Dissertations / Theses on the topic 'Professional care values'

Magister Artium (Social Work) - MA(SW)
Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.

Thesis (MPhil)--Stellenbosch University, 2001.
ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system.
AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

This thesis explores Greek social work students' perceptions of the development of their professional values and ethics in the workplace during their professional practice placement. To accomplish its goals, the thesis includes a literature review and employs a qualitative exploratory research design with descriptive elements positioned within the constructivist paradigm. This research design allows the researcher to explore and describe a topic - social work values and ethics - that is generally under-researched in the existing literature, as well as being complex in nature and difficult to study. Data were collected using the critical incident technique (CIT). This method took the form of a written questionnaire (the CIT questionnaire) completed by 32 students between 11th and 25th October, 2010. The data were inductively analysed using both qualitative and quantitative approaches. SPSS and SPAD software packages were also used to analyse the numerical and textual data respectively. The study findings underline the vital role of the workplace as a social space for students to learn and develop their professional social work values and ethics. They also highlight the complexity of implementing social work values and ethics in the different workplace environments that students, as trainees, are placed for their professional practice due to their situation-specific nature. Further, the study reveals a number of factors that, from the students' point of view, are important in applying and upholding professional ethical standards in social work practice. These factors are associated with: a) the need to practice social work values and ethics in the workplace on a daily basis in order to keep them alive and active; b) the students' own contribution to upholding ethical standards; c) the role practice instructors/supervisors play in the transmission of social work values to students during their placements; d) the importance of ethical collaboration inside and outside the workplace to achieve the best practices for clients; e) the client's behaviour as a determinant of the ethical practice of social workers in the workplace; and f) the importance of the ethics of management (including the political affiliation of the heads of organisations) in creating and sustaining an ethical work/learning environment. The study suggests that all the factors mentioned above-to a greater or lesser degree- should be considered important elements to take into account in the planning and development of values-based social work education programmes. Special attention should be paid to workplace conditions that can hinder or support the development of values-based social work practice. As the study clearly shows, daily ethical practice in social work, students as individuals, the role of practice instructors, ethical workplace collaboration, client behaviour, and the ethics of management are crucial components for building upon the ethical skills taught in the classroom and developing ethically informed professional identities in real-life workplace situations. The thesis concludes that the critical incidents experienced by students are a valuable source of knowledge and understanding of the development of social work values and ethics in professional practice. In this study, indeed, students gained valuable insights into their ethics development process in practice contexts, from both positive and negative critical incidents alike.

Face aux mouvements actuels dits de « désinstitutionalisation » et en référence aux propositions de nombreux auteurs faisant état de la faillite des métacadres et du mal-être contemporain, cette thèse se veut une étude et une exploration de ce qui persiste et survit de l'institution au quotidien dans les établissements du soin et du travail social. À partir de la clinique des pouponnières à caractère social, considérées comme des analyseurs potentiels et pertinents, nous avons proposé dans ce travail trois visions différentes mais complémentaires de l'institution et de ce qui fait institution en et pour chacun, collectivement et individuellement. Nous proposons ainsi de penser : - L'institution-environnement - L'institution comme un groupe - L'institution et les valeurs instituantes. Dans chacune de ces déclinaisons, nous avons travaillé les articulations à l’œuvre entre les sujets et les groupes, les réalités matérielles et psychiques, les imaginaires individuels et collectifs, etc. Nous avons également tenté de proposer des dépassements de certaines oppositions conceptuelles afin de promouvoir une pensée des articulations et maintenir un raisonnement processuel. À partir d'une épistémologie principale basée sur la psychanalyse des groupes, des familles et des institutions, nous nous sommes inscrit dans une recherche clinique qualitative intégrant et analysant les implications du chercheur à/dans ses terrains d'étude. Le recueil de données a été réalisé au sein de deux pouponnières durant une période de 3 mois pour chacune, avec une présence effective de deux jours par semaine minimum. Pour chacun de ces terrains d'étude, un dispositif méthodologique original a été conçu pour allier différentes sources de données (observation participante du quotidien institutionnel, observation des pratiques professionnelles dans les unités de vie, observation des réunions institutionnelles, entretiens individuels semi-directifs avec les professionnels des différents corps de métiers, lecture et analyse de documents institutionnels). La démarche de recherche a également bénéficié des apports d'une supervision individuelle afin de dégager et d'utiliser les ressentis, attitudes et contre-attitudes du chercheur au profit du recueil et de l'analyse des données. Parallèlement aux deux terrains d'étude, cette thèse a été réalisée dans le cadre d'une Convention Industrielle de Formation par la REcherche (CIFRE) avec l'Observatoire National de la Protection de l'Enfance (ONPE, anciennement Oned). À partir de l'analyse de scènes et pratiques quotidiennes, les résultats de ce travail se veulent à la fois des apports complémentaires aux théorisations et conceptualisations déjà existantes, ainsi qu'aux pratiques de terrain déjà à l’œuvre. Si elles sont résolument ancrées dans le champ spécifique des terrains d'étude (les pouponnières et la protection de l'enfance), nous pensons toutefois que les propositions peuvent éclairer aussi avec pertinence l'ensemble des secteurs médico-sociaux
Faced with current movements known as "deinstitutionalization" and in reference to the proposals of many authors on the failure of "metaframes" and contemporary disorder, this thesis is a study and an exploration of what persists and survives the institution in everyday life in care and social work institutions. Base on the example of institutionalized Foster Care on Babies (nursery), considered as potential and relevant analyzers, we have proposed in this study three different but complementary visions of the institution and of what makes it in and for each one collectively and individually. We propose to think: - The institution-environment - The institution as a group - Institution and institutional values. In each of these variations, we have worked the articulations between subjects and groups, material and psychic realities, individual and collective imaginaries, etc. We have also tried to propose the overtaking of conceptual oppositions in order to promote a reflection upon the articulations and maintain a dialectical reasoning. Starting from a main epistemology based on groups, families and institutions psychoanalysis, we entered into a qualitative clinical research integrating and analyzing the implications of the researcher to/in his study fields. The data collection was carried out in two nurseries during a period of 3 months for each, with an effective presence of two days per week minimum. For each of these fields of study, an original methodological device was designed to combine different sources of data (participative observation of the daily institutional, observation of professional practices in the units of life, observation of institutional meetings, semi-structured individual interviews with professionals from different trades, reading and analysis of institutional documents). The research approach also benefited from the contributions of individual supervision in order to identify and use the researcher's feelings, behaviors and counter- behaviors in order of collecting and analyzing data. In parallel to the two fields of study, this thesis was carried out within the framework of an Industrial Convention of Training by Research (CIFRE) with the National Observatory for the Protection of Childhood (ONPE, formerly Oned). From the analysis of everyday scenes and practices, the results of this work are intended to be complementary contributions to the existing theorizations and conceptualizations, as well as to the field practices already at work. If they are firmly rooted in the specific field of study areas (nurseries and child protection), we believe, however, that the proposals can also shed light on all the medico-social fields

The statutory requirement for staff supervision, as set out in the revised Early Years Foundation Stage (2012), does not stipulate a specific model to be followed. This leaves early years settings with a wide range of theories and models with which to consult. The literature suggests that the term ‘supervision’ can have different meanings for different professional groups. The aim of this study was to gain an understanding of what early years educators and carers would value in their supervision. A research methodology was sought which minimised the potential for researcher bias and maximised the opportunity for early years workers to give their personal view. Q methodology was employed to explore how 30 early years workers ranked statements of potential features of supervision. The Q set of 54 statements was developed through a focus group with early years staff and consultation with supervision literature. The participants were asked to sort statements from ‘most disagree’ (aspect I would least value) to ‘most agree’ (aspect I would value highly). The majority of participants in this study were not receiving supervision at the time of the research. Factor analysis was used to identify viewpoints which were common to a group of participants. In the results section each of the three emerging viewpoints are presented as a Q sort arrangement and also a written description produced by interpreting the factor analysis results using factor arrays and ‘crib sheets’. The emergent viewpoints are discussed along with the implications for early years settings and other professionals supporting early education. The role of the Educational Psychologist in working systemically with early years settings will also be considered in light of the findings.

Thesis (MPhil)--Stellenbosch University, 2000.
Some digitised pages may appear illegible due to the condition of the original hard copy.
ENGLISH ABSTRACT: Medicine in our country is under severe stress, brought about by internal and external forces that need a response from the medical profession. The profession's attempts and response will fall short unless the profession itself is aligned with the new social ethos and the responses are based on the profession's inherent values. Problem Statement: Medical doctors have always been highly valued in society because of the duty they have when illness and disease set in. As individuals, doctors have fulfilled other important roles in the communities where they work. These include giving advice to young people on career choices, counseling on various matters and provision of material help where there is need. This profession has for a long time been shrouded in mystery, being a trade learnt by a few. All these factors contributed to their social standing increasing phenomenally. There is a view that this has also led to public perceptions that doctors are the rich untouchable elite who have no interest or are unconcerned about problems faced by society. The medical profession faces a challenge that is more significant because of the value placed on it by society. The numerous submissions by the victims of human rights abuses to the Truth and Reconciliation Commission have cast a shadow of doubt on the medical profession for its complicity in these acts. The present government has declared transformation of health care as one of its top priorities. The response of the medical profession to this initiative has so far not led to any significant changes of public perception that the profession is unwilling to participate in the transformation of our society. The challenge and subject of discussion in this thesis therefore is: "What is the ideal role of the medical profession in a transforming South African society?" The medical profession, being the nerve centre of health care, has a big responsibility in social transformation. Doctors stand accused as a collective for failing to protect the human rights of patients and not living up to the standards of ethics required of them when patients' rights were violated. The Truth and Reconciliation Commission record of the hearings into the role of the professional organisations in health is used in this thesis to illustrate how serious society views the medical profession's role in the human rights abuses of the past. Based on the T. R. C's report and the assumption that society traditionally places high value on the medical profession, I conducted a survey among South African doctors to test their attitudes towards a range of policy and transformational issues. The unit of analysis was the medical doctors who are in active practice in South Africa in whatever mode of practice. The survey sought to explore the awareness of the respondents about a range of transformation policy changes and invite their comments on the role that they envisage for the medical profession in the process of transformation of society. There is unfortunately scarcity or a lack of applicable South African literature on this topic thus limiting local material for referencing. The search of international literature only yielded the subject of the study of professional values and not necessarily the role of a medical profession in a transforming society. The medical profession has to re-visit its foundations, analyse its history and map out its future in the context of the South African realities. It must find a way of aligning itself with the new ethos and diverse cultures South Africa possesses. Medicine has its own traditional goals and values derived and adapted from society's diverse cultural value systems. With its national and international networks, the inherent knowledge and skills that it possesses, guided by an ethical code, the Hippocratic Oath that serves as a public promise, it influences policy on the country's health care system - a mechanism that government uses to provide a basic human need. The medical profession therefore has to be responsive to the needs of society as much as society needs to support the profession. This thesis explores the role that the profession should play in a transforming South African society. The argument is that this can only be done through the profession examining its values and aligning itself with broader societal value systems, the moral and social norms. It is further argued that visible realistic commitment by the profession to public health will lead to an improvement in its public image. It is the actions or non-actions of the majority that the public notices. The majority of respondents to the survey have indicated that they approve of the transformation policies in health but that they may differ in the way they were introduced.
AFRIKAANSE OPSOMMING: Die geneeskunde in ons land is onder geweldige druk as gevolg van interne en eksterne faktore en dit is nodig dat die mediese beroep reageer. Dit sal die beroep egter nie help om te reageer indien sy lede hulle nie met die nuwe maatskaplike etos vereenselwig nie en die reaksie op die inherente waardes van die mediese beroep geskoei word nie. Probleemstelling Mediese dokters is nog altyd baie hoog geag deur die gemeenskap as gevolg van die verpligting wat hulle het om na mense om te sien wanneer hulle siek word. In hulle individuele hoedanigheid het dokters ook ander belangrike bydraes tot hulle gemeenskappe gelewer. Dit sluit in: advies aan jong mense oor loopbaankeuses, berading en die verskaffing van finansiele hulp waar nodig. Die beroep as sulks was egter vir baie lank ietwat van 'n misterie omdat dit 'n vakrigting is waarin baie min mense hulle kon bekwaam. Al hierdie faktore het die maatskaplike aansien/waarde van dokters geweldig verhoog. Daar is ook diegene wat van mening is dat hierdie faktore aanleiding gegee het tot die openbare mening dat dokters 'n ryk en onaantasbare elite is en glad nie in die probleme van die gemeenskap belangstel nie. Die etlike voorleggings deur die slagoffers van menseregtevergrype aan die Waarheids- en Versoeningskommissie het ook vrae rondom die beroep se betrokkenheid by sodanige gevalle laat ontstaan. Die huidige regering het die transformasie van gesondheidsorg as een van sy grootste prioriteite verklaar. Die reaksie van die beroep hierop het tot dusver nie tot enige noemenswaardige veranderinge in die openbare mening dat dokters nie bereid is om aan die transformasie van ons gemeenskap deel te neem gelei nie. Wat is die ideale rol van die mediese beroep in die transformasie van die Suid- Afrikaanse gemeenskap? As die senusentrum van gesondheidsorg het die mediese beroep 'n groot verantwoordelikheid in maatskaplike transformasie. Dokters word kollektief beskuldig dat hulle nagelaat het om die menseregte van pasiente te beskerm en nie voldoen het aan die nodige etiese standaarde wat van hulle verwag word in die tyd toe pasienteregte geskend is nie. Die rekord van die verhore van die Waarheids- en Versoeningskommissie oor die rol van professionele gesondheidsorganisasies is vir die doeleindes van hierdie tesis gebruik om te illustreer hoe ernstig die gemeenskap voeloor die mediese beroep se rol in die menseregte vergrype van die verlede. Gegrond op die WVK-verslag en die aanname dat die gemeenskap die mediese beroep hoog ag, het ek 'n meningsopname onder 300 Suid-Afrikaanse dokters gedoen om hulle houding jeens 'n aantal beleids- en transformasiekwessies te toets. Die eenheid van analise was mediese dokters wat in die aktiewe praktyk staan, ongeag hulle praktykgebied. Die opname het gepoog om te bepaal wat die vlak van bewustheid by die respondente oor 'n aantal beleidsveranderinge gerig op transformasie is, en hulle uit te nooi om kommentaar te lewer op die rol wat hulle meen die mediese beroep behoort in die proses te speel. Ongelukkig is daar nie toepaslike Suid-Afrikaanse literatuur oor die onderwerp beskikbaar me. 'n Internasionale literatuursoektog het net studies rondom waardes opgelewer, en nie oor die rol van 'n mediese beroep in die transformasie van 'n gemeenskap nie. Die mediese beroep moet die grondslag van sy wese in oenskou neem, die geskiedenis analiseer en sy toekoms in die konteks van die Suid-Afrikaanse realiteite uitstippel. Die beroep moet 'n manier vind om homself met die nuwe etos en uiteenlopende kulture van Suid-Afrika te vereenselwig. Die geneeskunde het sy eie tradisionele doelwitte en waardes gekry en aangepas vanuit die uiteenlopende kulturele waardestelsels van die gemeenskap. Deur middel van sy nasionale en internasionale netwerke, inherente kennis en vaardighede, die leiding van 'n etiese kode, die Eed van Hippokrates wat as 'n belofte aan die publiek dien, beinvloed die mediese beroep die land se gesondheidsorgstelsel - 'n meganisme van die regering om in 'n basiese menslike behoefte te voorsien. Die mediese beroep moet daarom ingestel wees op die behoeftes van die gemeenskap in dieselfde mate as wat die gemeenskap die beroep behoort te ondersteun. Hierdie tesis ondersoek die rol wat die mediese beroep behoort te vervul in 'n Suid-Afrikaanse gemeenskap waar transformasie besig is om plaas te vind. Daar word geargumenteer dat dit net gedoen kan word indien die beroep sy waardes ondersoek en hom met die breer maatskaplike waardestelsels vereenselwig. Daar word verder geargumenteer dat 'n sigbare realistiese verbintenis van die mediese beroep tot openbare gesondheid tot die verbetering van sy openbare beeld sal lei. Dit is die optrede of nie-optrede van die meerderheid wat die publiek raaksien. Die meerderheid respondente in die meningsopname het aangedui dat hulle die transformasiebeleid vir gesondheid ondersteun, maar dat hulle verskil van die wyse waarop dit in werking gestel is.

The field of mediation has emerged as one of the premier tools in the peacemaking process. While mediation has grown in popularity and become widely accepted in the judicial court system and corporate America, very few studies have focused on how mediators are impacted by the conflict resolution process. Moreover, few studies have focused on the role of spiritual self-care on the mediator. This research study explored how mediators who identify as spiritual integrate their spirituality in their own self-care practice. In order for mediation to continue as one of the most important tools in the peacemaking process, mediators of today and the future must have effective and beneficial self-care practices to perform professionally at a high level. This study utilized transcendental phenomenology to capture the lived experiences of 11 conflict professionals who incorporate spirituality into their self-care practices. Semi-structured interviews were conducted to explore how they practiced self-care and the essence of what spiritual self-care entailed. The major themes identified in this study were: (a) mediators spiritual practices were used as tools for preparation and protection in conflict work, (b) spiritual practices invoked deep and meaningful feelings of connectedness, and (c) that spiritually identifying mediators began to embody the same practices they used. Essentially, spiritual self-care was vital to being effective in their professional lives. Mediators were able to offer deep value to their clients through their spirituality and simultaneously found deep value in their spiritual self-care practices. The research was significant, as it allowed for a deeper understanding of conflict practitioners and could benefit the personal and professional growth of the mediation field.

La gestion de cas est une pratique professionnelle qui s'implante actuellement en France, en particulier dans le domaine des soins aux personnes âgées en perte d'autonomie. Les " gestionnaires de cas " interviennent auprès de personnes âgées vivant à domicile dont la situation est jugée particulièrement complexe sur le plan médical et social. Ils ont pour mission d'évaluer les besoins des personnes suivies, de mettre en place les soins et les aides nécessaires, et d'assurer un suivi à long terme. Ils participent au processus d'intégration de l'organisation des soins en identifiant les dysfonctionnements au niveau de leur territoire, dans le cadre du " dispositif MAIA ". L'apparition de cette nouvelle pratique professionnelle soulève des enjeux éthiques spécifiques, du fait du positionnement particulier des gestionnaires de cas vis-à-vis des personnes accompagnées et de leur rôle nouveau dans le système de soins. L'objectif de ce travail est de proposer un cadre cohérent pour penser l'éthique de la gestion de cas, à partir de l'analyse des valeurs, des attitudes et des pratiques des gestionnaires de cas. Notre approche méthodologique s'appuie sur une recherche qualitative permettant un dialogue permanent entre faits observés et constructions théoriques, selon les principes de l'éthique empirique intégrée. Notre recueil de données comprend des entretiens approfondis avec des gestionnaires de cas, des entretiens semi-structurés avec les " pilotes " qui les encadrent, des groupes de discussions et un questionnaire écrit. L'étude française est complétée par une étude de cas visant à évaluer les conséquences sur l'éthique des professionnels d'un contexte organisationnel différent, à partir de groupes de discussion réalisés au Québec (Sherbrooke) et en Allemagne (Greifswald). L'analyse des données nous a amené à reconnaitre l'individualisation de la relation comme une valeur phare de la gestion de cas. L'engagement des professionnels dans une relation soignante leur permet de faire face aux conflits de valeurs que crée leur double mission de protéger des personnes vulnérables et de respecter leurs choix. Les gestionnaires de cas s'appuient en effet sur cette relation pour négocier avec la personne accompagnée un projet de soin qui fasse sens dans son histoire de vie. Cette individualisation de la relation entre en tension avec la nécessaire à une organisation du système de soins juste et efficiente. Le développement d'une éthique professionnelle spécifique à la gestion de cas nécessite donc de penser conjointement le rôle clinique du gestionnaire de cas, vis-à-vis des personnes accompagnés, et son rôle institutionnel. L'équilibre entre ces deux rôles est à construire dans le cadre d'une éthique organisationnelle, compatible avec l'éthique des professionnels et garante des droits des personnes accompagnées, propre à chaque système de santé.

The phrase fit and proper is used in the Health Practitioners Regulation National Law Act (Qld), 2009, which came into effect nationally in 2010 and governs psychologists. As with previous legislation that used the phrase, the legislator does not define fit and proper, leaving it up to each profession to determine its exact meaning and inform the courts accordingly. A review of the literature established that to date no Australian psychologist has attempted to define the construct. This means that Australian lawyers do not get any guidance from psychologists regarding how they should interpret the phrase fit and proper in relation to psychologists. Ideally, however, the beliefs of psychologists as a group should inform any definition of what constitutes a fit and proper psychologist. In the absence of such research, the purpose of this study was to determine Australian psychologists’ understanding of the construct. During Stage One, semi-structured interviews with 16 Western Australian psychologists explored what they considered constituted a fit and proper psychologist. Using a grounded theory approach, the data analysis revealed 2 superordinate components to fitness and propriety. Participants believed that a fit and proper psychologist had 11 person features. These person features could be split into 3 categories, namely capability, character, and conduct. The second component, termed system issues contained the categories of selection and screening, monitoring, regulation, and prevention and remediation. The aim with Stage Two was to determine whether other Australian psychologists agreed that the 11 person features described a fit and proper psychologist, and if they did, how they ranked them. A cognitive interviewing strategy was employed to add rigour to the design of a questionnaire and to provide confirmation of the person features constructed from the Stage One interviews. The cognitive interview process established that 2 of the original 11 person features were too broad. As a result, both of these features were split into two, giving a total of thirteen person features that were included in the questionnaire. A representative sample of 226 Australian psychologists completed the questionnaire that collected both qualitative and quantitative data. Participants classified 8 features as critically important and 5 as important features of a fit and proper psychologist, with self-awareness ranked as the most important feature. An analysis of the qualitative data revealed a third superordinate component, termed moderators. Moderators, such as impact on practice, alter each person feature from a black and white concept to a nuanced and more complex one. Moderators build flexibility into the person features and allow for the role of each in fitness and propriety to alter according to a psychologist’s life stage and circumstance. Australian psychologists believe that a fit and proper psychologist exists in a professional system comprising psychologists themselves and bodies that perform a variety of functions related to the establishment, development, and regulation of standards in the profession. A fit and proper psychologist possesses 13 key person features that can be maintained because of moderating factors. This understanding has implications for psychologists, service users, regulators, and the judiciary.

L’amélioration du raisonnement clinique (RC) est un enjeu essentiel pour la Médecine de demain car il est établi que son utilisation imparfaite conduit à des résultats de soins insuffisants. Le RC est un processus cognitif complexe. Cette activité intellectuelle synthétise l’information obtenue à partir de la situation clinique et l’utilise pour faire une analyse diagnostique et prendre une décision de prise en charge du patient en intégrant les connaissances et expériences antérieures. La formation à cette compétence est donc essentielle. Pour améliorer le raisonnement, une connaissance des mécanismes qui le constituent est nécessaire et une revue de ces mécanismes constitue la partie initiale de cette thèse.La formation des professionnels de santé par la simulation se généralise avec pour objectif « jamais la première fois sur le patient ». En plein essor, le jeu sérieux (JS) représente un outil pédagogique intéressant. Une revue de la littérature sur l’efficacité des JS et plus particulièrement dans le cadre du RC est également incluse dans la partie initiale de cette thèse. Ainsi, les JS sont efficaces et peuvent, entre autres, cibler certaines compétences dont le RC. Cependant, la plupart des études sur le RC dans le cadre des JS, restent subjectives avec des évaluations qualitatives ou des autoévaluations des apprenants ou concernent uniquement le résultat (prise de décision). Par conséquent, la valeur éducative et les modalités des JS dans la formation du RC restent à approfondir.Le JS LabForGames Warning a été développé dans le centre de simulation LabForSIMS pour les étudiants infirmiers et cible la détection de l’aggravation d’un patient et la communication. Cette thèse a pour objectif de tester un mode d’apprentissage utilisant la simulation par les JS afin d’améliorer le RC chez les professionnels de santé.Une 1ère étude a évalué la validité du JS LabForGames Warning selon le cadre théorique proposé par Messick. Elle a démontré que les scores et le temps de jeu ne pouvaient pas différencier le niveau des compétences cliniques des infirmiers.Cependant, les preuves de validité étaient obtenues pour le contenu, le processus de réponse et la structure interne. Même si cette version du jeu ne peut donc pas être utilisée pour une évaluation sommative des étudiants, notre étude montre que ce JS est bien accepté par les étudiants et qu’il peut être utilisé pour la formation au sein d’un programme éducatif.Une seconde étude a évalué l’efficacité de 2 modalités pédagogiques sur l’apprentissage du RC à la détection de l’aggravation clinique d’un patient en comparant un groupe d’étudiants infirmiers formé par simulation avec LabForGames Warning par rapport à un groupe formé par un enseignement traditionnel. Le RC a été évalué par les tests de concordance de script immédiatement et 1 mois après. Cette étude multicentrique randomisée a inclus 146 étudiants infirmiers volontaires. Aucune différence significative n’a été observée sur le RC entre la formation par la simulation avec JS et l’enseignement traditionnel. Cependant, la satisfaction et la motivation étaient meilleures avec l’enseignement par simulation.En conclusion, nous avons tout d’abord confirmé la validité du JS LabForGames Warning en tant qu’outil pédagogique à visée formative et non sommative. Puis, bien qu’aucune différence d’apprentissage du RC n’ait été observée entre la formation par la simulation avec JS et l’enseignement traditionnel, la satisfaction et la motivation étaient meilleures avec l’enseignement par simulation avec le jeu. Les études sont à poursuivre pour préciser les modalités et stratégies pédagogiques des JS dans la formation des professionnels de santé, comme par exemple la place du débriefing, le rôle de la motivation. En effet, en plein essor, les développements technologiques telle que l’intelligence artificielle vont transformer la formation au RC ainsi que les outils pédagogiques disponibles dans les années à venir
Improvement of clinical reasoning (CR) is a key issue for the future of medicine because it has been established that imperfect reasoning leads to insufficient care results. CR is a complex cognitive process which synthesizes information obtained from the clinical situation, then uses it to make a diagnostic analysis and take a decision on patient management by integrating previous knowledge and experience. Training for this skill is therefore essential. To improve reasoning, knowledge of the mechanisms which build it up is necessary and a review of these mechanisms constitutes the initial part of this thesis.Training of healthcare professionals through simulation is becoming widespread with the objective of "never the first time on a patient". In rapid expansion, the use of serious games (SG) represents an interesting pedagogical tool. A review of the literature on the effectiveness of SG and more particularly in the context of CR is also included in the initial part of this thesis. Thus, SG is effective and may, among other things, target certain skills, including CR. However, most studies dealing with CR by using SG include qualitative assessments or self-assessments of learners or focus only on the outcome (decision making). Therefore, the educational value and modalities of SG in the training of CR of health professionals remain to be further explored.The SG LabForGames Warning was developed in the LabForSIMS simulation center for nursing students and targets detection of patient deterioration and the ensuing communication. The objective of this thesis is to test a learning mode using SG simulation in order to improve CR in healthcare professionals.The first study evaluated the validity of the SG LabForGames Warning according to the Messick’s Framework. This study showed that scores and playing time could not differentiate the level of clinical skills of nurses. However, evidence of validity was obtained for content, response process and internal structure. Although this version of the game cannot therefore be used for summative evaluation of students, our study shows that this SG is well accepted by students and can be used for training within an educational program.A second study evaluated the effectiveness of 2 teaching modalities on learning CR for the detection of clinical patient deterioration by comparing a group of nursing students trained by simulation with LabForGames Warning compared to a group trained by traditional teaching. CR was assessed by script concordance tests immediately and 1 month later. This randomized multicenter study included 146 volunteer nursing students. No significant difference was observed in CR change between simulation training with SG and traditional teaching. However, satisfaction and motivation were better with simulation instruction.In conclusion, we have confirmed the validity of SG LabForGames Warning as an educational tool with formative and not summative aims. Then, although no difference in learning about CR was observed between simulation training with SG and traditional teaching, satisfaction and motivation were better with simulation teaching with the game. Further studies are needed to clarify the modalities and pedagogical strategies of SG in the training of healthcare professionals, such as the place of debriefing and the role of motivation. Moreover, technological developments such as artificial intelligence might transform CR training and the available pedagogical tools in the coming years

The purpose of the study was to determine how professional nurses perceive their roles in patient centered care in various units, in three regional hospitals in Mpumalanga Province. The main objectives of this study were to determine * whether the working environment in provincial hospitals is supportive of patient centered care * what factors could hinder the provision of patient centered care * the extent to which patient centered care is provided to patients in provincial hospitals * professional nurses' perception of their role in patient-centered care The researcher used the descriptive exploratory method. A questionnaire with closed and open-ended questions was used to collect data from professional nurses in the three hospitals. Seventy- two (72) respondents returned the completed questionnaires. The findings indicated that the professional nurses perceived patients' and nurses' lack of knowledge as the biggest hindrance to patient centered care. Patients and relatives seemed to be less involved in their own care and the lack of information given to patients by professional nurses subsequently contributed to patients' inability to make
Health Studies
M.A. (Health Studies)

While information systems researchers have argued well from socio-technical and organizational culture perspectives that information technology (IT) and organizational structures are interdependent and continually reshape each other, few studies have sought fine-grained, micro-level explanations for the heterogeneity in IT use often observed across seemingly similar end users and seemingly similar work contexts. Using a nested comparative case study design, I explore electronic medical record (EMR) use by physicians in an integrated multi-specialty health care organization. I use multiple methods to observe and develop micro-level understandings of factors associated with EMR use. The study was conducted in eight practices operating within the same organization. Data collection methods included semi-structured interviews, non-participant observations, and questionnaires. A constant comparative approach guided data analysis. Differences in physician values were noted, as were differences in physician perspectives of uncertainty. I categorized physicians as high, medium and low EMR users depending on a variety of factors including degree to which the EMR was integrated into work practices, degree of feature use, and degree of EMR-enabled communication. Drawing on theories of professionalism, I explain between-physician heterogeneity in EMR use as partly a function of differences in dimensionality of professional values. Three dimensions of professional values were identified 1) profession-oriented, 2) patient-oriented and 3) organization-oriented. Drawing on complexity theory, I argue that differences in physician perspectives of uncertainty influence their EMR use. I found that physicians who viewed uncertainty primarily as reducible through information tended to be higher users of the EMR. Physicians who viewed uncertainty as fundamental, or inherent, in care delivery processes tended to be lower users of the EMR. This study contributes to information systems research by extending current understandings of IT use. The professional values held by physicians and their perspectives of uncertainty may be more important in shaping EMR use than previously thought. These findings indicate the need to more aggressively pursue EMR designs, implementation strategies and policies that accommodate these two additional factors. Additionally, findings from this research indicate a need for IT managers in professional settings to consider end-user professional values and perspectives of uncertainty in decisions involving IT assets.
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Staff who work in front line, direct contact support positions with community based clients with acquired brain injuries (ABI) hold unique responsibilities, and face unique challenges in their work due to the combination of three key factors: autonomous work environments, socially sanctioned power status over clients, and the decision making deficits of clients with ABI. These factors further contribute challenges to staff in the presently complex and ambiguous outreach context, where the embedded ideologies of the medical model of treatment remain in tension with the purported ideologies of the social model of disability and client self determination that drive outreach services. Using constructivist grounded theory methods and narrative and interpretive analysis strategies, this research interviewed fifteen (15) ABI outreach support workers to explore and examine their perceptions of the outreach context, how they negotiate decision spaces, and how they deal with the central ethical dilemma of outreach - achieving balance between their duty of care and the client's dignity of risk. The thesis documents decision making strategies used by the interview participants, examines the factors that influence their decision space when in the field with clients, and explores the role staff awareness of professional and personal values plays in making decisions in the best of interest of the client. Staff awareness is shown to be a critical, yet oft neglected factor in consideration of staff ethical decision making in ABI outreach. Implications for best practices in the field are discussed.
PhD Doctorate

Staff who work in front line, direct contact support positions with community based clients with acquired brain injuries (ABI) hold unique responsibilities, and face unique challenges in their work due to the combination of three key factors: autonomous work environments, socially sanctioned power status over clients, and the decision making deficits of clients with ABI. These factors further contribute challenges to staff in the presently complex and ambiguous outreach context, where the embedded ideologies of the medical model of treatment remain in tension with the purported ideologies of the social model of disability and client self determination that drive outreach services. Using constructivist grounded theory methods and narrative and interpretive analysis strategies, this research interviewed fifteen (15) ABI outreach support workers to explore and examine their perceptions of the outreach context, how they negotiate decision spaces, and how they deal with the central ethical dilemma of outreach - achieving balance between their duty of care and the client's dignity of risk. The thesis documents decision making strategies used by the interview participants, examines the factors that influence their decision space when in the field with clients, and explores the role staff awareness of professional and personal values plays in making decisions in the best of interest of the client. Staff awareness is shown to be a critical, yet oft neglected factor in consideration of staff ethical decision making in ABI outreach. Implications for best practices in the field are discussed.
PhD Doctorate

The study explored the cultural care beliefs, values and attitudes among Shangaans relating to hypertension. The study aimed to describe the cultural values, beliefs and practices such as taboos, rituals and religion within the world view of the Shangaan. The study was undertaken in the Mopani region of the Greater Giyani area, with the purpose of making recommendations on patient care. Data collection was done by conducting focus group and individual interviews. The five themes that emerged were: + Hypertension + The traditional healer: the instrumental role + Traditional medicine versus Western medicine + Magico-religious healings + Experiences of hypertensive patients with regard to traditional healers and hypertension
Health Studies
M. A. (Health Studies)