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L'informatique comme soutien à l'opérationnalisation des procédures analytiques en phénoménologie : un modèle de développement et de collaboration1
Positive attitudes among teachers toward inclusive education play an essential role in enabling students with special educational needs to participate in mainstream education. In this paper, we hypothesize that a conflict between the selection function of schools (i.e., the sorting of students into different academic pathways) and inclusive education makes it difficult for teachers to hold positive attitudes. Three studies (qualitative and quantitative) were conducted, providing support to this hypothesis. Overall, findings revealed that ideological barriers can hinder the implementation of inclusive education and raise new questions regarding the consequences of selection-predicated scholastic settings on students with special educational needs.
L’autonomie de l’action communautaire québécoise demeure un enjeu politique prioritaire. À la fois réclamée pour la gestion interne des organismes, l’autonomie fait également l’objet d’une revendication plus ou moins explicite pour les destinataires de leurs actions. En raison de l’intensification du rapport contractuel avec les bailleurs de fonds publics et privés et d’un discours favorisant l’autonomie-responsabilisation, l’action communautaire se voit confrontée à certaines logiques d’intervention susceptibles de modifier les rapports qu’entretiennent les responsables et les destinataires. Dans ce contexte, l’objectif principal de ce mémoire est de mieux comprendre les significations de l’autonomie des destinataires guidant les pratiques exercées par les organismes communautaires québécois, en portant une attention sur l’existence de tensions entre les pratiques communautaires effectives et la conception idéale de l’autonomie selon les destinataires et les responsables. De nature qualitative, cette recherche s’appuie sur un cadre théorique s’inspirant de la sociologie compréhensive postulant que la compréhension est plus à même de s’opérer à travers une conceptualisation d’idéaltypes (Weber, 1904/1913/1965). Ainsi, trois idéaltypes (expertise, représentation et participation) des pratiques communautaires actuelles concourant au développement de l’autonomie des destinataires ont été soumis à la discussion de six destinataires et six responsables d’organismes communautaires. Ces derniers ont été invités à repérer les positionnements effectifs des pratiques de leur organisme et à réfléchir sur l’adéquation de ces pratiques à celles désirées selon leur idéal. Dans l’optique de rendre possible la comparaison des points de vue, nous avons sélectionné six organismes communautaires très distincts dans leurs approches. L’analyse des résultats nous permet de constater une tendance inversée entre les deux groupes de répondants : les responsables reconnaissant davantage leurs pratiques au sein de l’idéaltype d’expertise tout en désirant se rapprocher de l’idéaltype de participation, alors que le contraire s’observe chez les destinataires. Si ces derniers soulignent le caractère rassurant de l’idéaltype d’expertise, les responsables insistent sur les défis qui accompagnent la mise en place de pratiques se rapprochant de l’idéaltype de participation. Favoriser des pratiques de prise en charge visant le développement d’une autonomie individuelle se justifierait à partir de raisons soulevées par les deux groupes de répondants (absence de compétences, besoins primaires et urgents, faible estime de soi qui ne favorise pas la motivation à agir, etc.). L’étude permet de conclure que l’autonomie est rarement abordée sous un angle relationnel, politique et collectif.
As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.
We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.
Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi 2 = 21.04, P less than 0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P less than 0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P less than 0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P less than 0.0001), but no differences in the percentage due to negligence.
There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.
Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.
A review of the medical records of over 14 000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an “adverse event”, which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
http://www.seuil.com/ouvrage/husserl-et-l-enigme-du-monde-emmanuel-housset/9782020338127
The contribution of nurses’ caring approach to patient safety in a rehabilitation setting : an innovative study
The specific contribution of caring to patient safety has not been explicitly clarified in previous studies, particularly in rehabilitation. Considering the particular needs of patients in rehabilitation, it seems that a caring approach could have an important role in their safety. Inspired by the Quality-Caring Model© of Duffy and Hoskins (2003), the objective of this study, realized with twenty nurses who work in rehabilitation setting, was to understand the way their caring approach could contribute to their patients’ safety. The findings, obtained from the semi-structured interviews performed within this qualitative phenomenological study, revealed that a caring approach leads to a beneficial transformation process not only for patients, but also for nurses and for the health care system, due to a positive feedback. This transformational process notably constitutes the particular contribution of a caring approach to physical, psychological and psychosocial patients’ safety.
In the evolution of the nursing profession, the phrases nursing care, therapeutic care, caring for others, and related expressions are used by nurses to describe their professional service to others. Members of our society have different thoughts and role expectations about these phrases in relation to the kind of care they receive from nurses. Furthermore, these expressions hold different meanings for nurses in their various care-giving roles, such as to individual clients, families, and community groups they serve. The concept of care is probably one of the least understood ideas used by professional and non-professional people, yet it is probably one of the most important concepts to be understood by human groups. It is a word with multiple social usages in the American culture, and has other meanings in other world cultures. It is time that we study the implicit and explicit meanings associated with the concepts of care and caring so that we can reduce their ambiguities.
The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies.
We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992.
We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event.
The measures were adverse events and negligent adverse events.
Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent).
The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.
The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals. The author defines caring and competency by providing examples of what they are not in examining 200 actual cases of hospital nursing acts of incompetence by nursing discipline. None of these examples of imputed negligence was reported to the National Practitioner Data Bank because the "corporate shield" protected the nurses by not being named in the complaint nor named as part of the settlement against the hospital.A new model of the hospitalist, the nurse hospitalist, is presented to act as a daily teacher and facilitator for hospital nurses based on a curriculum of day-to-day examples of substandard patient care. This nurse specialist is an inpatient generalist advanced practice nurse who is employed by the hospital and reports to the chief nurse executive. The author proposes that this new model of the nurse hospitalist be devoted entirely to collaborating with nurse leaders, educators, charge nurses, and floor nurses throughout disciplines in advancing the competency of nursing. This daily proactive and prospective model of improving nursing performance in a facultative manner offers strategies to mitigate the limitations of the retrospective model of quality control. Total quality improvement practiced retroactively is ineffective. The author recommends no structural change in the institution but an educational agenda by the nurse hospitalist, with hospital administration to assist nurses in a new learning environment.
Evidence supports associations between professional nursing and quality health outcomes. Yet, what specifically accounts for those linkages remains buried in the daily practice of nursing. The Quality-Caring Model exposes and demonstrates the value of nursing within the evidence-based practice milieu of modern health care. It favors a process, or way of being, that challenges modernist conventions and highlights the power of relationships. By reaffirming the nature of nursing's work as relationship-centered, the blended model describes the 2 dominant relationships that comprise professional encounters. Relationships characterized by caring are theorized to influence positive outcomes for patients/families, health care providers, and health care systems. Model components are clarified, assumptions described, and propositions stated. Conceptual-theoretical linkages in the model are identified and ties to empirical indicators provide the logical consistency necessary for validation. Clinical practice and research applications of the model are offered. The Quality-Caring Model helps to translate the hidden work of nursing into objective terms that can be tested. Scientifically demonstrating its worth will advance professional nursing while simultaneously improving the quality of health care.
Ensuring patient safety is essential for better health care, but preoccupation with niches of medicine, such as patient safety, can inadvertently compromise outcomes if it distracts from other problems that pose a greater threat to health. The greatest benefit for the population comes from a comprehensive view of population needs and making improvements in proportion with their potential effect on public health; anything less subjects an excess of people to morbidity and death. Patient safety, in context, is a subset of health problems affecting Americans. Safety is a subcategory of medical errors, which also includes mistakes in health promotion and chronic disease management that cost lives but do not affect "safety." These errors are a subset of lapses in quality, which result not only from errors but also from systemic problems, such as lack of access, inequity, and flawed system designs. Lapses in quality are a subset of deficient caring, which encompasses gaps in therapeutics, respect, and compassion that are undetected by normative quality indicators. These larger problems arguably cost hundreds of thousands more lives than do lapses in safety, and the system redesigns to correct them should receive proportionately greater emphasis. Ensuring such rational prioritization requires policy and medical leaders to eschew parochialism and take a global perspective in gauging health problems. The public's well-being requires policymakers to view the system as a whole and consider the potential effect on overall population health when prioritizing care improvements and system redesigns.
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