자연주의적 탐구조사(Naturalistic Inquiry)

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Using Multivariate Statistics

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

OBJECTIVES To develop a self-report scale to measure academic motivation among nursing students and to test its psychometric properties. METHODS a cross-sectional validation study with a convenience sample of nursing students (n=1,635) was performed. The Motivation Nursing Students Scale was developed; content, face, construct validity, hypothesis testing and reliability were evaluated. RESULTS The validity structure revealed a four-factor solution and the model reached a satisfactory fit (χ2=622.835 df=160, p<0.01, CFI=0.90, TLT=0.83, RMSEA=0.060 (90% [CI] 0.055-0.064, p=0.001, SRMR=0.067). The hypothesis testing was confirmed with a positive correlation of the academic self-efficacy with Introjected, Intrinsic motivation and a negative correlation with Amotivation. CONCLUSIONS We verified a link between academic self-efficacy and motivation. Both motivation and self-efficacy may increase academic achievement and the possibility for HEIs to degrees a number of students in line with demands.

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study.

Aim. The evaluation of academic education has become crucial in the European Union since the Bologna Process encouraged all European universities to reach high quality standards in education. Although several studies have been conducted on the quality of undergraduate nursing education, few studies have explored this topic from the students' perspective. The purpose of this study was to describe the experience of educational quality in undergraduate nursing students.Methods. The phenomenological method was used to study 55 students (mean age 24 years; 73% female) pursuing a baccalaureate degree in nursing in three universities in central Italy.Results. The following five themes emerged from the phenomenological analysis: 1) quality of faculties: teaching skills, preparation, sensitivity to students, self-discipline; 2) theory–practice integration and communication between teaching and clinical area; 3) general management and organization of the programme; 4) quality of infrastructures: libraries, classrooms, information technology, services, administration, and communication; and 5) clinical tutorship: humanity, relationships and ability of the clinical tutor to guide and support.Conclusion. This study's novel finding was a deeper understanding of the educational quality's meanings among undergraduate nursing students. Students thought educational quality consisted of the faculty members' sensitivity towards their problems and the clinical tutors' humanity, interpersonal skills, guidance and support.Keywords: Educational quality, undergraduate education, nursing students, phenomenology.L'esperienza della qualita' formativa negli studenti di infermieristica: uno studio fenomenologicoScopo. La valutazione della formazione accademica e diventata fondamentale nell'Unione Europea da quando il Processo di Bologna ha incoraggiato tutte le universiti  europee a raggiungere elevati standard di qualiti  nella formazione. Anche se diversi studi sono stati condotti sulla qualiti  della formazione negli studenti di infermieristica, pochi hanno esplorato questa tematica dalla prospettiva degli studenti. Lo scopo di questo studio e stato di descrivere l'esperienza della qualiti  formativa negli studenti del corso di laurea in infermieristica.Metodo. E' stato utilizzato il metodo fenomenologico per studiare 55 studenti (eti  media 24 anni; 73% donne) che frequentavano il corso di laurea in infermieristica in tre universiti  del centro Italia.Risultati. Dall'analisi fenomenologica sono emersi i seguenti cinque temi: 1) Qualiti  dei docenti: capaciti  di insegnamento, preparazione, sensibiliti  per gli studenti, autodisciplina; 2) Integrazione teoria-pratica e comunicazione tra l'insegnamento e l'area clinica; 3) gestione generale e organizzazione del corso; 4) la qualiti  delle infrastrutture: biblioteche, aule, tecnologie dell'informazione, servizi, amministrazione, comunicazione; e 5) tutorato clinico: umaniti , relazioni e capaciti  del tutor clinico di guidare e supportare lo studente.Conclusione. I risultati di questo studio forniscono una comprensione nuova e piu approfondita sul significato della qualiti  della formazione negli studenti di infermieristica. Gli studenti ritenevano che la qualiti  della formazione consistesse nella sensibiliti  dei docenti verso i loro problemi e nell'umaniti , capaciti  interpersonali, guida e supporto dei tutor clinici.Parole chiave: qualiti  formazione, studenti infermieristica, esperienza educativa, fenomenologia

The experience of educational quality in undergraduate nursing students: a phenomenological study

Preliminary results from the reliability and validity of the stroke impact scale in Italy

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A Single-Center, Randomized Controlled Trial to Test the Efficacy of Nurse-Led Motivational Interviewing for Enhancing Self-Care in Adults with Heart Failure

OBJECTIVES To describe the relationships among 3 measures of physical fitness (exercise capacity, muscle function and functional capacity) in patients with heart failure, and to determine whether these measures are influenced by impairment of movement. METHODS Secondary analysis of baseline data from the Italian subsample (n = 96) of patients with heart failure enrolled in a randomized controlled trial, the HF-Wii study. Exercise capacity was measured with the 6-min walk test, muscle function was measured with the unilateral isotonic heel-lift, bilateral isometric shoulder abduction and unilateral isotonic shoulder flexion, and functional capacity was measured with the Duke Activity Status Index. Principal component analysis was used to detect covariance of the data. RESULTS Exercise capacity correlated with all of the tests related to muscle function (r = 0.691-0.423, p < 0.001) and functional capacity (r = 0.531). Moreover, functional capacity correlated with muscle func-tion (r = 0.482-0.393). Principal component analysis revealed the bidimensional structure of these 3 measures, thus accounting for 58% of the total variance in the variables measured. CONCLUSION Despite the correlations among exercise capacity, muscle function and functional capacity, these measures loaded on 2 different factors. The use of a wider range of tests will help clinicians to perform a more tailored assessment of physical fitness, especially in those patients with heart failure who have impairment of movement.

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Ercole Vellone

Papers

Development and psychometric evaluation of the motivation for nursing student scale (MNSS): a cross sectional validation study.

The experience of educational quality in undergraduate nursing students: a phenomenological study

Preliminary results from the reliability and validity of the stroke impact scale in Italy

A Single-Center, Randomized Controlled Trial to Test the Efficacy of Nurse-Led Motivational Interviewing for Enhancing Self-Care in Adults with Heart Failure

Relationships among measures of physical fitness in adult patients with heart failure.