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1
Tzafettas, Marilena. "Women's decision making process regarding prenatal diagnostic testing." Thesis, London Metropolitan University, 2017. http://repository.londonmet.ac.uk/1244/.
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Objective: Expanding the original scope of the study, which was to explore the decision-making process of pregnant women in the uptake of invasive diagnostic tests - amniocentesis and Chorionic Villus Sampling (CVS) – and taking into account the latest emergence of a Noninvasive Prenatal Testing, NIPT, the primary goal of this study was to explore factors that influence women’s decision to have an invasive, a non-invasive or no further testing at all. Design and sample: The Prenatal Decision Making Questionnaire (PDMQ) developed for the purposes of this study. Following a pilot test and factor analysis, it was distributed to a population of pregnant women (N=421) prior to them receiving their combined screening results. The total sample was divided into three sub-groups according to their risk status (low-intermediate-high) for the analysis. Results. Logistic regression analysis using the R version 3.0.3 revealed that none of the PDMQ factors had a significant impact on women’s decision to have an invasive test (CVS), whereas the following three factors had a significant impact on the decision to have a non-invasive test (NIPT): negative attitude to doctors and an internal locus of control were associated with the uptake of NIPT, whereas a negative attitude to medicine was associated with rejection of NIPT When risk status was included in the model it was found that uptake of NIPT was predicted by the presence of some level of risk for T21 or T13/T18. On the contrary, uptake of CVS was only predicted by an increased risk for T21. Conclusion(s): Women’s decision making process in prenatal diagnosis is affected by several factors with personalised risk being one of the key determinants. The findings of this study can be used by healthcare professionals in providing the appropriate support and information and facilitating an informed decision during this stage of pregnancy.
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Bell, Mary Ann 1953. "Losing connections: A process of decision-making in late life suicidality." Diss., The University of Arizona, 2000. http://hdl.handle.net/10150/284294.
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Late life suicide is a major public health problem in the U.S. with elderly white men at highest risk of completed suicide. This grounded theory study explored individual perspectives of suicidality with men aged 67 to 83 years. A basic social psychological process, Losing Connections, was identified from interviews. Three stages of this process were identified during which the effect of cumulative losses culminated in depression, prompted suicidal ideation, and led to a decision point for the individual. Loss was the key theme in stage one. Relationship, health, and role losses were identified with professional role loss being the most prominent. The second stage was characterized by depression and despair during which suicidal ideation was prominent. Progressive alienation and the resolution to die characterized this phase. In stage three, the struggle between wanting to die and deciding to do so presented a decision point. The decision point was surrounded by a balance of triggers and barriers, which was modulated by ambivalence. The informant perceived they had reasons to die (triggers), but made the decision not to die because of perceived consequences (barriers). Triggers prompting the decision point were thoughts of a deceased spouse, emotional pain, health problems, and feelings of uselessness and/or hopelessness. The most common barrier to suicide was consequences to family members. Religion was not a significant barrier. Instead, there was a general lack of religious connections among informants. Likewise, social isolation was not prominent, as informants retained connections with family members, friends, and community.
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Mapis, Gachomo Joanne. "The Dietary Decision-Making Process of Women in Nigeria." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7696.
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Nigerians have been opting for a more processed Western diet. These changes in dietary choices have aligned with obesity and undernutrition, attributable to micronutrient deficiencies or malnutrition. Many scholars have presented varying intervention strategies ranging from consumption of a variety of foods containing the necessary micronutrients to food fortification. The purpose of this grounded theory study was to explore the perceptions of women in an urban city in Nigeria on indigenous foods and Western dietary influences to determine social interactions, the consequence of the interactions, and the women’s current perceptions of food choices. The social-ecological model was used to explore the interaction between a woman and her environment. Women between the ages of 20 to 30 from the urban city of Jos, Nigeria, constituted the population of interest, and 12 women were chosen for the sample. From the in-depth interviews, a thematic analysis was employed to provide sociocontextual reasoning for changes in diet that have led to the loss of interest in traditional foods and cultures. This study found that Jos has a variety of foods, yet women choose the same staple foods to feed their families. Additionally, despite a marginal understanding of the health impact of diet, most women choose the convenience and palatability of Western options, citing cost as the rationale for choosing to cook staple Western-inspired meals at home. Understanding media, convenience, and cost can impact social change by enlightening communities on the interconnectedness of human health, cultures, and industrialization. Health care providers can monitor the outcomes of those who consume a variety of indigenous foods to see how such a practice could influence the overall health status of Nigerian families.
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Quinonez, Bonnie. "Influence of Dual Process Decision-Making Theory in Patients Diagnosed With Cancer." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10639411.
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Each year millions of people face the medical decision-making cycle that comes with a diagnosis of cancer. For patients and their families, this can be a rollercoaster of confusion and fear. Researchers have indicated that the complexity of the decision-making process is underrepresented in the current approach of informed decision-making. The purpose of this study was to add to scientifically-validated research expanding the identification of factors that influence decision-making for individuals diagnosed with cancer. Fuzzy trace theory (FTT) is the dual process memory theory used as the framework for this study. Qualitative data were collected using semistructured interviews with 10 participants. The sampling strategy included purposeful sampling and snowball or chain sampling. The audio-recorded interviews were transcribed and analyzed. Software tools were used to aid in the creation of word mapping and clusters and a naming structure emerged. A comprehensive thematic analysis was completed. Participants detailed experiences with family and social dynamics, psychological or emotional stress, external influencing factors to the decision-making process, and experiences with cancer advertising. This research can create positive social change through the advancement of scientifically-validated research to support patients during the decision-making process.
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Eisenberg, Dana J. "Information Amount and Patient Empowerment: Participation in the HPV Vaccination Decision-Making Process." Columbus, Ohio : Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1243830226.
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Greener, Judith Robin. "Contralateral Prophylactic Mastectomy: An Exploratory Approach to Understanding the Decision Making Process." Diss., Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/354121.
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Public HealthPh.D.
The rate at which women choose mastectomy has grown dramatically, and of particular note is the increase in contralateral prophylactic mastectomy (CPM). For women with no history of breast cancer or genetic risk, CPM represents a treatment decision that does not offer better long-term outcomes than the decision not to remove a healthy breast and may be associated with increased surgical risk and interventions, increased cost to the healthcare system, and potential adverse psycho-social outcomes. To better understand the decision making process regarding the election of CPM among women with early stage unilateral breast cancer, with no family history or genetic risk, a three-phase exploratory study was conducted. Qualitative in-depth interviews were conducted with healthcare providers who have close interaction with women during the decision making process (N=3) and patients who made a surgical decision about breast cancer treatment within the past three years (N=11). These two phases informed the design of the quantitative internet survey, conducted among women diagnosed with early stage breast cancer in the process of making a surgical decision (N=336). The survey design was also guided by an existing model for treatment decision making which uses a social ecological framework (Revenson & Pranikoff, 2005). In addition to descriptive analyses, perceptual mapping was utilized to understand patients’ conceptualizations of the relative importance of factors considered during the decision making process, and AdSAM® was used to gauge emotional response. Results suggest that women more likely to elect CPM demonstrate an emotional response to a generalized fear of cancer, along with the need to take control of their situation. In addition, retrospective interviews emphasized somewhat different reasons for electing CPM, highlighting the importance of prospective research in studying the decision making process.
Temple University--Theses
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Quinonez, Bonnie D. "Influence of Dual Process Decision-Making Theory in Patients Diagnosed With Cancer." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4402.
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Each year millions of people face the medical decision-making cycle that comes with a diagnosis of cancer. For patients and their families, this can be a rollercoaster of confusion and fear. Researchers have indicated that the complexity of the decision-making process is underrepresented in the current approach of informed decision-making. The purpose of this study was to add to scientifically-validated research expanding the identification of factors that influence decision-making for individuals diagnosed with cancer. Fuzzy trace theory (FTT) is the dual process memory theory used as the framework for this study. Qualitative data were collected using semistructured interviews with 10 participants. The sampling strategy included purposeful sampling and snowball or chain sampling. The audio-recorded interviews were transcribed and analyzed. Software tools were used to aid in the creation of word mapping and clusters and a naming structure emerged. A comprehensive thematic analysis was completed. Participants detailed experiences with family and social dynamics, psychological or emotional stress, external influencing factors to the decision-making process, and experiences with cancer advertising. This research can create positive social change through the advancement of scientifically-validated research to support patients during the decision-making process.
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Puski, Athena Joy Bowen. "The Surgical and Management Decision-Making Process of BRCA1 and BRCA2 Mutation Carriers." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1459588788.
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Kier, Karen Leigh. "A study of the adaptive decision making ability of pharmacists' when patient counseling using a process-tracing technique /." The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488193665236376.
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Shi, Zhenzhen. "A MARKOV DECISION PROCESS EMBEDDED WITH PREDICTIVE MODELING: A MODELING APPROACH FROM SYSTEM DYNAMICS MATHEMATICAL MODELS, AGENT-BASED MODELS TO A CLINICAL DECISION MAKING." Diss., Kansas State University, 2015. http://hdl.handle.net/2097/20578.
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Doctor of PhilosophyDepartment of Industrial & Manufacturing Systems Engineering
David H. Ben-Arieh
Chih-Hang Wu
Patients who suffer from sepsis or septic shock are of great concern in the healthcare system. Recent data indicate that more than 900,000 severe sepsis or septic shock cases developed in the United States with mortality rates between 20% and 80%. In the United States alone, almost $17 billion is spent each year for the treatment of patients with sepsis. Clinical trials of treatments for sepsis have been extensively studied in the last 30 years, but there is no general agreement of the effectiveness of the proposed treatments for sepsis. Therefore, it is necessary to find accurate and effective tools that can help physicians predict the progression of disease in a patient-specific way, and then provide physicians recommendation on the treatment of sepsis to lower risk for patients dying from sepsis. The goal of this research is to develop a risk assessment tool and a risk management tool for sepsis. In order to achieve this goal, two system dynamic mathematical models (SDMMs) are initially developed to predict dynamic patterns of sepsis progression in innate immunity and adaptive immunity. The two SDMMs are able to identify key indicators and key processes of inflammatory responses to an infection, and a sepsis progression. Second, an integrated-mathematical-multi-agent-based model (IMMABM) is developed to capture the stochastic nature embedded in the development of inflammatory responses to a sepsis. Unlike existing agent-based models, this agent-based model is enhanced by incorporating developed SDMMs and extensive experimental data. With the risk assessment tools, a Markov decision process (MDP) is proposed, as a risk management tool, to apply to clinical decision-makings on sepsis. With extensive computational studies, the major contributions of this research are to firstly develop risk assessment tools to identify the risk of sepsis development during the immune system responding to an infection, and secondly propose a decision-making framework to manage the risk of infected individuals dying from sepsis. The methodology and modeling framework used in this dissertation can be expanded to other disease situations and treatment applications, and have a broad impact to the research area related to computational modeling, biology, medical decision-making, and industrial engineering.
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Boxenbaum, Eva. "The partnership metaphor in Quebec health care policy : the decision-making process with cognitively impaired elderly clients in home care." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33063.
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This research evaluates Quebec's health care policy by analyzing how the partnership metaphor is implemented in policy and practice. The partnership construction is identified in 4 interpretive communities within long-term community services to the elderly population. This analysis focuses on the placement decision for cognitively impaired clients in home care. Interpretive policy analysis is employed to examine 3 policy documents and 3 client files, while grounded theory serves to analyze 13 semi-structured interviews with 2 administrators and 3 open triads of client, caregiver, and case manager. The findings show partnership to be an egalitarian, collaborative ideal widely adopted but with little consensus on the pertinent objects and actors. Important differences emerge in how partnership is applied to the placement decision, indicating a too flexible application. Specific restrictions are recommended on the application of the partnership metaphor in order to improve community services and organizational structures in health care.
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Gregory, Daniel J. "Iowa men's decision-making process for prostate cancer prevention via screening with the prostate-specific antigen (PSA) test." Diss., University of Iowa, 2007. http://ir.uiowa.edu/etd/177.
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Lima, Clarissa Sucupira Andrade. "The use of formal methods for decision making in the planning phase of healthcare facilities." Thesis, Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-04042007-211547/.
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Banduch, Kaitlin. "Using the Theory of Motivated Information Management (TMIM) and Family Communication Patterns (FCP) to Understand Individual Decisions to Undergo Genetic Testing for Huntington's Disease (HD)." Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1397834101.
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Stepping, Katharina M. K. [Verfasser], and Stefan [Akademischer Betreuer] Voigt. "The Donor-Intermediary Interaction and the Decision-Making Process of Intermediaries for Development Assistance for Health / Katharina Magdalena Karoline Stepping. Betreuer: Stefan Voigt." Marburg : Philipps-Universität Marburg, 2012. http://d-nb.info/1027184103/34.
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Lamb, Christopher C. "STILL CROSSING THE QUALITY CHASM: A MIXED-METHODS STUDY OF PHYSICIAN DECISION-MAKING WHEN TREATING CHRONIC DISEASES." Case Western Reserve University School of Graduate Studies / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1519222095020285.
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Gonzaga, Rosalba Maria Morais. "Desenho institucional e efetividade deliberativa dos conselhos de saúde: dinâmicas de participação e processo decisório no município de João Pessoa PB." Universidade Federal da Paraíba, 2011. http://tede.biblioteca.ufpb.br:8080/handle/tede/7284.
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Previous issue date: 2011-12-12Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
In health, the creation of forums as Health Councils and the effect of the decentralization process emphasized by the Constitution of 1988, resulted in higher powers and the increasing importance of the public sphere of municipal administration. However, the participation of Councillors in the process of decision making has been identified as one of the challenging aspects in the work of these committees, because of limitations imposed by the powers of representation. The research is focused on understanding of this process, with emphasis on analyzes of the Municipal Health Council of João Pessoa (CMS/JP), more specifically, with regard to decision making and their effectiveness discussed. To this end, several analyzes were performed starting from a study of qualitative and quantitative, by using the linking of data from three basic elements in this study: information obtained from observations on the CMS / JP, texts of the Acts of the CMS/JP and texts drawn from interviews with some of the Municipal Board of Health/JP-CP. Under the quantitative approach, tables were compiled, whose goal was to obtain, among other data related to the issue of quorum at meetings of the CMS/JP, that is related to the presence / absence of Councillors representatives of the segments in that council. Once extracted, the data were tabulated from the use of measures of central tendency: mean, median, aiming to analyze the participation of the numerical representation for each segment in the meetings of the CMS/JP-CP. As the study indicates, the CMS/JP has acted in a much more purposeful than deliberative, ie, note that this collegiate has presented great difficulties for the performance of its deliberative character, with little expression of some debates in the field where the participation does not always result in significant decision-making influence in the deliberations of the municipal public health policies, focusing on very fragile deliberative.
No campo da saúde, a criação de fóruns, como Conselhos de Saúde, e o efeito do processo de descentralização, enfatizado a partir da Constituição de 1988, resultaram em maiores atribuições e aumento da importância da esfera pública municipal de administração. Contudo, a participação de Conselheiros no processo de tomadas de decisão tem sido apontada como um dos aspectos desafiadores na atuação desses colegiados, em razão das limitações impostas à representação pelos poderes instituídos. A pesquisa está voltada à apreensão desta reflexão, com ênfase nas análises do Conselho Municipal de Saúde de João Pessoa-PB (CMS/JP), mais especificamente, no que diz respeito ao processo decisório e sua efetividade deliberativa. Para tanto, foram realizadas diversas análises, partindo de um estudo de cunho qualitativo e quantitativo, sendo utilizado o cruzamento de dados entre três elementos basilares no referido estudo: informações obtidas através das observações no CMS/JP, textos das Atas do CMS/JP e textos elaborados a partir das entrevistas com alguns dos Conselheiros Municipais de Saúde/JP-PB. Sob o enfoque quantitativo, foram elaboradas tabelas, cujo objetivo foi obter, entre outros, dados relacionados à questão do quórum nas reuniões do CMS/JP, isto é, à presença/ausência de Conselheiros representantes dos segmentos no referido colegiado. Depois de extraídos, os dados foram tabulados a partir do uso de medidas de tendência central: média e mediana, com intuito de analisar a participação numérica da representação por segmento nas reuniões do CMS/JP-PB. Conforme indica o estudo, o CMS/JP tem atuado de forma muito mais propositiva do que deliberativa, ou seja, nota-se que este colegiado tem apresentado grandes dificuldades para o desempenho do seu caráter deliberativo, com pouca expressividade no campo de alguns debates onde a participação nem sempre resulta em significativa influência decisória nas deliberações das políticas públicas de saúde municipal, incidindo em grande fragilidade deliberativa.
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Boyle, David W. "Understanding the decision-making process of coaches and high-performance staff on player training and game availability in the National Rugby League (NRL) men." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2587.
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Abstract Abbreviated:
This research aimed to understand better the information coaches and high-performance managers use and how they make decisions on player availability in the National Rugby League (NRL) men. The three factors that contributed to decision-making were: (1) their experience in the NRL, (2) trust (between coach and support team) determines many (if not all) decision-making processes, and (3) managing expectations of coaches, their staff, and players. There was one common denominator across all player availability decisions – data provided a basis for deliberation – but ultimately, the human connection through conversations (formal and informal) determined selection.
Introduction:
The game of rugby league is a physically demanding contest where players repeatedly perform intermittent high-speed running bouts, involving frequent accelerations, decelerations, and numerous high-intensity collisions. These bouts result in fatigue, soreness, and at times varying degrees of injury during or in the subsequent days after a game. With the current evolution of sports science technology in rugby league, the team’s attempt to measure and monitor the physical demands (either internal or external training load) using objective (e.g. Global Positioning Systems) and subjective (e.g. through coach, trainers, or athlete feedback) information. To add complexity, the National Rugby League commission has recently made significant rule changes to speed the game up (e.g. six again call to keep play flowing), resulting in high-performance managers’ having to develop stronger, faster, and more conditioned athletes. An additional evolutionary challenge for elite coaches has been the escalation of staff and player roster numbers, the outcome seen as a requirement to recruit specialisation coaches for specific skills and high-performance areas. These changes in rules and staff structure have increased the need to have management and leadership skills to coordinate the magnitude of information before decisions on player availability are made. The purpose of this research was to achieve a greater understanding (descriptive research orhypothesis-generating) from an interpretative approach as to what external/internal training load information elite coaches and high-performance managers use and how they make decisions on player availability in the NRL.
Methods:
This research used a mixed-method design with the quantitative component adopting two deductive approaches; the first by extracting data from each participant’s demographic details. The second included a pre-interview questionnaire that was developed to better understand the framework of processes for monitoring, planning, and decision-making. The qualitative component used a grounded theory constructivist design through semi-structured interviews by asking open-ended questions with participants to explore and understand the decision-making process as no current theory exists in this population.
Findings:
This study’s main findings include that coaches and high-performance manager support that, a team first culture and relationship between coaches, medical, high-performance staff and players based on trust is critical for success observation and casual conversations are key areas for monitoring and information gathering surrounding player well-being and preparedness an emotional intelligence leadership approach has emerged as the preferred model to facilitate a functional coach - athlete relationship a proposed conceptual framework of processes for monitoring, planning, and decision-making is supported as being an appropriate model
Conclusion:
Based on the findings this study concludes there are numerous factors that determine criticaldecision-making on player availability in the National Rugby League. Experience in the National Rugby League plays a significant role in player selection Trust (between coach and support team) determines many (if not all) decision-making processes. Specialist staff provide objective and subjective data to the head coach who determines (through consultation) whether a player is available for selection. Communication, organisation and effort has positive implications across all functions of an NRL club including managing expectations of coaches, their staff, and players.
Managing expectations (of staff, players, administrators and the media) is a full-time role for head coaches in the National Rugby League and it is forever changing (rules, technology, compliance) requiring a delicate balance of art versus science. There was one common denominator across all player availability decisions – data provided a basis for deliberation – but ultimately it was the human connection through conversations (formal and informal) that determined selection.
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Alhajri, Jefain R. "Six element maturity model for health and safety improved performance in Kuwaiti oil sector." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/six-element-maturity-model-for-health-andsafety-improved-performance-in-kuwaiti-oilsector(8bda125b-6659-414b-96be-cfd2e8ce6d2f).html.
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The management of health and safety risks in the oil refinery tends to be centred on the collection and simulation of technical data which can then be used to make decisions on the wellbeing of the workforce as well as the refinery installations. While the number crunching in the process is immensely vital, there tends to be a problem of ignoring or, at the very least, side-lining the social-cultural values of the people dealing with health and safety risk assessment processes. The economic driver for the operation of the oil refinery tends to be more important because of the generally huge initial financial outlay, and the eventual high costs of maintenance; hence health and safety risk management should have evidence of ensuring that the installations, as well as the people that work in them, are well catered for. In the Kuwait Gulf Oil Company this problem is more evident in newer installations where lean management processes have been instituted by oil firms so that they can reduce waste in the oil refining process without compromising the occupational health and safety needs of the refinery. Therein lies the initial problem of integrating health and safety risk assessment processes because most approaches concentrate on the technical elements of waste elimination while ignoring the social-cultural factors that impact on the health and safety of the workforce. This is an exploratory piece of research that examines the impact of rational and cognitive decision theories – herein called the psychology of risk – and how they impact on the occupational health and safety systems in the oil and gas refining sector of Kuwait. The research concludes that the application of lean concepts in the oil refining process is noble in itself but it needs to be integrated with the rational and cognitive detection factors that are necessary to incorporate and support the social-cultural tendencies of the workforce. The research recommends a framework for incorporating social-cultural values in the decision making process pertaining to health and safety risk assessment in oil refining process plants. Key Words: occupational health and safety risk assessment; lean management; social-cultural values; rational and cognitive decision making; oil and gas process plants.
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Vianna, Rodrigo de Souza. "Processo decisório e inovação em serviços: um estudo a partir da trajetória de uma instituição hospitalar." Universidade do Vale do Rio dos Sinos, 2015. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4955.
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UNISINOS - Universidade do Vale do Rio dos Sinos
A adequada articulação entre processo decisório e inovação em serviços pode levar ao sucesso ou fracasso de uma empresa ou instituição. A inovação em serviços é também o resultado de um processo decisório, e este deve ser bem gerenciado, de forma a abarcar os possíveis desdobramentos deste processo, principalmente para evitar eventuais vieses. A reflexão sobre processo decisório e inovação em serviços no ambiente hospitalar também se justifica pela atualidade do tema. A administração hospitalar é resultado de um sistema que se expandiu, e o hospital é visto como uma empresa moderna. A vantagem competitiva em saúde pode ser obtida através de estratégias de diferenciação ligadas a muitos fatores geradores de custos (estrutura hospitalar e operacional, cultura da organização, entre outras), que precisam ser administrados (PORTER e TEISBERG, 2007; KLOCK, 2009; NEVES, 2009). O estudo buscou demonstrar como ocorre o processo decisório para inovação em serviços em uma instituição hospitalar que, recentemente, implementou novos serviços e em breve ampliará toda a sua estrutura física (inclusive com novas tecnologias e serviços). O estudo também percorreu uma trajetória de forma a verificar se os novos serviços podem ter auxiliado nos resultados financeiros da instituição. No desenvolvimento do trabalho, foram realizadas pesquisas em doutrinas, sites, artigos, bem como coleta de dados através de documentação fornecida pela instituição e entrevistas com alguns tomadores de decisão da instituição. O estudo teve como objetivo geral identificar o funcionamento do processo decisório na inovação em serviços em um ambiente hospitalar, e verificar de que forma tais inovações podem ter impactado os resultados financeiros da instituição. Já os objetivos específicos deste trabalho foram identificar como funciona o processo decisório da instituição hospitalar em estudo, quais as inovações em serviços foram implementadas recentemente, bem como quais foram os seus objetivos e resultados financeiros alcançados. Analisando os dados coletados, buscou-se entender se as decisões tomadas, sobre os novos serviços, realmente beneficiaram o desempenho da instituição. Os principais resultados sugerem que existe relação entre os investimentos em novos serviços e os resultados da instituição. Assim, a decisão pela ampliação da estrutura física, que também será acompanhada de novos investimento em serviços, pode ter sido uma acertada decisão.
Proper coordination between decision-making and innovation in services can lead to success or failure of a company or institution. Innovation in services is also a result of a decision-making process, and this must be well managed in order to cover the possible consequences of this process, mainly to avoid any bias. The consideration of decision-making and innovation in services in hospitals is also justified because this theme is current. The hospital administration is a result of the system that has expanded, and the hospital is seen as a modern company. Competitive advantage in health can be achieved through differentiation strategies related to many factors causing costs (hospital and operational structure, culture of the organization, etc.) that need to be administered (Porter and Teisberg, 2007; Klock, 2009; Neves, 2009). The study sought to demonstrate how is the decision-making process for innovation in services in a hospital,whichrecently implemented new services and soon it will expand its entire physical structure (including new technologies and services). The study also covered a trajectory in order to demonstrate if the new services may have aided the recent results of the institution. In developing this work, surveys were conducted in doctrines, websites, articles, and data collection through documentation provided by the institution and interviews with some decision makers of the institution. As a general aim, the study wanted to identify the functioning of the decision-making process on innovation in services in a hospital setting, and check how these innovations impact the results of the institution. As for the specific objectives of this study they were to identify how the decision-making process works, which innovations in services have been implemented recently, and what were your goals, beyond of understanding the relationship between decision-making and innovation in services in the context of the study. Analyzing the data collected, we sought to understand whether the decisions taken on the new services actually benefited the performance of the institution. The main results suggest that there is a relationship, although not significant, between investments in new services and the results of the institution. Thus, the expansion of physical infrastructure, which will also be accompanied by new investments in technologies and services, suggests a positive conclusion as to the decision made.
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Muge, Lydiah Joyce C. "Experiences of caregivers around the final decision-making process of transferring an older person living with dementia to long-term care: A grounded theory study." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2510.
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The decision to transfer an older person living with dementia to long-term residential care is challenging for family caregivers. The experiences of family caregivers leading up to the transfer have been previously explored; however, no study has explicitly focused on family experiences related to making the final decision to transfer. This study presents a constructivist grounded theory of the experiences of 12 family caregivers of older adults living with dementia. Caregivers of these older people were recruited through a residential aged care facility in the metropolitan area, Western Australia. Data collection was conducted using face to face interviews with the participants and guided by the interview questions. Data collection and analysis followed the steps and fundamentals of a grounded theory approach which included concurrent data collection and analysis, constant comparison and memo-writing. Data was analysed using Charmaz’s coding technique to include initial coding, focused coding and theoretical coding (Charmaz, 2006).
This thesis presents a substantive constructivist theory of: “The journey of uncertainty punctuated by key moments.” The journey of uncertainty in the context of this study includes the unpredictable experiences of family caregivers before, during and post transfer of an older person living with dementia to long-term residential care. The key moments were the major changes that older people living with dementia, or the family caregiver, experienced. Four core categories exemplified the journey of uncertainty: “cascade of events triggering the final decision.” which illuminated the burden of care to family caregivers, the gradual deterioration and the unpredictable acute care needs of the older person living with dementia. “Responsibility for decision-making and living with the decision” captured the experiences of family caregiver on decision-making to transfer and life post decision. The complex transfer process to residential aged care was perceived as “Navigating the maze of the complex transfer process” punctuated by bureaucracy and lack of knowledge and support. “Life after transfer to long-term residential care” depicted continuity of the journey with ongoing uncertainties among family caregivers about the need to partner and build relationships with long-term residential staff and the support they needed post transfer. The substantive grounded theory suggests that there is need to increase support provided to family caregivers. The study highlights implications for professional practice, future policy and residential aged care providers and identifies areas for further research.
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Chen, Chen. "An e-health system for personalized automatic sleep stages classification." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066664/document.
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Dans cette thèse, un système personnalisé de stadification automatique du sommeil est proposé, combinant fusion symbolique et système de contrôle rétroactif. La fusion symbolique est inspirée par le processus décisionnel mis en œuvre par les cliniciens experts du sommeil lors la reconnaissance visuelle des stades de sommeil. Il commence par l'extraction de paramètres numériques à partir des signaux polysomnographiques bruts. L'interprétation symbolique de haut niveau se fait par l'intermédiaire de l'extraction de caractéristiques à partir des paramètres numériques. Enfin, la décision est générée en utilisant des règles inspirées par les recommandations internationales en médecine du sommeil. Les symboles et les valeurs des caractéristiques dépendent d'un ensemble de seuils, dont la détermination est une question clé. Dans cette thèse, deux algorithmes de recherche différents, Differential Evolution et Cross Entropy ont été étudiés pour calculer la valeur de ces seuils automatiquement. La variabilité individuelle a souvent été ignorée dans les systèmes automatiques de stadification du sommeil existants. Cependant, elle a été démontrée dans plusieurs travaux de recherche vis à vis de nombreux aspects du sommeil (comme les enregistrements polysomnographiques, les habitudes de sommeil, l'architecture du sommeil, la durée du sommeil, les événements liés au sommeil, etc.). Afin d'améliorer l'efficacité des classificateurs des stades de sommeil, un système automatisé de sommeil automatique adapté aux différentes personnes et tenant compte de la variabilité individuelle a été exploré et évaluéIn this thesis, a personalized automatic sleep staging system is proposed by combining symbolic fusion and feedback system control technique. Symbolic fusion is inspired by the decision-making process of clinical sleep staging. It starts from the extraction of digital parameters from raw polysomnography signals and it goes up to a high-level symbolic interpretation through a features extraction process. At last, the decision is generated using rules inspired by international guidelines in sleep medicine. Meanwhile, the symbols and the features computations depend on a set of thresholds, whose determination is a key issue. In this thesis, two different search algorithms, Differential Evolution and Cross Entropy, were studied to compute these thresholds automatically.Individual variability was often ignored in existing automatic sleep staging systems. However, an individual variability was observed in many aspects of sleep research (such as polysomnography recordings, sleep patterns, sleep architecture, sleep duration, sleep events, etc.). In order to improve the effectiveness of the sleep stages classifiers, a personalized automatic sleep staging system that can be adapted the different persons and take individual variability into consideration was explored and evaluated.The perspectives of this work are based on evaluating the complexity and the performances of these algorithms in terms of latencies and hardware resource requirements, in order to target a personalized automated embedded sleep staging system
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Sadli, Nabila. "Le rôle des informations de santé en ligne sur le processus décisionnel d’achat de médicaments d’automédication." Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLV128.
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La généralisation de l'usage destechnologies numériques a imposé au secteur dela santé de nombreux changements, notammentceux qui se rapportent à la circulation del'information sur les médicaments. Le volumeconsidérable d'informations de santé auquel sontconfrontés régulièrement les consommateurs estsusceptible d'affecter la manière avec laquelle cesderniers évaluent les différentes opportunités dece marché, notamment celles qui sont relatives àl'automédication. L'analyse des données obtenues,d'une part à l'aide d'entretiens approfondis avecdes pharmaciens, et d'autre part, grâce à uneimmersion totale en officine, nous ont apporté deséléments de réponses sur les implications quidécoulent de l'usage d'internet en sa qualité desource d'informations sur la perception du risquelors du processus de décision relatif à l'achat debiens de santé, plus particulièrement celui desmédicaments d'automédicationThe general use of digital technologieshas imposed on the healthcare sector manychanges, in particular, those relating to the flowof information on drugs. Consumers areconfronted with a sheer volume of healthinformation that is likely to affect the way inwhich they evaluate the different opportunitiesin this market, particularly those related to selfmedication.In this research, in-depth interviewswith pharmacists and participant observation(full immersion in pharmacies), were selected asthe data collection techniques. The analysis ofdata provided some possible answers about theimplications arising from the use of the Internetas a source of information on perceived risk inthe health products decision-making process,more particularly, that of self-medication drugs
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Schweitzer, Bethany S. "Coming to America sixth form students' reasons for considering undergraduate study in the United States /." Ohio : Ohio University, 2009. http://www.ohiolink.edu/etd/view.cgi?ohiou1242409170.
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Castro, Andrezza Belluomini [UNESP]. "Processo decisório da gestão e as repercussões para trabalhadores de instituição pública de saúde." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/149995.
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O processo decisório nas instituições de saúde acontece cotidianamente e suas repercussões podem causar impactos positivos ou negativos para aqueles que as vivenciam. As ações de decisão habitualmente estão centralizadas no corpo de gestores da instituição e, portanto, compete a eles a responsabilidade de criar estratégias para que escolhas realizadas tenham o propósito de levar a instituição a atingir seus melhores resultados. Nesse sentido, esta pesquisa tem como objetivo apreender as repercussões profissionais e pessoais para os trabalhadores de uma instituição pública de saúde, decorrentes do processo decisório da gestão. Trata-se de um estudo qualitativo realizado em um Hospital Público de referência em ensino do estado de São Paulo, após aprovação do Comitê de Ética em Pesquisa sob n. CAAE: 47979115.0.0000.5411. Participaram deste estudo 25 trabalhadores do quadro efetivo institucional, pertencentes a diferentes categorias da equipe administrativa e equipe de saúde. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, previamente agendadas, realizadas em locais escolhidos pelos participantes e gravadas em aparelho digital. O tratamento dos dados foi realizado segundo a Análise de Conteúdo e os resultados emergentes apontam para três categorias de análise que emergiram dos discursos dos sujeitos da pesquisa: “O conhecimento dos trabalhadores sobre o organograma institucional está focado na proximidade com os cargos”; “O sistema decisório da gestão influencia na vida profissional do trabalhador de saúde” e “O sistema decisório da gestão exerce influência na vida pessoal do trabalhador”. Os discursos foram analisados com base na literatura e documentos oficiais sobre o tema envolvendo Processo Decisório. Assim, esse estudo implementa ações de mudança no processo tradicional “centralizado” das instituições de saúde, no sentido de propor a ruptura de ações dominantes e decisões autônomas da gestão. Neste sentido, como produto dessa pesquisa foi elaborado um vídeo que constitui um canal de comunicação no processo admissional, visando acolhimento, inclusão nos processos hierárquicos e à integração entre os gestores e seus liderados no sentido de possibilitar novos olhares e viabilização de parcerias para um melhor convívio no ambiente profissional.
The process of decision making is present routinely in health institutions and their repercussions may cause positive or negative impact on those who are exposed. The decision making is normally centralized in the managers of the institution, thus, they being responsible for creating strategies for the institution reaching the best result. The aim of this study was to analyze the impact of the management on the personal and professional repercussions of the employees in a public health institution. The study design is a qualitative study, being realized in a public health teaching hospital in the State of São Paulo-Brazil. The study was approved by the local Ethic commission (protocol CAAE: 47979115.0.0000.5411); all participants signed a written consent. 25 employees of different areas of the administration and of the health care team were invited. Data were achieved by semi-structured interviews, previously scheduled, at a place of choice of the interviewer. All interviews were recorded. The analyses of the data were based on the principles of the analysis of context. Results pointed out three categories of analysis “ The knowledge of the employees about the institucional organogram is focused on the approach of the positions”; “The system of decision making in management influences the professional life of the health worker” and “ The system of decision making in management influences the personal life of the health worker”. The analyses of the interviews were based on literature and documents about the thematic of Process of decision making. Thus, this study implements action for changing the traditional centralizing process in health institutes and proposes the break of dominant actions and autonomous actions of management. As part of the results, a video was produced, as an instrument of communication during the admission process which focuses on hosting, inclusion in the hierarchical processes and on the integration between employees and managers. These action will bring new insights and possibilities of partnerships for a better professional environment.
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Castro, Andrezza Belluomini. "Processo decisório da gestão e as repercussões para trabalhadores de instituição pública de saúde." Botucatu, 2017. http://hdl.handle.net/11449/149995.
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Orientador: Eliana Mara BragaResumo: O processo decisório nas instituições de saúde acontece cotidianamente e suas repercussões podem causar impactos positivos ou negativos para aqueles que as vivenciam. As ações de decisão habitualmente estão centralizadas no corpo de gestores da instituição e, portanto, compete a eles a responsabilidade de criar estratégias para que escolhas realizadas tenham o propósito de levar a instituição a atingir seus melhores resultados. Nesse sentido, esta pesquisa tem como objetivo apreender as repercussões profissionais e pessoais para os trabalhadores de uma instituição pública de saúde, decorrentes do processo decisório da gestão. Trata-se de um estudo qualitativo realizado em um Hospital Público de referência em ensino do estado de São Paulo, após aprovação do Comitê de Ética em Pesquisa sob n. CAAE: 47979115.0.0000.5411. Participaram deste estudo 25 trabalhadores do quadro efetivo institucional, pertencentes a diferentes categorias da equipe administrativa e equipe de saúde. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, previamente agendadas, realizadas em locais escolhidos pelos participantes e gravadas em aparelho digital. O tratamento dos dados foi realizado segundo a Análise de Conteúdo e os resultados emergentes apontam para três categorias de análise que emergiram dos discursos dos sujeitos da pesquisa: “O conhecimento dos trabalhadores sobre o organograma institucional está focado na proximidade com os cargos”; “O sistema decisório da gestão in... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The process of decision making is present routinely in health institutions and their repercussions may cause positive or negative impact on those who are exposed. The decision making is normally centralized in the managers of the institution, thus, they being responsible for creating strategies for the institution reaching the best result. The aim of this study was to analyze the impact of the management on the personal and professional repercussions of the employees in a public health institution. The study design is a qualitative study, being realized in a public health teaching hospital in the State of São Paulo-Brazil. The study was approved by the local Ethic commission (protocol CAAE: 47979115.0.0000.5411); all participants signed a written consent. 25 employees of different areas of the administration and of the health care team were invited. Data were achieved by semi-structured interviews, previously scheduled, at a place of choice of the interviewer. All interviews were recorded. The analyses of the data were based on the principles of the analysis of context. Results pointed out three categories of analysis “ The knowledge of the employees about the institucional organogram is focused on the approach of the positions”; “The system of decision making in management influences the professional life of the health worker” and “ The system of decision making in management influences the personal life of the health worker”. The analyses of the interviews were based on l... (Complete abstract click electronic access below)
Mestre
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Pucci, Marcos. "Análise do processo de tomada de decisão orçamentária no setor de saúde." Universidade Presbiteriana Mackenzie, 2013. http://tede.mackenzie.br/jspui/handle/tede/907.
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Previous issue date: 2013-02-04One of the challenges of contemporary businesses is to enhance and strengthen the human resource, one of the most important in the current competitive scenario (YOUNDT; SUBRAMANIAM; SNELL, 2004). Although the search for maximizing the performance of organizations (and the people involved with them, regarding their decision-making processes) is not a new concern in disciplines related to management and production, there are still gaps to be filled. For the development of this research was used as a theoretical model for Decision Making from a research line called neuroaccounting, which is been developing in the Center for Research on Controlling of Mackenzie Presbyterian University. The research question is to understand how the manager of healthcare makes decisions related to budget goals. Always focusing on the process of decision-making for budget, it discusses theoretical foundations from classic to the contemporary, including cognitive psychology, economics and information processing. Through the application of electronic questionnaires, which were directed to hundreds of hospital managers involved in decision-making budget, we obtained sufficient data to conduct an analysis of the cognitive processes adopted by these managers. Once with the data collected, was used descriptive statistics and multivariate factor analysis (to reveal constructs) and Structural Equation Modeling (to assess the correlations between the constructs suggested by theoretical) via method Partial Least Squares (PLS). The results, in line with previous studies on the same topic and line of research confirms, the pattern of behavior of managers in relation to the search for information to make budget decisions. Among the results highlight the pronounced influence of socio-affective, which can interfere with the quality of the decision-making process for budget. Besides the academic contribution that was obtained by confirmation of a specific model of Decision Making, operated by Neuroaccounting line of research, was proposed a study being conducted in partnership with software developers specializing in hospital management. It was found that there is a need for developed a study is more technical, detailed and focused on socio-affective aspects, aiming at the development of a computational functionality that be able mitigate the undesirable effects in the Process of Decision Making Health Sector Budget with the elimination of such effects, it is expected to extend the authorizing rationality, mitigate budget deviations and so save resources so scarce for the sector.
Um dos desafios das empresas contemporâneas é valorizar e potencializar o recurso humano, um dos mais importantes no atual cenário competitivo, uma vez que sua potencialização pode se reverter em sucesso para as empresas. Ainda que a busca de maximização do desempenho das organizações (e das pessoas com elas envolvidas, com relação aos seus processos de tomada de decisão) não seja uma preocupação nova nas disciplinas relacionadas à gestão e à produção, ainda há lacunas a serem preenchidas. Uma dessas lacunas está relacionada à compreensão do processo de tomada de decisão de médicos ou de outros profissionais que atuam como gestores em ambientes hospitalares cada vez mais competitivos. Para compreender esse processo decisório teve-se como questão de pesquisa: Qual é o modelo adotado pelo gestor do Setor de Saúde, que atua em organizações hospitalares, ao tomar decisões relacionadas às metas orçamentárias?Com enfoque no processo de tomada de decisão orçamentária, o referencial teórico deste estudo abordou as modelos econômicas clássicos para decisão bem como modelos oriundos da psicologia cognitiva. Em termos metodológicos, o enfoque do estudo foi quantitativo. Os dados foram colhidos utilizando-se questionários eletrônicos, que foram enviados a centenas de gestores hospitalares envolvidos no processo de tomada de decisão orçamentária, obtendo-se uma amostra de 76 respondentes (70 com a segunda parte do questionário totalmente preenchida). Os dados foram analisados com estatística descritiva e multivariada, com ênfase na Modelagem de Equações Estruturais para avaliação das correlações entre os constructos sugeridos pelo referencial teórico, via método Partial Least Squares (PLS). Dentre os resultados encontrados destaca-se a pronunciada influência dos aspectos socioafetivos sobre a decisão, mostrando a influência social na decisão e o medo relacionado às decisões em si ou ao resultado obtido com a decisão. Como desdobramento prático apresenta-se a proposição de um estudo a ser realizado em parceria com desenvolvedores de softwares especializados em gestão hospitalar, especialmente no tocante à análise dos efeitos em médio e longo prazo de decisões ancoradas em aspectos sócio-afetivos, propondo-se a inclusão de indicadores do custo de oportunidade sócio afetivo . Com o controle desse tipo de custo espera-se ampliar a racionalidade no processo de estimativa de metas do gestor hospitalar, contribuindo para melhor alocação de recursos sempre tão escassos para o setor.
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Denieul, Myriam. "Procéduralisation de la décision publique face aux risques sanitaires et environnementaux posés par les produits." Thesis, Sorbonne Paris Cité, 2019. http://www.theses.fr/2019USPCB033.
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Au cours des dernières décennies, de nombreuses procédures ont progressivement encadré la prise de décision publique en matière de risques sanitaires et environnementaux posés par les produits. Un tel phénomène a d'abord été observable aux États-Unis avant de se propager en droit de l'Union européenne et en droit français. Face à la multiplication désordonnée de telles procédures se pose la question de l'existence d'un cadre procédural commun de la décision publique en matière de risques et de ses conséquences. À ce titre, deux catégories principales de procédures peuvent être distinguées. La première concerne l'encadrement de l'évaluation scientifique des risques et son articulation avec la décision finale. Ces procédures ont été dictées par la contrainte, que ce soit en réponse à des crises sanitaires et environnementales, en raison de la nécessité d'encadrer la décision dans un contexte d'incertitude scientifique, ou encore sous influence supranationale. La seconde catégorie comprend les procédures visant à mettre en évidence les impacts des mesures envisagées ainsi qu'à encourager une meilleure participation du public. Si le développement de ces dernières résulte cette fois plus d'un choix que d'une contrainte, leur poids dans le processus de décision s'avère également moindre. La procéduralisation facilite enfin le contrôle juridictionnel des décisions relatives aux risques et doit s'accompagner d'une approche pragmatique des vices de procédure. Cette recherche tend ainsi à dégager des principes généraux à destination du décideur public lorsque celui-ci est confronté à un risque identifié ou suspectéIn the past few years, procedures have multiplied for structuring and framing the decision-making process of public entities when they are confronted with environmental and health-related risks caused by products. This trend first emerged in the US, and then spread over in the EU and in France. The patchy and disorganised development of such procedures yet begs the question of a common procedural framework for public decision-making when dealing with risks, and of its associated consequences. In this view, two main categories of procedures can be distinguished. The first one applies to the scientific assessment of risks, and its consequences for the final decision. Those procedures have been stirred by external drivers, namely successive health and environmental crisis, the ever-growing necessity to cope with situations characterised by scientific uncertainty, or by influences at the supranational level. The second category covers procedures aiming at assessing the impacts of the contemplated decision, and at ensuring participation from the public. The development of this second category results more of a deliberate choice than a constraint, and the respective weight of such procedures within the decision-making process is also more limited. This so-called 'proceduralisation' facilitates the judicial review of risks-related decisions, and requires a more pragmatic approach when examining procedural irregularities. This research aims to highlight key general principles that public decision-makers may use when confronted to identified or suspected risks
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Francisco, Fernando de Rezende. "Aplicação da Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais." reponame:Repositório Institucional do FGV, 2017. http://hdl.handle.net/10438/18165.
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There is a lack in literature about the use of Health Technology Assessment (HTA) for decision making in Brazilian’s hospitals. In addition, there is evidence that the application of HTA in hospitals can improve the use of financial investments. The objective of this study was to analyze the application of HTA methods in decision making in hospitals linked to REBRATS (Brazilian Network for the Health Technologies Assessment). Grounded Theory methodology has been applied, and the interviews data were analyzed using the ATLAS.ti software. Interviews were conducted with managers of eleven hospital-based HTA units (called “NATS”, Núcleo de Avaliação de Tecnologias em Saúde), based on a semi-structured script prepared from the 15 guiding principles for good practices in hospital-based HTA units. The results indicated that HTA is applied in an incipient way in the decision making process in hospitals. The analysis of the interviews’ content also allowed us to conclude that the success of the hospitalbased HTA units for the incorporation and disincorporation of health technologies depends on a chain of related strategic actions, and the lack of any of the stages weakens or even impedes the full application of HTA for decision-making in hospitals.
Faltam informações na literatura sobre a aplicação de Avaliação de Tecnologias em Saúde (ATS) em hospitais no Brasil. Adicionalmente, há indícios de que a aplicação de ATS em hospitais pode melhorar o uso dos investimentos financeiros. O objetivo do trabalho foi analisar a aplicação dos métodos de ATS na tomada de decisão em hospitais vinculados à REBRATS (Rede Brasileira de Avaliação de Tecnologias em Saúde). Optou-se por utilizar o método da Grounded Theory, ou Teoria Fundamentada nos Dados, e os dados foram analisados com o uso do software ATLAS.ti. Foram realizadas entrevistas com gestores de onze núcleos de ATS (NATS), baseadas em roteiro semiestruturado preparado a partir dos 15 princípios orientadores para boas práticas de ATS em hospitais. Os resultados indicaram que a ATS é aplicada de maneira incipiente no processo de tomada de decisão em hospitais. A análise do conteúdo das entrevistas permitiu, ainda, concluir que o sucesso dos NATS para a incorporação e desincorporação de tecnologias em saúde depende de uma cadeia de ações estratégicas relacionadas, e a falta de qualquer uma das etapas enfraquece, ou mesmo inviabiliza, a plena aplicação da ATS para a tomada de decisões em hospitais.
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Ramalho, Bruno Araujo. "Processo decisório e motivação no âmbito das normas sobre o 'rol de procedimentos e eventos em saúde': uma análise exploratória." reponame:Repositório Institucional do FGV, 2017. http://hdl.handle.net/10438/18085.
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Procedural requirements related to decision making and justification of regulatory choices may have limited application under uncertainty, informational limitation and other obstacles that lead the regulator to adopt strategies to tailor decision making to reality. Based on this hypothesis, and considering the uncertainties and issues of high technical complexity related to the 'list of health care procedures and events in health care', the objective of the research was to carry out an exploratory analysis intended to identify limitations, obstacles and observable strategies in the elaboration and justification of these norms. For this purpose, it was adopt a methodology of qualitative analysis based on documentary research, which included different documents available through the National Regulatory Agency for Private Health Insurance and Plans (ANS) website in public consultations, in the Technical Group for reviewing the list of procedures and in the Committee on Regulation of Health Care (COSAÚDE). As a result, it was verified the hypothesis mentioned above, since the dynamics of the choice presents restrictions that lead the regulator to adopt different strategies to deal with. The obstacles related to 'decision-making' dimension arise from the complexity and uncertainties related to the medical evidences, informational limitations and from interferences of the Legislative Branch and the Judiciary. Regarding the giving reasons requirement, although it is possible to see a greater density of justification starting in 2013, the reasons and replies presented in a synthesized format often do not suffice to clarify all the issues that support complex choices. Among the proposals of the study, the regulator should to provide a more detailed record about the valuation and the operationalization of its methodology criteria.
Exigências procedimentais relacionadas ao processo decisório e à justificação de escolhas regulatórias podem ter sua aplicação limitada em cenários de incerteza, limitação informacional e demais obstáculos que levam o regulador a adotar estratégias para adequar a tomada de decisão aos recursos disponíveis. Partindo-se desta hipótese, a pesquisa teve por objetivo a realização de uma análise exploratória com vistas a identificar limitações, obstáculos e estratégias observáveis na elaboração e justificação do rol de procedimentos e eventos em saúde – eis que a elaboração do 'rol' é permeada por incertezas e por questões de alta complexidade técnica. Para tanto, adotou-se a metodologia de análise qualitativa baseada em pesquisa documental, que englobou diferentes anexos disponibilizados a partir do sítio eletrônico da Agência Nacional de Saúde Suplementar (ANS) em consultas públicas, no Grupo Técnico de revisão do rol de procedimentos e no Comitê Permanente de Regulação da Atenção à Saúde (COSAÚDE). Ao final, foi possível evidenciar importantes elementos que moldam ou restringem a tomada de decisão e a sua respectiva justificação. No âmbito dos resultados, os obstáculos relacionados à dimensão 'processo decisório' decorrem de diferentes fontes de incerteza, do volume (e complexidade) das informações e de interferências promovidas pelo Poder Legislativo e Judiciário – sendo observáveis diferentes providências do regulador para cada caso. No que tange ao dever de motivação, embora se percebam melhorias a partir de 2013, a apresentação de justificativas e réplicas segue um formato mais compactado e não contempla algumas questões metodológicas que servem como base para premissas elencadas pelo regulador. Dentre outras propostas do estudo, sugeriu-se que a agência disponibilize o amplo acesso a documentos ou relatórios que registrem, de forma pormenorizada, a operacionalização dos quesitos que integram a metodologia de decisão.
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RUSCIO, DANIELE. "Tempi di Reazione alla Guida: Il ruolo dei processi attentivi, decisionali ed emotivi sulle aspettative di pericolo in contesti reali e virtuali." Doctoral thesis, Università Cattolica del Sacro Cuore, 2014. http://hdl.handle.net/10280/2872.
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Lo scopo della presente ricerca è studiare il peso del fattore umano nei tempi di reazione alla guida. I tempi di reazione son stati studiati sin dalle origini della Psicologia sperimentale, tuttavia se applicati alla guida risulta obsoleto a causa delle specifiche condizioni in cui la reazione si svolge, ai cambiamenti del traffico moderno e ai nuovi dispositivi di supporto intelligente. In letteratura emerge chiaramente l’influenza sul tempo di reazione delle aspettative, della salienza della risposta, della percezione del rischio, dei carichi cognitivi e delle condizioni di rilevazione. La presente ricerca si prefigge di affrontare l’impatto e le modalità di influenza di questi aspetti psicologici sui tempi di reazione alla guida. In particolare i dati registrati in condizioni di guida ecologica reale saranno usati per a) studiare l’influenza delle aspettative sui processi attentivi, emozionali e di presa di decisione alla guida in risposta al pericolo, e b) per valutare l’influenza di diversi livelli di realismo di simulazioni e simulatori virtuali sui processi psicologici che determinano l’IPTR.
I risultati mostrano differenze significative nelle diverse fasi che compongono l’IPTR nelle diverse condizioni. I simulatori di guida si sono rivelati avere una validità relativa, ma non assoluta rispetto ai processi attivati nelle condizioni ecologiche, dimostrandosi però in grado di ricreare e modificare coerentemente i processi di avvistamento del pericolo in funzione della prevedibilità dello stesso; rendendoli strumenti utili per l’apprendimento. La ricerca fornisce informazioni sul funzionamento dei processi cognitivi ed emotivi alla guida utili per la ricostruzione degli incidenti, la sicurezza e la prevenzione stradale.The aim of the present research is to study the role of human factor in a salient driving ability for road accident prevention, that is reaction time to danger. Reaction times (RTs) have been investigated since the origin of experimental Psychology, however when applied to driving, the values became obsolete due to modern driving conditions and interaction with advance driving automatic systems and devices. The influence of expectation, urgency, risk perception, cognitive load and driving conditions on the process that determine RTs have been steadily proven in literature. The present research aims to tackle the influence of these factors on RTs while driving. In particular data measured in real-life driving are used to a) study the influence of expectation on attention, emotions and decision making process, and b) assess the influence of virtual settings with different levels of realism, on the psychological process that determine RTs. A specific task that manipulate driver’s expectations was created to assess the influence of attention and decision making process in the different context on RTs. Results show significant differences in the RTs phases, for different situation. Driving simulators with different levels of realism proved to not have absolute validity, but rather relative on the meanings and learning process in detecting danger and deciding what response foster; giving us interesting information for drivers education, road safety and accident reconstruction.
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Belo, Clayton Moura. "Aplicação da ultrassonografia portátil no âmbito da clínica médica." Universidade Tecnológica Federal do Paraná, 2018. http://repositorio.utfpr.edu.br/jspui/handle/1/3202.
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A pesquisa buscou avaliar se a ultrassonografia portátil, durante consulta clínica em uma unidade básica de saúde pública do Sistema Único de Saúde brasileiro, foi capaz de fornecer informações adicionais confiáveis para a tomada de decisões terapêuticas e diminuir o tempo de espera para uma eventual avaliação especializada, por meio da comparação entre os achados obtidos na ultrassonografia portátil e na ultrassonografia convencional. A ultrassonografia é o segundo método de avaliação por imagem mais utilizado na prática médica, após o Raio-X. Não emite radiações ionizantes e seu efeito sobre os tecidos biológicos é seguro, desde que em nível de intensidade acústica mínima para obtenção dos resultados desejados. Este trabalho surgiu da observação de quão prolongado é o tempo de espera por exames de ultrassom a que estão sujeitos os pacientes da saúde pública brasileira, chegando até dois anos em alguns casos, contrariando protocolos de recomendação e podendo comprometer a saúde do paciente. Avaliou-se custo-efetividade da tecnologia, suas principais limitações, a necessidade de criação de protocolos para sua utilização e os subsídios fornecidos para a tomada de decisões pelo médico clínico. A tecnologia foi aplicada em exames nas áreas de medicina interna, sistema musculoesquelético e cardiologia. Empregou aparelho de ultrassom portátil aprovado pela Anvisa, modelo Vscan™ Dualprobe. Conforme protocolos do Instituto Americano de Ultrassom em Medicina (AIUM), os sujeitos da pesquisa foram submetidos a exame com aparelho portátil, durante o momento da consulta com o pesquisador, após anamnese e exame físico. Posteriormente, foram submetidos a exame empregando aparelho convencional, com médico possuindo titulação em ultrassonografia. As imagens e os achados foram comparados entre os exames e se calculou um índice de confiabilidade Kappa global nas três áreas estudadas de 91,12%, embora o índice para a área cardíaca tenha sido de 76,92%, o que demonstra a limitação do uso do ultrassom portátil para a área. A pesquisa demonstrou que o emprego da ultrassonografia portátil pode vir a ser um importante aliado do médico clínico, permitindo melhoria da qualidade da saúde prestada aos pacientes do Sistema Único de Saúde brasileiro.The research aimed to evaluate whether portable ultrasonography, during clinical consultation in a basic public health unit of the Brazilian Unified Health System, was able to provide reliable additional information for therapeutic decision-making and to reduce the waiting time for a specialized evaluation, by means of the comparison between the findings obtained in portable ultrasonography and conventional ultrasonography. Ultrasonography is the second method of image evaluation more used in medical practice after the X-ray. It does not emit ionizing radiation and its effect on biological tissues is safe, provided that at minimum acoustic intensity level to obtain the desired results. This study was based on the observation of the length of time the patient waits for the ultrasound exams to which Brazilian public health patients are subjected, up to two years in some cases, contrary to recommendation protocols and potentially compromising patient´s health. It evaluated the cost-effectiveness of the technology, its main limitations, the need to create protocols for its use and the subsidies provided for the decision-making by the clinician. The technology was applied in examinations in the areas of internal medicine, musculoskeletal system and cardiology. It was used a portable ultrasound device approved by Anvisa, model Vscan™ Dualprobe. According to protocols of the American Institute of Ultrasound in Medicine (AIUM), the subjects were examined with a portable device, during the moment of the consultation with the researcher, after anamnesis and physical examination. Subsequently, they were submitted to an examination using a conventional device, with a doctor having ultrasound titration. The images and findings were compared between the exams and a global Kappa reliability index was calculated in the three studied areas of 91.12%, although the index for the cardiac area was 76.92%, which demonstrates the limitation of the use of portable ultrasound for the area. The research demonstrated that the use of portable ultrasonography can be an important ally of the clinician, allowing an improvement in the quality of health provided to patients of the Brazilian Unified Health System.
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Peng, Chiao-Ching, and 彭巧菁. "The Study of Organization Reform Decision-Making Process ofthe Bureau of National Health Insurance." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/67562521736847104645.
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碩士國立臺北大學
公共行政暨政策學系碩士在職專班
96
Since the implementation of National Health Insurance (NHI) in our country, targets such as “NHI-for-all”, “comprehensive medical care” “affordable fees”, and “high satisfaction level” have been accomplished. However, due to the financial imbalance of NHI, people from all walks of life queried the financial performance of Bureau of National Health Insurance (BNHI). There had also been frequent criticisms regarding year-end bonuses given to BNHI employees. As a result, the Dept. of Health, the Health Bureau, and the Executive Yuan were all put under tremendous pressure. The public managed public insurer system had often received challenges and queries from its early planning, legislation, to implementation. Since it was also subject to impacts of “privatization”, “diversification”, and “market-driven” trends, structural reforms have not been possible as of date. According to the government’s latest 2007 reform plan, The BNHI will reform into an administrative agency. This research will focus and probe into: 1. The reasons why the government chose to change the BNHI into an administrative agency; and 2. The policy setup process. The framework of this research covers the multiple streams model proposed by John W. Kingdon (1984) that consists of the problem stream, the policy stream, and the political stream. The documentary analysis method and in-depth interview are adopted as the study methods based on the researcher’s experience in personal participations and observations. During the study process, large quantities of journal articles, books,dissertation papers, study reports, newspapers, and journals from the Legislative Yuan are collected. Moreover, representatives from all circles are interviewed. The data is then compiled, compared and analyzed to obtain the following conclusions: 1. The co-payment rate issue disclosed the hidden truth about the financial status of NHI and aroused people’s anxiety and dissatisfaction. 2. The dispute over performance bonus has made the health insurance system a problem of concern, which draws the opportunity to initiate organization reform. 3. The formulation of the administrative agency reform plan is able to present characteristics of the “policy primeval soup.” The final policy plan chosen is entirely different from plans proposed by researchers and experts. Employees of BNHI are the main planners of the administrative agency reform plan. The feasibility of the administrative agency plan is much higher than the administrative institution plan. 4. The media and the Legislative Yuan play essential roles in the political stream of the NHI organization reform plan. The role of interest groups is relatively neutral throughout the BNHI organization reform process. The influence of political party involvement is apparent. 5. The three streams are completely integrated to initiate the “policy window” of the Executive Yuan. Meanwhile, cabinet reorganization is the crucial time of opportunity for BNHI organization reform. 6. The policy entrepreneur plays an important role in policy formulation. Other than government officials, legislators, and BNHI employees, the media are also active policy entrepreneurs. 7. During the BNHI organization reform decision-making process, both rational and irrational processes exist. Therefore, parts of rational processes will be present in the multiple stream model. 8. The problem stream, political stream, and policy stream are not completely independent or unrelated. 9. The analytic structure and policy window of the multiple streams model are applicable in the decision-making process of organization reform policies; however, they may not be applicable in decision-making processes of other policies.
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Hsu, Lo-Lan, and 徐洛蘭. "The Research on Consumer Decision-Making Process of Members in Health and Leisure Center." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/71851823912669651515.
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碩士國立臺北教育大學
文化創意產業經營學系
103
Abstract The purpose of this research is to discuss 「The Research on Consumer Decision-Making Process of Members in Health and Leisure Center」. The four purposes of this study are:Ⅰ. Discussion on motivation factors of consumer decision-making in Taipei City Health Center. Ⅱ. Discussion on differences of the importance and the consumer’s satisfactions on the services in Health Center of Taipei . Ⅲ. To understand the status of consumers in Health Center of Taipei, in order to analyze the characteristics of consumer by groups. This research is based on the decision-making process of EKB modelwith study subjects of members living in Taipei and New Taipei City. There are 220 valid samples. Data of this survey is analyzed with SPSS Research results are summarized as following: 1.Female members are more than male members, age of 30-39 years unmarried office workers, education of bachelor degree or higher, monthly income 20,000 to 40,000 maximum. Live in districts of Daan, Ban Ciao, Zhongshan, Chiang Kai-shek, and Sanchong as the top five most living districts. 2.Most members are mainly motivated to purchase for "sports and fitness" and " pressure relief". They mostly purchase by "Referral" and "Website". 3.Regarding the members attitudes after their purchases, this study shows that these members are mostly first-time buyers, and the perchasing year is less than one year or less in average. Most members are found willing to renew and recommend to other consumers. 4.Through IPA analysis, the importance are ordered as, (1) the safety of Sports facilities and equipments; (2) the convinence of using these equipment and facilities; (2) the location of the Center. The following items meets satisfactory by customers in orders of (1) the convinence of using these equipment and facilities; (2) the location of the Center. 5.Through SPSS analysis, the four major lifestyle groups are: health and leisure facets, brand facets, home and focus on the social dimensions function facets. It provides industry insight into the lifestyle and consumer decision-making process. Keywords：Health and leisure center, Consumer behavior, Consumer lifestyle.
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Park, EunHee. "The role of regret and its applications in IS decision making." 2014. http://scholarworks.gsu.edu/cis_diss/55.
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Although IS studies have begun to recognize the role of emotion in decision making, the research in this area is still in its infancy. The exploration of IS decision making phenomena through the lens of regret can offer rich implications to both research and practice. The presence of regret, for instance, can explain how and why IS decision makers choose a certain option. Motivated by the gap in the literature, the three papers in this dissertation investigate the role of regret in decision making in IS contexts. Specifically, the three projects investigate the following: IT real options decision in the context of RFID investment in libraries, whistle-blowing decision in the context of violations of heath information privacy, and process documentation decision in the context of investment in process improvement initiatives in an IT project. The contributions and implications of the three studies are presented further.
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Beukes, Johannes Andries. "Facilitation of awareness in the decision-making process of a marital partner as an integral part of mental health." Thesis, 2013. http://hdl.handle.net/10210/8366.
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D.Phil. (Educational Psychology)There is substantial evidence that potential marital partners have difficulty with their decision-making for a marital partner. As a result these potential marital partners often base their decisions of a marital partner on limited awareness. Little or no research has been done on the decision-making process of a marital partner, and that is why the question can be asked: "How did you make the choice for a marital partner?" The purpose of this study is to develop a model as framework of reference for the facilitation of awareness in the decision-making process for a marital partner as integral part of mental health. A theory generative, qualitative, explorative, descriptive and contextual research design was used to conduct this study. The fieldwork was done by having semistructured phenomenological interviews with marital partners. The results obtained were analysed and categorised. The results obtained from the analysed data reflect the fact that potential marital partners make the choice of a marital partner based on limited awareness. The main concept of facilitation of awareness in the decision-making of a marital partner was identified and defined as creating a safe space wherein people can be assisted in becoming conscious about their inner and outer world. A model was developed as framework of reference to facilitate awareness in the decision-making process of a marital partner as integral part of mental health.
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Lin, Hsin-I., and 林欣怡. "The Study of Individual Ethical Decision-Making Process under Different Ethical Principles－An Example of the Health Care Industry." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/34401201141468802303.
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碩士國立嘉義大學
行銷與流通管理研究所
91
Abstract Because of the professional knowledge in health care from doctors will bring about knowledge asymmetric situation between doctors and patients. Therefore, health care usually catch up in moral and ethical problems. Based on Ferrell’s sysnthesis model and Jones issue contingent model, this research attempted to investigate the influences of individual factors and organizational factors on ethical decision-making process. After depth interview with professional and two times tests, the researcher developed four scenarios as the survey tool. This research surveyed doctors with convenience sampling. After the survey, this research got the following conclusions: 1.There were positive correlation between moral judgment and moral intention. 2.Code of professional ethics and moral intensity affected the ethical decision-making. 3.Moral Philosophy didn’t affect the ethical decision-making process. Besides, this research had the following implications for managers : 1.Managers can forecast ethical decision-making levels by code of professional ethics and moral intensity in different stage. 2.Managers can adopt laws and enhance professional training to control doctor’s ethics.
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Davis, Selena. "Shared decision making via personal health record technology as normalized practice for youth with Type 1 diabetes." Thesis, 2018. https://dspace.library.uvic.ca//handle/1828/10024.
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Engaging youth with Type 1 diabetes (T1D) in the self-management of daily tasks and decision- making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. The process of shared decision making (SDM) comprises four key elements – acknowledge, consider, decide, act - and is identified as an optimal approach to making self-management decisions, yet it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision making.
Using a sequential two-phased investigation, this dissertation describes how PHRs can be designed to enable SDM and integrated into clinical practice to engage youth with T1D in self-management decision making. Phase 1 proposed an integrated SDM–PHR (e-PHR) functional model justified by youth with T1D (n=7) and providers (n=15) via a user-centered design approach. Located within an interconnected EHR ecosystem, e-PHR integrates 23 PHR functionalities for the SDM process, whereby each SDM element was mapped to PHR functions with a moderate level of agreement between patients and providers (Cohen's kappa 0.60-0.74). The Phase 2 mixed methods, pre-implementation evaluation utilized an online measurement instrument and survey and individual interviews, underpinned by the Normalization Process Theory (NPT), to describe the four cognitive and behavioural processes (coherence, cognitive participation, collective action, reflexive monitoring) known to influence the success of complex socio-technical implementations. Youth with T1D (n=8), providers (n=11), and EHR/clinical leaders (n=8) in British Columbia participated. Reliability tests of NPT-based instrument negated the use of scores for the coherence and reflexive monitoring constructs. Qualitative results indicated that e-PHR made sense as explained by two themes for ‘Coherence’: game changing technology and sensibility of change. Participants strongly agreed (mean score=4.6/5) with ‘Cognitive Participation’ processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (mean score=3.6/5) was observed with ‘Collective Action’ processes requiring an investment in effort, explained by one theme, uncovering the challenge of building collective action, and 3 sub-themes, assessing fit, adapting to change together, and investing in the change. Participants appraised e-PHR as explained by two themes for ‘Reflexive Monitoring’: reflecting on value, and monitoring and adapting. Finally, participants strongly agreed (mean score=4.5/5) that e-PHR would positively affect engagement in self-management decision making in two themes: care is efficient and care is person-centred.
The establishment of a e-PHR functional model is a precursor to system design requirements. Using the NPT framework, findings from the process evaluation indicated participants invest in sense-making, commitment and appraisal work of this technology. However, successful integration of e-PHR into clinical practice to positively affect engagement in self-management decision making will only be attained when systemic effort is invested to enact it. Further research is needed to explore this gap to inform priorities and approaches for future implementation success.Graduate
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Richardson, Winnifred G. "The process of knowledge exchange and uptake to inform decision-making: How do organizational values impact managers in a Regional Health Authority?" Thesis, 2007. http://hdl.handle.net/1882/957.
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Examining the process of knowledge exchange and uptake (KEU) involved collaborating with a current decision-maker to determine what knowledge would be examined to increase the understanding why evidence is accepted or rejected as evidence for decision-making. The knowledge selected were the organizational values of a Regional Health Authority from a managerial perspective. The uptake was how the values informed decision-making. The secondary attributes were identified as the conditions and characteristics that enable or challenge using values. As decision-makers prefer usable tools as a research deliverable, a Continuous Improvement Model and Logic Model were populated with the results of a mixed method inquiry. The actionable recommendations are intended to counter challenges and encourage best practices, and provide evaluation indicators. This dissertation will add to the growing literature on how to influence the uptake of evidence through collaboration and effective knowledge transfer plans that aid in bridging the know-do gap.
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Shifali, Shifali. "Optimal Mammography Schedule Estimates Under Varying Disease Burden, Infrastructure Availability, and Other Cause Mortality: A Comparative Analyses of Six Low- and Middle- Income Countries." 2020. https://scholarworks.umass.edu/masters_theses_2/992.
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Low-and-middle-income countries (LMICs) have a higher mortality-to-incidence ratio for breast cancer compared to high-income countries (HICs) because of late-stage diagnosis. Mammography screening is recommended for early diagnosis, however, current screening guidelines are only generalized by economic disparities, and are based on extrapolation of data from randomized controlled trials in HICs, which have different disease burdens and all-cause mortality compared to LMICs. Moreover, the infrastructure capacity in LMICs is far below that needed for adopting current screening guidelines. This study analyzes the impact of disease burden, infrastructure availability, and other cause mortality on optimal mammography screening schedules for LMICs. Further, these key features are analyzed under the context of overdiagnosis, epidemiologic/clinical uncertainty in pathways of the initial stage of cancer, and variability in technological availability for diagnosis and treatment. It uses a Markov decision process (MDP) model to estimate optimal schedules under varying assumptions of resource availability, applying it to six LMICs. Results suggest that screening schedules should change with disease burden and life-expectancy. For countries with similar life-expectancy but different disease burden, the model suggests to screen age groups with higher incidence rates. For countries with similar incidence rate and different life expectancy, the model suggests to screen younger age groups for countries with lower life-expectancy. Overdiagnosis and differences in screening technology had minimal impact on optimal schedules. Optimality of screening schedules were sensitive to epidemiologic/clinical uncertainty. Results from this study suggest that, instead of generalized screening schedules, those tailored to disease burden and infrastructure capacity could help optimize resources. Results from this study can help inform current screening guidelines and future health investment plans.
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Cheng, Hui-Ju, and 鄭惠如. "An exploratory Study of Cosmetics and Health Care Products Consumer Decision Making Process with High Loyalty On Online Auction Websites：An Exemplar of Female Consumers on Yahoo Online Auction." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/20527524124052044843.
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碩士世新大學
傳播管理學研究所(含碩專班)
94
Although the online-auction grows up fast and become an important shopping channel, but with high uncertainty to the consumers it’s hard to check the goods before buying; as for the seller, the low barrier of entry of market leads the competitive situation, and the convenience of comparing the product of price is hard to maintain consumer’s loyalty. Cosmetics and health care products are the popular products for the consumers of online auction every year, for the females, this kind of products present beauty, so the process of consuming decisions are more sophisticated, and it is more important to understand the factor of buying and re-buying behavior. This explotary research tries to understand the online auction behavior of females in Taiwan now, and tries to find the factors that affecting their buying behavior of the cosmetics and health care products on online auction, further more tries to combine the use and gratification theory and the model of consumer decision making process, and give the participants of online auction a comment of practice, including the portal site; the sellers and the consumers of online auction.
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(14010143), Vanessa C. Ghea. "Motives for the adoption of protective health behaviours for men and women: A social psychological model versus the ordered protection motivation model." Thesis, 2002. https://figshare.com/articles/thesis/Motives_for_the_adoption_of_protective_health_behaviours_for_men_and_women_A_social_psychological_model_versus_the_ordered_protection_motivation_model/21397740.
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The aims of the present study were to (a) evaluate and to compare the adequacy of a social psychological model and a cognitive appraisal model in predicting intention and action with respect to the adoption of protective health behaviours, (b) investigate the direction and strength of the path coefficients linking the predictor and criterion variables in each model in order to determine which predictor variables played a significant role in the (non)adoption of protective health behaviours, and (c) investigate the direct and indirect roles that gender role and SES play in determining the decision to adopt or not to adopt protective health behaviours. Existing knowledge about disease and illness makes it imperative for health researchers to understand the factors involved in reducing exposure to these endemic threats. Whilst extensive research has been carried out to investigate health beliefs and health threats, most of the results that have been obtained have been descriptive in nature. They say very little about how males and females internalise and conceptualise the identified social psychological and cognitive appraisal variables or how these variables influence the health decision-making process. Two theoretical models were developed to represent the decision-making process regarding the adoption of good health behaviours. A total of 550 males and 759 females (total n = 1,309) from Rockhampton and Gladstone in the State of Queensland, Australia, participated in the study by responding to one of three questionnaires designed to measure the study's critical variables. Whilst the overall findings generally supported the decision-making process represented by both models, the results indicated that the social psychological model represented a better predictor of the health decision-making process than the cognitive appraisal model. The findings also indicated that high masculinity combined with low femininity and a low SES directly decreased the motivation of males and females to adopt protective health behaviours when confronted by a health threat. Finally, for both models, the results indicated that the exogenous variables of gender role and SES had both direct and indirect influences on behavioural intention and action for males and females across the three disease dimensions. The implications of the findings with regards to differences in male and female health status are discussed.
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Παπαθανασόπουλος, Φώτιος. "Αποτελεσματικότητα τεχνολογιών υγείας." Thesis, 2011. http://hdl.handle.net/10889/5358.
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Η παρούσα διατριβή έχει στόχο τη διερεύνηση της επίδρασης της νέας ιατρικής τεχνολογίας στην αποτελεσματικότητα παραγωγής των Μονάδων Εντατικής Θεραπείας (ΜΕΘ) στην Ελλάδα, καθώς και τον εντοπισμό των στοιχείων που επηρεάζουν τη διαδικασία λήψης αποφάσεων στο πλαίσιο του Εθνικού Συστήματος Υγείας (ΕΣΥ) για την υιοθέτηση ιατρικής τεχνολογίας.
Για την εκτίμηση της αποτελεσματικότητας κάθε μονάδας, εφαρμόζεται η τεχνική bootstrapped DEA των Simar και Wilson (2007), ενώ για την διερεύνηση των στοιχείων που οδηγούν στην απόφαση υιοθέτησης γίνεται χρήση υποδειγμάτων probit. Κατόπιν, με τη χρήση υποδειγμάτων επιβίωσης εντοπίζονται οι παράγοντες που κατηγοριοποιούν τις Νοσοκομειακές μονάδες αναφορικά με το χρόνο υιοθέτησης. Ο αξονικός τομογράφος στα δημόσια νοσοκομεία χρησιμοποιείται σαν μελέτη περίπτωσης.
Η μελέτη κατέδειξε ελλείμματα τόσο στην τεχνική αποτελεσματικότητα όσο και στην αποτελεσματικότητα κλίμακας στις περισσότερες μονάδες που εξετάστηκαν, κυρίως λόγω έλλειψης νοσηλευτικού προσωπικού. Τα αποτελέσματα δείχνουν ότι αν και η τεχνική αποτελεσματικότητα επωφελείται από την ενσωμάτωση των νέων ιατρικών τεχνολογιών, η αποτελεσματικότητα κλίμακας παραμένει ανεπηρέαστη. Αναφορικά με το την πιθανότητα και το χρόνο υιοθέτησης, διαπιστώθηκε ότι το μέγεθος του νοσοκομείου και η πληρότητα επιδρούν θετικά.
Τέλος, τα συμπεράσματα επεξηγούν το βαθμό στον οποίο η υιοθέτηση νέας τεχνολογίας επηρεάζει τόσο την αποτελεσματικότητα των Νοσοκομειακών μονάδων γενικότερα, όσο και τη διαδικασία λήψης σχετικών αποφάσεων.
Η παρούσα Διατριβή συμβάλλει στην γενικότερη ανάπτυξη της αποτελεσματικότητας του Συστήματος Υγείας και στην προώθηση του διαλόγου μεταξύ των εμπλεκόμενων στα θέματα διοίκησης και διαχείρισης του Συστήματος Υγείας.This thesis aims to investigate the effect of new medical technology on the production efficiency of Intensive Care Units (ICUs) in Greece and unravel the elements which influence the decision making process concerning the adoption of new medical technologies in the context of the Greek Health System. In order to evaluate the efficiency of each Unit, the bootstrapped DEA of Simar and Wilson (2007) is applied, while a probit model is used for exploring the elements that lead to the adoption decision. Then, the factors that categorize hospitals regarding the timing of adoption are identified through the use of survival models. Computerized tomography in the Greek public sector is used as a case study. The study demonstrated deficits in both technical and scale efficiency in most Units, mainly due to lack of nursing staff. The results show that while technical efficiency has benefited from new medical technology integration, the scale efficiency remains unaffected. With respect to the likelihood and the time of adoption, it was found that the hospital’s size and plenitude have positive impact. Finally, the findings explain the extent to which health technology adoption affects both the hospital’s efficiency and the decision-making process. The present thesis contributes to the overall increase of the Health System efficiency as well as in promoting the dialogue between health administrators.
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Taillefer, Catherine. "Prise de décision quant au devenir d’une grossesse compliquée par une anomalie fœtale sévère : facteurs impliqués, impacts et considérations éthiques." Thèse, 2019. http://hdl.handle.net/1866/22811.
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Ntsoane, Dikeledi Regina. "Tsoga O Itirele : a reflection on a participatory action research process." Diss., 2001. http://hdl.handle.net/10500/15676.
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The report is about participatory action research with caregivers at the 'Tsoga 0 ltirele" centre for the mentally disabled. It was a process where the caregivers were involved in a series of action, plan and reflection in researching their situation. The facilitation process assisted the caregivers to look at their problems at the centre
and improve service delivery in caring for the mentally disabled children. Several meetings were held where action, plan and reflection took place. Caregivers decided on their own when to meet and discuss issues that concerned them. They planned what needed to be dealt with and took collective action to address these needs.
The facilitation process enabled caregivers to research their own problems, embrace errors experienced and recognise progress. People Centred Approach, Community Development and Participatory Action Research complemented one another in capacitating caregivers. Through it they learned to improve their own programmes and to run their meetings, improve marketing skills and fundraising.Social Work
M.A. (Social Science (Mental Health))
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Kai-yang, Lo, and 羅凱暘. "The Process of Decision Making:9-years Joint Curriculum “Healthy and Physical Education” Learning Area." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/44013151137833853231.
Full textAbstract:
碩士國立臺灣師範大學
體育研究所
89
The Process of Decision Making:9-years Joint Curriculum “Healthy and Physical Education” Learning Area Kai-yang Lo The first grade in elementary in Taiwan will implement 9-years joint curriculum in Sep.2001. The change surmount the boundary of disciplines, and integrated the disciplines to 7-learning area. Healthy education and physical education become “Healthy and Physical Education” Learning Area. The purpose of this study is to analyze and critique the process of decision making and influences factors. Data were collected through government publications, provisional outline of 9-years joint curriculum, study findings in relative area, and interviews of decision makers. The results of content analysis were as follows: a. “Healthy and Physical Education” Learning Area was formed through the supporting scholars and educational innovation groups. b. The message of that physical education was included in the Acquirement learning area was basing the thinking of transmutation from subject into learning area. c. Physical education was the basic conception during the process of decision making, until the provisional outline completed. d. In the process of decision making, it was transmutation the term of ”Health” from concept into the knowledge of subject. e. The inconsistent written standard of competency indicator caused the difficulty in transferring subject matters. The suggestions of study were as follows: a. Increase the basic studies of the curriculums of physical education. b. When hold an conference, it is important to explicate the background, spirit of educational innovation, to avoid falling the limitation of disciplines. c. Institution of teacher education should increase the ability of combining educational conception with time. Keywords: Nine-years Joint Curriculum Healthy and Physical Education Decision Making
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Leite, Mariana dos Reis Oliveira de Sousa. "Women's attitudes and beliefs about using fertility preservation to prevent age-related fertility decline: a two-year follow-up." Master's thesis, 2018. http://hdl.handle.net/1822/55702.
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Dissertação de mestrado integrado em PsychologyBACKGROUND: Women are using the fertility preservation (FP) technique at an age that undermines its success potential. Thus, it is crucial to understand how the process of decision-making about its use unfolds over time. The present study tries to describe and predict the actual decision-making and behaviour toward FP, based on the health belief and transtheoretical models. METHOD: A prospective study with 107 women, aged 30 to 37 years, who two years ago had a child-wish but were childless. Based on an online survey that assessed individual factors, intentions to use FP, variables of the health belief model, women’s decisional stage about its use and their behaviour. RESULTS: A low engagement in the decision-making process was observed, only 14% women decided about its use, and all decided not to use. Women realised that their chances to achieve parenthood were decreasing and have revised down their goals. Women’s intentions to use FP did not predict their decision. CONCLUSIONS: FP is not the preferred route to parenthood but seemed to remain an open option. This suggest that women do not engage in the FP decision-making process by themselves and need to have some advice, according to their personal circumstances, to start engaging.
BACKGROUND: A técnica de preservação da fertilidade (PF) está a ser utilizada numa idade que compromete a sua taxa de sucesso, sendo crucial compreender o processo de tomada de decisão sobre a sua utilização. Este estudo tenta descrever e predizer esta tomada de decisão e o comportamento, com base nos modelos das crenças de saúde e transteórico. MÉTODO: Estudo prospetivo com 107 mulheres, 30-37 anos, que há dois anos desejavam, mas não tinham filhos. Baseado num questionário online, que avaliou fatores individuais, intenções para utilizar PF, variáveis do modelo das crenças de saúde, etapa de decisão e o comportamento. RESULTADOS: Foi observado um pequeno envolvimento das mulheres no processo de tomada de decisão, 14% tomou uma decisão e decidiu não utilizar. As mulheres reconheceram a diminuição das suas hipóteses para a atingir a parentalidade e ajustaram os seus objetivos. As suas intenções para utilizar PF não predisseram a sua decisão. CONCLUSÕES: PF não é o caminho preferido para atingir a parentalidade, mas parece permanecer uma opção em aberto. Isto sugere que as mulheres não se envolvem sozinhas neste processo de tomada de decisão, mas precisam de algum aconselhamento, de acordo com as suas circunstâncias pessoais, para se começarem a envolver.
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El, Khoury Caline. "La prise de décision stratégique en contexte hospitalier pluraliste." Thesis, 2021. http://hdl.handle.net/1866/25527.
Full textAbstract:
Le système de santé libanais connait une évolution chaotique de son secteur sanitaire, dans un univers en concurrence croissante. De plus, dans l’organisation de ce système, divers groupes d’acteurs évoluent et influencent directement ou indirectement les prises de décisions stratégiques dans les établissements de santé libanais. Voilà pourquoi, dans un contexte où évolue une pluralité d’acteurs qui sont interdépendants et poursuivent des objectifs divergents, la prise de decision stratégique semble un défi de taille.
La présente étude vise donc à comprendre et à analyser les processus dynamiques des décideurs ayant une influence sur la prise de décision stratégique dans une organisation de santé, en contexte pluraliste, où diverses forces externes et internes exercent une influence sur ce processus décisionnel. Pour y arriver, la prise de décision stratégique est analysée selon une perspective de relations de pouvoir, en partant des acteurs de l’organisation de santé et du contexte dans lequel ils évoluent.
Cette recherche propose un modèle conceptuel qui s’appuie sur les concepts généraux de l’analyse stratégique de Crozier et Friedberg (1977) jumelés au modèle de la poubelle « Garbage Can ». Les éléments proposés de ce cadre conceptuel sont pertinents pour expliquer l’interaction entre la liberté des acteurs et les relations de pouvoir qui en ressortent, la présence fortuite des courants menant à la prise de décision et l’environnement dans lequel baignent les acteurs et l’organisation, qui influencent de façon majeure l’élaboration de la prise de décision stratégique dans un établissement de santé pluraliste.
Afin de répondre à l’objectif de cette recherche, nous nous sommes basés sur une revue de littérature sur la prise de décision stratégique en contexte hospitalier pluraliste. Ensuite, nous avons procédé à une démarche qualitative basée sur les entrevues semi-structurées et l’analyse documentaire, dans le cadre de deux hôpitaux libanais, représentatifs du bassin hospitalier libanais. Cette étude de cas a permis de retracer 4 cas traceurs à partir desquels les comportements stratégiques mobilisés par les acteurs concernés par le processus décisionnel ont été mis en évidence. Pour ne citer que quelques stratégies répertoriées, nous prenons l’exemple des stratégies d’adaptation à l’environnement, d’implication des acteurs externes ainsi que de collaboration et de négociation qui prennent en considération l’environnement turbulent dans lequel baignent ces établissements de santé.
En outre, l’interprétation des résultats a mis l’accent sur les stratégies d’acteurs internes et externes qui ont mené à la formation d’une constellation de leadership élargie, composée d’acteurs stratégiques multiples en constante interaction. Ces jeux de pouvoir ont influencé le processus décisionnel et ont permis la rencontre des processus formels et « informels » de prise de décision, menant à une meilleure compréhension du cheminement décisionnel stratégique dans les établissements de santé pluralistes.
En conclusion, des recommandations concrètes sont formulées à l’intention des décideurs en santé. De plus, la rencontre théorique développée pour la première fois dans cette thèse, apporte une contribution intéressante aux théories des organisations. Ultimement, la thèse ouvre la voie à des pistes de réflexion prometteuses sur la prise de décision stratégique, en contexte pluraliste.The Lebanese health system is experiencing a chaotic evolution of its health sector, in a world of increasing competition. In addition, in the organization of this system, various groups of actors evolve and influence directly or indirectly the strategic decision-making of the Lebanese healthcare establishments. In a context in which evolves a plurality of actors who are interdependent and pursue divergent objectives, strategic decision-making seems a major challenge. Therefore, the present study aims to understand and analyze the dynamic processes of decisionmakers having an influence on strategic decision-making in a healthcare organization, in a pluralistic context, where various external and internal forces exert an influence on this strategic decision-making. To achieve this, strategic decision-making is analyzed from a power relation’s perspective, starting with the players in the health organization and the context in which they operate. This research proposes a conceptual model based on the general concepts of strategic analysis of Crozier and Friedberg (1977) combined with the garbage can model. The proposed elements of this conceptual framework are relevant for explaining the interaction between the freedom of actors and the power relations that emerge from it, the fortuitous presence of the currents leading to decision-making and the environment in which the actors are immersed which have a major influence on the development of strategic decision-making in a pluralistic healthcare establishment. To meet the objective of this research, we started with a literature review on strategic decisionmaking in a pluralistic context. Then, we used a qualitative approach based on semi-structured interviews and documentary analysis, within two Lebanese hospitals that are representative of the Lebanese hospital basin. This case study made it possible to trace 4 decisions from which the strategic behaviors mobilized by the actors were highlighted. To cite only a few listed strategies, we take the example of strategies of adapting to the environment, involving external actors as well as collaboration and negotiation that take into consideration the turbulent environment in which these establishments are surrounded. The results of this thesis show how the strategies developed by internal and external actors led to the formation of a broad constellation of leadership. This constellation is composed of multiple strategic actors who are in constant interaction, thus influencing the decision-making process through their power relations and strategic plays. Also, the results of this thesis highlight the 7 political decision-making process that takes place in a pluralistic health care organistion, leading to a better understanding of the strategic decision-making process in these establishments. In conclusion, concrete recommendations are made for decision-makers, to better manage health care organisations. In addition, the theoretical encounter developed for the first time in this thesis, makes an interesting contribution to the theories of organizations. Ultimately, the thesis opens the way to promising lines of reflection on strategic decision-making, in a pluralistic context.
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Blais, Julie. "L’approche dialogique dans les comités d’éthique clinique en Amérique du nord." Thèse, 2012. http://hdl.handle.net/1866/6919.
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Cette recherche s’intéresse aux processus communicationnels utilisés dans les comités d’éthique clinique (CEC) en Amérique du nord dans leur fonction de consultation. Selon la littérature, les CEC bénéficieraient de «pay closer attention to group process [as an] effective communication in a HEC is essential to a committee’s function» (Berchelmann and Blechner 2002 p.143). Or, très peu de données sur les dynamiques de groupe et les modes de communication en CEC sont disponibles. Ce travail cherche à savoir si l’approche dialogique peut être utile au soutien des discussions de groupe des CEC.
Dans un premier temps, une revue de littérature rend compte, à partir de son historique, de l’état actuel des CEC. Sont ensuite explorées et analysées, dans leurs avantages et leurs limites, les diverses méthodes utilisées afin de mener les discussions dans le cadre des consultations. Dans un deuxième temps, les barrières communicationnelles qui affectent potentiellement les CEC sont identifiées. Par la suite, afin d’améliorer le processus de communication (et diminuer l’effet des barrières), une nouvelle piste de solution est proposée : le dialogue tel que développé par le milieu organisationnel. Le dialogue est alors conceptualisé et mis en lien avec les besoins des CEC en matière de communication.
Bien que le dialogue propose plusieurs contributions avantageuses pour les CEC et leurs membres, certaines contraintes réduisent sa faisabilité d’une façon globale dans le contexte particulier des CEC. Par contre, en l’utilisant comme formation complémentaire, le dialogue permet le développement de l’individu et du groupe et demeure une approche intéressante et utile pour les CEC qui éprouvent des difficultés systémiques et comprennent les implications de sa démarche.This research focuses on communication processes used in hospital ethics committees (HECs) in North America in their consultation role. According to the literature, HECs would benefit if they ―pay closer attention to group process [as an] effective communication in a HEC is essential to a committee’s function‖ (Berchelmann and Blechner 2002 359 p.143). However, very little data on group dynamics and modes of communication are available. This thesis explores whether the dialogical approach may be useful to supporting group discussion in HECs. The first part of this thesis presents a literature review and history to situate the current state of HECs. The various methods used to conduct discussions in ethics consultations are then explored and analyzed, with regards to their advantages and limitations. The second part of the thesis examines communication barriers that potentially affect HECs, and then proposes a possible solution to improve the communication process (and reduce the effect of barriers), that is, the dialogic approach as developed by the organizational setting. This approach is then conceptualized and linked with the communication needs of HECs. Although dialogue can provide several beneficial contributions to HECs and their members, some contextual constraints reduce its feasibility for a comprehensive application. However, using it as a means of additional training, dialogue enables the development of the individual and the group and remains an interesting and useful approach for HECs facing difficulties, and who are able to understand the systemic implications of this approach.
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Lan, Shu-Fan, and 藍淑芬. "The Lived Experience of Families with Congenital Heart Disease Child during the Decision-Making Process of Cardiac Surgery." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/21678897525923846648.
Full textAbstract:
碩士國立陽明大學
臨床護理研究所
91
Undergoing cardiac surgery is an important decision related to life continuance for congenital heart disease children and their families. The purpose of this study was to investigate the essence of family experience during the decision-making process of cardiac surgery. Phenomenology was employed in this study. From January to April 2003, nine subjects were purposely chosen from a medical center in Kaohsiung. The criteria for choosing the caregivers were: the child had received cardiac surgery in toddlerhood, surgery underwent in 6 months, and no complication of postsurgery. The interview guide was based on the family systems theory（Montgomery ＆ Fewer, 1988） and the descriptive decision-theoretic model（Winterfeldt ＆ Edwards, 1986）. The interview were conducted at the interviewees’ houses and each subject was audio-taped between 45 to 90 minutes. The interview content employed the skill of 『brackets』during interview and collected data were analyzed by Colaizzi（1987） data analysis method. The results of this study show that the decision-making process of the family experience includes six dimensions: （1）the change and process of knowing about decision；（2）physio-psychological disturbance；（3）establishing care abilities progressively；（4）resources of family coping；（5）building a common atmosphere to do family’s upmost, advancing suitable development ；（6）deliberate about decision, strive to make a correct decision without repentance. The results of this study show that essence of decision-making process experience includeing emotion impact、establish disease recognition、change family’s interaction pattern to achieve balance and deliberate about decision. These findings provide information for nursing members have a better understanding about those families in different phases with difficulties and requirements, and to help those families getting through the process , making a correct decision without repentance by providing proper knowledge and emotional assistance.