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1
Nita, Yunita. "Adverse drug reaction reporting in Australian hospitals." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/1234.
Full textAbstract:
Adverse drug reactions (ADRs) are known to be a major cause of morbidity and mortality. However, only a small proportion are reported. An increase in the number and quality of reports by improving ADR reporting systems in hospitals, could improve patient outcomes and save healthcare costs. The first part of this project was to review the ADR reporting systems in Australian hospitals and to determine factors contributing to the ADR reporting rate. Data were collected by a postal, self-administered questionnaire. Questionnaires were sent to 299 chief pharmacists of Australian hospitals listed in the Society of Hospital Pharmacists of Australia (SHPA) directory. The response rate was 49.5%. Seventy seven (60%) hospitals had a formal hospital policy for ADR reporting and 110 (85.3%) hospitals targeted all drugs to be reported. ADR reporting rates to ADRAC in 2000 (ADR reports per patient admission) were between zero and 1.09% (median=0.02%) with 7.1% of hospitals having a reporting rate of zero. A centralised ADR system and the existence of an ADR policy was not associated with higher reporting rates. The next part of the project was a survey of 803 Western Australian (WA) doctors and 1323 Australian hospital pharmacists to evaluate involvement in, understanding of and reasons for reporting ADRs. A postal, self-administered, anonymous questionnaire was sent to doctors at two tertiary hospitals in Perth and three regional hospitals in WA. A similar questionnaire was sent to all hospital pharmacists listed in the membership list of SHPA, as well as non-SHPA members in WA. Response rates obtained for the WA doctors survey was 35% (n=277) and 43% (n=574) for hospital pharmacists. Sixty four percent of doctors and 96% of hospital pharmacists knew how to report ADRs within the hospital while 57% and 98% (respectively) knew how to report ADRs to ADRAC.Factors that would encourage respondents to report ADRs included serious reactions, unusual reactions, reaction to a new product and confidence in the diagnosis of the ADR. More than 70% of respondents agreed that an uncertain association between the ADR and the suspected drug, minor reactions and well known reactions were factors that would deter them from reporting ADRs. From a list of 14 hypothetical ADR questions, it was found that respondents were more likely to report serious and uncommon reactions. Finally, the incidence of cross-sensitivity between penicillin and other β-lactam antibiotics among patients experiencing penicillin allergy in Fremantle Hospital and Health Services (FHHS) was assessed, along with the appropriate documentation of penicillin allergy in the medical records. The study was a retrospective audit and review of medical records in FHHS (1994-2000). All medical records of patients experiencing penicillin allergy during admission, or causing admission to FHHS, (n=85) were reviewed and data on reactions to other β-lactams were recorded. The incidence of definite cross-sensitivity between penicillins and cephalosporins was 6%, consistent with the reported rate of cross-sensitivity. The documentation of penicillin allergy in the medical records was less than optimal, with alerts on 89% of medication charts and only 28% of medical records (front cover). Improvement in the documentation of ADRs in patients' medical records would likely decrease the risk of preventable adverse events.
2
Nita, Yunita. "Adverse drug reaction reporting in Australian hospitals." Curtin University of Technology, School of Pharmacy, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14052.
Full textAbstract:
Adverse drug reactions (ADRs) are known to be a major cause of morbidity and mortality. However, only a small proportion are reported. An increase in the number and quality of reports by improving ADR reporting systems in hospitals, could improve patient outcomes and save healthcare costs. The first part of this project was to review the ADR reporting systems in Australian hospitals and to determine factors contributing to the ADR reporting rate. Data were collected by a postal, self-administered questionnaire. Questionnaires were sent to 299 chief pharmacists of Australian hospitals listed in the Society of Hospital Pharmacists of Australia (SHPA) directory. The response rate was 49.5%. Seventy seven (60%) hospitals had a formal hospital policy for ADR reporting and 110 (85.3%) hospitals targeted all drugs to be reported. ADR reporting rates to ADRAC in 2000 (ADR reports per patient admission) were between zero and 1.09% (median=0.02%) with 7.1% of hospitals having a reporting rate of zero. A centralised ADR system and the existence of an ADR policy was not associated with higher reporting rates. The next part of the project was a survey of 803 Western Australian (WA) doctors and 1323 Australian hospital pharmacists to evaluate involvement in, understanding of and reasons for reporting ADRs. A postal, self-administered, anonymous questionnaire was sent to doctors at two tertiary hospitals in Perth and three regional hospitals in WA. A similar questionnaire was sent to all hospital pharmacists listed in the membership list of SHPA, as well as non-SHPA members in WA. Response rates obtained for the WA doctors survey was 35% (n=277) and 43% (n=574) for hospital pharmacists. Sixty four percent of doctors and 96% of hospital pharmacists knew how to report ADRs within the hospital while 57% and 98% (respectively) knew how to report ADRs to ADRAC.Factors that would encourage respondents to report ADRs included serious reactions, unusual reactions, reaction to a new product and confidence in the diagnosis of the ADR. More than 70% of respondents agreed that an uncertain association between the ADR and the suspected drug, minor reactions and well known reactions were factors that would deter them from reporting ADRs. From a list of 14 hypothetical ADR questions, it was found that respondents were more likely to report serious and uncommon reactions. Finally, the incidence of cross-sensitivity between penicillin and other β-lactam antibiotics among patients experiencing penicillin allergy in Fremantle Hospital and Health Services (FHHS) was assessed, along with the appropriate documentation of penicillin allergy in the medical records. The study was a retrospective audit and review of medical records in FHHS (1994-2000). All medical records of patients experiencing penicillin allergy during admission, or causing admission to FHHS, (n=85) were reviewed and data on reactions to other β-lactams were recorded. The incidence of definite cross-sensitivity between penicillins and cephalosporins was 6%, consistent with the reported rate of cross-sensitivity. The documentation of penicillin allergy in the medical records was less than optimal, with alerts on 89% of medication charts and only 28% of medical records (front cover). Improvement in the documentation of ADRs in patients' medical records would likely decrease the risk of preventable adverse events.
3
Martin, Geraldine M. "Outsourcing in Western Australian hospitals: Management considerations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1996. https://ro.ecu.edu.au/theses/961.
Full textAbstract:
This thesis examines Health Care Managers' considerations with and experiences of outsourcing services in Western Australian hospitals. Support services such as cleaning and maintenance are some of the areas which have been targeted for outsourcing (contracting out) by the state government. These services have traditionally been delivered by permanently employed staff either on a full or part- time basis, usually with active union involvement. Core services such as nursing and medical care which involve direct patient care delivery are not included in the outsourcing debate. Firstly, this thesis reviews the literature on outsourcing and its application to the health care industry. Performance indicators and benchmarking are also explored within the context of contracted out services in a variety of settings. The implicit economic, social and legal implications are discussed. This study involved Health Care Managers in Western Australian hospitals and was conducted between June 1995 and May 1996. Their experiences with outsourcing of services together with the hospitals and the communities they served were key considerations in the final analysis. The research findings support the views of more recent studies which emphasize the importance of the context within which outsourcing is implemented, such as rural versus metropolitan hospitals. Hospital size, location, accessibility to contractors, human resource issues and funding arrangements such as those which affect teaching and non- teaching facilities were identified as major determinants affecting the degree to which outsourcing had been embraced. Finally, the implications of this research for future studies are discussed.
4
Tan, Ee Lyn. "Drug and Therapeutics Committees: Studies in Australian hospitals." University of Sydney. Pharmacy Practice, 2005. http://hdl.handle.net/2123/711.
Full textAbstract:
Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.
5
Gallego, Gisselle. "Access to High Cost Medicines in Australian Hospitals." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1008.
Full textAbstract:
In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.
6
Gallego, Gisselle. "Access to High Cost Medicines in Australian Hospitals." University of Sydney, 2006. http://hdl.handle.net/2123/1008.
Full textAbstract:
Doctor of Philosophy(PhD)In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.
7
Boyce, Rosalie A. "The organisation of allied health professionals in Australian general hospitals." Thesis, Queensland University of Technology, 1996. https://eprints.qut.edu.au/107083/1/T%28BS%29%20134%20The%20organisation%20of%20allied%20health%20professionals%20in%20Australian%20general%20hospitals.pdf.
Full textAbstract:
This research is a case study in the sociology of professions. It reports on the Australian allied health professions, a group that has rarely been the subject
of sustained research. The central purpose of the research is to examine the impact of local workplace organisation in Australian general hospitals in the public sector on the position of the allied health professions and their
autonomy. Further, the research seeks to unbundle the competing claims about the utility of alternative organisational approaches and to examine how the allied health professions negotiate inter-professional relationships as a consequence of particular organisational approaches. The research draws on Eliot Freidson's professional dominance theory (medical dominance theory) as the underpinning theoretical framework. Medical dominance theory portrays the allied health professions as inevitably subject to medical dominance and subordination, a proposition which is critically appraised through a contemporary analysis of local workplace arrangements.
To address these issues three models of allied health profession organisation were identified; the classical medical model, division of allied health model and
the unit dispersement model. The research method involved a comparative case study approach and included fifty-three interviews, document analysis, observation strategies and key informants over a two year period. Data collection was guided by seventeen themes of inquiry which were identified
from a multiple methods approach as likely to be important in a comparative analysis of the organisation of the allied health professions.
8
Sukkar, Malak, and sukkarm@stvmph org au. "Executives' Decision Making in Australian Private Hospitals: Margin or Mission?" RMIT University. Graduate School of Business, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20081031.162754.
Full textAbstract:
This thesis examines decision making at executive level in Australian private hospitals as a social phenomenon, since individuals draw meaning from their own biographical and social environmental experiences. The researcher interpreted the constructed realities of the factors influencing executives' decisions within the context of private hospitals - a field that is rarely examined through the lens of social research. Using an Interpretivist research paradigm, the researcher conducted semi- structured and in-depth interviews with sixteen executive members who are experts in their field and represent both sectors of the private hospital industry: private for-profit and private not-for-profit. The data generated was transformed into technical accounts using an abductive research strategy and adopting Schütz's notion of first-order and second-order constructs. Using Giddens' Structuration Theory, that stressed the fundamental role of the human agent, the structure and their mutual dependence, the researcher moved beyond the interpretation of individuals' meanings, to incorporate the structure as an entity that can be formed and reformed. The researcher interpreted social actors' constructed meanings of these social phenomena in their work environment to form the elements of a two-dimensional decision making model at organisational level, incorporating the present with the future and the internal with the external factors. On an individual level, three different approaches to decision making were identified, based on whether executives perceived the decision making phenomenon as intuition, as a reasoned process or as an expected outcome. While being from a limited research sample, the findings of this study suggest that the paradox of mission / economic decisions restrained executives in the not-for-profit sector from strengthening their hospitals' financial performance, putting at risk, therefore, their ability to achieve social dividends as a way to proclaim their mission. On the other hand, in the for-profit sector, shareholders' dividends appeared to be a strong catalyst for attaining profit maximisation when making decisions. In both settings, the findings suggest that the role of stakeholder theory is questionable, particularly when executives remained hesitant to involve medical specialists, whom they considered to be major stakeholders and profit generators for private hospitals. This attitude appeared to be constant, despite the changes identified in executives' individual approaches to decision making. However, early signs of shifts towards adopting more commercially and socially accountable decisions were apparent in not-for-p rofit and for-profit sectors respectively. The thesis sets out recommendations to assist executives in managing the different factors that interplay to form executives' decisions. The importance of having a mission in business longevity and the integration, as opposed to alignment, of strategic goals with business operations when making executive decisions in private hospitals was highlighted. The implications for both sectors are described and recommendations for further research are suggested.
9
Fry, Margaret Mary. "Triage nursing practice in Australian emergency departments 2002-2004 an ethnography /." Connect to full text, 2004. http://hdl.handle.net/2123/701.
Full textAbstract:
Thesis (Ph. D.)--University of Sydney, 2005.Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.
10
Coulter, Sonali A. "An economic evaluation of antimicrobial stewardship programs in metropolitan Australian hospitals." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/116505/9/Sonali_Coulter_Thesis.pdf.
Full textAbstract:
This thesis provides the first economic evaluation of Antimicrobial Stewardship (AMS) interventions in two Metropolitan Australian Hospitals. AMS interventions are cost-saving from a hospital perspective and are cost-effective particularly if teamed with rapid diagnostics in the microbiology laboratory. The uncertainty in the mortality estimates does not allow for a high level of confidence in the cost-effectiveness decision for policy makers. While mortality is a useful metric, morbidity associated with bloodstream infections due to inappropriate prescribing needs to be collected over a longer period of time to capture the true benefits of AMS interventions.
11
Mussett, Janis. "An analysis of quality practices and business outcomes in Western Australian hospitals." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1651.
Full textAbstract:
This study aimed at identifying aspects of health care organisational management and activities that produced the highest level of quality care. A Literature review was conducted to determine the most successful quality activities currently used in a wide variety of industries. Using the findings of this review a questionnaire and interview questions were designed to identify factors associated with successful quality activities I health care organisations. Four Western Australian hospitals that were believed to have effective quality activities were randomly selected as a hospital from each of the following categories. A private hospital accredited by the Australian Council on Health Care Standards. A country hospital that had 100% patient satisfaction and a city hospital with above 96% patient satisfaction assessed by the State wide Government Patient Satisfaction with Care Survey. A hospital that the Health Department of Western Australia considered had best practice in Quality Activities. Each of these hospitals was matched with a control hospital. Data was collected through direct observation of a questionnaire and interviews with people in predetermined health service employment positions and the completion of one randomly selected supplier interview for each of the eight health services studied. The questionnaire was supplied to a range of staff members and interviews were conducted with these employees and hospital goods or service suppliers. Data was analysed using qualitative evaluation, frequency distribution and a factor analysis. Results obtained in this study identified that the most important factors required to produce the most profitable and highest quality of health care were a culture of caring, providing employees with enough time to complete their work and having effective organisation wide communication. A Quality Care Model for use in Health Services was created based on the research findings. When used this model of quality activities should provide customer satisfaction and a high standard of cost effective health care service.
12
Suiter, S. R. "Factors influencing Western Australian clinical registered nurses in discharge planning." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1166.
Full textAbstract:
A descriptive quantitative study was conducted to determine what factors nurses considered when discharge planning, and how these factors compared with factors identified in the literature as being effective in planning for discharge. This study was undertaken because with the intended Prospective Payment System (PPS) of funding to hospitals, it is essential that Western Australian Clinical Registered Nurses are able to prepare patients for discharge effectively to prevent the financial burden of cost outliers and re-admissions. Anderson and Steinberg ( 1984) in their studies of factors that influence the cost of hospital care for the elderly, found that the results of inappropriate and premature discharges resulted in a 22% readmission rate within 60 days of discharge for all Medicare hospitalisation. Their (1988) study of readmission rates of Medicare beneficiaries between 1974 and 1977 showed that the added costs associated readmissions cost the U.S. government more than US$2.5 billion per annum. It would seem probable that such a system introduced into the Australian health:care system will have the potential to produce similar effects for Western Australian patients, nurses and nursing.
13
Ramamurthy, Vijaya Lakshmi. "Australian federalism and the use of tied grants: case studies of public hospitals and schools." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1081.
Full textAbstract:
Tied grants are a contentious feature of Australian federalism. This study evaluates the policy making dynamics and performance of tied grants using case study evidence on public hospital and school grants from 1975 to 2008. The study finds that policy control has wavered between the Commonwealth and States. Further, the study argues that provided the Commonwealth acts as a strategic and refined player, the tied grant and co-operative federalism can offer distinct performance advantages.
14
Mousa, Ahmad. "Nurse staffing, patient falls and medication errors in Western Australian hospitals: Is there a relationship?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2017. https://ro.ecu.edu.au/theses/1998.
Full textAbstract:
Background: According to the Australian Bureau of Statistics (2013) falls and medication errors in hospitals are among the first twenty leading causes of death. Research on the relationship between nurse staffing, patient falls, and medication errors are limited. Even scarcer are studies that examine this relationship on a nursing shift by shift and ward by ward basis, and no research exists on shift overlap periods and adverse patient outcomes.
Objective: This study examined whether there was a relationship between hospital inpatient falls and medication errors and nurse staffing on a shift by shift and ward by ward basis, including an analysis of patient characteristics and the severity of incidents.
Research Design: Multinomial logistic regression models were used. Data were collected using a secondary analysis of two existing databases: Advanced Incident Management System (AIMS) database and the nursing staff roster database (RoSTAR) over two years (January 2011 to December 2012). The Kane framework of nurse staffing was used to guide the current study.
Setting: The study was conducted in three adult tertiary teaching hospitals in Perth, Western Australia.
Participants: Reports of 7,558 incidents that occurred during the study period from 76 nursing wards and wards (4,677 medical, 2,209 surgical, and 672 critical care wards incidents), and 320,009 nursing shift records in three hospitals, were examined.
Measures: The occurrence and severity of shift-level inpatient falls and medication errors were measured as dependent variables. Independent variables included nursing staff skill-mix, staff experience, and actual nursing hours. Control variables were shift, ward type, and hospital.
Results: This study supports the importance of RN staffing levels in improving patient outcomes. However, it also shows that the relationship between nurse staffing and patient outcomes can be affected by different factors such as patient characteristics, nurse characteristics, and ward type. The number of total clinical incident reports decreased by 7.4% from 2011 to 2012. Falls declined by 4.6% and medication errors declined by 10.8%. The average age of patients who fell or had medication errors was 56.3 years (range of 15 to 100 years) but was more common in patients over 65 years old (57.3%). The number of incidents was highest during the morning shift, less during the evening and lowest during the night shift (28.4%, 27.2%, and 21.8% respectively). Notably, 22.6% of total incidents were reported during the overlap period (13:00 pm to 15:29 pm) which is only two and a half hours. Medical wards had the highest incident records followed by surgical wards; fewer incidents occurred in critical care wards (61.9%, 29.2%, and 8.9% respectively). More registered nurses and more experienced staff on the shift were both associated with fewer falls and medication error incidents, as well as less severe injuries. An increase in the actual nursing hours was associated with fewer medication errors but not fewer fall incidents. However, an increase in in the actual nursing hours was associated with less severe falls but not less severe medication errors.
Conclusion: Overall, the fall and medication error incidents in three Perth hospitals decreased over the study period. However, the large variation in the incidents at both the shift and the ward level indicated room for improvement related to fall and medication error prevention. A relationship was identified between both more RNs and more experienced nurses in attendance and fewer incidents and less severe injuries. Further studies are necessary to identify prevention strategies for hospital falls and medication errors in the overlap period. Immediate consideration of the number of incidents that occurred during the overlap period is required. It is necessary to improve communication and teamwork among staff. Actions should be taken to review, implement and evaluate policies and procedures.
15
Gates, Jillian Marie. "Aesthetics for Visual Arts in Hospitals." Thesis, The University of Sydney, 2009. http://hdl.handle.net/2123/7354.
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The impetus for Aesthetics for Art in Hospitals emerged from my first waiting experiences in hospitals whilst being well, from my first pregnancy check ups ten years ago, accompanying my children to our doctor’s surgery, and later, sitting with my mother in palliative care; I was acutely aware of the lack of thought and organisation behind the display of visual imagery and signage in hospital waiting rooms. As an artist, I wondered who decides what images will be displayed in waiting areas of health clinics and hospitals. This idea gradually developed from 2005 when I attended the Arts Health and Humanities Conference in Newcastle, and realised that patient’s perspectives regarding aesthetics appeared to be overlooked. It was from this point that this inquiry became a research project that led me to the University of Sydney and in particular to The Sydney College of the Arts and the Medical Humanities Unit. This thesis is the outcome of this original inquiry and examines the questions, how can visual arts be received in hospitals? and how does western society represent illness and death? These questions explores how patients, their family members, and carers respond to art in hospitals, while acknowledging their discomfort experienced in hospital settings. This inquiry took the form of a comparative case study between Balmain and Wyong Hospitals, NSW, Australia. The aim of the study was to produce a reflective and empathetic response to elderly patients in waiting rooms as a mode to investigate the potential of evidence based art for hospitals. The intention was to produce a series of digital photographs that reflected the art preference of elderly patients. The outcomes of the study uncovered the patients waiting experience and recorded their levels of discomfort. It established the potential and significance of landscape photography in hospital waiting rooms to create a less threatening environment. The participants selected landscapes as their preferred subject matter for visual arts in hospitals. The study contributes to Australian arts health research by comparing Australian arts health projects to international examples. These comparisons indicate that further research is required to comprehensively understand the hospital waiting experience of Australian patients, and their family members in order to create visual arts that they can appreciate and respond to.
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Williams, J. Gary. "Supervised autonomy : medical specialties and structured conflict in an Australian General Hospital /." Title page, contents and abstract only, 1991. http://web4.library.adelaide.edu.au/theses/09PH/09phw7242.pdf.
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Alahmari, Mohammed Ali S. "Awareness and knowledge of radiation protection in interventional laboratory: a comparative study between Australian and Saudi Arabian hospitals." Thesis, Curtin University, 2015. http://hdl.handle.net/20.500.11937/962.
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This research project aims to investigate the attitudes and practices of medical staff engaged in interventional procedures regarding personal radiation protection, as well as the relationship between their uses of protective devices and training in radiation protection. Research findings of this study show the necessity and efficacy of radiation protection training for providing a safer environment when utilising the fluoroscopic image-guided machines in clinical practice.
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Ingarfield, Sharyn Lee. "The epidemiology of respiratory infections diagnosed in Western Australian hospital emergency departments 2000 to 2003." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0014.
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[Truncated abstract] Background Emergency department (ED) presentations of respiratory infections are not well described. Baseline ED data are needed to monitor trends, and to help evaluate the impact of health interventions, and assess changes in clinical practice for these conditions. Aims: To describe the epidemiology of respiratory infections diagnosed in Western Australian hospital EDs from 2000 to 2003; to determine the extent and usefulness of bacterial cultures ordered in hospital, and to describe and evaluate the antibiotic prescribing pattern in the ED setting. Methods: The cohort consisted of patients diagnosed with a respiratory infection at the ED of Perth's major metropolitan teaching hospitals from 1 July 2000 to 30 June 2003. The analysis was based on a linked data set containing patient data from the Emergency Department Information System, the Hospital Morbidity Data Set, the death registry, and the Ultra Laboratory Information System. Further, a sample of patient medical records from 1 adult hospital was examined to assess antibiotic prescribing practice. Results: Overall, there were 37,455 presentations (28,885 patients) given an ED diagnosis of a respiratory infection. Of these, 14,884 (39.7%, 95% CI: 39.2 to 40.2) were admitted and 715 (1.9%, 95% CI: 1.8 to 2.0) died in hospital. The infections included; 48.1% acute upper respiratory infections (URI), 18.5% pneumonia, 23.5% other acute lower respiratory infections (LRI), 7.4% chronic obstructive pulmonary disease with lower respiratory infection (COPD+), 1.3% influenza or viral pneumonia and 1.2% other URI. Children accounted for 80.7% of acute URI diagnoses, COPD+ mainly affected the elderly, just over 40% of pneumonia diagnoses were in patients 65 years or older and 30.7% in patients younger than 15 years. ... The most common pathogen isolated from blood was Streptococcus pneumoniae and 10.4% (95% CI: 4.8 to 16.0) had reduced susceptibility to penicillin. For those diagnosed with pneumonia, Strep. pneumoniae accounted for over 90% of pathogens isolated from the blood of young children and isolation of Enterobacteriaceae from blood increased with age. Around 30% of patients had positive sputum cultures and from these Haemophilus influenzae, Strep. pneumoniae and Pseudomonas aeruginosa were the most common organisms grown. Of those diagnosed with pneumonia, acute LRI or COPD+, 34.7% (95% CI: 26.1 to 43.3) of S. aureus isolated from sputum and 16.4% (95% CI: 7.1 to 25.7) from blood were methicillin resistant. Of 366 adult patient medical records reviewed, 56.8% (95% CI: 51.7 to 61.9) noted that an antibiotic was prescribed in the ED and amoxycillin was the most frequently prescribed. For those with pneumonia, concordance between prescribing guidelines and practice was low. Conclusions The administrative data sets used in the present study are useful for monitoring outcomes for respiratory infections diagnosed in the ED. Pneumonia continues to place a burden on the hospital system. Routine blood and sputum cultures have limited value. However, an appropriately designed surveillance program is needed to monitor potential Abstract v respiratory pathogens and assist in monitoring the appropriateness of current empiric antimicrobial therapy.
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Fox, Stephanie, and n/a. "Learning and leaving : a study of the interrelationships among innovation in nursing education, professional attitudes and wastage from nursing." University of Canberra. Education, 1987. http://erl.canberra.edu.au./public/adt-AUC20060710.132455.
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The purpose of this study was to examine some of the
interrelationships between innovation in nursing education,
professional attitudes and wastage from nursing. Five groups of
students who participated in innovative nurse education courses in
A.C.T. hospitals in the 1970's were surveyed by a self
administered questionnaire which gathered biographical data as
well as attitudinal information. Their responses were compared
with those of students who had undertaken a traditional nursing
course at an A.C.T. hospital in the same period.
The findings of this study suggested that the instrument used may
provide a better measure of satisfaction with nursing than of
professional attitudes. One of the unexpected findings from the
survey which suggested the need for further study was that many of
those who had undertaken further nursing study indicating apparent
commitment to continuing education in a chosen career would not
encourage others to enter nursing. Another was that those who
indicated greater career choice commitment may in fact be those
who felt unable to obtain alternative employment.
It was found that innovation in hospital based nurse education
courses attracted different people and produced graduates with
different attitudes to professional issues,who followed
different career pathways compared to graduates of traditional
nurse education courses. Innovative courses appear to have
attracted older and better qualified entrants and to have
increased the likelihood of graduates being promoted. Respondents
from the innovative courses showed increased interest in
continuing education and Professional Association activity than
their control group colleagues. They were more frustated with the
traditional role of the nurse as the selfless, dedicated worker
and were less commited to their career choice, overall these
findings perhaps indicated a level of dissatisfaction with nursing
higher in the innovative course graduates than in the control
group. These findings may support Brief's contention (1976) that
expectations raised during the educational process, if not
fulfilled, will lead to wastage.
wastage from nursing was intimately linked with dissatisfaction
with work conditions in nursing. Those who had permanently left
nursing had more frequently left for work related reasons and
undertaken non-nursing study than those who had left and returned
or who had never left. Those who left for work related reasons
were less likley to return and less likely to choose nursing again
if given the chance than those who left for other reasons.
Findings about the institutionalisation of innovation in nursing
education were difficult to identify with certainty, since time
lapse alone could explain many of the findings. Attitudes to the
Professional Association were more favourabe in respondents from
the later intakes into the innovative courses than from the
earlier. Given the recent increases in industrial activity in
nursing, this finding is consistent with time lapse. Later intakes
also demonstrated greater commitment to continuing education than
earlier. This too can probably be explained by the greater
availability of such facilities in more recent times.
In a period of shortages of nurses prepared to work in the health
care facilities of Australia, and of changes in the educational
preparation of nurses, the findings of this study relating to
attitudes and wastage should be used as the basis for future
workforce planning.
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Thangavelu, Rajan Remya. "An evaluation of intravenous antifungal medications in patients in a paediatric hospital." Thesis, Curtin University, 2008. http://hdl.handle.net/20.500.11937/2436.
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Objective: To retrospectively evaluate intravenous antifungal medications in paediatric patients in a public hospital for children.Method: Data relevant to the antifungal prescription were collected for all the patients <18 years of age who had been prescribed IV antifungal therapy. All paediatric patients prescribed intravenous antifungal treatment for one year (July 2006 to 30th June 2007) at PMH were evaluated retrospectively. The data collected were evaluated against the Australian Therapeutic Guidelines: Antibiotic Version 13 and hospital in house guidelines for IV antifungal therapy from the microbiology department at the hospital.Results: There were 59 patients included in the study and the most frequently diagnosed disease was leukemia. Of the total 59 patients, liposomal amphotericin B (L-AmB) was prescribed for 47 patients, conventional amphotericin B (C-AmB) for four patients, caspofungin for two patients and voriconazole for one patient. Five patients received combination antifungals. The dose of C-AmB was 1 mg/kg/day. Voriconazole dose of 5 mg/kg/day was given for a period of four days for one patient. Nine patients included in this study were neonates and they were prescribed L-AmB, C-AmB and a combination of Voriconazole and L-AmB. 34 patients out of 47 were prescribed 3mg/kg/day of L-AmB and the highest L-AmB dose prescribed was 5 mg/kg/day and the lowest dose was 1 mg/kg/day. The median number of days for L-AmB treatment was found to be 11 days and the maximum was 51 days. Additionally 6% of patients who received L-AmB had oral fluconazole recommended r five days after cessation of L-AmB. It was found that 27% of patients had a low potassium level and a significantly higher proportion of patients had abnormal alanine aminotransferase and 11(18.6%) of the 59 patients had abnormal serum creatinine levels. It was found that the mean temperature decreased to 37.0°C from a 38.3°C from commencement to the cessation of the IV antifungal treatment. The longest duration of antifungal treatment in this study period was L-AmB prescribed for a period of 102 days.The estimated treatment cost for the longest treatment in this study was found to be AUD 34,222 if prepared in the pharmacy (CIVAS) and AUD 43,784 if prepared in the ward setting. Estimated total treatment cost for a four year old patient with a bodyweight of 21 kg on L-AmB for a period of 21 days was found to be AUD 7,803 when prepared in Pharmacy (CIVAS) and AUD 12,029 for Ward reconstitution.Conclusion: The data from this study indicated a satisfactory quality of IV antifungal treatment; however the remaining requirements for appropriate use required additional education. This study found that L-AmB was the antifungal agent of choice. Considerable savings could be made for pharmacy reconstituted IV antifungals by CIVAS over a ward setting where wastage occurs from unused antibiotic vials. At present the understanding of newer antifungal agents in children is limited. In future children should be included in the studies of new antifungal drugs and combination therapy and stratify the results by age, given the potential differences in pharmacokinetics, pharmacodynamics, efficacy and safety and cost.
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Gones, Vania. "Hospital Pharmacy Management: Australian and Indonesian Perspectives." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15655.
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The role of pharmacists in the healthcare sector is vital. In Indonesia, medicines accounted for 12 – 38% of hospitals’ expenses, and hospital pharmacy is the main department in the hospital charged with the responsibility to manage the safe, appropriate and judicious use of medicines. Many studies have investigated clinical and financial benefits of pharmacists and pharmaceutical services in hospitals. To assist authorised bodies in each country to establish relevant document and regulations, World Health Organization (WHO) and International Pharmaceutical Federation (FIP) have stipulated Good Pharmacy Practice (GPP) guidelines. Hospital pharmacy practice standards have also been ratified in many countries, and a global consensus was developed and called “The Basel Statements on the future of hospital pharmacists”. It reflects the importance of service provision by hospital pharmacy. However, much variation of hospital type, ownership (private or public), and stage of regional development is common in Indonesia. With constant changes in healthcare industry, such as change of health systems, patients’ demography, or advancement of medical technology and science, many hospital pharmacies face challenges to meet the practice standards. For example, with the implementation of National Health Insurance scheme in Indonesia in early 2014, the medicines funding scheme was changed. Healthcare funding which was previously dominated by private health funds has been reformed into public funding using case mix. In the old scheme, medicines costs were paid out-of-pocket by patients, or fully reimbursed by private or public health insurance bodies. In the new scheme, medication costs are paid as a package with other health costs. Hence, hospital pharmacy plays a vital role in managing medicines to improve efficiency and service quality as well as managing financial sustainability. Management is an essential factor to ‘scale up’ service delivery to strengthening health systems and improving population health in low-middle income countries. Managers in the hospital sector are key health service managers especially in low income countries. Although the importance of management in hospital pharmacy is clear, it is common for many hospital pharmacists to overlook rather than value management practice. While there has been some research reported from developed countries, there is relatively little current research from developing countries. Research exploring hospital pharmacists’ experiences in hospital pharmacy management is critical to gain more understanding about current issues, and potential future application of management in hospital pharmacy. Therefore, the aims of the research described in this thesis were to explore Australian and Indonesian hospital pharmacists’ perceptions of their roles in hospital pharmacy management, challenges and enablers in managing hospital pharmacy, and vision for the future. This research has adopted a qualitative approach using semi-structured interviews in two stages. Stage 1 explores the Australian hospital pharmacists’ and Stage 2 investigates Indonesian hospital pharmacists’ perceptions and experiences in hospital pharmacy management. The main focus of this research is on Stage 2, thus the results are presented in three chapters. However, Stage 1 provides an international perspective and commentary for the findings in Stage 2. In Chapter 1, an overview of the literature regarding hospital pharmacy management, details of the Australia’s and Indonesia health systems, and hospital pharmacy activities in each country are summarised and discussed. It also includes a structured literature review to explore international perspectives on management aspects in hospital pharmacy. The results are presented and discussed in this chapter. In Chapter 2, the Stage 1 of this research is presented comprising a qualitative study exploring the perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Australian hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 3, the first part of Stage 2 of this research is documented. A qualitative study was conducted to explore perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Indonesian hospital pharmacy. This chapter focuses on Indonesian hospital pharmacists’ perceptions of roles, barriers and facilitators of roles, and attitudes toward current roles. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 4, the second part of Stage 2 is documented. This chapter focuses on Indonesian hospital pharmacists’ experiences and concerns in the management of hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 5, the last part of Stage 2 is documented. This chapter focuses on the views and perceptions of Indonesian hospital pharmacists related to the professions’ future direction and vision for hospital pharmacy practice. The main themes identified from semi- structured interviews are summarised and discussed in this chapter. In Chapter 6, main findings of each project stage from each stage are compared and summarised. Future directions in this area are discussed in this chapter.
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Regan, Patrick Michael Humanities & Social Sciences Australian Defence Force Academy UNSW. "Neglected Australians : prisoners of war from the Western Front, 1916-1918." Awarded by:University of New South Wales - Australian Defence Force Academy. School of Humanities and Social Sciences, 2005. http://handle.unsw.edu.au/1959.4/38686.
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About 3850 men of the First Australian Imperial Force were captured on the Western Front in France and Belgium between April 1916 and November 1918. They were mentioned only briefly in the volumes of the Official Histories, and have been overlooked in many subsequent works on Australia and the First World War. Material in the Australian War Memorial has been used to address aspects of the experiences of these neglected men, in particular the Statements that some of them completed after their release This thesis will investigate how their experiences ran counter to the narratives of CEW Bean and others, and seeks to give them their place in Australia???s Twentieth Century experience of war.
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Clifford, Sally Margaret. "Why have you drawn a wolf so badly? : community arts in healthcare." Thesis, Queensland University of Technology, 1997. https://eprints.qut.edu.au/35893/1/35893_Clifford_1997.pdf.
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Community arts is often criticised for its tendency to be more about welfare than art. This thesis investigates this claim through the environment of a growing number of
arts projects taking place in healthcare settings. Healthcare settings inherently deal with the field of welfare. This research has recognised that many of these projects are participation-based community arts projects. I have termed these projects arts-inhealth
and they form the case studies of this research.
Arts-in-health is not art therapy. Arts-in-health is a community arts-based approach to artmaking which enables people to access art processes and skills which are not part of the treatment or diagnosis of their illness. This thesis recognises that people belong to a communal web of relationships which can often be severed when they
become ill. Because arts-in-health encourages artmaking beyond a treatment framework, it can re-connect people to their communal web. is thesis claims that for community art to have this impact it must be designed and
implemented through artistic processes and not treatment, therapeutic or clinical ones. If community art processes do become distorted by therapeutic processes, they
will become more about welfare and less about art; consequently, they contribute less to the community in which individuals live.
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Hogan, Jane. "Evaluation of automation on the Gold Coast University Hospital Pharmacy department." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/410157.
Full textAbstract:
Background: Pharmacy robotics have been implemented globally to create medication management efficiencies. However, translation to the Australian public hospital environment has not been evaluated. It is also not known what factors influence pharmacy staff to use new technologies that could guide future automation implementation strategies.
Aim: The primary aim of this research is to evaluate the introduction of a Pharmacy Robotic Dispensing System (PRDS) in an Australian public hospital pharmacy and the impact it had on pharmacy staff medication supply activities in both the dispensary and imprest management.
Secondly, this research aims to identify factors that influence hospital pharmacy staff acceptance of robotics during implementation and over time.
Method: This study was conducted in a tertiary public hospital on the Gold Coast, Australia and took place in two phases, each phase consisting of a staff survey and a time in motion study.
Phase one: May 2016; an initial assessment prior to the PRDS becoming operational for baseline data. Data for the staff survey and time and motion study were collected and analysed in this phase.
Phase two: August 2017; PRDS had been operational for 15 months and the study was repeated. Data for the staff survey and time in motion study were remeasured in this phase for comparative analysis
Staff survey: A single centred, prospective, longitudinal cohort quantitative study. Pharmacy staff were surveyed using the Extended Technology Acceptance Model (ETAM). Fischers exact test and correlation analysis of paired responses was used to identify significant factors influencing usage of the PRDS between the two time points.
Time in motion study: A single centred, prospective, longitudinal time in motion study. Time stamped video footage was collected tracking medication orders in numbered containers throughout the pharmacy dispensary. Activities observed and recorded comprised of dispensing, labelling, assembly of items, number of items and time waiting to be actioned. Data was analysed and compared overall turnaround times; time waiting to be actioned; dispensing, assembly and labelling times; plus dispensing rates (items/person/hours). Fitbit Zip® used to anonymously track pharmacy assistant steps per day in the dispensary. Dispensing software (iPharmacy ®) supplied the location of stocked medication and electronic tracking databases provided data for imprest medication supply turnaround time, picking and waiting for action times. Median turnaround times and Mann Whitney U test used to examine relationships between phases, plus mean steps per day and two tailed t-test used to analyse changes in movement.
Results: Sixty four respondents completed surveys during phase one (70%: 64/91) and 34 paired surveys were collected fifteen months later in phase two (53%: 34/64). Respondents were predominantly young, female with a tertiary qualification. Initial perceptions of the pharmacy robot did not change over time, with the exception of ‘reliability’. Participants found the robot less reliable than expected after working with it for fifteen months. Departmental leaders had greatest influence on technology acceptance during implementation and over time. Other key factors correlating with pharmacy staff acceptance included: how useful the robot was perceived to be; ease of use; and how relevant the robot was for an individual role. Higher levels of education had a negative association with usage during implementation and age was not a factor. Medication stored in the robot was limited to 46% (n=20,771 full packs) of total pharmacy holdings (n= 45,437 full packs). At baseline, 774 orders were received in the dispensary over five days increasing by 13% to 887 in phase two (p<0.01). Dispensary workload increased, staff levels remained constant and pharmacy assistant movement significantly reduced (p<0.05). However, there were no significant changes to dispensing rates and turnaround times.
Conclusion: This study identified critical insights influencing staff acceptance of pharmacy robots that will help inform future implementation. The influence of pharmacy leaders emerged as key influence on technology acceptance. Leveraging on this influence a communication strategy prior to implementation should include information on useful functions and known benefits of the system customised for individual roles. In addition, pharmacy robotics has the potential to absorb increased workload and reduce staff movement in the dispensary when staffing levels remained constant. However, turnaround times alone are too simplistic as a sole measure of benefits for robotics in Australian public hospital pharmacy.Thesis (Masters)
Master of Medical Research (MMedRes)
School of Pharmacy & Med Sci
Griffith Health
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Maddern, Guy J. "A review of cardiac surgery in South Australia /." Title page, contents and summary only, 1990. http://web4.library.adelaide.edu.au/theses/09MS/09msm1788.pdf.
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Sheridan, Jeanette. "Activity Based Funding: The implications for Australian health policy." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15763.
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This thesis answers the question: Has the throughput of patients in public hospitals changed since the introduction of Activity Based Funding? A multi-case study of one New South Wales Metropolitan and one Regional Local Health District, was conducted. Hospital admissions and visits to Emergency Departments of patients with chronic diseases, are analysed over the period 2009 to 2013. Changes in patient throughput are identified, and seven possible explanations for these changes, such as a change in demography of patients or a change in clinical practice, are explored. An index (the PARI) was developed from which the potential revenue and resource implications for each clinical condition, in each hospital, in each Local Health District, are examined. The findings from this study are discussed within the theoretical framework of Alford’s (1974) structure interests at three levels: first, the micro level (public hospitals and patient care); second, the meso level (public health policy for publicly-owned and operated health services); and third, the macro level (the role of the state vis-à-vis capital accumulation, interest groups and the global health market)«br /» «br /» It is concluded that, many patients who were ‘eligible’ to be treated in a setting other than that of an inpatient, were admitted to hospital for their treatment. Activity Based Funding has, however resulted in patients spending fewer days in hospital. The implications of these findings are that: (i) the ‘bio-medical’ model of the provision of health care will continue, and the interest of current interest groups preserved; (ii) the increasing amounts of public expenditure to the private sector, means less funding is available for publicly-owned and operated health services; and (iii) more of the cost of health care is being passed from the taxpayer to the consumer. The greatest change in dominant interests, since the work of Alford, is the growing influence of multi-national companies that supply health-related goods and infrastructure globally, which hinders the development of a competitively strong domestic industry.
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Nitschke, Monika. "Glutaraldehyde exposures and health effects among South Australian hospital nurses /." Title page, table of contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmn732.pdf.
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Walker, Annette Clare, of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient." THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
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Irving, Kate. "Case studies in restraint use in an acute teaching hospital : a Foucauldian approach." Thesis, Curtin University, 2001. http://hdl.handle.net/20.500.11937/918.
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This thesis reports the outcomes of research into the use of restraint in the care of patients in an acute teaching hospital in Australia. The literature review undertaken for the study revealed much research into restraints showing evidence of the harm they cause, and their ineffectiveness as a safety measure. The literature indicates that the prevalence of restraint use is high - about a third of all hospital patients over the age of eighty-five years may be restrained at some time during the period of their admission.The main emphasis in my investigation was to uncover an understanding of how the use of restraints has remained possible, despite negative reports on their efficacy and questions about their possible abuse of human rights. Primarily, 1 set out to provide vide an understanding of restraint practice, and of how it is maintained and legitimised in a metropolitan teaching hospital.The study was guided by a Foucauldian approach to discourse analysis. The study reports on in depth studies of three patients. The case studies extend beyond observations of the patients to include interviews with members of the multidisciplinary team: nurses, doctors, occupational therapists and physiotherapists. Medical and nursing notes were another source of data.A discursive formation was identified by which restraint use is justified, and legitimised by the health professionals who use it. Five discourses were established, constituting: inability to 'self govern'; an appropriate environment; treatment; duty of care; and marginalisation.The study concludes that restraint use can be understood as a complex discursive practice. Through this discursive practice we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use. Knowledge of these discursive practices enables an understanding of how the current educational approaches to restraint reduction are likely to have little immediate or sustained impact. With these understandings, we are hopefully better placed to change practice in a way that does not substitute one undesirable approach for another. If this is so, the value of this thesis will lie in its influence on practice as much as in its contribution to scholarship.
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/1517.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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Sayers, Jan Maree. "The role of the nurse educator in acute care hospitals Australia." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/622.
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The health workforce is one of the critical issues facing contemporary Australian health care systems. Therefore carefully defining roles in the health care system is of great importance. The Role of the Nurse Educator in Australian Acute Care Hospitals study used a mixed-method research design to develop a performance self-assessment scale for nurse educators and describe instances of role ambiguity and conflict. These findings will facilitate comprehensive understanding and integration of nurse educator roles throughout healthcare and education.
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Clarke, Emma. "Ethical dilemmas experienced by Australian public practice occupational therapists." Thesis, Discipline of Occupational Therapy, 2016. http://hdl.handle.net/2123/14207.
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Occupational therapists working within Australia’s dynamic and complex publicly-funded health sector may experience ethical dilemmas as they fulfill their professional responsibilities, compromising client care, straining collegial relationships and negatively affecting their personal well-being. This thesis describes and explores the nature of the ethical dilemmas experienced by public practice occupational therapists. Section One: LITERATURE REVIEW The literature review comprises two parts. First a background to ethics in health care is outlined, where the Person-Environment-Occupation Model is presented as a way of evaluating the ethical dilemmas experienced by occupational therapists. This is followed by a review of literature exploring the ethical dilemmas experienced by health professionals including occupational therapists, speech pathologists, physiotherapists, social workers, rehabilitation counsellors and nursing and medical professionals. However, no literature was identified exploring the nature of ethical dilemmas experienced by public practice occupational therapists, providing an opportunity for further research. Section Two: JOURNAL MANUSCRIPT The journal manuscript outlines a qualitative, descriptive study exploring the ethical dilemmas experienced by five public practice occupational therapists. Findings indicate that public practice occupational therapists experience an array of ethical dilemmas which reflect the complexities of working within Australia’s publicly-funded health care context. Ethical dilemmas reported by public practice occupational therapists are encompassed by five themes: defining boundaries in professional relationships, fair access to quality services, professional status, life choices and the complex client at the heart of the dilemma. Person, environment and occupation factors were all found to contribute to the ethical dilemmas experienced by participants.
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Britton, Lauren Heather. "A contemporary view of occupational therapy in acute hospitals in metropolitan Western Australia." Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/55062.
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Ongoing healthcare reforms within Australia continue to shape occupational therapy practice within acute hospitals. This thesis explores the practice challenges experienced by occupational therapists in the acute context and the responses they are making to their practice as a result in this setting. It discusses a need for occupational therapists to re-form their approach to acute care practice to ensure ongoing relevance to the health system where further innovations will influence future healthcare provision.
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Mathiasen, Lis. "Children's attitudes to a hospital familiarisation programme." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1326.
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Many young children are admitted to the emergency departments of our childrens hospitals without the opportunity to receive any preparation in terms of what to expect and what to do or not to do (Health Department of W A, 2000). Surrounded by strange people, environment, smells, sounds and medical equipment, and confronted with possibly painful and invasive procedures, many young children become stressed and anxious. Negative psychological effects may have immediate and/or long lasting psychological consequences (Zuckerberg, 1994; 0 Byrne, Peterson & Saldana, 1997). It is important to protect young childrens rights and to minimise upset and trauma whenever possible. To meet the needs of children who may experience unplanned hospitalisation, preventative measures have been taken by the Association for the Welfare of Children in Hospital (AWCH). One of these preventative measures is a Hospital Familiarisation Programme (HFP) designed to prepare healthy young children for possible hospitalisation. This study investigated the effect of the HFP on 5 years olds understanding of common items of medical equipment and procedures, using a Medical Equipment and Procedures Test (MEPT). In addition, their feelings towards possible hospitalisation and medical intervention were obtained by the use of a Hospital Intervention Footings Index (HIFI). A Solomon Four Group design (Salkind, 1997) was employed with a total sample of 84 five-year-olds drawn from 4 pre-primary centres in a large metropolitan ' primary school. The treatment consisted of a Hospital Familiarisation Session conducted by a presenter from the Association for the Welfare of Children iii Hospital, W.A. An analysis of variance revealed th8t there was a significant increase in the childrens understanding of medical equipment and procedures, as well as an increase in positive feelings towards medical intervention as a result of the Hospital Familiarisation Programme. On the basis of these results and from a review of the research literature and an analysis of developmental theories, some modifications to the presentation of the HFP were suggested to maximise its effectiveness. Further recommendations were also made for current practice and future research investigation.
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Thomas, Claudia. "The epidemiology and control of Clostridium difficile infection in a Western Australian hospital." University of Western Australia. School of Population Health, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0011.
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[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression
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Golois, Eleni. "Caesarean section : the perspectives of obstetricians in a South Australian tertiary referral hospital /." Title page, table of contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09HS/09hsg627.pdf.
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Willmott, Julie Debra. "Health Professionals’ Perception of Patient Safety and Quality in a Western Australian Hospital." Thesis, Curtin University, 2018. http://hdl.handle.net/20.500.11937/73515.
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A descriptive, cross-sectional design study conducted to determine health professionals’ perception of patient safety and quality in a Western Australian hospital. The validated Hospital Survey on Patient Safety Culture™ tool was used to collect quantitative data and a small component of qualitative data from a free text section. Comparison of the findings were made with the Agency for Healthcare Quality and Research 2016 comparative database to allow quantification of PSC in the Australian healthcare context.
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Albsoul, Rania Ali Mohammad. "Investigating missed nursing care in an Australian acute care hospital: An exploratory study." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/132413/2/__qut.edu.au_Documents_StaffHome_staffgroupW%24_wu75_Documents_ePrints_Rania%2520Ali%2520Mohammad_Albsoul_Thesis%5B1%5D.pdf.
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This thesis is a mixed methods study of missed nursing care in an Australian acute care hospital. It explores the concept so as to further understand and to build a detailed theoretical understanding of the phenomenon. The study identified a range of factors influencing missed nursing care including the number of working hours per week, interruptions, and perceived lack of management support. A conceptual and holistic understanding of the phenomenon using Complexity Theory has been constructed. The thesis recommends incorporating nursing reflective practice into healthcare organisations and informing nursing management about change theories.
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Johnstone, Patricia Lynne. "The process and organisational consequences of new artefact adoption in surgery." Thesis, Electronic version, 2001. http://hdl.handle.net/1959.14/3905.
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Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001.Bibliography: leaves 288-310.
Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion.
Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption.
Electronic reproduction.
xii, 347 leaves, bound :
Mode of access: World Wide Web.
Also available in print form
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings." Curtin University of Technology, School of Nursing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11092.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++
process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
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Bull, Claudia F. "Patient Experiences in the Emergency Department: A Multi-Methods Study." Thesis, Griffith University, 2022. http://hdl.handle.net/10072/418663.
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Introduction: Measuring and evaluating patient experiences of care is critical to improving the delivery of high quality, safe, value-based healthcare; monitoring service and system performance; and enacting person-centred care. However, few psychometrically robust and parsimonious patient-reported experience measures (PREMs) are available for use in hospital Emergency Departments (EDs), and none are specifically designed for the Australian healthcare context. The overarching aim of this research was to develop and psychometrically evaluate a new ED PREM that can be used across Australian public hospital EDs.
Methods: This research used a three-phase, sequential multi-methods design where each phase informed the next. Phase one involved undertaking two systematic literature reviews. The first review sought to identify, describe and critically appraise the psychometric properties of published PREMs. The second review sought to identify and describe adult ED patient experiences from the patient perspective, as described in published studies. Phase one also involved semi-structured telephone interviews with adult patients purposively recruited across two southeast Queensland public hospital EDs. Phase two comprised the development of items for the ED PREM and established its content validity from the patient perspective using a two-round online reactive Delphi method. Phase three involved psychometrically evaluating the new ED PREM in a sample of adult patients recruited from one southeast Queensland public hospital ED. Multi-modal ED PREM administration was used, where recruited patients could choose to complete the ED PREM online, via telephone or post. The structural validity, internal consistency reliability and discriminant validity of the ED PREM was then assessed.
Results: In phase one, the first review included 109 studies describing 88 published PREMs of variable validity and reliability. The most frequently reported validity and reliability statistics included internal consistency reliability (65.2%), structural validity (55.1%) and content validity (38.2%). The second review included 54 published studies highlighting inter-related themes of adult ED patient experience: (i) Relationships between ED patients and care providers and (ii) Spending time in the ED environment. These findings were supported by semi-structured interviews with 30 adult ED patients. Four themes were inductively identified and included: (i) Caring relationships between patients and ED care providers; (ii) Being in the ED environment; (iii) Variations in waiting for care and (iv) Having a companion in the ED. Collectively, the phase one findings informed the development of a conceptual model of patient experience in the ED and subsequent ED PREM item development.
In phase two, 37 items were developed and assessed for clarity, relevance and importance using a Content Validity Index by 15 patient participants (83.3%). After round one of the Delphi process, 22 items were retained for the final ED PREM, two items were dropped and 13 items were revised and included in round two. In the second round, a total of 35 items reached consensus for clarity, relevance and importance, and were retained for the final ED PREM.
In phase three, the 35 item ED PREM was psychometrically evaluated using the responses of 349 (68.4%) adult ED patients. All items indicated ceiling effects ranging between 34.4-79.7%. Exploratory factor analysis revealed a four-factor solution, comprising 26 items that explained 55% of the model variance. Factors included: (i) Person-centred relationships between patients and ED care providers; (ii) Receiving timely ED care; (iii) Patient engagement in ED care and (iv) Privacy and comfort in the ED environment. Internal consistency reliability (Cronbach’s α) for all factors ranged between 0.84-0.97. Using the known-groups technique, the ED PREM demonstrated good discriminant validity in its ability to differentiate ED experiences based on gender, age and self-reported ED length of stay.
Conclusions: This research contributes to new knowledge through the development of a conceptual model of patient experience in the ED, published guidance for establishing PREM content validity and the development of a new ED PREM. With further psychometric testing, the ED PREM could be used to capture adult patient experiences across Australian public hospital EDs. These findings have important research, clinical practice and policy implications for building capacity in service and system-level performance measurement, benchmarking and quality improvement.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
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Boyce, Rosalie A. "Resource acquisition and resistance to change at National Hospital for Mothers and Babies : a case study into the implications of medical dominance." Thesis, Queensland University of Technology, 1989. https://eprints.qut.edu.au/36382/1/36382_Boyce_1989.pdf.
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This research project is an expost case study
analysis of the failed attempt of a small allied
health professional department (dietitians) in a
large public hospital to achieve a substantial
increase in resources. The research utilizes a
qualitative case study approach in which the
researcher was an active and leading participant in
the case events. The case study research methodology
is critically reviewed and justified in terms of its
applicability, objectivity and limitations.
The case study investigates a five year (1983 - 1988)
period at the National Hospital for Mothers and
Babies (NHMB) . A detailed description of the case
setting, the planning and change processes used by
the dietitians, and the response of NHMB management
are presented. This material provides the empirical
data for analysis. An interdisciplinary approach from theoretical paradigms such as sociology, economics and
organisational psychology are utilized in order to
provide a complementary analysis. The NHMB case study is a single case with embedded units of analysis. The units selected for examination are presented in the form of an analysis of critical issues influencing the outcome of the resource acquisition process. From an analytical
perspective the research concentrates on the
implications of substantial resource acquisition
goals in an emerging profession (dietitians) under
the direct control of a dominant profession
(medicine) in the hospital setting. A set of complementary hypotheses are developed and
assessed in terms of their ability to adequately
explain the case events from a theoretical
perspective. The first hypothesis proposes that
theories of medical dominance are able to explain
case events on an organisational scale. The
remaining hypotheses are located at the microanalytical
level. The second hypothesis postulates that the actions of the dietitians to commence an aggressive campaign for
additional resources can be explained as an adaptive
behaviour in an environment of conflicting
expectations. The third hypothesis contends that the dietitian's failure to achieve the desired resource objectives is able to be explained by assessing the levels of power able to be exercised by the dietitians relative to other actors in the case. The review of relevant literature and subsequent analysis of significant issues impacting on the outcome of the resource acquisition objectives suggests support for the hypotheses.
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Irving, Kate. "Case studies in restraint use in an acute teaching hospital : a Foucauldian approach." Curtin University of Technology, School of Nursing, 2001. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=12711.
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This thesis reports the outcomes of research into the use of restraint in the care of patients in an acute teaching hospital in Australia. The literature review undertaken for the study revealed much research into restraints showing evidence of the harm they cause, and their ineffectiveness as a safety measure. The literature indicates that the prevalence of restraint use is high - about a third of all hospital patients over the age of eighty-five years may be restrained at some time during the period of their admission.The main emphasis in my investigation was to uncover an understanding of how the use of restraints has remained possible, despite negative reports on their efficacy and questions about their possible abuse of human rights. Primarily, 1 set out to provide vide an understanding of restraint practice, and of how it is maintained and legitimised in a metropolitan teaching hospital.The study was guided by a Foucauldian approach to discourse analysis. The study reports on in depth studies of three patients. The case studies extend beyond observations of the patients to include interviews with members of the multidisciplinary team: nurses, doctors, occupational therapists and physiotherapists. Medical and nursing notes were another source of data.A discursive formation was identified by which restraint use is justified, and legitimised by the health professionals who use it. Five discourses were established, constituting: inability to 'self govern'; an appropriate environment; treatment; duty of care; and marginalisation.The study concludes that restraint use can be understood as a complex discursive practice. Through this discursive practice we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use. Knowledge of these discursive practices enables an understanding of how the current ++educational approaches to restraint reduction are likely to have little immediate or sustained impact. With these understandings, we are hopefully better placed to change practice in a way that does not substitute one undesirable approach for another. If this is so, the value of this thesis will lie in its influence on practice as much as in its contribution to scholarship.
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Walton, Merrilyn. "A multifactorial study of medical mistakes involving interns and residents." Thesis, School of Public Health, 2004. http://hdl.handle.net/2123/9309.
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Alcaino, Eduardo A. "The demand for dental general anaesthesia in children at Westmead Hospital, Sydney, Australia." Thesis, The University of Sydney, 1998. http://hdl.handle.net/2123/4752.
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Alcaino, Eduardo A. "The Demand For Dental General Anaesthesia In Children At Westmead Hospital, Sydney, Australia." Thesis, Faculty of Dentistry, 1998. http://hdl.handle.net/2123/4426.
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Dedman, Graeme Lee. "The dimensions of efficiency and effectiveness of clinical directors in Western Australia's public teaching hospitals." Thesis, Curtin University, 2008. http://hdl.handle.net/20.500.11937/229.
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The management of healthcare has changed dramatically over the past two decades. Such change has not just been in the way medicine is practiced, but also in the way the health dollar is spent. Hospitals have found themselves under constant and increasing pressure to not only reduce costs in relative terms, but also at the same time, provide new and expanded services. These pressures caused hospitals worldwide to closely examine the means by which they met the demands that were placed upon them (Royal Perth Hospital, 1994a; Asay and Maciariello, 1991). One common response was to embrace New Public Management strategies, such as devolved management. That is, to place the responsibility for managing diminishing health care resources, into the hands of those who use them the most - doctors (Chantler, 1993). To achieve this many hospitals adopted organisational structures known as clinical directorates (Chantler, 1993). Following international trends, the clinical directorate model was adopted by all of Western Australia’s public teaching hospitals in the mid 1990s. The belief was that by devolving hospital management to doctors, the clinical knowledge they possess will lead to improved clinical outcomes through the better allocation of resources. From the perceptions of Clinical Directors, Chief Executives, Nurse Managers, Business Managers and Department Heads, this research has developed a model, termed the Clinical Director Efficiency and Effectiveness (CD2E) model, that describes the dimensions of efficiency and effectiveness of Clinical Directors in the Western Australian public teaching hospital context.The model proposes that there are three perceived dimensions of efficient and effective clinical directorship. They are: those that are brought to the role by doctors and governed by the health environment in which they develop (Domain Knowledge and Skills), those that are learned (Business Skills) and those that are innate (Personal Attributes). The three perceived dimensions consist of nine components. ‘Domain Knowledge and Skills’ comprise clinical expertise, peer influence, political expertise and environment knowledge. ‘Business Skills’ comprise financial management, strategic management and human resource management. ‘Personal Attributes’ comprise commitment and participation, and communication. The CD2E model not only describes the perceived dimensions of efficiency and effectiveness, it also outlines those dimensions that are brought to the role of a Clinical Director by the medical profession and those areas where there are perceived deficiencies. Whilst the final CD2E model can be used to assist in developing and selecting future Clinical Directors who are more appropriately equipped to improve healthcare delivery within Western Australia, the literature suggests that the model also has features which are common and applicable to other health environments.
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Carlson, Samantha Jennifer. "Attitudes about and access to influenza vaccination in Australia: experiences of parents of children hospitalised for acute respiratory infection." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23701.
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Influenza vaccination is the most effective tool to prevent influenza disease, however, uptake in children in Australia is low. Accordingly, this thesis asked: why is influenza vaccine coverage low, and how can it be increased to prevent children from being hospitalised for influenza? Methods include: 1) a systematic review of the known barriers and facilitators of influenza vaccination of children and pregnant women in Australia between 2004 and 2015, 2) qualitative interviews with parents of children hospitalised in two sites in Australia for influenza in 2017, and 3) a cross-sectional survey with parents of children who were hospitalised for acute respiratory infection (+/– laboratory-confirmed influenza) in five sites across Australia in 2019. To understand the complexities of behaviour, the Capability-Opportunity-Motivation-Behaviour model was used across the multiple studies. This thesis highlights the importance of receiving an influenza vaccination recommendation from a health care provider; the lack of such a recommendation was a strong variable associated with lack of influenza vaccination in children who had been hospitalised for acute respiratory infection. This thesis also highlights the importance of increasing influenza vaccination opportunities; motivation to vaccinate is low if influenza vaccination is difficult to remember, organise and access. By systematically mapping out the barriers to influenza vaccination of children in Australia, we were able to understand exactly where and how to practically target efforts to change behaviour, and thus increase uptake of influenza vaccine.
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Dunne, Catherine Margaret. "An ado/aptive reading and writing of Australia and its contemporary literature." Connect to full text, 2007. http://hdl.handle.net/2123/2320.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed 29 Apr. 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of English, Faculty of Arts. Degree awarded 2008; thesis submitted 2007. Includes bibliographical references. Also available in print form.
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Melo, Maria Antónia Corga de Vasconcelos. "Language and resistance in the work of Janette Turner Hospital." Master's thesis, Universidade de Aveiro, 1999. http://hdl.handle.net/10773/18362.
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