Marie Carney - Academia.edu (original) (raw)
Papers by Marie Carney
Journal of general practice, Jan 18, 2017
C onsensus management is presented in the context of emerging trends and challenges in health and... more C onsensus management is presented in the context of emerging trends and challenges in health and hospital management. Consensus is viewed differently in organizations. Consensus management approaches used in Australia, Ireland, United Kingdom, United States and New Zealand are explored along with the advantages and disadvantages to using consensus management in healthcare organizations. Carney (2006) designed the 'Consensus Management Model of Healthcare' that incorporates concepts of strategic involvement, commitment to the organization and organizational culture. The model was developed from findings from her study undertaken amongst 860 middle manager health care professionals working in 60 of the 65 acute care hospitals in the Republic of Ireland. She found that a multidisciplinary approach to health care management incorporates managerial, behavioural, professional and organizational dimensions, resulting in professionals being committed to delivering excellent health care in the most effective and efficient way possible. Identification of practical challenges facing management in the education and management of advanced nurse practitioners is explored. Biography Carney completed her PhD studies and MBA degree in University College Dublin (UCD) and is a registered nurse, midwife and nurse teacher and Fellow from the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI). She is Dean Emeritus and Board member of the Faculty of Nursing and Midwifery having held the position of Dean and Chair of the Faculty from 2014 to 2016. She was appointed to University College Dublin in 1994 and held the position of Head of the
drugsandalcohol.ie
Dublin. Her research interests include fatherhood, single parent families, parenting, and immigra... more Dublin. Her research interests include fatherhood, single parent families, parenting, and immigrant families. She is the author of a number of research reports and articles and has recently completed two studies of parenting in Ireland.
Journal of Nursing Management, 2019
Over my career as a nurse, midwife, nurse tutor and academic in two universities in Ireland, duri... more Over my career as a nurse, midwife, nurse tutor and academic in two universities in Ireland, during which time I was appointed head of the school of nursing in University College Dublin where I managed the entry of nursing and midwifery students into academia, in 2001. This heralded a change in nurse teaching from schools of nursing based in hospitals to university education.
Journal of Nursing Management, 2021
PURPOSE This Commentary illustrates how innovative clinical and research initiatives highlight th... more PURPOSE This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 which commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. BACKGROUND Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to Covid-19 and how the global crisis will change and shape the future of healthcare delivery. EVALUATION Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. KEY ISSUES The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. CONCLUSIONS Global leaders and policy makers must seek the knowledge and skills they need to support their work during a global crisis. IMPLICATIONS FOR NURSING MANAGEMENT Achieving population health and equitable access to health care is dependent on an adequate health workforce.
Journal of Nursing Management, 2020
Background: The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties wo... more Background: The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for postgraduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences. The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan, Monaghan and the Rotunda. Combined these hospitals have 120 registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients. The drive to establish the forum between the faculty and the six Dublin hospitals was to build capacity among advanced nurse practitioners and advanced midwife practitioners (ANP/AMPs) who are seen as intelligent consumers of evidence-based research and safe practice. The SCAPE report identified research as the single domain that was underdeveloped within the ANP role, in the study exploring the role of ANPs and CNSs. Latterly, the Nursing and Midwifery Board of Ireland highlighted research as a vital component of the ANP/AMP role in its standards for advanced nurse and midwife practice. The faculty acted collaboratively to introduce an ANP/AMP forum to support advanced practitioners working in the university hospital group in their education and professional development, support the expansion of their knowledge base through practice-based enquiry and research and act as a conduit for interactions between ANPs/AMPs by keeping them up to date with practice and research. Methods: The Initiation phase was undertaken through a survey of needs; Implementation phase by extensive literature review and research-based newsletters sent to individuals by the forum coordinator; and the Evaluation phase through focus groups.
Journal of nursing management, Jan 7, 2015
To explore the regulation of advanced nurse practice internationally and to identify differences ... more To explore the regulation of advanced nurse practice internationally and to identify differences and commonalities. Regulation of advanced practice nursing does not occur in many countries. Ireland is currently in the minority in regulating advanced practice at a national level. Lack of regulation poses difficulties for national governments and for society due to uncertainty in advanced practice concept and role. A literature review of 510 scholarly nursing papers published in CINAHL, PubMed and MEDLINE between 2002 and 2013 and 30 websites was undertaken. There is a lack of consistency in legislative systems internationally. Nursing organisations have recognised advanced nurse practice by regulation in some countries and by voluntary certification in others. Research has demonstrated that care delivered by advanced nurse practitioners has enhanced patient outcomes yet regulation of advanced practice is not undertaken in most countries. Nurse managers need to know that criteria for ...
Seminars for nurse managers, 2002
This article presents a change management model that may be used in the evaluation of the change ... more This article presents a change management model that may be used in the evaluation of the change process. The model may be used to evaluate how well change is being managed or has been managed. The Change Management Model developed by the author aims to provide nurse managers or change agents with a structured and measurable model for managing change, and to allow the change process to be evaluated. A measurement constructs tool also has been developed to further assist the evaluation process. The author argues that certain key variables can be identified that contribute to the successful implementation of change. These include critical success factors for change, communication issues, change dynamics that include resistance or acceptance of change, and the management of the implementation and evaluation stages of the change process.
Nurse Education in Practice, 2014
Background: Undergraduate nursing programmes are designed to equip student nurses with the skills... more Background: Undergraduate nursing programmes are designed to equip student nurses with the skills and knowledge necessary for their future work as professional nurses. Influences on the role during the transition period from student to staff nurse are unclear. Purpose: This paper explores the experience of role transition for newly-qualified nurses from an Irish perspective. Methods: A Heideggerian Hermeneutic approach was the research method adopted. Ten newly qualified nurses from one of Dublin's Academic Teaching Hospitals were interviewed. Data were analysed using Van Manen's thematic analysis. Influences on the transition period were explored in the context of Chick and Meleis's Transition Concept. Findings: Newly-qualified nurses initially felt excited upon qualification. However, professional responsibility and accountability associated with the new role were overwhelming for participants. They felt frustrated when they didn't receive adequate support during transition. Conclusion: Newly-qualified nurses need support while they incorporate their knowledge into clinical practice. Hidden influences should as education levels and scope of practice should be considered before nurse educators begin to develop education programmes for undergraduate nurses.
Nursing and Health Sciences, 2004
There is increasing emphasis on interdisciplinary involvement by health care managers. The object... more There is increasing emphasis on interdisciplinary involvement by health care managers. The objective of the present paper was to identify the level of involvement that middle manager heads of department have in strategy development in acute care hospitals in Ireland, and to identify if professional clinicians were more involved than non-clinicians. Twenty-five interviews were undertaken. Findings indicated that middle managers were strategically involved and that non-clinicians perceived that they were more involved in strategy development than professional clinicians. Strategic involvement appeared to result from a higher level of strategic awareness and confidence by non-clinicians in the process. Professional clinicians perceived that their expertize was not recognized or appreciated by non-clinicians or by senior management. Agreement of strategy amongst both groups is critical, as exclusion will lead to demotivation and consequent deterioration in health care delivery.
Journal of Nursing Management, 2006
Literature review Quinn (1995: 5) defines strategy as 'the pattern or plan that integrates an org... more Literature review Quinn (1995: 5) defines strategy as 'the pattern or plan that integrates an organization's major goals, policies and action sequences into a cohesive whole'. Strategic planning, an essential part of strategy development, is an ongoing decision-making process, the purpose of which is to specify the ideals, goals and objectives required by the organization in the future (Quinn 1995). A critical component of the strategic-planning process is the generation and formulation of strategic
Journal of Nursing Management, 2009
Public health nurses perception of clinical leadership in Ireland: narrative descriptions Aim The... more Public health nurses perception of clinical leadership in Ireland: narrative descriptions Aim The aim of the study was to identify how clinical leadership skills are perceived by Public Health NursesÕ in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. Background Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. Method Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. Results Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. Conclusions Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. Relevance to nurse managers Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.
Journal of Nursing Management, 2009
Journal of Nursing Management, 2007
Literature review The role of the clinician or non-clinician head of department is a key role in ... more Literature review The role of the clinician or non-clinician head of department is a key role in health service delivery (Carney 2004a). Currie (1999) identifies the positive influence of middle managers in the business planning process. Harrison and Miller (1999) argue that clinicians, including nurse managers, are embracing new
Journal of Nursing Management, 2009
Journal of Nursing Management, 2009
To provide a synthesis of literature on international policy concerning professional regulation i... more To provide a synthesis of literature on international policy concerning professional regulation in nursing and midwifery, with reference to routes of entry into training and pathways to licensure. Internationally, there is evidence of multiple points of entry into initial training, multiple divisions of the professional register and multiple pathways to licensure. Policy documents and commentary articles concerned with models of initial training and pathways to licensure were reviewed. Item selection, quality appraisal and data extraction were undertaken and documentary analysis was performed on all retrieved texts. Case studies of five Western countries indicate no single uniform system of routes of entry into initial training and no overall consensus regarding the optimal model of initial training. Multiple regulatory systems, with multiple routes of entry into initial training and multiple pathways to licensure pose challenges, in terms of achieving commonly-agreed understandings of practice competence. The variety of models of initial training present nursing managers with challenges in the recruitment and deployment of personnel trained in many different jurisdictions. Nursing managers need to consider the potential for considerable variation in competency repertoires among nurses trained in generic and specialist initial training models.
Journal of Nursing Management, 2009
Enhancing the nursesÕ role in healthcare delivery through strategic management: recognizing its i... more Enhancing the nursesÕ role in healthcare delivery through strategic management: recognizing its importance or not? Aims To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nursesÕ vocabulary. Background Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. Methods A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. Results Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. Conclusion The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. Implications for nursing management Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.
Journal of Nursing Management, 2000
... Conclusion The Change Model was developed through reflection on critical incidents related to... more ... Conclusion The Change Model was developed through reflection on critical incidents related to ... The Measurement Construct Tool was developed through a review of the tools currently in ... involved in the initial focus group discussions agreed that the Change Model was highly ...
Journal of general practice, Jan 18, 2017
C onsensus management is presented in the context of emerging trends and challenges in health and... more C onsensus management is presented in the context of emerging trends and challenges in health and hospital management. Consensus is viewed differently in organizations. Consensus management approaches used in Australia, Ireland, United Kingdom, United States and New Zealand are explored along with the advantages and disadvantages to using consensus management in healthcare organizations. Carney (2006) designed the 'Consensus Management Model of Healthcare' that incorporates concepts of strategic involvement, commitment to the organization and organizational culture. The model was developed from findings from her study undertaken amongst 860 middle manager health care professionals working in 60 of the 65 acute care hospitals in the Republic of Ireland. She found that a multidisciplinary approach to health care management incorporates managerial, behavioural, professional and organizational dimensions, resulting in professionals being committed to delivering excellent health care in the most effective and efficient way possible. Identification of practical challenges facing management in the education and management of advanced nurse practitioners is explored. Biography Carney completed her PhD studies and MBA degree in University College Dublin (UCD) and is a registered nurse, midwife and nurse teacher and Fellow from the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI). She is Dean Emeritus and Board member of the Faculty of Nursing and Midwifery having held the position of Dean and Chair of the Faculty from 2014 to 2016. She was appointed to University College Dublin in 1994 and held the position of Head of the
drugsandalcohol.ie
Dublin. Her research interests include fatherhood, single parent families, parenting, and immigra... more Dublin. Her research interests include fatherhood, single parent families, parenting, and immigrant families. She is the author of a number of research reports and articles and has recently completed two studies of parenting in Ireland.
Journal of Nursing Management, 2019
Over my career as a nurse, midwife, nurse tutor and academic in two universities in Ireland, duri... more Over my career as a nurse, midwife, nurse tutor and academic in two universities in Ireland, during which time I was appointed head of the school of nursing in University College Dublin where I managed the entry of nursing and midwifery students into academia, in 2001. This heralded a change in nurse teaching from schools of nursing based in hospitals to university education.
Journal of Nursing Management, 2021
PURPOSE This Commentary illustrates how innovative clinical and research initiatives highlight th... more PURPOSE This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 which commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. BACKGROUND Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to Covid-19 and how the global crisis will change and shape the future of healthcare delivery. EVALUATION Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. KEY ISSUES The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. CONCLUSIONS Global leaders and policy makers must seek the knowledge and skills they need to support their work during a global crisis. IMPLICATIONS FOR NURSING MANAGEMENT Achieving population health and equitable access to health care is dependent on an adequate health workforce.
Journal of Nursing Management, 2020
Background: The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties wo... more Background: The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for postgraduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences. The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan, Monaghan and the Rotunda. Combined these hospitals have 120 registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients. The drive to establish the forum between the faculty and the six Dublin hospitals was to build capacity among advanced nurse practitioners and advanced midwife practitioners (ANP/AMPs) who are seen as intelligent consumers of evidence-based research and safe practice. The SCAPE report identified research as the single domain that was underdeveloped within the ANP role, in the study exploring the role of ANPs and CNSs. Latterly, the Nursing and Midwifery Board of Ireland highlighted research as a vital component of the ANP/AMP role in its standards for advanced nurse and midwife practice. The faculty acted collaboratively to introduce an ANP/AMP forum to support advanced practitioners working in the university hospital group in their education and professional development, support the expansion of their knowledge base through practice-based enquiry and research and act as a conduit for interactions between ANPs/AMPs by keeping them up to date with practice and research. Methods: The Initiation phase was undertaken through a survey of needs; Implementation phase by extensive literature review and research-based newsletters sent to individuals by the forum coordinator; and the Evaluation phase through focus groups.
Journal of nursing management, Jan 7, 2015
To explore the regulation of advanced nurse practice internationally and to identify differences ... more To explore the regulation of advanced nurse practice internationally and to identify differences and commonalities. Regulation of advanced practice nursing does not occur in many countries. Ireland is currently in the minority in regulating advanced practice at a national level. Lack of regulation poses difficulties for national governments and for society due to uncertainty in advanced practice concept and role. A literature review of 510 scholarly nursing papers published in CINAHL, PubMed and MEDLINE between 2002 and 2013 and 30 websites was undertaken. There is a lack of consistency in legislative systems internationally. Nursing organisations have recognised advanced nurse practice by regulation in some countries and by voluntary certification in others. Research has demonstrated that care delivered by advanced nurse practitioners has enhanced patient outcomes yet regulation of advanced practice is not undertaken in most countries. Nurse managers need to know that criteria for ...
Seminars for nurse managers, 2002
This article presents a change management model that may be used in the evaluation of the change ... more This article presents a change management model that may be used in the evaluation of the change process. The model may be used to evaluate how well change is being managed or has been managed. The Change Management Model developed by the author aims to provide nurse managers or change agents with a structured and measurable model for managing change, and to allow the change process to be evaluated. A measurement constructs tool also has been developed to further assist the evaluation process. The author argues that certain key variables can be identified that contribute to the successful implementation of change. These include critical success factors for change, communication issues, change dynamics that include resistance or acceptance of change, and the management of the implementation and evaluation stages of the change process.
Nurse Education in Practice, 2014
Background: Undergraduate nursing programmes are designed to equip student nurses with the skills... more Background: Undergraduate nursing programmes are designed to equip student nurses with the skills and knowledge necessary for their future work as professional nurses. Influences on the role during the transition period from student to staff nurse are unclear. Purpose: This paper explores the experience of role transition for newly-qualified nurses from an Irish perspective. Methods: A Heideggerian Hermeneutic approach was the research method adopted. Ten newly qualified nurses from one of Dublin's Academic Teaching Hospitals were interviewed. Data were analysed using Van Manen's thematic analysis. Influences on the transition period were explored in the context of Chick and Meleis's Transition Concept. Findings: Newly-qualified nurses initially felt excited upon qualification. However, professional responsibility and accountability associated with the new role were overwhelming for participants. They felt frustrated when they didn't receive adequate support during transition. Conclusion: Newly-qualified nurses need support while they incorporate their knowledge into clinical practice. Hidden influences should as education levels and scope of practice should be considered before nurse educators begin to develop education programmes for undergraduate nurses.
Nursing and Health Sciences, 2004
There is increasing emphasis on interdisciplinary involvement by health care managers. The object... more There is increasing emphasis on interdisciplinary involvement by health care managers. The objective of the present paper was to identify the level of involvement that middle manager heads of department have in strategy development in acute care hospitals in Ireland, and to identify if professional clinicians were more involved than non-clinicians. Twenty-five interviews were undertaken. Findings indicated that middle managers were strategically involved and that non-clinicians perceived that they were more involved in strategy development than professional clinicians. Strategic involvement appeared to result from a higher level of strategic awareness and confidence by non-clinicians in the process. Professional clinicians perceived that their expertize was not recognized or appreciated by non-clinicians or by senior management. Agreement of strategy amongst both groups is critical, as exclusion will lead to demotivation and consequent deterioration in health care delivery.
Journal of Nursing Management, 2006
Literature review Quinn (1995: 5) defines strategy as 'the pattern or plan that integrates an org... more Literature review Quinn (1995: 5) defines strategy as 'the pattern or plan that integrates an organization's major goals, policies and action sequences into a cohesive whole'. Strategic planning, an essential part of strategy development, is an ongoing decision-making process, the purpose of which is to specify the ideals, goals and objectives required by the organization in the future (Quinn 1995). A critical component of the strategic-planning process is the generation and formulation of strategic
Journal of Nursing Management, 2009
Public health nurses perception of clinical leadership in Ireland: narrative descriptions Aim The... more Public health nurses perception of clinical leadership in Ireland: narrative descriptions Aim The aim of the study was to identify how clinical leadership skills are perceived by Public Health NursesÕ in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. Background Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. Method Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. Results Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. Conclusions Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. Relevance to nurse managers Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.
Journal of Nursing Management, 2009
Journal of Nursing Management, 2007
Literature review The role of the clinician or non-clinician head of department is a key role in ... more Literature review The role of the clinician or non-clinician head of department is a key role in health service delivery (Carney 2004a). Currie (1999) identifies the positive influence of middle managers in the business planning process. Harrison and Miller (1999) argue that clinicians, including nurse managers, are embracing new
Journal of Nursing Management, 2009
Journal of Nursing Management, 2009
To provide a synthesis of literature on international policy concerning professional regulation i... more To provide a synthesis of literature on international policy concerning professional regulation in nursing and midwifery, with reference to routes of entry into training and pathways to licensure. Internationally, there is evidence of multiple points of entry into initial training, multiple divisions of the professional register and multiple pathways to licensure. Policy documents and commentary articles concerned with models of initial training and pathways to licensure were reviewed. Item selection, quality appraisal and data extraction were undertaken and documentary analysis was performed on all retrieved texts. Case studies of five Western countries indicate no single uniform system of routes of entry into initial training and no overall consensus regarding the optimal model of initial training. Multiple regulatory systems, with multiple routes of entry into initial training and multiple pathways to licensure pose challenges, in terms of achieving commonly-agreed understandings of practice competence. The variety of models of initial training present nursing managers with challenges in the recruitment and deployment of personnel trained in many different jurisdictions. Nursing managers need to consider the potential for considerable variation in competency repertoires among nurses trained in generic and specialist initial training models.
Journal of Nursing Management, 2009
Enhancing the nursesÕ role in healthcare delivery through strategic management: recognizing its i... more Enhancing the nursesÕ role in healthcare delivery through strategic management: recognizing its importance or not? Aims To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nursesÕ vocabulary. Background Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. Methods A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. Results Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. Conclusion The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. Implications for nursing management Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.
Journal of Nursing Management, 2000
... Conclusion The Change Model was developed through reflection on critical incidents related to... more ... Conclusion The Change Model was developed through reflection on critical incidents related to ... The Measurement Construct Tool was developed through a review of the tools currently in ... involved in the initial focus group discussions agreed that the Change Model was highly ...