Dissertations / Theses on the topic 'Hospital patients – Care'
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Wendall, Pamela S. "Clients' spiritual perspective of care." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1191724.
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Spiritual dimensions are an important focus for nursing care and nurses can be catalysts for spiritual care. The purpose of this descriptive comparative analysis is to examine the spiritual care needs as perceived by terminally ill clients, non-terminally ill clients, and well adults. The theoretical framework for this study is Leininger's "Cultural Care Theory" that supports the notion that spiritual care needs to be culturally congruent.Participants were obtained from a 225-bed hospital, hospice, home care, and a wellness program in a midwestern city. Permission was obtained from the hospital President, Vice President of Nursing, the directors of Hospice and Home Care, and the community's Wellness Program. The number of participants was 76. The process for the protection of human rights was followed.Findings were that terminally ill, non-terminally ill, and well-adults all agree that receiving spiritual care that is congruent with beliefs is important. The terminally ill clients rated spiritual needs higher than both non-terminally ill and well-adults. All groups rated the same in the persons from whom it was wished to receive spiritual care. Common themes of spiritual care desired from these persons for the terminally ill group was: pray for/with me and talk to me. For the non-terminally ill group it was: give me information, The understanding, and provide emotional and spiritual support. Finally, for the well-adults it was: listen to me, talk to me, be confident, and support me.No statistical difference between groups (.940) on the SPS. On the SPC, the terminally ill group was more satisfied (5.20) with spiritual support they were receiving than the non-terminally ill group or well-adults.It was concluded that regardless of the stage of illness, the same spiritual needs are prominent, all individuals have spiritual needs, and several types of interventions are preferred. It has been demonstrated in this study that prayer is the most sought after component of spiritual care among all three groups. Second to that would be someone to talk to and someone to listen to them.Implications call for nurses to facilitate spiritual care from family, friends, minister or priest, and hospital chaplain. This could be written into the plan of care by having the client describe the type of spiritual care they want to receive. Nursing Administration needs to work with nursing staff to define spirituality and religion and what they mean to the nurse.School of Nursing
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Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /." Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
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Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
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Schirg, Glenn Richard. "Determining the patient satisfaction factors for hospital room service & the association of room service with the overall satisfaction with the hospital experience." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007schirgg.pdf.
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Abrahamsen, Grøndahl Vigdis. "Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-9023.
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There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital. Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis. Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV). Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.
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Piterman, Hannah, and Hannah Piterman@med monash edu au. "Tensions around introducing co-ordinated care a case study of co-ordinated care trial." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20050418.092951.
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The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered.
The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.
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Bechel, Diane Lynn. "The effect of patient-centered care on hospital inpatient cost and quality outcomes the experience in southeast Michigan." Ann Arbor, Mich. : University of Michigan, 1998. http://books.google.com/books?id=bhUvAAAAMAAJ.
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Sutton, Jane C. "Accidents to patients in hospital." Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.292535.
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Beattie, Michelle. "Measuring the patient experience of hospital quality of care." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/23410.
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The primary motivation of this PhD by publication has been the apparent disconnect between the metrics of hospital quality of care at national and board level and patients’ experiences. Exploration of the gap led to the realisation of two key points. Firstly, the concept of healthcare quality continually evolves. Secondly, the NHS Scotland Measurement Framework does not include a measure of patient experience at the microsystem level (e.g. hospital ward). This is needed to counterbalance easier to obtain metrics of quality (e.g. waiting times). Resource tends to follow measurement. Papers 1 and 2 were exploratory, investigating theoretical and practical aspects of measuring quality of hospital care at the clinical microsystem level. With the associated Chapters, they highlighted both the necessity and the possibility of measuring the patient experience at the micro level of the healthcare system. They also drew attention to the inadequacy of “satisfaction” as a metric, leading to closer examination of “experience” as the decisive metric. This required the development of a systematic review protocol (Paper Three), then a systematic review (Paper Four). The review (Paper Four) examined the utility (validity, reliability, cost efficiency, acceptability and educational impact) of questionnaires to measure the patient experience of hospital quality of care, with a newly devised matrix tool. Findings highlighted a gap for an instrument with high utility for use at the clinical microsystem level of healthcare. Paper Five presents the development and preliminary psychometric testing of such an instrument; the Care Experience Feedback Improvement Tool (CEFIT). The thesis provides, as well as the matrix tool and CEFIT, theoretical and methodological contributions in the field of healthcare quality. It contributes to an aspiration that the patient’s voice can be heard and acknowledged, in order to direct improvements in the quality of hospital care.
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Trofino, Joan Alhanati. "A study of the consistency of nursing care hours and patient length of stay per DRG category in selected joint commission on accreditation of health care organizations as measured by diverse patient classification systems /." Access Digital Full Text version, 1988. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10810626.
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Quinlan, John. "The essence of pastoral care an investigation of patient satisfaction with pastoral care in an acute general and psychiatric hospital /." Online full text .pdf document, available to Fuller patrons only, 2000. http://www.tren.com.
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Walker, Annette Clare, of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient." THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
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Kihlgren, Annica. "Older patients in transition : from home care towards emergency care /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-271-3/.
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Thompson, Margit. "Long term care patients in acute care hospitals : examining the discharge barriers." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=32893.
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Many elderly patients remain in acute care hospitals while they await transfer to Long Term Care (LTC) facilities. Complex problems, common for this special group of patients, place them at risk for delayed discharge. Discharge planning, for these patients, has become an increasingly critical activity for social workers.This study examined factors that predict the risks for inappropriate hospitalization for 244 patients waiting for LTC in 1999, and it explored the LTC application process to identify barriers to delayed discharges.
It was found that 63% of the hospitalization of these patients was inappropriate. System related factors, such as the timing of the LTC application, were identified as predictors. Timeline investigations revealed areas for improvement in the discharge process and were discussed with a view to social work implementation, for example, the introduction of a high-risk screening protocol.
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Smith, Cheryl. "Patients’ Perceptions of Patient-Centered Care and the Hospital Experience Pre- and Post-Discharge." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etd/3388.
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Florence Nightingale used the principles of patient-centered care as the foundation for nursing practice. Today, patient-centered care delivery is part of the healthcare reform process that extends interprofessionally throughout all settings of healthcare in the United States (U.S.). Patient satisfaction measurement is one primary determinant of effective patient-centered care. The standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and methods is a nation-wide tool used to measure patient satisfaction. However, this method of patient satisfaction assessment relies on recollections of patients’ hospital experiences and requires accurate memory and recall. This study sought to examine the effect of the memory-experience gap on patients’ perceptions of their hospital experiences and address this research question: Are there any statistical differences between in-hospital and two-week post-discharge perceptions of patient-centered care as measured with HCAHPS patient satisfaction ratings on (a) the composite scores for communication with nurses, communication with physicians, communication about medicines, pain management, staff responsiveness, (b) the individual scores for the hospital environment’s cleanliness and quietness, and the inclusion of patient and family preferences in the plan of care, and (c) the overall global rating score? The design was a non-experimental, prospective, descriptive correlational study. The setting was a 255-bed regional hospital that serves individuals from eight surrounding rural counties in southern middle Tennessee. The case-mix contained diverse individuals with multiple economic, environmental, physical, social and spiritual dynamics. A convenience sample of 82 adult patients ages 26 - 93 represented mainly Caucasian females with mostly cardiovascular and respiratory illnesses who had a minimum one-day stay.
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Mohammed, Safwat Nirmeen Ahmed Sabry. "Hospital discharge planning and interface liaison for elderly care patients." Thesis, King's College London (University of London), 2004. https://kclpure.kcl.ac.uk/portal/en/theses/hospital-discharge-planning-and-interface-liaison-for-elderly-care-patients(73c7c480-a132-4a1a-b411-82eb7dbdcaea).html.
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Payne, Ashley Renee. "Home Care Factors Associated with Hospital Readmission of Psychiatric Patients." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4471.
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There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.
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Griskonis, Sigitas. "Patients' perceived satisfaction with hospital services." Thesis, Nordic School of Public Health NHV, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3250.
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ackground. There are a number studies related to patients’ satisfaction with health care. Since the Baltic States regained independence in 1990, a reform of the health care system took place in which a serious consideration is paid to health care quality. Patients' views are becoming increasingly important in the current health system. They provide information on effectiveness of healthcare and how it may be improved.The main objective of this study was to investigate inpatients experiences with the care and treatment given in Klaipeda hospitals in order to improve the quality of care and patients’ satisfaction. Material and methods. A cross-sectional survey with questionnaires was made. The subjects of the investigation were patients (from 18 years old), hospitalized in internal and surgery departments in different Klaipeda city hospitals. The survey questions were divided into sections that broadly followed the patient's experience in the hospital. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multiple logistic regression to estimate Odds for each of the independent variables in the model.Results. The study shows that 60-80 % of the respondents were satisfied with different parts and aspects of health care services. Satisfaction with getting enough time for discussion with the doctor was higher for younger, male and employed patients. Those from the city needed more understandable explanation from doctor about health condition or treatment plan. Doctors listened more to male patients compare to female. Those results were statistically significant. Conclusions. Majority of the patients were satisfied with hospitalization order in Klaipeda hospitals. Better physician communication skills can improve patient satisfaction and clinical outcomes. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Hospital cleanliness is quite important factor to overall satisfaction with hospital care. Waiting time is a significant component of patient satisfaction and depends from patients’ characteristics and their behavior. Different aspects of reception can influence patients’ satisfaction and must be considered. Information about continuity of the treatment were needed more for patients with an increased need for follow up, younger and living alone patients. It is important to provide the setting customers expect and create an environment that meets or exceeds customer needs for safety, security, support, competence, physical comfort, and psychological comfort.ISBN 91-7997-146-6
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Kirk, Judy Gail. "Difference in quality of life of referred hospital patients after hospital palliative care team intervention." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/10751.
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Includes bibliographical references (leaves 34-39).Since 1948, when the World Health Organization (WHO) defined health as being not only the absence of disease and infinity but also the presence of physical, mental, and social well-being (Constitution of the World Health Organization, 1952), quality of life issues became more apparent. The aim of the research undertaken was to establish whether the hospital palliative care team (HPCT) at the Johannesburg General Hospital was making a difference to referred hospital patients' quality of life. The HPCT was started at the Johannesburg General Hospital in 2001. The team functions as an advisory body on pain and symptom control. Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The method used was the FACT G questionnaire, which was completed by the patient group initially, and thereafter HPCT intervention. The questionnaire is used to measure quality of life (QOL). The study is a descriptive cohort design. The first 24 patients completed the informed consent prior to completing the questionnaire. The pre QOL questionnaire served as the baseline QOL scores prior to HPCT intervention. The initial QOL scores were then compared to the post QOL scores after HPCT intervention. Seven subjects were excluded from the research as six patients were discharged from hospital early due to a bed shortage and one patient died. The seven patients' results from the pre FACT G questionnaire were discarded and all subsequent calculations did not include their results. The increase in the total percentage scores (45.53 to 63.35) was statistically significant (p< 0.001) using the paired t-test. Thus the results show a significant difference between pre and post assessment QOL scores. The research demonstrates significant improvements in patients' quality of life (p<0.001) after HPCT intervention. It is hoped that future research would continue to show the value of HPCT and their effect of benefiting patients' quality of life.
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Oswald, Sharon. "A retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27289.
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This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.
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Al-Awa, Bahjat. "Impact of hospital accreditation on patients' safety and quality indicators." Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209917.
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Ecole de Santé Publique Université Libre de Bruxelles
Academic Year 2010-2011
Al-Awa, Bahjat
Impact of Hospital Accreditation on Patients' Safety and Quality Indicators
Dissertation Summary
I.\
Doctorat en Sciences
info:eu-repo/semantics/nonPublished
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Luke, Gary Joseph. "An assessment of the service quality expectations and perceptions of the patients of Awali Hospital in the Kingdom of Bahrain." Thesis, Rhodes University, 2008. http://hdl.handle.net/10962/d1003850.
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The quality of service from a hospital is the number one factor that will either turn a customer/patient away or make one for life. More and more hospitals are competing for greater shares in the market and customer-driven quality management is becoming the preferred method for improving their performance. Awali hospital is a private hospital in the Kingdom of Bahrain. It is a small 35-bed hospital that offers private medical services to the public. The hospital was originally built to serve the Bahrain Petroleum Company (Bapco) refinery workers but later opened its doors to the public. With the introduction of private patients came higher expectations of quality and higher demands on the overall services. A number of service quality shortfalls were identified over the years but never identified quantitatively by a patient evaluation survey. An English and Arabic version of the questionnaire based on SERVQUAL (Zeithaml, Parasuraman and Berry, 1988) was developed and placed in Awali hospital to test these service quality shortfalls. This study intends to evaluate these areas by answering questions about the relevant areas of service provided by the hospital. It measured patient satisfaction by looking at human aspects of service (responsiveness, reliability, empathy and assurance) with only one factor of the instrument being devoted to the non-human aspect of care rendered (tangibles). The SERVQUAL instrument has five dimensions that were measured by 21 pairs of item statements. One statement from each pair reflects perceptions, the other expectations. Measurement was accomplished by subtracting expectation from perceptions resulting in a service quality score. Positive or zero scores would reflect ideal or adequate service quality offered by the hospital. A negative score would be indicative of a service experience that did not meet customer expectations. Using the SERVQUAL questionnaire provided, quantifiable reasoning to the research questions in each dimension could be obtained so that precision, objectivity and rigour replaced hunches, experience and intuition as a means of investigating problem areas. Customers were first asked to supply some additional demographic information, for example gender, number of hospital visits, nationality, patient type (Bapco worker, general practitioner referred or private) and type of visit (inpatient, outpatient or both). They werethen asked to rate the hospital service on a 7-point Likert scale ranging from Strongly Agree (7) to Strongly Disagree (1). At the end of the questionnaire was space to write open comments. In total 600 paper questionnaires were distributed in the hospital, 300 English and 300 Arabic. Another 150 electronic questionnaires via emails were sent to refinery workers. Of the total 750 questionnaires distributed 162 were returned of which 156 (or 21.6%) could be statistically analysed. The empirical data results showed that the perception scores were significantly different at the p < 0.05 level from expectation scores. All the service quality differences (SQ=P-E) were negatively scored. This indicated that patients were not satisfied in all five dimensions of services offered by the hospital. Of the five dimensions responsiveness had the largest difference with assurance and reliability following with no significant differences between them. The demographic information revealed some interesting differences between the groups. Of all the demographic groups the most significant differences were between groups, “patient types” and “types of visit”, which showed differences between private patients and refinery workers and patients who used the hospital only as an outpatient and patients who used both services, outpatient and inpatient. In terms of the managerial implications, it was recommended that Awali hospital look to closing Gaps 1-4 of the SERVQUAL gap model which would result in closing the consumer gap, Gap 5. A process model for continuous measurement and improvement of service quality was recommended that looks at asking questions about how the hospital is performing. By adopting some of the recommendations identified in the research questions, Awali hospital could improve their quality of service, and as a consequence, their customer satisfaction and loyalty.
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Lawson, Kristin M. "Characteristics of Patients Seeking Care From a Hospital-Based Infant Dental Clinic." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1404603761.
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Clements, Linda. "CAREGIVERS’ INFLUENCE ON PATIENTS’ HEART FAILURE SELF-CARE, HOSPITAL READMISSION AND MORTALITY." UKnowledge, 2019. https://uknowledge.uky.edu/nursing_etds/48.
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Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of caregivers on HF patient self-care, readmission, and mortality.
Objective: The purpose of my dissertation was to determine the influence of HF caregivers on patient self-care, readmission, and mortality. The specific aims of this dissertation were to: (1) to determine if caregiver depressive symptoms mediate the relationship between family functioning and caregiver quality of life, (2) to determine if there is an association between living arrangements (living with someone vs. living alone) and all-cause readmission and death in patients with HF, and (3) to determine the efficacy of an in-hospital, multi-session, educational intervention for caregivers on heart failure patients’ self-care and 30 day readmission rate, and to evaluate the efficacy of the intervention on caregivers’ knowledge, self-efficacy and perceived control.
Methods: Specific aim one was addressed by a secondary analysis of data from one- hundred and forty-three HF caregivers recruited from an outpatient clinic. Multiple regression with mediation analysis was used to determine whether depressive symptoms mediated the relationship between family functioning as measured using the three scales of the Family Assessment Device (i.e., general, problem-solving, communication) and caregiver quality of life. Specific aim two was addressed by a retrospective chart review of all 398 patients with a primary diagnosis of HF admitted to an academic medical center in one year. We collected data on patient sociodemographic, clinical characteristics, and patient living condition. The independent association of living alone with all-cause readmission or all-cause death was evaluated using Cox proportional hazards modeling adjusting for covariates. Specific aim three was addressed using a two-group (educational intervention for caregivers of patients with heart failure vs. usual educational care), prospective, repeated measures randomized controlled trial of 37 patient and caregiver dyads in which caregivers only received in-hospital HF education. Outcome measures included patient self-care, and patient all-cause readmission or all- cause death, as well as caregiver self-efficacy, knowledge, and perceived control. Patient self-care, and caregiver self-efficacy, knowledge, and perceived control were assessed at baseline (in hospital), at discharge, 7 and 30-days after patient discharge. Patient readmissions and death were assessed by a phone call at 30-days follow-up. The intervention directed only at caregivers consisted of three in-hospital, educational sessions with telephone follow-up. The educational sessions were designed to deliver HF information and skills to caregivers, thereby providing them with the resources needed to improve their self-efficacy, perceived control and HF knowledge thus improving patient self-care and readmission rates.
Results: Specific aim one: The three subscales of the Family Assessment Device predicted depressive symptoms (p < 0.001) and caregiver quality of life (p < 0.001). Depressive symptoms also predicting caregiver quality of life (p < 0.001). The inclusion of depressive symptoms in the final model with each subscale of the Family Assessment Device (i.e., general family functioning, problem-solving, communication) decreased the significance of family functioning as a predictor of caregiver quality of life indicating mediation by depressive symptoms. Specific aim two: Heart failure patients living with someone experienced a significantly longer time to rehospitalization than those living alone (290 vs. 201 days, p=0.005). In a Cox regression hazard regression model, adjusting for covariates, patients who lived alone were 1.42 times more likely to be rehospitalized one year after discharge than those who lived with someone (p=0.013). The relationship between living alone and all-cause death was not significant after adjustment for covariates. Specific aim three: A linear mixed-model analysis revealed that patients whose caregiver was in the intervention group had significantly better self- care maintenance (p < 0.001) and self-care management (p < 0.001) across time. Cox survival analysis demonstrated that patients whose caregiver did not receive the educational intervention were 11 times more likely (p=0.002) to experience cardiac readmission than patients whose caregiver did receive the educational intervention. Caregivers who received the educational intervention had higher perceived control (p < 0.001) for up to 30-days post-intervention versus the control group, however, there were no differences between caregiver groups in self-efficacy and HF knowledge.
Conclusion: In this dissertation, we found caregivers to play an important part in improving patient outcomes of self-care and readmission after discharge from a hospitalization for HF. Future large-scale studies are needed to develop and test interventions focused on caregivers to improve both patient and caregiver outcomes. Such studies will assist clinicians in understanding how better to support caregivers in their ability to positively influence HF self-care and readmission rates in patients with HF.
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Ti, Lianping. "Improving hospital care for patients who use illicit drugs in Vancouver, Canada." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/53955.
Full textAbstract:
Background: People who use illicit drugs (PWUD) experience a number of health-related harms that often lead to frequent hospitalizations. However, there exists little scientific evidence that has explored utilization and retention in hospital care, including leaving hospital against medical advice (AMA), among this population. The objective of this thesis is to provide evidence to improve hospital care for PWUD by first, identifying individual and contextual factors associated with leaving hospital AMA and other hospital-related experiences; and, second, to use these findings to develop and evaluate novel approaches to minimizing the risks and harms that PWUD experience in hospital settings. Methods: This dissertation draws on data collected from two open prospective cohort studies of HIV-positive and HIV-negative PWUD in Vancouver, Canada. These data were confidentially linked to a hospital discharge database as well as comprehensive records of HIV treatment and related clinical outcomes through a clinical monitoring laboratory. A variety of longitudinal and cross-sectional analytic techniques were used to examine the impact of intersecting individual and contextual factors on various hospital service outcomes. Results: This dissertation identified hospitals as a risk environment for PWUD, given the high prevalence of hospital discharge AMA and active illicit drug use in hospitals. The study findings highlighted various risk and protective factors for leaving hospital AMA, and discussed the negative consequences of being denied pain medication on illicit drug use in hospitals. The findings from this dissertation also point to novel strategies that may address these issues, including the implementation of an adult HIV/AIDS integrated health program operating in proximity to a hospital to minimize hospital discharge AMA among HIV-positive PWUD, as well as the potential for an in-hospital supervised injection facility (SIF) to reduce the harms associated with illicit drug use in hospital. Conclusion: Despite this setting of universal access to healthcare, there are individual- and contextual-level factors that play a pivotal role in shaping utilization and retention in hospital care among PWUD. The collective findings of this dissertation offer insights into how integrated harm reduction-based interventions may mitigate the risks associated with leaving hospital AMA and active illicit drug use in hospitals.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Eiu-Seeyok, Busarin. "Quality and safety of inter-hospital transfers care of critically ill patients from rural community hospitals to the Tertiary Regional Hospital in Thailand : a focused ethnographic study." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33222.
Full textAbstract:
Background: The safety of critically ill patients during inter-hospital transfer is recognised as a globally important issue. However, little evidence exists pertaining to the care provided by transfer nurses throughout the processes of inter-hospital transfer in rural community hospitals where there is a high risk of adverse clinical events occurring during transportation. Aim: The overall aim of the study was to explore transfer nurses' understanding of the delivery of quality of care during the transfer of critically ill patients from rural community hospitals to a tertiary regional hospital in Thailand. Design and Methods: The theory of symbolic interactionism (Blumer, 1986) and focused ethnography methodology were used. Data were collected using multiple qualitative methods including sixteen semi-structured interviews with transfer nurses, fourteen observations of critically ill patients' transfers from three rural community hospitals to a tertiary centre and twenty-three subsequent handover events and the analysis of transfer documents from four hospital settings (e.g. one regional hospital and three rural community hospitals) in Thailand. Translation from Thai into English and back translation into vernacular language was required. Inductive, thematic analysis was conducted to identify major themes by using qualitative data analysis software, NVivo 10 to assist data management during the analysis. Results: Five major themes emerged including (i) protective factors influencing safe transfer care, (ii) barrier factors influencing safe transfer care, (iii) behavioural patterns in transfer care processes, (iv) maintaining the health condition of the patients, and (v) overcoming adverse events. These particular themes elaborate the meaning of the quality and patient safety of transfer care, the provision of care for safe transfer care, and significant contextual factors that influence the quality of inter-hospital transfer care for critically ill patients. In addition, Donabedian's model (Donabedian, 1966, 1988) incorporated within the concept of context and culture was utilised to assist in conceptualising the framework for the quality of inter-hospital transfer care of critically ill patients in Thailand. Conclusion: The Donabedian model is useful as it is simple, but it does not include detail of the organisational context and culture as determinants of care quality. A conceptual framework for the quality of inter-hospital transfer care of critically ill patients in Thailand was therefore proposed. This study has expanded on current theoretical knowledge of the quality of inter-hospital transfer care by elaborating the patterns of thought and the behaviour of transfer nurses during provision of care throughout the processes of the inter-hospital transfer. It also highlights the limitations of organisational structure and the environment in which transfer work takes place, including issues on handover processes in hospital transfer care. The results can be useful to transfer nurses in that they facilitate greater understanding of the provision of better quality of care. They also help to inform hospital policy makers how to ensure safety of critically ill patients being transferred from community hospital settings.
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Tang, Yuen-ming Lewis. "Clinical outcomes for patients with traumatic brain injury in Kowloon Hospital." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23295818.
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McIlfatrick, Sonja Jayne. "Exploring patients', caregivers' and nurses' experience of day hospital chemotherapy : a phenomenological study." Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272334.
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Campbell, Patricia A. "Therapeutic self-care demands perceived by out-patients receiving external radiation therapy." Virtual Press, 1990. http://liblink.bsu.edu/uhtbin/catkey/722453.
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Zele-Mqonci, Nozuko. "Assessment of quality of care provided to patients who died in the care of Tshwane District Hospital." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30089.
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Objective: To assess the quality of care rendered to admitted patients in need of end-of- life care
at Tshwane District Hospital in Pretoria Central, Gauteng, South Africa.
Method: A combined retrospective review of the patient’s folder and a descriptive qualitative
study through interviewing the deceased patient’s relatives was used. An after-death audit (ADA)
tool, developed by the researcher and supervisor using the Gold Standard Framework ADA Tool,
which is used in the UK was used as a reference as was agreed to be appropriate for this study.
This explored the ability of healthcare workers at district hospital level to identify patients who
were at end-of-life through noting and recording the end-of-life symptoms and signs and the
interventions taken within the last 72 hours of the patients’ life. An interview guide for the
bereaved family members was developed using the family medicine principle of patient-centred
care and management in order to investigate their perception of the quality of care rendered to their
relatives whilst admitted at Tshwane District Hospital during their last days.
Results: 96 files were audited, revealing that patients between the ages of 21 years to 101 years
were admitted. This confirmed the increase in number of older people with incurable chronic
disease and multi-morbidity such as malignancy and HIV/AIDS, as compared to younger patients.
Of those admitted, 55.2% were admitted from home and 15.6% were referred from a tertiary
institution. 83% of these patients were admitted due to non-cancer diagnosis, of which about 36%
of those admissions were HIV- related, followed by renal causes (10%), cardiac (10%) and COPD
(3%). Cancer accounted for approximately 16.6% of the admissions. The duration of stay was
between 4.3 to 4.7 days, with younger and white patients admitted for shorter periods compared
to their older and black counterparts. The audited patient records recorded signs in their files
(gasping - 51.04%, low BP, low pulse - 18.75%) and symptoms of end-of-life (confused, ill, weak
- 18.75%) but patients were not identified or recognised as being close to end-of-life and were
not referred for palliative care. The only recorded intervention that patients received was oxygen
by mask (54.1%). Record reviews and family interviews revealed poor patient involvement in decision-making as
only about 9.3% were involved in their own care management. There was also a lack of family
involvement in patient management (4.4%), poor multi-disciplinary /team involvement as only
29.2% were referred to the other members of the multi-disciplinary team, and a low referral to
hospice (8.3%). According to the 18 consented family members’ interviews conducted, there was
lack of information with poor updates on patients’ problems or prognosis. Only 58,8% felt that
enough information was given and the members interviewed were not offered any additional
services (76.5%). They indicated that they thought referral to hospice would have improved the
quality of life and care of their loved ones at end-of-life. The majority of family members (88.24%)
also reported little care for patients during the dying phase as their relatives (patients) had
symptoms (23.53%) but nothing had been done to relieve these symptoms.
Conclusion: There is an increased need for palliative care and end-of-life care education and skills
at district hospitals as most patients are admitted or down-referred for care to district hospitals at
the end-of-life. When looking at interventions rendered, the study revealed poor quality of care
rendered to patients at their end-of-life, poor patient and family involvement in management
decisions, and a lack of multi-disciplinary approach of care. Helping or training of the healthcare
workers at District Care level Hospitals to be able to recognise a patient in need of palliative care
or have an ability in recognising those patients who require end-of-life care or are in their last
72hrs of life (which refers to the patients in the final hours or days of their lives, or those with a
terminal illness that has become progressively advanced) is still a challenge in the District level
hospital. The integration of palliative care at district hospitals would improve the quality of care
for both patients and their families.
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Mahgoub, Nelly Ahmed. "Bridging therapy in hospital- and community-based psychiatric nursing care : a comparative study." Thesis, Sheffield Hallam University, 1988. http://shura.shu.ac.uk/20834/.
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This study presents a detailed account of Bridging Therapy - an innovative intervention aimed at providing relatively comprehensive psychiatric nursing care for mentally ill patients. Starting at hospitalisation, Bridging Therapy continues as planned nursing care based on detailed assessment of the patient's short- and longer-term needs both before and after discharge to the community, delivered where possible by the same nurse, or by members of the same nursing team. Bridging Therapy thus presents a remedial model for current fragmented patterns of nursing care, based on an eclectic approach to psychotherapy and nursing process known as the "flexible integrative approach" (FIA).The study recognises problems caused by lack of patient outcome measures in psychiatric nursing; and approaches this by developing an appropriate assessment instrument, the Behaviour Adjustment Inventory (BAI), which is initially tested in concurrent use with a well-validated psychometric instrument (the GHQ); with a second well-validated instrument (the EPI) acting as an initial screening device. The BAI assesses patients' initial status on admission and subsequent responses to Bridging Therapy on a five-point scale, used in conjunction with detailed clinical criteria of behaviour and attitude change. Clinical evaluation of patients in the contrasted contexts of Sheffield and Cairo is described. In each context, experimental (Bridging Therapy) and control (non-Bridging Therapy) groups are studied (Sheffield total N = 22: Cairo total N = 18). Assessment of initial condition was carried out on admission to hospital; recovery status on discharge, and at the close of therapeutic follow-up in the community. Results indicate similar levels of recovery for Sheffield and Cairo groups, with a more pronounced tendency to recovery in the experimental (Bridging Therapy) groups; however, this difference does not reach statistical significance. Psychometric findings are augmented by qualitative descriptions of the implementation process. Two detailed nursing studies from each context are presented. The investigation highlights the complexity of the research problem, including important transcultural considerations; identifies multifactorial issues governing patient care; and supports further research into Bridging Therapy as a potential remedy for current gaps in psychiatric nursing care, both in Britain and Egypt. Relevant materials concerning historical/structural aspects of mental health care and varieties of psychotherapy (Chapters 1 through 3) are included because of their contextual importance both to British and Egyptian workers.
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Hennessy, Carrie Olsen. "Monitoring Psychiatric Patients’ Preparedness for Hospital Discharge." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1521494115246141.
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Krevers, Barbro. "Patient and relative perspectives regarding quality in hospital care for older people : theory and methods /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med773s.pdf.
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Campbell, Ross Thomas. "Prevalence of palliative care needs in patients admitted to hospital with heart failure." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/7946/.
Full textAbstract:
Background: The syndrome of heart failure is common, and is associated with high morbidity and reduced life expectancy. Patients can experience high symptom burden, low mood, and impaired quality of life. Repeated, and often prolonged, hospitalisations due to exacerbations of heart failure and other co-morbidities are common. Over the last 25 years, the evidence base for the treatment of heart failure has increased, with an associated improvement in prognosis. However, many patients with heart failure still have a poor prognosis. International guidelines for the treatment of heart failure now suggest referral to palliative care services, particularly in patients thought to have a poor prognosis and impaired quality of life. Despite these recommendations, few patients with this condition have access to specialist palliative care services in the United Kingdom. However, not every patient with heart failure will have palliative care needs, therefore the extent of the problem of unmet palliative care needs in patients with heart failure is unknown. I systematically reviewed the published literature to identify studies describing the palliative care needs, including prevalence, of patients with heart failure. Although my search identified over 60 publications describing the palliative care needs of patients with heart failure, most of the studies were of highly selected cohorts, did not include descriptions of therapy, or descriptions of severity of heart failure such as ejection fraction, natriuretic peptides, prognostic scores or clinical outcomes. Most studies used a cross-sectional approach to describe the potential palliative care needs, and therefore, were unlikely to appreciate the variable clinical course of patient with heart failure. Although the studies identified were informative, a definitive description of the prevalence of palliative care needs in a well described, contemporary cohort of patients with heart failure is lacking. My systematic review also identified a number of preliminary randomised controlled clinical trials, assessing the effect of early palliative care in patients with heart failure. However, these studies included small numbers of participants, and only had qualitative endpoints such as change in quality of life measures without assessment of clinical outcomes such as death or hospitalisation. Again, although these preliminary trials are informative, a definitive evidence base comparing palliative care to standard care in heart failure is not available. Aims: The primary aim of this study was to inform the design of a randomised controlled clinical trial of palliative care in patients with heart failure. The first step in this process was to define the clinical problem and identify a suitable target population by describing the prevalence of patients with heart failure who have palliative care needs. I then aimed to describe whether these patients could be identified from data collected during an index hospital admission. The final aim of my study was to identify useful outcome measures which could be used in a randomised controlled clinical of palliative care in heart failure. Methods: This was a prospective, longitudinal study of the prevalence of possible palliative care needs, defined using quantifiable patient reported outcome measures. An unselected cohort of patients admitted to hospital with a primary diagnosis of heart failure were recruited and extensively characterised. The World Health Organisation definition of palliative care was used to identify patients with heart failure who had palliative care needs. I made objective assessments of quality of life (using the Kansas City Cardiomyopathy and Short Form 12 questionnaires), mood disturbance (using the Hospital Anxiety and Depression Scale), symptom burden (using the Edmonton Symptom Assessment Scale), and caregiver strain (using the Zarit Burden Interview questionnaire). These assessments were made at baseline and repeated every four months for the duration of the study. Patients were identified as having palliative care needs if they had persistently severe impairment of any patient reported outcome measure without improvement, or severe impairment of any patient reported outcome measure followed by death. End-of-life care was assessed using the Views Of Informal Caregivers Evaluation of Services questionnaire, and by comparing preferred place of end of life care to actual place of death. Multivariate logistic regression analysis was used to determine if baseline prognostic markers, physician completed assessments, or patient reported outcome measures could identify patients with palliative care needs. Results: Between January 9th 2013 and December 1st 2014, 313 near consecutive patients with heart failure were enrolled in the study. Of these, 272 (86.9%) completed patient reported outcome measures at baseline and agreed to attend study visits. Patients were elderly, with a median [interquartile range] age of 76 [70-82] years, and 47% of participants were female. 56% of patients did not have a previous diagnosis of heart failure. Most participants had heart failure with reduced ejection fraction (67.3%) compared to heart failure with preserved ejection fraction (32.7%). Use of disease modifying pharmacotherapy was high, especially in participants with heart failure with reduced ejection fraction. Participants suffered from a number of physical and psychological symptoms, as recorded using patient reported outcome measures. The most common physical symptoms were shortness of breath and fatigue, followed by drowsiness and lack of appetite. Although less frequent, pain and nausea were also common. Participants reported higher scores for depression and anxiety compared to studies using similar mood assessments in the general population. Quality of life was impaired in most participants at baseline, with 77.9% of participants being classified as having moderate or severe impairment as assessed by the Kansas City Cardiomyopathy questionnaire. At baseline, 114 (41.9%) participants scored severe in at least one patient reported outcome measure. Of these, 95 (83%) participants scored severe on the Kansas City Cardiomyopathy Questionnaire. Participants were invited to attend study visits, or have home study visits, every four months for the duration of the study. The minimum number of study visits offered was two for the last participant enrolled. A total of 691 study visits were performed. 37% of these assessments were home visits. Participants were also followed up passively using record linkage to report number and cause of hospitalisations, and cause and location of any deaths. Participants were followed up for a minimum of one year. During follow-up, 217 (79.8%) participants were re-admitted to hospital. The median number of admissions was 3. Most hospitalisations were due to non-cardiovascular causes. During passive follow-up until December 1st 2015, there were 103 (37.8%) deaths. Most (60.2%) deaths were due to cardiovascular causes. 73 (26.8%) participants met my criteria for having palliative care needs. These patients had worse summary scores at baseline for all patient reported outcome measures. Patients who met my definition of palliative care needs spent fewer days alive and out of hospital than the group who did not meet the definition of palliative care needs. The median [IQR] days alive out of hospital in the group meeting the definition of palliative care needs was 394 [172-586], compared to 638 [420-809] in the group not meeting the definition of palliative care needs (p<0.001). After adjusting days alive out of hospital for quality of life, patients in the palliative care needs group had fewer days of good health as a percentage of total follow-up, median 12 [3-22] % of potential follow-up, compared to 47 [25-68] % in those not meeting my definition of palliative care needs (p < 0.001).Most participants expressed a wish to spend the end of their life at home, but despite this, most died in hospital. 17 caregivers completed the Views Of Informal Caregivers Evaluation of Services questionnaire. Overall care in the last few months of life was assessed as fair or poor by 35.3%. Of the 272 participants who participated in the whole study, 33 (12.1%) had access to specialist palliative care services. Of the 73 participants who met the definition of PC needs, 19 (26.0%) accessed specialist PC services. 6 (2.2%) participants used hospice care during the duration of the study. Using multivariate logistic regression analysis, a low Kansas City Cardiomyopathy Questionnaire summary score and a low Australia Modified Karnofsky Performance Scale (a physician completed assessment) score, were predictive of patients with palliative care needs. Conventional prognostic markers, such as natriuretic peptides or ejection fraction, were not predictive of patients with palliative care needs. Physicians, using their clinical judgement, were only modestly accurate at predicting patients with heart failure who had or would go on to develop palliative care needs. Physicians were better at predicting prognosis than need for palliative care.
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Molapo, Johanna. "Eye care services for diabetic patients at Dr George Mukhari Hospital, Gauteng Province." Thesis, University of Limpopo ( Medunsa Campus ), 2011. http://hdl.handle.net/10386/419.
Full textAbstract:
Thesis (MPH)--University of Limpopo, 2011.Introduction: Diabetes, also known as diabetes mellitus characterized by hyperglycemia is a global health problem. The World Health Organization (WHO) reports an estimated 177 million diabetics worldwide and this number is expected to double by the year 2030 mainly because of the unhealthy life styles of not doing physical exercises and eating unhealthy food. The resultant obesity is putting people at risk of developing diabetes and micro vascular complications like diabetic retinopathy that can affect a person’s eyesight. Aims and Objectives: The aim and objectives of this study were to determine the socio-economic characteristics and the level of awareness regarding the eye care services offered by the diabetic clinic at Dr George Mukhari Hospital as well as to identify the referral patterns and possible factors that may influence diabetic patients to utilize these offered services. Study methodology: Data was collected from adult diabetic patients attending the diabetic clinic at Dr George Mukhari Hospital by making use of an anonymous researcher assisted structured questionnaire. The questionnaire had sections covering the socio demographic and epidemiological information of the respondent; awareness about diabetic complications with emphasis on routine eye care; referral patterns of health professionals to the eye specialist and other barriers that the respondents experienced in attending the available eye care services. Results: Data was collected from a total of 175 respondents. The majority of the respondents were African (98%) females (75%) and older than 56 years of age (82%). Basically all the respondents (98%) did not have a medical aid and 50.3% of them were unemployed and had to make use of public transport to visit the clinic. Ninety six percent of the respondents were aware of the fact that diabetes can cause eye complications and that a routine eye test is important to prevent blindness. In this group of participants there was a referral rate of 95% which proved to be very successful because only 18% of the respondents were in need of an eye operation while the rests were treated for minor problems and then discharged. Conclusions: Based on the findings of this study all indications are that the referral patterns for diabetic patients from the diabetic clinic at the Dr George Mukhari hospital for eye testing is effective. All efforts should be made to ensure that diabetic patients go for a yearly routine eye test.
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Jones, Sian. "An analysis of processes and strategies used by qualified nurses in assessing the mental capacity of acutely and critically ill hospitalised adult patients." Thesis, University of South Wales, 2016. https://pure.southwales.ac.uk/en/studentthesis/an-analysis-of-processes-and-strategies-used-by-qualified-nurses-in-assessing-the-mental-capacity-of-acutely-and-critically-ill-hospitalised-adult-patients(849aa416-240e-40f3-8f11-4e36c71ac121).html.
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Mental capacity is the ability to understand, reason, and exercise choice by making informed decisions. Acute and/or critical illness may impact upon the decision making abilities of hospitalised adult patients. Assessment of patients for reduced, fluctuating or absent capacity gives the healthcare team the legal authority to assess best interests and to make treatment decisions without consent under this justification. Qualified nurses are the everpresent professional group in acute and critical care settings. They may initiate assessments of mental capacity which may be influential in the ways that the decision making of patients is facilitated or substituted. There are, however, few studies that focus on processes employed by them in this area in fast-moving clinical settings, although it is recognised that physical illness may have a significant impact upon capacity status.
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Mullins, Lesley. "The lived experience of seclusion in a psychiatric hospital." Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/958790.
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The purpose of this Heideggerian phenomenological study was to understand the meaning of the lived experience of seclusion in a psychiatric hospital. Five people with a long standing mental illness who had spent time in a locked seclusion room in a psychiatric hospital were asked to describe their experience in seclusion.Consistent with the method, purposive sampling was used in order to obtain an understanding from those who had lived the experience of seclusion and could articulate their experience. Interviews were audiotaped and the data were transcribed by the researcher. Audiotapes were destroyed when the study was completed. Transcribed data were shared with other researchers who were familiar with Heideggerian phenomenology and hermeneutics for the purpose ofgaining insight into the interpretations. When data were shared, names of participants and other identifying information were removed. Sharing of data for purpose of interpretation is inherent in the Heideggerian method as described by Diekelmann, Allen, and Tanner (1989). Data were analyzed using Diekelmann, Allen, and Tanner's (1989) seven stages. The following patterns emerged constituted pattern- Seclusion, A Paradox Being Powerless yet Hopeful with the supporting themes of 1.) Being Punished, 2) Being Abandoned, and 3) An Opportunity for Reflection and Self Growth.School of Nursing
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Steckler, Josephine. "Do elderly clients in an acute care hospital perceive they are treated with dignity and respect." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28799.
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The purpose of this study was to investigate whether elderly clients in an acute care setting perceived themselves as being treated with dignity and respect, and whether clients with a higher socioeconomic status are more likely than clients with a lower socioeconomic status to be treated with dignity and respect.
Sixty-two elderly clients who had been in hospital at least five days, were alert and oriented during their hospitalization, and could speak English were selected for the study. Using a convenience sampling technique, the clients were selected from medical and surgical units of two major teaching hospitals. They were interviewed within three days after discharge to respond to items on a questionnaire selected from the Medicus Quality Assurance Tool.
The results of the study show that elderly clients may not perceive that they are consistently treated with dignity and respect. Older clients (75+ years) are less likely than younger older clients (65-74) to be treated with dignity and respect, and elderly clients with a lower socioeconomic status and women, are less likely to be treated with dignity and respect.Applied Science, Faculty of
Nursing, School of
Graduate
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Maeser, Donna Lee. "In-home health care and hospitalization status." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1202.
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The purpose of the study was to describe the relationship between in-home health care services for elderly patients who were recently discharged from inpatient care and re-hospitalization rates. The design was descriptive and the hypothesis was that the provision of in-home health care services would mitigate a decline in the health status, of an elderly patient, following discharge from inpatient care and prevent re-hospitalization.
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McGorm, Kelly J. "Patients frequently referred from primary care to hospital outpatient clinics for medically 'unexplained' symptoms." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/29262.
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AIM: The aim was to identify and describe patients frequently referred from primary care to hospital clinics for medically ‘unexplained’ symptoms (FRMUS) and compare them with patients frequently referred with medically explained symptoms (FRMES) and patients infrequently referred for symptoms (IRS). HYPOTHESIS: Compared to FRMES and IRS patients, a greater proportion of FRMUS patients would have anxiety or depression and this would be inadequately treated. Subsidiary hypotheses relating to: doctor ‘shopping’, health care costs, disability, satisfaction with care, and health beliefs, as well as the general practitioners’ (GPs) expressed difficulty managing the patient, were also tested. METHODS: (1) Case and control identification from five Edinburgh general practices using a combination of National Health Service (NHS) referral data and primary care case notes. (2) A case-control study including a questionnaire survey of GPs and patients. (3) A prospective follow-up study of FRMUS patients’ new referrals over a one year period. RESULTS: FRMUS patients made up 1.1% of the primary care population aged 18-64 years, and nearly two thirds were female. Compared to controls, FRMUS patients were more likely to be anxious or depressed, but 64% were receiving ‘adequate’ treatment. FRMUS patients were also more likely to: be considered difficult to help by a GP, consult many different GPs, have high health care costs, and report high levels of disability. FRMUS patients were more likely to live in a socially deprived area and nearly half were unemployed. FRMUS patients continued to be referred for MUS during follow-up. DISCUSSION: Although a substantial proportion of FRMUS patients had anxiety and depression, considerably more had received apparently adequate treatment when compared to the two comparison groups. Lack of coordinated patient care, rather than undetected psychiatric morbidity, may be the key factor leading to repeat referrals.
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Fylan, Beth. "Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
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Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentship
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Ramasamy, Kasturi. "Educational Training on Falls Intervention for Elderly Patients in Acute Care Settings." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7064.
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Falls among hospitalized elderly patients are a safety concern for health care organizations and the patients they serve, but falls can be prevented through the team effort of nurses and other health care professions to promote safety within the organization. The project site was experiencing an increase in the number of patients falls and identified the need for staff education related to assessment and intervention to prevent patient falls in the elderly population. Thus, the practice-focused question for this project was whether an educational program on evidence-based fall prevention strategies using the American Medical Directors Association clinical guidelines would improve staff nurse ability to assess fall risk and apply intervention strategies for elderly patients in an acute care setting compared to standard practice. Lewin's change theory was used as the theoretical foundation for this project. A total of 29 cardiac unit staff nurses who participated in the educational program were provided information on recognizing risk factors for falls, conducting an accurate fall risk assessment using the Morse Fall Scale, and developing individualized care plan for managing fall risk. The Agency for Healthcare Research and Quality 2E Fall Knowledge Test was used in a pre- and posttest design to assess the efficacy of the educational program. The results showed a statistically significant increase (p < 0.001) in staff members' knowledge in recognizing, assessing, and managing falls. This project can improve nurse's knowledge with evidence-based recommendations in practice, which promotes positive social change through improved staff competency that may result in decreased patient falls and adverse patient outcomes.
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Tang, Yuen-ming Lewis, and 鄧遠明. "Clinical outcomes for patients with traumatic brain injury in Kowloon Hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31969938.
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Lipovich, Carol Jean. "Analysis of Ventilator Associated Pneumonia Patients' Hospital and Intensive Care Charges, Length of Stay and Mortality." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366228755.
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Baird, Mary K. "The effects of warming me[t]hods on patient's self-report of thermal comfort and anxi[e]ty levels." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/693.
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Fylan, Gwynn Elizabeth Margaret Mary. "Medicines management after hospital discharge : patients' personal and professional networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
Full textAbstract:
Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
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Walts, Lynn Maddox Walker George M. "Patient classification system : an integrated method for measuring nursing intensity and optimizing resource allocation /." See options below, 1992. http://proquest.umi.com/pqdweb?did=745208811&sid=2&Fmt=2&clientId=68716&RQT=309&VName=PQD.
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Al-Surimi, Khaled Mohammed. "Patients' perceptions of hospital care and quality policy development for health care in developing countries : a case study from Yemen." Thesis, University of Liverpool, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442730.
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Abo, Yasuyo. "The need for social work intervention for the elderly patients and their family members." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2789.
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Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.
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McCormick, Jill S. "Hospital costs for acute myocardial infarction patients receiving perfect compliance of evidence-based care bundle." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/JMcCormick2008.pdf.
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Chisaka, Joseph Wangisani. "The use of traditional herbal medicines among palliative care patients at Mulanje Mission Hospital, Malawi." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31511.
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Background: The prevalence of use of traditional medicines by patients receiving palliative care is poorly documented. In 2002, the World Health Organisation estimated about 4 billion people (80% of the world’s population) used traditional medicines for some aspect of primary healthcare, with 90% of users living in low and middle income countries. Studies in Africa have shown that patients on palliative care are more likely to use traditional medicines especially after the diagnosis of cancer. This study describes the prevalence of and reasons for TM use amongst PC patients and also explores the common herbs used by this population. Methodology: A mixed method descriptive cross sectional study design was used including the following: questionnaire administered to patients attending palliative care clinic and focus group discussions with palliative care patients. Results: 60.4% of palliative care patients (n = 96; males = 53%) reported use of traditional herbal medicines. The majority of survey participants had the diagnosis of cancer (94%; n = 90) and HIV (89%; n = 85). Traditional herbal medicine use was common in participants who had the following symptoms: diarrhoea 83%, anorexia 63%, pain 61% etc. Traditional medicine use was not associated with age, gender, education, occupation, distance from hospital, diagnosis or symptom. 62% of the participants who used herbal medicines did not know the herbs they were taking. Kigelia Africana, Moringa oleifera, Cyphostema sp, and Strychnos innocua were the common herbs used. Cultural practices, limitations of conventional health system and credibility of traditional healers were the main reasons for using traditional herbal medicines. Conclusion: Use of traditional herbal medicines is high among patients receiving palliative care at Mulanje Mission hospital mainly for symptom management and cancer. Further research is needed to investigate effectiveness of identified herbs and also assess their potential herb-drug interactions. Ongoing work including liaison with traditional healers would assist to formulate effective local palliative care management programs that are sensitive to traditional medicine practices.