Making sense of health information technology implementation: A qualitative study protocol

BACKGROUND: Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff members observe and make sense of unexpected disruptions in care. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning, and effective problem solving -- strategies that studies have linked to successful change. Project teamwork is a change strategy increasingly used by hospitals that facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. METHODS: In this longitudinal case study, we aim to examine project teams' sensemaking and action as the team prepares to implement new information technology in a tiertiary care hospital. Based on management and healthcare literature on HIT implementation and project teamwork, we chose sensemaking as an alternative to traditional models for understanding organizational change and teamwork. Our methods choices are derived from this conceptual framework. Data on project team interactions will be prospectively collected through direct observation and organizational document review. Through qualitative methods, we will identify sensemaking patterns and explore variation in sensemaking across teams. Participant demographics will be used to explore variation in sensemaking patterns. DISCUSSION: Outcomes of this research will be new knowledge about sensemaking patterns of project teams, such as: the antecedents and consequences of the ongoing, evolutionary, social process of implementing HIT; the internal and external factors that influence the project team, including team composition, team member interaction, and interaction between the project team and the larger organization; the ways in which internal and external factors influence project team processes; and the ways in which project team processes facilitate team task accomplishment. These findings will lead to new methods of implementing HIT in hospitals

Albedo-dosimeter response to monoenergetic neutrons

NRC publication: Ye

Producing reflective practice capability: a textual analysis of practice learning and assessment portfolios

Within portfolios used by nurse education programmes of higher education for practice learning and assessment, reflective narrative accounts are considered evidence of practice learning outcomes. Evaluation research of portfolios used in nurse education programmes is for the most part based on student perceptions which show students are conflicted on the inclusion of reflective accounts in the portfolio. This paper examines how structural influences of the practice learning milieu shape the reflective practice capability of the learner based on an analysis of 15 reflective narrative accounts from five practice learning and assessment portfolios of an undergraduate professional development programme for specialist community nursing in the United Kingdom. Ethnomethodology provided an orientation for single case textual analysis of related interactional sequences. Findings from a case comparison take the form of a local practice learning scene showing two structural patterns of orientation: a learning practice and the formal programme. These orientations can be differentiated by the accomplishments of reflective thinking-for-action, reflective thinking-for-evaluation and reflective thinking-for-critical enquiry. Reflective practice capability as an accomplishment of how the local practice learning milieu constitutes the portfolio approach to practice learning and assessment is presented through a case comparison of some interactions, roles and outcomes. The analysis draws attention towards theoretical sensitivity to client outcomes for enhancing the portfolio as an enquiry based approach for the accomplishment of reflective practice capability and the need for further investigation into the role of the academic nurse tutor in the portfolio approach

Nurse practitioner education: a research-based curriculum structure

Background. The process and content of nurse practitioner educational preparation has received scant research attention, despite increasing interest in and investigations into nurse practitioner services in Australia and internationally. Aims. The aim of this paper is to report a study investigating the educational process and content required for nurse practitioner preparation. Methods. A trial of practice was conducted with four nurse practitioner candidates over a 12-month period. The candidates practised in different specialities, giving rise to four models of the nurse practitioner role. The trial had multiple aims related to the role and scope of practice of the nurse practitioner. An action learning model was used, in which participating nurse practitioner candidates 'worked-into-the-role' of extended practice and learned from experience through clinical mentoring, reflection and action. Data collection methods centred on transcripts from group work activities related to a collaborative engagement with and reflections on clinical practice. This resulted in the collaborative production of data to inform a research-based nurse practitioner curriculum structure. Findings. The findings relate to the content and learning process required for nurse practitioner education and are described in terms of three broad areas of study: clinical practice, clinical sciences and nursing studies. Conclusions. A curriculum structure that describes content and process for nurse practitioner education was developed from the findings. A further outcome of this trial was confirmation of importance of the clinical environment for nurse practitioner education. Inherent in this aspect of clinical learning is the role of a committed clinical mentor who can facilitate purposeful learning