list of positive practices; rather they were identified because they had appeared in prior research, they represented behavioral practices or activities, and they possessed at least one of the three connotations of positive mentioned above. The resulting list of positive practices was not comprehensive, but it represented an extensive inventory of the behaviors and attributes assumed to characterize positivity in organizations. The studies reported here are exploratory, therefore, in the sense that no previous investigations have examined positive practices in combination nor has their connection to organizational performance been explored. The survey initially consisted of 114 Likert-type items representing desirable, positivelyfocused behaviors, techniques, or routines. The survey instrument was analyzed using exploratory factor analysis in order to identify the underlying structure. Using data sets from both industry studies (2) , an underlying structure with six stable dimensions emerged which reduced the number of relevant items to 29. That is, the same 6 positive practice dimensions were reliably reproduced in each data set and in each administration of the survey over multiple years. These six factors, therefore, were the ones used to predict organizational effectiveness in both studies (3) . Appendix A reports factor loadings using Varimax rotation for three different data sets. Items in the survey asked respondents to describe the behaviors, practices, or activities of the organization and its employees, not individual attitudes or attributes. Therefore, the 9 organization is the unit of analysis, not the individual respondent. Attributes and activities of organizations are assessed, not behaviors or traits of individual respondents. Study 1 Methods The first study was conducted in the financial services industry because of its focus on short-term monetary returns, financial trading, high-pressure climates, and objective outcomes These items all have Likert-type response scales, and completed surveys were submitted to the consulting firm for analysis. 12 Commission prohibits confidential financial data from being shared in its raw form with outsiders-the data were provided in a coded form. This coding scheme for the six P&L business units was explained in the following way. The financial performance of each business unit was compared to the overall average performance for the entire company. Units achieving above average performance were deemed more successful, whereas units achieving below average performance were deemed less successful. Financial data were provided to the researchers as a percentage of performance relative to the company's average as well as in the form of a rating of each financial indicator. A rating of ‗1' indicated that the unit performed three standard deviations below average. A rating of ‗2' indicated performance two standard deviations below average. A ‗3' meant performance one standard deviation either way-plus or minus-from the company's average. A rating of ‗4' indicated two standard deviations above the average. A ‗5' indicated three standard deviations above the average. Appendix C provides the percent deviations and ratings received by each of the six P&L business units. The reduction in variance that resulted from data coding represents another conservative constraint on the study. Significant relationships between positive practices and financial performance are less likely to emerge when the amount of variance in the data has been constricted. Consequently, the likelihood of uncovering significant relationships between positive practices and organizational performance is substantially reduced due to restricted variance. Expert Ratings. Three senior executive officers in the company were asked to rank order the six P&L business units according to two general criteria. First was the extent to which the business units were -effective,‖ meaning the extent to which the unit achieved its goals by the end of 2006. The second criterion was the extent to which employees were highly -engaged,‖ or the extent to which the business unit possessed a vibrant working climate at the end of 2006. These rankings were subjective ratings by knowledgeable experts regarding the 13 performance of these units, apart from objective financial or climate survey data. Units were compared to one another and ranked from 1 to 6 by the executives. These data provide the subjective impressions of executive-level decision makers who have responsibility for making resource allocation decisions in the firm. These senior executive evaluations are important because they impact the amount of future financial and human resources that units are able to acquire. If positive practices are an important predictor of organizational effectiveness, they should show a strong, negative association with voluntary turnover. In addition, the climate (EOS) survey instrument asked a direct question about employees' propensity to leave the company, so a business' EOS scores were expected to be strongly associated with the extent to which employees voluntarily left. Turnover rates among these business units ranged from zero to 21.9 percent with most units reporting low turnover, so restriction in variance reduced the probability of statistically significant results. Nevertheless, the correlation between turnover and positive practices is r = -.21, and the correlation between turnover and EOS (intent to leave) is r = -.34 Study 1 Results Measures . These results suggest that when employees indicate an intention to leave the firm on the EOS Moreover, certain climate factors-e.g., ethics, reward systems-were measured by only one or two survey items, and in the case of the ethics dimension, the favorability of the ratings was above 90 percent. Hence, restricted variance in responses makes significant relationships very unlikely. - ------------------------- 16 With an N=6 for financial and expert rankings data and high multicolinearity among the six positive practice dimensions, it was not possible to analyze the individual effects of the different positive practices. In addition, data were collected at a single point in time, and whereas a year time lag was incorporated into the analysis of performance, change scores were not available. A more rigorous analysis of the effects of positive practices would examine whether improvements in positive practices could predict improvements in organizational effectiveness. Consequently, a second study was conducted to examine more precisely the relationships between positive practices and organizational outcomes, and more specifically, to Study 2 Methods The second study was carried out in 29 nursing units in a large, comprehensive health care system. These units are all inpatient units. Appendix B lists the 29 unit names in Study 2. Nurses provided the survey data in the study and rated the unit in which they worked. Total nursing employment was approximately 3200 during the period of the study -2005 through 2007. A multi-year research grant through the Health Resources and Services Administration was obtained to fund the implementation of positive practices throughout these 29 nursing units and to assess the extent to which these practices affected indicators of organizational performance. Multi-day sessions were held with the nursing leaders and directors in this health system which exposed them to POS concepts, and day-long implementation sessions were conducted by an external consultant with the 29 nursing units as a follow-up. By the third year 17 of the study, all 29 units had been exposed to POS and had held implementation sessions. Over the period of the study, positive practices tended to increase in the 29 units included in the study, but they did not change, or slightly deteriorated, in the non-involved units. health system that were not included in the study would likely produce more variance and, consequently, the probability of stronger statistically significant relationships. However, performance data were available only for units participating in the study. The analyses in Study 2, therefore, represent another conservative test of the effects of positive practices on effectiveness by analyzing only units exposed to positive practices. --------------------------Figure 3 about here -------------------------- Several indicators of performance were obtained for these units. They were identified as among the most important indicators of effectiveness by senior executive officers. They are similar to, but not exactly the same as, the indicators assessed in the financial service industry (6) . These indicators included: to 87 on the 100-point scale. Overall Satisfaction and Willingness to Recommend. On an annual basis, nurses rated the extent to which they were satisfied with the health care system and the degree to which they were willing to recommend the hospital as a place where their family members or close friends should come for treatment. This assessment was designed to capture an overall assessment of quality of care, adequacy of resources, nature of the work environment, and the amount of compassionate and caring attention that is available. Only about half the units had data available on this measure, and the range was from 47 to 92 on a 100-point scale. Employee Turnover. Voluntary turnover rates are collected monthly by the organization, and they ranged between zero and 33 percent across the units. At the beginning of the study in 2005 overall turnover was 10.5 percent and in 2007 it was 9.8 percent, a slight overall decrease. Turnover is affected by a large variety of factors including the economic downturn in the geographic area in which the health system is located, so the probability that positive practices would be powerful enough to overcome these macro-economic factors is small. Turnover was included in Study 2, nevertheless, since it is an important proxy for organizational effectiveness. Study 2 Results Figure ------------------------- -------------------------- Strongest Positive Practices Predictors These findings made possible an examination of the second research question, "Which of the positive practices are most predictive of effectiveness?" Each performance criterion was examined individually, and the most predictive positive practices were identified using a cut-off level of 0.7 standard deviation units, representing at least a 25 percent or greater improvement in performance for improving organizations compared to non-improving organizations. Change scores between 2005 and 2007 were used so that a causal direction could be examined. ------------------------ Caring appears to be the only positive practices that accounted for little improvement in organizational effectiveness indicators in these nursing units. This is likely explained by the fact that at the very heart of a nursing unit is the core value and practice of caring. An intervention to increase positive practices is unlikely to dramatically affect that already-existing practice. The central theme in the most predictive positive practices centers on the contributions made by the organization to the welfare of its human capital. That is, improvement in patient satisfaction, internal climate, employee participation, and quality of care occurs when organizations provide compassionate support for employees, emphasize positive and inspiring messages to employees, forgive mistakes, express gratitude to and confidence in employees, clarify the meaningfulness of the work being done, and reinforce an environment characterized by respect and integrity. No one positive practice stands out as the single most important determinant of improvement, but positive practices in combination appear to have the most powerful impact. Discussion The credibility of Positive Organizational Scholarship is dependent to some degree on its ability to demonstrate desired effects of organizational positivity on organizational performance and improvement. Unless bottom line outcomes are benefited, it is unlikely the organizations will invest resources in implementing positive practices. Moreover, in light of the criticisms of a positive orientation in the literature In Study 1, positive practices in financial service business units were significantly associated with financial performance, work climate, turnover, and senior executive evaluations 24 of effectiveness. In an industry in which positive practices might be assumed to carry little importance, organizational performance was substantially affected by the implementation of positive practices. In Study 2, improvement in positive practices over a two year period in health care units predicted improvements in turnover, patient satisfaction, organizational climate, employee participation in the organization, quality of care, managerial support, and resource adequacy. The specific positive practices that emerged as most predictive (in Study 2) were those associated with the development and support of human capital-including fostering respect, integrity, gratitude, compassion, forgiveness, inspiration, and meaningful work. Explanations for Positive Effects Whereas these explanatory mechanisms are not tested directly in this study, each is grounded in existing literature which provides a rationale for their explanatory role in linking positive practices to organizational performance. Several authors argue that a biological foundation exists for these factors linking positivity to outcomes (Lawrence & Norhia,2002; Positive practices provide an amplifying effect because of their association with positive emotions and with social capital Several authors have reported that exposure to positive practices produces positive emotions in individuals, which, in turn, lead to elevation in individual performance in organizations A second rationale for the amplifying effects of positive practices is their association with social capital formation (Coleman, 1988; Buffering Effects. Positive practices also buffer the organization from the negative effects of trauma or distress by enhancing resiliency, solidarity, and a sense of efficacy (Masten 26 & Hubbard, Gest, Tellegen, Garmezy, & Ramirez, 1999; They reported that compassion, courage, forgiveness, integrity, and optimism, for example, prevent psychological distress, addiction, and dysfunctional behavior At the group and organization levels, positive practices enhance the ability to absorb threat and trauma and to bounce back from adversity Heliotropic Effects. Positive practices also possess attributes consistent with heliotropism The point is that at least three explanations find grounding in the literature for why positive practices are predictive of organizational effectiveness. Cognitively, emotionally, behaviorally, physiologically, and socially, evidence suggests that human systems naturally prefer exposure to the positive, so it is expected that organizational performance would be enhanced by positive practices. 28 The Role of the Negative It is important to keep in mind, of course, that some of the greatest triumphs, most noble virtues, and highest achievements result from the presence of negative occurrences. In fact, common human experience as well as abundant scientific evidence supports the idea that negativity has an important place in producing positive outcomes. A comprehensive review of psychological research by In three controlled experiments, however, Wang, Galinski, and Murnighan (2009) found that the negative has its strongest effects on emotions and psychological reactions, whereas the positive has its strongest effects on behavior. They concluded that -bad affects evaluations more than good does, but that good affects behavior more than bad does‖ (p. 642). The point is, tendencies toward protection and survival make negative events and negative stimuli extremely potent in affecting human emotions and, potentially, organizational performance Conclusion It has also been established that positive emotions affect individual performance at work (the second link i

Psychological and biological differences among first-episode and recurrently depressed women during depression and recovery.

Depression remains one of the most common mental health problems in the United States. Although the social, psychological, and physiological impact of recurrent depressive episodes have not been systematically studied, accumulating clinical evidence suggests that there is indeed a toll paid for experiencing recurrent depression. The purpose of this study was to describe the psychological and neuroendocrine differences between women who had experienced only one episode of Major Depressive Disorder (FE) with women who had experienced recurrent depressive episodes (RD). Thirty-two depressed female clients from a large university medical center's outpatient clinic for depression were placed into first-episode (n = 14) and recurrent groups (n = 18), and were compared to a community sample of age-matched, female control subjects (n = 20). A battery of psychological instruments used to measure perceptions of control and helplessness, emotional responsiveness, interpersonal dependency, and self-appraisal and coping responses were administered while subjects were in an episode of depression, and again, when subjects were euthymic for at least a four week period (controls were measured at two time points, 8 to 12 weeks apart). Urinary-free cortisol measures for all groups were also completed at the same time points. Analyses using ANOVAs and paired t-tests have revealed significant differences in emotional responsiveness between first-episode and recurrently depressed groups during the episode of depression, and more importantly, after the depressive episode has resolved. Recovered, recurrently depressed women also endorsed a significantly greater number of items related to feeling a loss of control. Coping responses for the total depressed group were also significantly different than controls after recovery. Differences in urinary-free cortisol were not demonstrated. These findings suggest that experiencing recurrent episodes of depression may indeed have psychological consequences which may impact one's response to subsequent stressors. The development of a psychological sensitivity to depression is hypothesized.Ph.D.Clinical psychologyHealth and Environmental SciencesMental healthNursingPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128924/2/9303702.pd

Clinical Study Building the Clinical Bridge to Advance Education, Research, and Practice Excellence

The University of Michigan School of Nursing and the Health System partnered to develop an undergraduate clinical education model as part of a larger project to advance clinical education, practice, and scholarship with education serving as the clinical bridge that anchors all three areas. The clinical model includes clusters of clinical units as the clinical home for four years of a student's education, clinical instruction through team mentorship, clinical immersion, special skills preparation, and student portfolio. The model was examined during a one-year pilot with junior students. Stakeholders were largely positive. Findings showed that Clinical Faculty engaged in more role modeling of teaching strategies as Mentors assumed more direct teaching used more clinical reasoning strategies. Students reported increased confidence and competence in clinical care by being integrated into the team and the Mentor's assignment. Two new full time faculty roles in the Health System support education, practice, and research

Additional file 1 of A randomized trial of a theory-driven model of health coaching for older adults: short-term and sustained outcomes

Additional file 1

Status of the ITER Ion Cyclotron H&CD

The ITER Ion Cyclotron Heating and Current Drive system (IC H&CD) is designed to deliver 20MW to a broad range of plasma scenarios between 40 and 55MHz, during very long pulses. It consists of two broadband equatorial port plug antennas, their pre-matching and matching systems, transmission lines, Radio Frequency (RF) Sources and High Voltage Power Supplies. The overall project schedule has been revised and agreed by ITER Council; it re-integrates the second antenna and its power supplies in construction baseline and sets the dates for progressive installation with DT phase planned in 2035. Recent progress on ICRF subsystems is reported, covering design evolution, qualification of test articles and specific R&D results in domestic agencies, suppliers, associated laboratories and IO

Status of the ITER Ion Cyclotron H&CD

The ITER Ion Cyclotron Heating and Current Drive system (IC H&CD) is designed to deliver 20MW to a broad range of plasma scenarios between 40 and 55MHz, during very long pulses. It consists of two broadband equatorial port plug antennas, their pre-matching and matching systems, transmission lines, Radio Frequency (RF) Sources and High Voltage Power Supplies. The overall project schedule has been revised and agreed by ITER Council; it re-integrates the second antenna and its power supplies in construction baseline and sets the dates for progressive installation with DT phase planned in 2035. Recent progress on ICRF subsystems is reported, covering design evolution, qualification of test articles and specific R&D results in domestic agencies, suppliers, associated laboratories and IO