Dissertations / Theses on the topic 'Clinical and critical reflection'

Questo studio vuole indagare il concetto di qualità nel lavoro educativo, individuandone le possibili determinazioni a livello teorico e pratico, attraverso un confronto con le pratiche e i problemi concreti dell’educare. Quello della qualità è un tema assai complesso e costituito da numerose variabili, attorno a cui hanno preso avvio una serie di dibattiti (Abbott L., 1955; Feigenbaum A. V., 1951; Crosby P. B., 1979; Juran J. M., 1974; 1988; Parasuraman A., Zeithaml V.A., Berry L.L, 1985) che hanno contribuito a rendere la parola qualità un contenitore da riempire con le più varie attribuzioni di significato. Definire la qualità non è solo un processo difficile, ma anche in trasformazione. Questo è ancor più vero nei riguardi di un settore articolato come quello educativo, dove essa assume tratti di complessità che occorre considerare. Se da un lato è possibile riscontrare un’idea di qualità tecnica, orientata alla progettazione e al controllo, dall’altra esiste una qualità pedagogica che spesso rimane nell’ombra. Con l’intento di inquadrare il concetto di qualità nell’ambito di una riflessione pedagogica, lo studio prende avvio da una ricognizione teorica che ha come oggetto il sapere pedagogico (Bertolini, 1988; Cambi, 2000; Cambi, Cives, Fornaca, 1991; Frabboni, Pinto Minerva, 2003; Massa, 1987, 1990), di cui si evidenzia il carattere complesso e multidimensionale che lo rende capace di orientare le pratiche senza la pretesa di giungere a verità assolute. In seguito è stato approfondito il tema del lavoro educativo, un lavoro esercitato nel campo-dispositivo dell’educazione (Massa, 1987) e che è esaminato nelle sue dimensioni materiali, inconsce e pragmatiche. Dopo aver posto le basi concettuali e teoriche del sapere pedagogico e del lavoro educativo, si entra nel merito del concetto di qualità, ripercorrendone le origini storiche e le relative evoluzioni, per poi considerare i significati che essa può assumere a seconda delle diverse prospettive epistemologiche: positivismo, ermeneutica, approccio critico-decostruttivo e clinico. Si fa così ritorno all’educativo: si cerca di mostrare il rapporto che la qualità intrattiene con l’educazione e le possibili accezioni attribuite alla qualità in tale ambito, in termini di capacità di gestione delle relazioni, di costruzione e progettazione di setting educativi, di decostruzione e riflessione sulle pratiche e sulle esperienze educative. Infine, si pone la qualità a confronto con i problemi dell’educazione, entrando nel vivo delle questioni concrete concernenti la pratica. L’ultima parte dello studio è dedicata alla ricerca. Essa si colloca all’interno del più ampio Progetto PRIN, cui ho preso parte, che ha avuto come obiettivo esplorare le culture e le politiche della valutazione in due servizi educativi e di cura per adolescenti del territorio lombardo. L’approccio entro cui è inserita è di tipo qualitativo (Denzin & Lincoln, 2000) ed essa è stata condotta attraverso la strutturazione di un “collective case study” (Yin, 1994; Mortari, 2007; Riva, 2007), utilizzando un approccio metodologico di tipo ermeneutico, clinico-critico, in particolare quello della ‘clinica della formazione’ (Massa, 1992; Riva 2000). Per la raccolta dei dati sono stati utilizzati diversi strumenti: l’osservazione etnografica (Anderson-Levitt, 2006; Angrosino & Rosenberg, 2011; Bove, 2009) per esplorare quanto agito nei due contesti; interviste e focus group per indagare quanto dichiarato dai professionisti rispetto al loro sapere; un percorso clinico pedagogico per esplorare i significati attribuiti alle pratiche. La ricerca sul campo ha evidenziato alcune delle possibili accezioni che la qualità può assumere nel lavoro educativo; significati generati dai contesti e dai soggetti che li abitano, che si costruiscono e si determinano nel quotidiano e nelle relazioni tra i professionisti, con gli utenti e con i diversi stakeholder.

This dissertation aims to trace the origin and evolution of Massa’s thought. The latter is also placed within the current debate on learning theories, and further developed thanks to Fook’s critical reflection and Latour’s actor-network theory. Firstly, Massa’s writings are discussed. The influence of Marxism, Althusser, Foucault, and psychoanalysis on Massa’s socio-materialistic understanding of the learning process is investigated. Particular attention is given to the Foucauldian notions of ‘micro-physic of power’, ‘apparatus’, and ‘clinic’. On that basis, Massa’s ‘educational apparatus’ and ‘Clinica della formazione’ [Foucauldian clinic applied to the learning process] are debated, together with their mutual relationships. Educational apparatus is proved to be the core of Massa’s thought. Thanks to this notion, Massa simultaneously granted agency to materiality, and depicted education as a complex phenomenon underpinned by both human and non-human elements in interactions between each other. The ‘educational apparatus’ also acts as a theoretical grid to be projected on the learning process under scrutiny in order to reveal its hidden complex structure. Clinica della formazione consists in the set of techniques which makes this procedure possible; hence, it is Foucauldian. Clinica della formazione is presented and placed within the Italian educational debate of the 80’s-90’s. Moreover, its goals and methods are debated. Clinica della formazione is proved to be anthropocentric: it does not grant agency to non-human and it is based on a reflective process. In order to highlight the gap between Clinica della formazione and Massa’s original socio-materialistic epistemological background, the notions of reflection and reflexion are discussed, together with the works of Dewey, Kolb, Schön, Mezirow, Sheppard, Brookfield, and Fook. In order to further develop Clinica della formazione as a consultancy and supervision methodology, a contamination between Clinica della Formazione and Fook’s critical reflection is suggested. Latour’s actor-network theory (ANT) is identified as the most suitable research methodology to investigate the learning process according to Massa’s original materialistic epistemology. History and key aspects of ANT are presented; its position within Science and Technology Studies debated. The impact of ANT on educational research is discussed. Massa’s work is lastly compared to Latour’s one: the notion of ‘educational apparatus’ is compared to Latour’s notion of ‘network’ and Massa’s learning theory is reread taking into consideration Latour’s concepts of ‘translation’, ‘mediation’, and ‘assemblage’. Finally, Massa’s ‘theatrical deixis’ is discussed. This notion clearly suggests that Massa was moving away from Clinica della formazione methodological apparatus to fully embrace his original materialistic background. It also shows Massa’s attempt to plan and implement a consultancy process in line with the socio-material understanding of the learning process.

Rasch measurement analysis and theory was used to critically examine data from the recently developed Parental Reflective Functioning Questionnaire (PRFQ) for both mothers and fathers in the context of the longitudinal Peel Child Health Study (N = 120 families). Data from a subset of seven items proved to be a valid measure of child-focused parental mentalizing (PRFQ-CF). Properties of the PRFQ-CF are described in detail and the shortcomings of other PRFQ subscales are identified.

This thesis argues that there is a philosophical attempt directed at combating the fragmentation of the sciences that starts with Heidegger and continues today through Trish Glazebrook's interpretations of the former's concept of "reflection," and Carl Mitcham and Robert Frodeman's concept of "critical interdisciplinarity" (CID). This is important as the sciences are both more implicated in our lives and more fragmented than ever. While scientific knowledge is pursued for its own sake, the pertinent facts, meaning, and application of the science is ignored. By linking Heidegger's views on the fragmentation of the sciences to Glazebrook's interpretations of reflection and Mitcham and Frodeman's CID, I show that CID is a concrete realization of Heidegger's reflection.

In keeping with the University guidelines and current literature on the topic this portfolio is an intense and personal document that resembles an autobiography of my professional life. Reflection and analysis form key components of the portfolio development. The task of demonstrating coherence and continuity between publications and projects is an inherent challenge of the portfolio route. I developed this portfolio as a collection of evidence of both the products and processes of learning that attests to my personal and professional development and achievement. The products are demonstrated within my two main projects (Timmins 2002 page 131, Timmins 2005 page 298) and associated publications and international presentations. The process of my learning has been examined and professed through reflection upon these projects and subsequently analysed and presented in the overarching statement. The aim of my portfolio is to provide a reflective overview of these two projects to highlight coherence between projects and identify my unique contribution to knowledge. This thesis reports on the development and use of a framework for reflection that best suited this purpose. I also construct my professional working theory as a result of this critical reflection. This framework proved invaluable to uncover the connections between my projects and the inherent meaning of my portfolio. What began as a series of disparate products (articles, conference presentations, books) the use of the framework for critical reflection enabled me not only to elicit inherent connections but to gain a new clarity about my own professional development and motivation that was previously unknown. Using the framework for critical reflection enabled to me to identify themes from reflection upon my projects: disempowerment, knowledge, emancipation and empowerment. These themes appear implicitly in several recent studies in the Republic of Ireland. Ultimately the impetus for my projects was rooted in my own professional disempowerment. Obedience was a pattern intrinsic to the social fabric of nursing in Republic of Ireland. The identified themes resonate not only my professional growth within but also the current orientation of the nursing profession in the Republic of Ireland. Using the framework for critical reflection also permitted me to outline my original contribution to knowledge. This originality is reflected in the public provision of knowledge to nurses in the area of nursing clients with coronary heart disease. This includes a reorientation of informational support towards symptom management and encouraging a critical awareness of previously used research methods. There is also an original contribution to the ongoing development of nursing practice with the suggested critique; adaptation and use of conceptual models of nursing in coronary care units.

Le performing arts sono spesso considerate come un settore in perenne crisi, che, per le sue caratteristiche strutturali e il suo ruolo nella società, ha sempre dovuto contare sul supporto pubblico per mantenersi in vita. In Italia, la crisi pluriennale dei teatri d’opera lirica, ha portato ad interrogarsi particolarmente sulle capacità manageriali e sulle scelte strategiche adottate dalle organizzazioni. Il caso che qui viene raccontato, si presenta come un caso di successo, in cui, pur dentro i confini della produzione culturale sovvenzionata dallo stato, una svolta manageriale ha portato ad un sensibile miglioramento in produttività ed efficienza, e a un sostanziale incremento di entrate proprie rispetto ai contributi pubblici. La descrizione e l’analisi del caso, lungi dall’essere presentato come best practice con pretese di generalizzazione, permette una riflessione critica sul management delle arti che parte dalla tensione tra arte e commercio sottolineate inizialmente dalla Frankfort school. In particolare ci si sofferma sulla frustrazione della massa creativa, contraltare dell’esaltazione della classe creativa, e sul ruolo conservativo intrapreso dal management in organizzazioni che hanno nell’ innovazione artistica la loro ragion d’essere.

Reflection of feeling (ROF), a component of empathy, has been widely theorized as a technique that can benefit clients and enhance the therapeutic relationship, but scant research has been conducted on it. The current study aimed to fill a gap in the literature by being the first to examine how often novice therapists utilized reflections of feeling in actual psychotherapy sessions with clients who experienced trauma.

A deductive and inductive qualitative content analysis was employed to investigate the use of ROF by four therapist-client pairs in 12 psychotherapy sessions at a university’s community counseling clinics. For each therapist-client pair, three recorded sessions representing the beginning, middle, and end of treatment were selected, transcribed and analyzed.

Results indicated that the ROF technique was used infrequently (11.6%). When ROF was used, simple reflections were more prevalent than complex reflections, and were the most frequently coded reflection type (18 out of 31 ROF codes) in both trauma and non-trauma discussions. Inductive analyses revealed that the most common codes observed throughout psychotherapy sessions included acknowledgements (e.g., “mm hmm;” “yeah”; 50.56%) and follow-up questions (25.1%).

Future research regarding ROF in a naturalistic setting appears needed to study whether clients find this technique useful or not, how it impacts the therapeutic relationship, what training conditions enhance its use, and whether it differentially affects different populations (e.g., trauma and nontrauma survivors). Researchers who aim to study ROF could replicate and enhance the coding scheme developed in the present study.

Nurses who can critically think and make clinical judgments in the clinical setting are crucial to safe and effective nursing care. This type of critical thinking and clinical judgment is best developed during clinical education, which provides students with the opportunity to bridge the theory to practice gap. Clinical instructors guide students’ development of critical thinking and clinical judgment in the clinical setting. Despite clinical instructors having such a significant impact on critical thinking and clinical judgment there is limited research on how they facilitate students’ development of critical thinking and clinical judgment. This qualitative analysis explored how clinical instructors facilitate the development of critical thinking and clinical judgment of nursing students. This study used interpretive description to analyze interviews with eight clinical instructors to develop themes and subthemes within the data. These themes were discussed in relation to definitions of critical thinking and clinical judgment, indicators for evaluation, clinical teaching strategies, and contextual facilitators and barriers. Clinical instructors who took part in this study defined the concept of critical thinking as : The process that leads to clinical judgment, the decision. Evaluation was based on broad indicators of patient safety, effective communication, students’ confidence in their ability to critically think and make clinical decisions, and taking ownership of their patient care. Clinical instructors identified a variety of clinical teaching methods that they adapted and individualized to specific student needs. Clinical instructors also use multiple strategies to meet student needs, which they then adapt for each cohort. Contextual factors also impact students’ development of critical thinking and clinical judgment such as buddy nurses, the school of nursing curriculum, clinical ]instructors, and the nursing student themselves. This study identified suggestions for curriculum development, clinical instructor development, and potential areas for future research in relation to clinical education. Clinical instructors are key components of nursing education and the development of critical thinking and clinical judgment in nursing students; as such, it is important to understand their perspectives on how they develop these student abilities.
Applied Science, Faculty of
Nursing, School of
Graduate

Thesis (DTh (Practical Theology and Missiology))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The aim of our study was not merely to recount the ethical problems of the Korean Protestant Church and its members, but to suggest a new ethical preaching mode for resolving these problems. Thus, in order to research the subject of our study, we used two methodologies: Dingemans’s practical theological methodology and the Heidelberg method of sermon analysis. In chapter one, we stated the question why the Korean Protestant Church’s growth is declining, and described the current social situation in which the Korean people are starting to turn their backs on the Korean Protestant Church, and also mistrusting the morality of this Church as its members do not seem to act in accordance with their stated beliefs. Their ethical behaviour does not correspond with the content of their confession. In order to show exactly the practical and problematic phenomenon of the Korean Protestant Church and its members, we used the results of six surveys conducted recently by several institutes. Furthermore, in order to expose exactly the Korean Protestant Christian’s ethical problems in terms of homiletics, we suggested that our study focuses on the following three issues: political, triumphal and narrative, as these three sermon patterns flow like rivers into the Korean Protestant Church and its American theological connection. By doing so, our study hoped to contribute ultimately towards the rediscovery and revalidation of ethical preaching in contemporary Korea. From chapter two to chapter seven, we thus strived to explain the content of, and relationship between, the three preaching modes as described above (political, triumphal, and experiential), and we analysed the sermons of three representative Korean Protestant preachers in detail, by using the framework of the Heidelberg method. In chapter eight, we evaluated the ethical situation of the Korean Protestant Church and its members in contemporary Korea as follows: “Consequently, in contemporary Korea, the Koreans no longer believe and trust the Korean Protestant Church. Thus, since the 1990s, the present Korean Protestant Church is experiencing a decline in the attendance of its members because the present Korean Protestant Church has lost its dignity due to its ethical problems. In our opinion, it is true that the Korean Protestant Church needs to discover Christian ethics; thus, the Church must especially focus on its lack of social ethics and political responsibility in the Reformed theological views. In order to promote the public’s trust in the Korean Protestant Church and its members, it is inevitable that Korean Protestant ministers must focus more on Christian ethics than on the outward development of the Church in contemporary Korea. Thus, in order to establish Christian ethics in Korea, the Korean Protestant preachers must consider ethical preaching, through which naturally, Christians will try to follow Jesus’ life and teachings before God by faith in the world.” In chapter nine, we explained in detail what ethical preaching is, i.e. we introduced the necessity for ethical preaching, and defined it as well as components thereof. In particular, we emphasized that the world’s position and function are unique, as evil controls the world in terms of ethical preaching because human beings have been captured by the multiplicity of the powers or related them to contemporary social realities, and they cannot but produce Christian ethical problems in the world. Furthermore, we suggested the following: “We obviously need the harmony of Campbell and Long’s homiletical views in order to create the best framework for ethical preaching for contemporary Korea.” In chapter ten, we critically compared and reflected on the homiletical views of Campbell and Long in terms of ethical preaching. Furthermore, we created a new ethical preaching mode for contemporary Korea. In chapter eleven, we introduced some suggestions as regards the way ethical preaching could be done in contemporary Korea, i.e. we strived to compose a sermon’s synopsis of ethical preaching with the newly formed framework. Thus, with Luke 8:22-39, we dealt with “the division of Korea into North and South” and, with Luke 10:25-37, “racial prejudice toward coloured foreign workers” by using the newly formed ethical preaching mode. In chapter twelve, we summarized and concluded our dissertation. As regards the homiletical field of Korea, we introduced four benefits our study can offer. On the other hand, we pointed out the shortcomings of our study as follows: “Jesus Christ and ethical issues from the Old Testament” and “the relationship between our ethical preaching mode and Christian worship, especially liturgy.” In this chapter, thus, we emphasized the abovementioned points as suggestions for future research.
AFRIKAANSE OPSOMMING: Die doel van ons studie was nie ʼn blote weergee van die etiese probleme van die Koreaanse Protestantse Kerk en sy lidmate nie, maar om ʼn nuwe metode van etiese prediking ter oplossing van hierdie probleme voor te stel. Gevolglik het ons, ten einde navorsing oor ons onderwerp te doen, twee metodologiee aangewend: Dingemans se prakties-teologiese metodologie en die Heidelbergse metode van prediking analise. In hoofstuk 1 het ons die vraag gestel waarom daar ʼn afname was in die groei van die Koreaanse Protestantse Kerk en die huidige sosiale situasie waarin die Koreaanse bevolking die Koreaanse Protestantse Kerk die rug keer en ook die moraliteit van die kerk aangesien sy lidmate nie handel volgens hul verklaarde oortuigings nie beskryf. Hul etiese gedrag stem nie ooreen met die inhoud van hul belydenis nie. Ten einde die praktiese en problematiese verskynsel van die Koreaanse Protestantse Kerk en sy lidmate juis te beklemtoon, het ons die resultate van ses opnames wat onlangs deur verskeie institute gedoen is gebruik. Verder, om die etiese probleme van die Koreaanse Protestantse Christen in terme van homilitiek noukeurig bloot te le, het ons voorgestel dat ons studie op die volgende drie aspekte fokus: politiese, triomferende en narratiewe aangesien hierdie drie erediens patrone soos riviere in die Koreaanse Protestantse Kerk en sy Amerikaanse teologiese verbintenis vloei. Sodoende hoop ons studie om uiteindelik ʼn bydrae te lewer tot die herontdekking en herbekragtiging van etiese prediking in hedendaagse Korea. Vanaf hoofstuk twee tot hoofstuk sewe het ons dus daarna gestreef om die inhoud van en die verhouding tussen die drie metodes van prediking, soos hierbo beskryf (politiese, triomferende en narratiewe), te verduidelik en het ons deur middel van die Heidelbergse metode die preke van drie verteenwoordigende Koreaanse Protestantse predikers breedvoerig geanaliseer. In hoofstuk ag (t) het ons die etiese situasie van die Koreaanse Protestantse Kerk en sy lidmate soos volg geevalueer: “Gevolglik glo en vertrou die Koreane in hedendaagse Korea nie meer die Koreaanse Protestantse Kerk nie. Dus, sedert die 1990’s beleef die huidige Koreaanse Protestantse Kerk ʼn afname in die bywoning van sy lidmate omdat die Koreaanse Protestantse Kerk sy waardigheid verloor het as gevolg van sy etiese probleme. Volgens ons is dit waar dat die Koreaanse Protestantse Kerk Christelike etiek moet ontdek; dus, die Kerk moet spesifiek fokus op sy gebrek aan sosiale etiek en politieke verantwoordelikheid in die gereformeerde teologiese gesigspunte. Ten einde die publiek se vertroue in die Koreaanse Protestantse Kerk en sy lidmate te bevorder, is dit onvermydelik dat die predikante van die Koreaanse Protestantse Kerk meer moet fokus op Christelike etiek as op die uiterlike ontwikkeling van die kerk in hedendaagse Korea. Dus moet Koreaanse Protestantse predikers etiese prediking, waardeur Christene in die wereld sal probeer om Jesus se lewe en onderwysings voor God deur geloof te volg, oorweeg ten einde Christelike etiek in Korea te vestig.” In hoofstuk nege het ons breedvoerig verduidelik wat etiese prediking behels, d.w.s. ons het die noodsaaklikheid van etiese prediking ingelei en dit tesame met die komponente daarvan gedefinieer. Ons het in besonder die uniekheid van die wereld se posisie en funksie beklemtoon aangesien boosheid die wereld in terme van etiese prediking beheer omdat mense gevange geneem is deur die veelvoudige magte of eietydse, met hul verbonde sosiale werklikhede en hulle nie anders kan as om Christelike etiese probleme in die wereld voort te bring nie. Verder het ons die volgende voorgestel: “Ons het duidelik die harmonie van Campbell en Long se homiletiese standpunte nodig ten einde die beste raamwerk vir etiese prediking vir hedendaagse Korea te skep.” In hoofstuk tien het ons die kritiese vergelyking getref tussen en gereflekteer op die homiletiese uitgangspunte van Campbell en Long in terme van etiese prediking. Voorts het ons ʼn nuwe metode van etiese prediking vir hedendaagse Korea ontwikkel. In hoofstuk elf het ons sekere voorstelle betreffende die manier waarop etiese prediking in hedendaagse Korea gedoen sou kon word aangebied, d.w.s. ons het daarna gestrewe om ʼn prediking se oorsig van etiese prediking met ʼn nuutgevormde raamwerk saam te stel. Dus, met Lukas 8:22-39 het ons gefokus op “die verdeling van Korea in Noord en Suid” en met Lukas 10:25-37, “rassistiese vooroordeel teenoor gekleurde buitelandse arbeiders” deur van die nuutgevormde metode van etiese prediking gebruik te maak. In hoofstuk twaalf het ons die dissertasie saamgevat en afgesluit. Ons het, betrekking tot die homiletiese landskap in Korea, vier voordele wat ons studie kan bied voorgestel. Enersyds het ons sekere tekortkominge van ons studie soos volg uitgewys: “Jesus Christus en die etiese kwessies van die Ou Testament” en “die verhouding tussen ons etiese predikingswyse en Christelike aanbidding, veral liturgie”. In hierdie hoofstuk het ons dus die bogenoemde punte as voorstelle vir toekomstige navorsing voorgestel.

The purpose of this study is to understand how Clinical Nurse Educators use reflective practices with students. While the value of reflective practice has been vigorously discussed in both nursing and educational literature, studies to support its benefits remain strangely elusive. The appeal of reflective practice has arisen out of a sustained conviction that life experience offers a legitimate and rich form of knowledge. If captured, it may narrow the gap between the non practical nature of theories and the complexities of everyday practice problems. The research question for this study is: "How do Clinical Nurse Educators foster student reflection?" The primary source of data for this qualitative study was generated from in-depth interviews with five clinical nurse educators at the University College of the Cariboo school of nursing. Participants were selected on the basis of their interest in reflective practice which was in part determined by their attendance at a seminar presentation on this topic. The data collected from the interviews were categorized into predominant emergent themes outlined below and explored within the context of current literature. As a result of the findings, practice recommendations follow. These were further developed to offer suggestions for fostering reflective thinking in students. The themes outlined in this study are as follows: Reflection is deliberate and purposeful Reflection triggers a critical response to any situation whether good or bad Affect and reflective practice are strongly linked Reflection occurs on a continuum Reflection provides increased awareness of problems and issues Fostering reflection with students requires time and an open and caring environment

This thesis is comprised of a novel and a critical exegesis with an 80/20 split. The novel is called Killing Daniel and is a literary crime which investigates the impact of Daniel's death on the main character, Fleur. The critical exegesis is called Reasons for Killing Daniel and considers my reasons for writing the novel. This thesis explores the relationship between text and writer and between text and reader. It considers how the implied reader (Iser 1980) might actualise the text. Furthermore, it explores the similarity between the representation of coma in the novel and the way in which the reader constructs the actualised text from the 'gaps ... blank[s]' and 'indeterminac[ies]' (Iser: 167) put in place by the author. It also explores how the construction of time in a narrative can inform the reader's response. The second main concern of the thesis is the exploration of the relationship between character and crime. It examines how an appreciation of the crime genre can heighten our understanding of the characters and tensions at play in this particular novel. It considers the significance of the doubling of characters with reference to cultural parallels between these characters and the UK and Japan. The thesis analyses how consciousness is constructed within the novel and how the coma state can be used to explore the different states of consciousness. It utilises Dorrit Cohn's (1984) analysis of narration to explore how POV can be used to represent consciousness. Finally, it investigates the construction of narrative. It considers various drafts of the novel, exploring how these choices inform our understanding of male and female stereotypes in the text.

Thesis (PhD)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: South Africa faces many challenges, as a country. Our communities are struggling with many issues such as poverty, inequality, rape, abuse, violence, corruption and many more. Yet, our faith community seems reluctant to lament these issues during their worship services. This research looks specifically at the practice of the Uniting Reformed Church in Southern Africa. The question that this research wrestles with is: “Given the challenging times that we live in, in what way could a re-discovery or a re-claiming of lament in liturgy, against the background of healing and hope, obtain new meaning in our congregations?” The assumption of the research is that if the church wants to be relevant in the lives of their members today, she would need to revisit and reclaim the process of lament in the liturgy. It could further be argued that a re-thinking and a re-introduction of lament in liturgy could have far-reaching and enriching implications in the life of the faith community, especially where the healing of memories is concerned. Part of the research was a literature study while another section consisted of empirical studies. Congregations from the Uniting Reformed Church in Southern Africa, in the Western Cape, took part in the studies. The main focus of the research was descriptive empirical and the information gathered had to be interpreted. Through the normative task, theological reflections could be carried out and finally possible criteria could be deduced in terms of how lament could be re-integrated into existing liturgies of our church.
AFRIKAANSE OPSOMMING: Suid Afrika word gekonfronteer met baie uitdagings. Ons gemeenskappe gaan gebuk onder geweldige druk en word daagliks gekonfronteer met armoede, ongelykheid, verkragting, mishandeling, geweld, korrupsie en nog vele meer. Ongeag hierdie uitdagings blyk dit asof ons geloofsgemeenskap teensinnig is om te weeklaag gedurende eredienste. Hierdie navorsing kyk spesifiek na die praktyk rondom weeklaag in die liturgie van spesifieke gemeentes in die Verenigende Gereformeerde Kerk in Suider Afrika. Die vraag waarmee hierdie navorsing worstel is: “Gegewe die uitdagende tye waarin ons lewe, op watter manier kan die herontdekking of die her-besit van weeklaag in liturgie (teen die agtergrond van heling en hoop), nuwe betekenis aanneem in ons gemeentes?”. Die uitgangspunt van die navorsing is dat as die kerk relevant wil bly in die lewens van haar lidmate, dan het sy nodig om die proses van weeklaag, binne die liturgie, weer te besoek en te eien. Verder kan dit geredeneer word dat ‘n nuwe denkpatroon en ‘n nuwe bekendstelling aan weeklaag in die liturgie verreikende gevolge kan hê in die lewens van die geloofsgemeenskap, veral waar daar na die heling van ons verlede gekyk word. Een deel van die navorsing was ‘n literêre studie terwyl die tweede deel ‘n empiriese studie was. Gemeentes van die Verenigende Gereformeerde Kerk in Suider-Afrika het deel uitgemaak van die empirisie navorsing. Die klem van die navorsing was beskrywendempiries en die data moes interpreteer word. Gedurende die normatiewe deel kon daar teologies gereflekteer word oor die maniere waarop weeklaag weer deel van die bestaande liturgie gemaak kan word in ons kerk. Verskeie moontlikhede het aan die lig gekom in hierdie verband.

A number of approaches and methods are being used to assess higher cognition within online threaded discussions, as evidenced by the corpus of scholarship. However, a review of the literature suggests that current strategies relating to asynchronous discourse have tended to focus on cognitive processes that are mostly driven by task-oriented communication, thereby failing to assess the quality of interactions that engender meaning-making and knowledge creation. The first goal of this study was to decompose and interpret examples of threaded conversation exhibiting lexical attributes of higher cognition. The second goal was to identify instances of critical thinking and indicators of deep learning contributing to meaningful reflection within diachronic encounters to develop more effective higher-order thinking strategies within discussions. Discourse analysis theory in conjunction with Garrison's stages of critical thinking was used to examine meaning-making within contexts of social interaction. Archival discussion data were examined from 39 participants derived from 2 online undergraduate courses at a small private university in the southeastern United States. The content analysis qualitative design applied computer-mediated discourse analysis (CMDA) to analyze and classify statements in discussion transcripts according to Garrison's stages of critical thinking. Results indicated a pattern of utterances suggesting in-depth learning, with a smaller sample of stanzas indicating surface-level processing. Results of this study can be used by teachers and course designers to create positive change by purposefully engendering critical reflection, thereby preparing learners for the work of the future necessitating well thought-out approaches to grapple with new problems and situations in new ways.

Abstract The purpose of the study was to broaden understanding of structural racism by examining the relationships between Indigenous peoples and nation-states in the context of education and how this affects Indigenous lives. This thesis delves into understanding both the theoretical and methodological contributions that more critical analyses can have on: the role of de-colonial approaches to Indigenous health research methodologies so that the most urgent health inequities are addressed through more rigorous and Indigenous specific research processes; and to improve our understanding of the complex interactions that historical and contemporary legacies of residential schools and boarding schools have on the health and well-being of Indigenous populations in Canada and Finland. The research design was a qualitative multiple case study informed by a public health critical race praxis. The study was completed in two phases; consisting of a literature study using content analysis of Indigenous research ethics protocols and policies, in Canada and the Nordic countries; and, three case studies developed from open ended questions from structured interview research comparing discriminatory experiences and its impact on self-perceived health with participants from Six Nations of the Grand River, Canada (n = 25) and the Sámi in Inari, Finland (n = 20); and their family members. The case studies were analyzed using both Western and Indigenous methodologies. Results of Phase one shows how Indigenous resistance to colonial structures within academia in Canada and Finland has resulted in dialogical processes to create an ethical space for working between the differing worldviews of academia and Indigenous communities with the aim to produce ethically valid knowledge. Phase two results shows that regardless of contextual differences of the experiences in Canada and Finland, the main parallel outcomes are similar, i.e. the teachings of shame received in these educational environments. This produces both vulnerabilities and resiliencies and the negative effects of shame require an ongoing healing journey for both individuals and their families and communities at large. Conclusion: For a more in depth understanding of structural racism and its influence on Indigenous health, investigations require methodological choices by both Western and Indigenous methodologies
Tiivistelmä Tutkimuksen päämääränä on tuottaa tietoa rakenteellisesta syrjinnästä. Tämä tapahtuu tutkimalla alkuperäiskansojen ja kansallisvaltioiden välisiä suhteita koulujärjestelmissä sekä sitä, miten rakenteellinen syrjintä vaikuttaa alkuperäiskansojen jäsenten elämään. Tutkimuksen kriittinen analyysi tuottaa dekoloniaalisia lähestymistapoja terveystutkimuksen menetelmiin, jolloin tärkeimmät terveyserot paljastuvat alkuperäiskansalähtöisten tutkimusprosessien kautta. Tutkimus pyrkii lisäämään ymmärrystä siitä, millaisia väliaikaisia sekä nykypäivään asti ulottuvia vaikutuksia sisäoppilaitoksilla ja kouluasuntoloilla on ollut Kanadan ja Suomen alkuperäiskansojen jäsenten terveyteen ja hyvinvointiin. Väitöskirjan tutkimusasetelma on laadullinen monitapaustutkimus, jossa sovelletaan Critical Health Praxis (PHCR) -menetelmän viitekehystä. Tutkimuksen ensimmäisessä osassa vertaillaan laadullisen sisällönanalyysin avulla Kanadan ja Pohjoismaiden alkuperäiskansojen tutkimuseettisiä käytäntöjä ja menettelytapoja. Toisessa osassa on kolme tapaustutkimusta, jotka perustuvat strukturoidun kyselytutkimuksen avovastausten syrjintäkokemuksiin ja niiden vaikutuksiin itsekoettuun terveyteen Kanadan ensimmäisten kansojen jäsenillä (Six Nations of the Grand River, n = 25) sekä Suomen saamelaisilla (Inarin kunta, n = 20). Tapaustutkimuksissa sovelletaan alkuperäiskansalähtöisiä ja länsimaisia tutkimusmenetelmiä. Tulokset osoittavat, että alkuperäiskansojen vastustus kolonialistisia akateemisia rakenteita kohtaan Suomessa ja Kanadassa on synnyttänyt dialogisia prosesseja, joiden avulla voidaan luoda eettistä tilaa tiede- ja alkuperäiskansayhteisöjen maailmankuvien yhteensovittamiseksi ja eettisesti hyväksyttävän tiedon tuottamiseksi. Toisen vaiheen tulokset osoittavat, että vaikka Kanadan sisäoppilaitosten ja Suomen kouluasuntoloiden yhteiskunnalliset lähtökohdat ja käytännön toteutustavat eroavat toisistaan, lopputulos on samansuuntainen: kouluympäristön aiheuttama häpeä, joka tuottaa sekä haavoittuvuutta että resilienssiä. Kielteisten kokemusten työstäminen vaatii pitkää, parantavaa prosessia, joka koskee niin yksilöitä, perheitä kuin yhteisöjäkin. Johtopäätöksenä todetaan, että tarvitaan sekä länsimaisia että alkuperäiskansalähtöisiä tutkimusmenetelmiä, jos halutaan ymmärtää syvällisesti rakenteellista syrjintää ja sen vaikutuksia alkuperäiskansojen terveyteen ja hyvinvointiin

Clinical psychologists have an increasing presence in the media, however the way they are portrayed rarely distinguishes them from other types of psychologists and psy-professionals, and the information communicated is often unclear, inaccurate and lacking usefulness. Therefore, this thesis sought to examine how people working in the media understand clinical psychology and the way this then informs the portrayal of clinical psychologists. On the basis of this, possible solutions to improve their portrayal in the media would be identified. A secondary aim of the thesis was to investigate what clinical psychologists wanted the media to know about their profession. Fifteen media personnel were interviewed and the data were analysed using a descriptive analysis and a critical discourse analysis (CDA). Sixteen clinical psychologists answered a single question survey about what they would like the media to know regarding their profession and their answers were analysed using a content analysis (CA). The media samples' responses to the interview, and the clinical psychologists' responses to the survey question were then subjected to a descriptive comparison. The descriptive analysis of the media samples' interviews highlighted much confusion about clinical psychology, the activities of clinical psychologists and the way they are different from other psychologists and psy-professionals. The CDA revealed three main discourses underlying the way in which media personnel spoke about clinical psychologists, these being: i) the clinical psychologist as authority/expert, ii) the clinical psychologist as mind reader, and, iii) the clinical psychologist as rescuer. Another descriptive analysis highlighted how decisions were made by media personnel as to when and how to portray the profession. The CA revealed 25 separate coding categories indicating what clinical psychologists would like the media to know about their profession. A comparison of both sample's responses revealed similarities and differences as to how they conceptualised clinical psychology. On the basis of the above analyses, new possibilities to improve the portrayal of clinical psychologists were identified and the results are discussed in relation to the broader literature.

An important goal of nursing education is to produce graduates who are problem solvers and competent clinical practitioners able to practice in a very complicated health care environment; reflection and inquiry are two ways to accomplish this goal. This qualitative study explored how eight senior baccalaureate nursing students developed in their ability to utilize reflection and inquiry at higher stages over time through the use of the online clinical post-conference conducted as an asynchronous discussion board. Transcripts of participant postings were examined weekly to determine the stage of reflection and inquiry displayed and a comparison was done to determine if the stages increased over time. Boud's model of the reflective process and the practical inquiry model of Garrison, Anderson, and Archer provided the theoretical framework for this study.

Findings from this study demonstrated that participants developed in their ability to utilize reflection and inquiry at higher stages over time by engaging in the online clinical post-conference and that the online clinical post-conference was an effective venue that encouraged the use of reflection and inquiry. The social aspect of the online clinical post-conference (reading others' posts, having others read and comment on their posts, and asking each other questions) was seen as promoting learning from peers.

Findings of this study could be used by nurse educators to change their pedagogy to produce nurses who learn from experiences and are lifelong learners. Nurse faculty should consider incorporating the use of reflection, inquiry, and the online clinical post-conference in all clinical courses.

This qualitative study seeks to understand the development of secondary science pre-service teachers. A case study is developed about each of the five participants, in effort to answer the research questions, which are: How did critical reflection inform teacher capacity within the secondary science pre-service teacher population? What knowledge, skills, and dispositions facilitated secondary science pre-service teachers in developing a critically reflective practice? It is the author's expectation that by teaching these pre-service educators to develop their skills of critical reflection by using external methods of assessment such as videotaping, peer feedback, and student work, the participants in this study will increase and expand their capacity as teachers, or their "innate potential for growth, development, and accomplishment" (McDiarmid & Clevenger-Bright, 2008), and be better prepared to accomplish the goals that are expected of a master teacher. Data is collected from interviews, participant work samples, and observations from the researcher and other key individuals who worked with each participant, such as: the methods instructor, university supervisors, and cooperating teachers. Over the course of two semesters, the researcher developed a detailed description of each of the participants through analyzing passages selected from interview transcripts and student work samples for reflection type, factor of teacher capacity, and commonplace interaction group. The first outcome of this study includes an understanding of the relationship between critical reflection and teacher capacity and the knowledge, skills and dispositions that facilitate the development of a critically reflective practice. The second outcome of this study was the development of a new adaptation of a teacher interaction model (commonplace interaction groups) based on Schwab's Commonplaces of Educating. Lastly, three conclusions were drawn about the five participants in this study: There was a change in the participants' reflection level from the methods semester to the student teaching semester, most shifted their focus of reflection from teacher-self to teacher-student, and the weakest area of reflection with all participants was content / subject area and curriculum / standards.

This situated self-as-researched investigation explores the impact of critical reflection on a private practice singing teacher’s thinking. The project is based upon the use of five ‘vehicles’ through which to develop the skills of critical reflection, these being journal writing, personal writing, critical incident technique, narrative inquiry and ideology critique. Each of these vehicles is used to undertake critical reflection of singing teaching practices whereby values and assumptions are interrogated. Each of the vehicles of critical reflection used in this inquiry is evaluated for their ease of use and effectiveness in enabling critical reflection processes to be developed in the participant. Engaging in critical reflection presents the possibility for transformative learning (Mezirow 1990) whereby frames of reference are challenged and altered as a result of the processes undertaken and examples of this in action are included in this research report. This dissertation contributes to the small but growing body of research in the area of private professional music education. The private instrumental and vocal teacher often works in an isolated environment with limited development opportunities available. This research proposes that critical reflection may be a viable tool for professional development and practice improvement.

Thesis (MA (Political Science))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The essence of this study is about structural change and how it is affected by competing social forces. My primary aim is to examine the problems and contradictions in Mozambique‟s development strategy and to gain an understanding of how these problems are influenced by the structure of the contemporary world order. A central focus will be on how social forces at various levels influence the way in which development strategy is formed through superior material capabilities, shaping ideas and establishing institutions. The main argument is that the hegemonic neoliberalist ideology has been perpetuated in Mozambique by external social forces and has become the mainstay of the development approach in the country. By acknowledging that theory is used by different social groups for various purposes, I depart from the common assumption of considering the Mozambican development example as a success, and rather ask „for whom it has been a success‟. The theoretical approach in this study is based on Coxian Critical Theory (CCT) and a significant proportion is dedicated to evaluate Cox‟s works and how he applies his theoretical framework in the analysis of the changing world order. To get a better appreciation for the strengths and weaknesses of CCT, the study will also examine the works of several scholars that use CCT in their studies of social forces in Southern Africa. The case study will be guided by the findings generated by the theoretical evaluation, particularly with regards to the way CCT allows for various points on entry in the analysis. The case study of Mozambique generated three main conclusions. Firstly, that Frelimo has failed to create a broad based consensus for its ideology among different social forces in Mozambique and that the historic bloc in Mozambique remains fragile. Secondly, that the economic elite in South Africa and the ANC collaborated with Frelimo in structuring the development strategy in Mozambique, and through this collaboration, perpetuated values consistent with the hegemonic neoliberal consensus. Finally, that the prevailing order in Mozambique is strengthened by the involvement of the international community and that structural change is unlikely to take place without the development of a stronger civil society. The theoretical contribution of the study has been to further support that the logic provided by CCT remains valid in the African context, and that it is highly compatible with other social theories. Furthermore, the study concludes that CCT is particularly compatible with post-colonial theory and social psychology and can be used to address the shortcomings of each other.
AFRIKAANSE OPSOMMING: Die sentrale punt van die studie is strukturele verandering en hoe dit beïnvloed word deur mededingende sosiale kragte. Die primêre doel van die tesis is om die probleme en teenstrydighede in Mosambiek se ontwikkelingstrategie te ondersoek en om te verstaan hoe hierdie probleme verband hou met die struktuur van die teenswoordige wêreld-orde. ‟n Belangrike fokus is ook hoe sosiale kragte op verskeie vlakke die wyse waarop ontwikkelingstrategie gevorm word beïnvloed, via besondere materiële vermoeëns, die vorm van idees en die skep van instellings. Die hoof argument is dat „n hegemoniese neoliberale ideologie perpetueer is in Mosambiek deur eksterne sosiale kragte en dat dit sodoende die bakermat van dié land se benadering tot ontwikkeling geword het. Deur te erken dat teorie deur verskillende sosiale groepe vir uiteenlopende redes gebruik word, beweeg ek weg van die algemene aanname, naamlik dat ontwikkeling in Mosambiek as suksesvol beskou kan word. Die vraag moet eerder gestel word, “vir wie is ontwikkeling in Mosambiek „n sukses?” Die teoretiese benadering in hierdie studie is gegrond op Coxiaanse Kritiese Teorie (CKT) en „n betekenisvolle proporosie van die studie word gewy aan „n evaluering van Cox se benadering en hoe hy dit toepas in „n analise van die veranderende wêreld-orde. Ten einde „n beter waardering daar te stel vir die voor- en nadele van CKT, ondersoek die studie ook die bydraes van „n aantal ander geleerdes wat die benadering gebruik in hul bestudering van sosiale kragte in Suider-Afrika. Die gevalle-studie word gerig deur die bevindinge wat gegenereer word deur hierdie teoretiese evaluering, in die besonder met betrekking tot die manier waarop CKT die gebruik van verskillende invalshoeke tot die analise fasiliteer. Die Mosambiekse gevalle-studie lewer drie hoof-gevolgtrekkings op. Eerstens, dat FRELIMO nie daarin geslaag het, om „n breë konsensus vir sy ideologiese uitgangspunte onder die verskillende sosiale kragte in die land te skep nie. Derhalwe, is die „historiese blok‟ in Mosambiek kwesbaar. Tweedens, dat die ekonomiesse elite in Suid-Afrika en binne die African National Congress (ANC) vi saamgewerk het met FRELIMO om die ontwikkelingstrategie in Mosambiek te struktureer. In daardie opsig, is waardes perpetueer wat saamhang met die hegemoniese neoliberale konsensus. Laatstens, dat die heersende orde in Mosambiek versterk word deur die betrokkenheid van die internasionale gemeenskap en dat strukturele verandering in dié land onwaarskynlik is sonder die ontwikkeling van „n sterker burgerlike samelewing. Die teoretiese bydrae van die studie ondersteun verder die premis dat CKT geldig bly binne die konteks van Afrika en dat dit versoenbaar is met ander sosiale teorieë. Verder, word die gevolgtrekking gemaak dat CKT ook besonder versoenbaar is met post-koloniale teorie en sosiale sielkunde en dat dit gebruik kan word om die tekortkominge in elkeen aan te spreek.

This commentary illustrates significant developments in my recent creative practice, as demonstrated in the accompanying portfolio of compositions. Over the period of research, spanning three years and resulting in a substantial body of new work, I have developed and explored the configuring of a compositional architecture which addresses and emphasises the creation of restrictive boundaries in the composition process. These restrictions are placed to control development, whereby strict objectives are set but paths of reaching those goals allow for creative freedom. The interconnections between composer/score/performer/receiver are also examined. This segues into exploring the pragmatic decision–making during the writing process. Paths of enquiry and development within my creative output are outlined and discussed. These relate specifically to: development of a harmonic methodology which abandons conventional chords and progressions in favour of hyper-chromatic harmonic fields; non– teleological structural approaches which explore self-similarity, scaling and intersemiosis; exploration of material identity, morphology and interconnectivity; as well as consideration of instrumentation alternatively through compositing, synthesis, ‘opening’ and extended techniques. Each chapter in the following document examines the works in the accompanying portfolio individually, as a set of small case studies. A discourse is established which discusses each work as well as connecting and establishing context between works — as a body. Developments are demonstrated through analysis and comparison between my own works and those of other creatives.

University instructors can improve how they promote critical thinking in the classroom by fostering reflective writing habits with students. Midwest University requires all undergraduate students to complete 2 capstone courses, which are framed around a critical thinking curriculum. The skills of analyzing and reflecting on experiences are important components of critical thinking. Despite this acknowledged importance of critical thinking, there is currently no structured training for instructors of the capstone course on how to develop critical thinking abilities among adult students. The purpose of this case study was to examine the perceptions of the instructors of the capstone courses and their approaches to promoting critical thinking. Literature on critical thinking and reflective writing provided the framework for this study. Participants included 5 instructors with experience teaching one of the capstone courses. Data collection included semi-structured interviews, classroom observations, and reflective journals. Analysis was inductive using open coding and constant comparison to identify emergent themes. Findings indicated that a common practice to promote critical thinking was through probing questions and deep discussions, that a challenge to promoting a critical thinking curriculum was student engagement, and that more importance should be placed on assessing critical thinking in the grading rubrics. Results prompted the creation of a professional development workshop to offer training to instructors that included the experience of progressing through reflective activities and deep discussion to better guide their students through the same process in an effort to strengthen critical thinking development. University instructors may glean best practices from this study to guide students in developing the capacity to think from a more critical and global perspective.

Introduction – Objectives. The cardiovascular system is in direct and constant interaction with its environment. Exposure to various environmental parameters, such as low temperature, air pollution and tobacco smoke, has been strongly associated with serious or even fatal cardiovascular outcomes. Arterial stiffening and greater wave reflection are age-related vascular modifications that lead to an increased risk of cardiovascular events. The aim of this work was to explore the relationship between selected environmental factors and arterial elastic properties in an effort to elucidate the underlying mechanisms that link these factors to increased cardiovascular mortality.

Study 1: Effects of cold exposure on central and peripheral vascular tone. Our first study explored the effects of cold exposure on aortic stiffness and peripheral microvascular tone. We observed that cold exposure, in addition to its chronotropic effects, provoked an increase in aortic stiffness, as assessed by aortic pulse wave velocity, as well as significant vasoconstriction of peripheral arterioles in the microcirculation. Moreover, we explored the magnitude of this effect in a different population (Black subjects of African origin), which is traditionally characterized by exaggerated reactions to adrenergic stimuli. We noted that the vascular reactions, in terms of both aortic stiffness and microvascular vasoconstriction, were more profound in Black Africans than in age-matched Caucasian-Whites. These results argue for a direct effect of cold exposure on arterial stiffness and peripheral vascular tone, probably through activation of the orthosympathetic system.

Study 2: Exposure to ambient particulate matter and arterial stiffness. We explored the effects of acute exposure to outdoor particulate matter on aortic stiffness and aortic wave reflection. We studied the relationship between central hemodynamic parameters and ambient concentration of particulate matter in a population of patients who attended the Hypertension Clinics of Athens University. After statistical correction for a number of potential confounders, we did not observe an association between ambient concentrations of particulate matter and aortic stiffness. However, in men, particulate matter concentration was related to the amplitude of the reflected wave reaching the aorta from the periphery. These results suggest a direct acute interaction between particulate matter concentration and vascular tone, leading to an enhanced arterial wave reflection.

Study 3: The role of nicotine on the vascular effects of environmental tobacco smoke. Environmental tobacco smoke is considered as the most important source of particulate matter in the indoor environment. We recently demonstrated that exposure to tobacco smoke augmented wave reflection, an effect that was not seen after equivalent exposure to the smoke of non-tobacco, herbal cigarettes. We also noticed that the increased wave reflection was proportional to the plasma concentrations of nicotine. However, a direct causal effect between nicotine, arterial wave reflection and aortic stiffness has never been clearly demonstrated. We observed that increasing nicotine plasma concentration to levels comparable to those seen after extensive exposure to environmental tobacco smoke, provoked an increase in both aortic stiffness and arterial wave reflection after correction for heart rate and blood pressure changes. These results confirm the significant participation of nicotine in the vascular effects of passive smoking.

Conclusions. Globally, our results reveal the deleterious effects of cold, particulate matter exposure, and nicotinic stimulation on arterial stiffness, peripheral microcirculation and aortic wave reflection. The hemodynamic modifications associated with these effects may at least partially explain the causal relation between cold exposure, ambient air pollution and cardiovascular mortality.

Introduction-Objectifs. Le système cardiovasculaire est en relation directe et constante avec l’environnement. L’exposition au froid, la pollution atmosphérique et le tabagisme passif sont associés à des événements cardiovasculaires aigus graves et même fatals. La rigidification des artères et l’intensification de la réflexion de l’onde de pouls au niveau de l’aorte accompagnent le vieillissement et prédisent un risque cardiovasculaire accru. Nous avons testés l’hypothèse que les effets cardiovasculaires délétères des facteurs environnementaux comportent une altération des propriétés élastiques artérielles. Ceci pourrait être un des mécanismes physiopathologiques qui lie la mortalité cardiovasculaire aux variables environnementales.

Étude 1 :Exposition au froid ;effets centraux et périphériques. Notre première étude portait sur l’effet de l’exposition au froid sur la rigidité aortique et le tonus vasculaire des artérioles périphériques. Nous avons démontré que l’exposition au froid, hormis ses effets chronotropes, provoquait une augmentation de la rigidité artérielle – mesuré par la vitesse de l’onde de pouls au niveau de l’aorte - ainsi qu’une vasoconstriction importante au niveau des artérioles de la microcirculation. Nous avons ensuite déterminé l’amplitude de cet effet dans une autre population (sujets Africains-Noirs) qui se caractérise par des réactions plus prononcées aux différentes stimulations adrénergiques. Nous avons observé que les réactions vasculaires, tant au niveau de la rigidité aortique qu’au niveau de la microcirculation, étaient plus marquées chez les Africains-Noirs que chez les Caucasiens. Ces résultats révèlent un effet délétère de l’exposition au froid sur la rigidité aortique et le tonus vasculaire des artères périphériques, probablement via une activation du système orthosympathique.

Étude 2 :Exposition aux microparticules atmosphériques et rigidité artérielle. Nous avons ensuite investigué les effets de la pollution atmosphérique sur la rigidité artérielle et la réflexion de l’onde de pouls vers l’aorte. Nous avons étudié la relation entre les paramètres hémodynamiques centraux et la concentration atmosphérique de microparticules dans une population de patients qui ont consulté la Clinique Universitaire d’Hypertension Artérielle d’Athènes. Après correction statistique pour les facteurs confondants, nous n’avons pas observé de corrélation entre la rigidité artérielle et le taux de microparticules atmosphériques dans l’ensemble de la population investiguée. Par contre, si on restreint l’analyse aux résultats obtenus chez les sujets masculins, on s’aperçoit que la concentration atmosphérique de microparticules était associée de façon significative avec l’amplitude de l’onde réfléchie par la périphérie vers l’aorte et la pression pulsée aortique. Ces résultants suggèrent un effet direct des microparticules au niveau de la microcirculation. L’augmentation de l’amplitude de l’onde réfléchie consécutive à une vasoconstriction périphérique, modifie vraisemblablement les pressions au niveau de l’aorte chez le sujet masculin lors de pics de pollution.

Etude 3 :Le rôle de la nicotine dans les effets vasculaires du tabagisme passif. Le tabagisme passif est considéré comme la source la plus importante d’émission de microparticules au niveau domestique. Cependant, la composition chimique des particules semble jouer un rôle essentiel sur les ondes de réflexion. Nous avons démontré récemment que l’exposition passive à la fumée des cigarettes du tabac augmente l’intensité de la réflexion de l’onde de pouls. Ceci n’a pas été observé avec l’exposition à la fumée des cigarettes non tabagiques, en dépit d’une concentration ambiante tout à fait comparable de microparticules. Par ailleurs, nous avons observé que l’augmentation de l’incidence de l’onde de pouls au niveau de l’aorte était fortement associée à la concentration plasmatique de la nicotine. Un lien causal entre la nicotine, réflexion de l’onde de pouls et rigidité artérielle n’avait jamais clairement été établi. Nous avons testé cette hypothèse en administrant la nicotine pure chez des sujets sains. Nous avons observé que l’augmentation des taux plasmatiques de la nicotine à des valeurs comparables à celles qui surviennent après une exposition intensive au tabagisme passif, intensifiait la réflexion de l’onde de pouls et augmentait la rigidité artérielle. La correction statistique pour l’augmentation de la fréquence cardiaque et l’augmentation de la pression artérielle en réponse à la nicotine ne modifiait pas ces conclusions. Nos résultats démontrent ainsi les effets cardiovasculaires importants de faibles concentrations de nicotine, similaires à ceux qui sont atteints en cas d’exposition à un tabagisme passif.

Conclusions. Nos résultats révèlent les effets néfastes de l’exposition au froid et aux microparticules atmosphériques sur la rigidité artérielle, la microcirculation périphérique et la réflexion de l’onde de pouls. Nous avons pu également démontrer le rôle de la stimulation nicotinique dans les effets vasculaires aigus du tabagisme passif, comme en témoigne l’augmentation de la réflexion de l’onde de pouls au niveau aortique. Ces modifications hémodynamiques favorisent l’ischémie myocardique, et constituent un des mécanismes par lesquels l’exposition au froid et à la pollution atmosphérique favorisent la pathologie cardiovasculaire.

Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

The health care environment continues to be fraught with errors and poor patient outcomes. Nurses, having the most constant time with patients, are in a position to make a difference in those outcomes. Due to many technological, social, and health care changes and advancements, nurses have responsibilities requiring high levels of clinical judgment. Nursing education must respond to the changes and expanded roles of nurses by changing how students are taught, specifically in the clinical setting. Pedagogical tools and methods are needed to assist the student with making integrations between classroom theory and clinical practice. The purpose of this study was to explore the use of a guided reflection tool based on a model developed from the practice of novice and experienced registered nurses on clinical judgment development as measured by a rubric based on the same model, of associate degree nursing students, in an acute care setting. A mixed methods approach was used. Clinical judgment scores of a comparison group (n = 9) were compared with an intervention group (n = 9) and each groups’ scores were examined for progression of clinical judgment abilities using a quasi-experimental time series design for the quantitative portion of the study. Using RM-ANOVA, findings indicated there was no statistical significance between the two groups or within the time intervals for either of the groups. A focus group interview was also held to identify perceptions of each group concerning reflective journaling and development of clinical judgment. Both groups felt reflective journaling enhanced development of clinical judgment; however, the intervention group articulated situational learning to a greater degree than the comparison group.

The health care field has become increasingly more complex, requiring new nurses to be prepared upon graduation to respond to a variety of complex situations. Unfortunately, many graduates from associate degree nursing (ADN) programs are not able to think critically upon entering the work force. This presents a major problem for the nurse and for the employer. The purpose of the study, therefore, was to gain a deeper understanding of the graduates' perceptions of their ability to critically think during their first year of clinical practice, and if they believed their program prepared them to be critical thinkers. The key research questions focused on how the novice nurses reconciled their performance on a critical thinking, online assessment, the Health Sciences Reasoning Test (HSRT), with their perception of their critical thinking skills, and if they felt prepared, during their first year of clinical practice, to critically think. The conceptual framework applied was Bloom's Taxonomy and Tanner's clinical judgment model. A purposeful sampling of 7 novice nurses from 3 ADN programs was chosen. After completing the HSRT, audio-taped phone interviews were conducted. The data indicated that the participants felt unprepared to respond to emergent patient situations, thus undermining their self-worth and clinical competency. The participants agreed there was a need for a critical thinking course in ADN curriculum. A project was created for a 9-week critical thinking course, incorporating theory, clinical practice, and simulation exercises. Social change is expected to occur when student nurses are able to critically think upon graduation, resulting in positive patient outcomes, both of which will benefit patients, their families, and their communities.

In establishing the core of his psychotherapeutic perspective, Eugene Gendlin constantly refers to the natural sciences in general terms and the behavioural sciences in particular terms, stressing their limitations in addressing human foundations of subjective experience. He argues, for instance, that science does not have concepts or methodologies to properly address the process of bodily felt experiencing. He argues that science is based on the empirical testing of logical statements, and that these impose an artificial order on the natural concretely felt human experience, as if everything was reducible to mathematical formulas. This paper examines Gendlin's arguments on the matter in some detail focusing on Gendlin's 1962 book (Experiencing and the creation of meaning) and 1991 book chapter (Thinking beyond patterns: Body, language, and situations), which contain his main arguments. Gendlin's reference to Logical positivism in his characterization of the ways of science is presented and critically examined. Gendlin's claims to a phenomenological perspective is also presented and critically examined. It is concluded that (1) Gendlin overlooked the possibility that the debate over what science is might not be resolved with the proposals of Logical positivism, (2) that, consequently, he overlooked the possibility that more recent views of what science is might satisfactorily address some or all of the difficulties raised by his possibly outdated view, and (3) that his phenomenology was idiosyncratic rather than profoundly rooted in the philosophical tradition. Popperian Critical Rationalism, as a philosophy of science. is shown to resolve some of the major difficulties noted by Gendlin, and the limitations of this more recent epistemological perspective vis-a-vis the understanding of the conscious flow of human experience are discussed.

Critical reflection as a learning tool for nursing supervisors is a complex and multifaceted process not completely understood by healthcare leadership, specifically nurse supervisors. Despite a multitude of research studies on critical reflection, there remains a gap in the literature regarding the perceptions of the individual, the support required in the environment, and stimulus needed to integrate critical reflection into the nurse supervisor role. The purpose of this qualitative hermeneutic phenomenological study was to explore the meaning critical reflection has for nurse supervisors and the role of critical reflection within clinical practice settings. The data obtained through a modified vanKaam analysis employing NVivo 9 software revealed five themes concerning critical reflection. These five themes include (a) personal experience, (b) sources of valuing critical reflection, (c) self-awareness as primary competency, (d) time is a function of prioritization and (e) framework tools for workplace integration. Critical reflection meaning developed through nurse supervisors’ past experiences with critical incidents and a willingness to develop their own self-awareness. The role critical reflection plays in the environment can be enhanced through making it a priority in the workplace and providing training necessary to increase understanding of the process. Workplace integration requires developing nurse supervisors’ facilitation skills. The study findings support the underlying value critical reflection holds as a significant part of supporting organizational transformation toward a learning organization culture.

Critical reflection is increasingly regarded as a necessary requirement of professional practice. Yet there are many differing perspectives on what it is, and how it should be taught in professional education, and it is not easy to see how they all relate. This is often confusing for students and educators. This potentially leads to poor standards of reflection, and little rigorous research or development of critical reflection. This thesis aims to address this problem by developing an integrated understanding of critical reflection. It draws together the different perspectives on critical reflection (including reflective practice, the concept of reflexivity, postmodernism and critical perspectives), and shows how these different understandings can be integrated under the rubric of learning from experience. Although the idea of learning from experience in fact underpins early understandings of critical reflection, this thesis demonstrates how later formulations add to and develop this conception. In doing this, the thesis traces the practical and theoretical development of critical reflection into a framework which might be used as a basis for researching professional practice experience. The thesis begins with an introduction which outlines the context of my thinking about social work knowledge, in which my thinking about critical reflection is located. The body of the thesis traces how I have developed these frameworks, from a mix of practical experience, theorizing from different perspectives, and reviews of literature, into the potential for its use as a research method. The concluding section of the thesis returns to the original outline of social work knowledge, and shows how this integrated understanding of critical reflection is also congruent with basic principles of social work. In this sense, the development of thinking about critical reflection is also a contribution to the development of social work knowledge.

South African International Relations (IR) is a prominent source of China-Africa research and analysis, producing reports, journal articles and books that seek to illuminate the emerging relationship between China and Africa. It plays an important role in the framing of the relationship, as well as how it is perceived outside of the discipline. However, critical concerns have been raised about the context within which South African IR operates. It is therefore important that IR research, including its assumptions, dominant concepts, professed values and aspirations to studying the China-Africa relationship, be critically examined. The aim of this thesis is to contribute to critical thinking in South African IR by opening up for future discussion the new directions and possibilities for China-Africa IR. Utilising a critique located in Critical International Relations Theory (CIRT), this thesis critically reflects upon both the context of South African IR’s China-Africa research and the perspectives it has produced. The thesis argues that in spite of many descriptive and empirical studies, China- Africa research is theoretically underdeveloped in South African IR. Further, it argues that theoretical work is marginalised despite the fact that both historical and contemporary research relies on concepts drawn from IR theory. South African IR’s focus on policy relevance is advanced as a reason for the prevalence of theoretical underdevelopment. This thesis concludes by reviewing arguments for the improved use of IR theory in China-Africa IR, which will lead to a better understanding of this important relationship.

Formative periods represent early phases in life when we are particularly sensitive to experiences that influence later choices. This investigation hypothesised that the design of products associated with formative periods continues to influence preference throughout life. In design for an ageing population these preferences are important because designers often wrongly assume a decline in interest in design and physical ability. If these assumptions are prioritised there can be a detrimental effect on the visual sensitivity and emotional value products convey. In the United Kingdom a significant proportion of the ageing population is financially independent, physically healthy and resistant to traditionally negative associations of ageing. However, limited interrogation of the design process, or of the products produced, leaves a largely youth orientated design industry ill- equipped to challenge these associations and design for consumers whose experiences differ from their own. This investigation interviewed leading design professionals to test these assumptions and to inform an innovative questionnaire to identify visual preference. The questionnaire incorporated images of domestic products from 1930 to 1990 and asked for rapid responses reflecting intuitive preferences. A fifty five percent , response rate was achieved from 5,000 questionnaires posted to respondents aged fifty to seventy five years. Analysis of the findings identified two associations. Firstly, a statistically small association between age and visual preference, older respondents preferred older products, although the association was marginal and insufficient to support the hypothesis. Secondly, visual analysis revealed a strong preference for the most familiar form of the product, proposed as representing the 'contemporary essence'. These findings challenge assumptions that ageing is accompanied by a decline in design interest. Rather, the economic and social cost of establishing a design environment reduces the flexibility of future choices. These issues are age neutral. To address these issues, a critically reflective design approach is proposed as a positive response to an ageing population in an inclusive society.