Dissertations / Theses on the topic 'Hospitals Victoria Staff Attitudes'

Thesis (M.N. (Hons))--University of Western Sydney, 2004.
A thesis presented to the University of Western Sydney, College of Social and Health Sciences, School of Nursing, Family and Community Health, in fulfilment of the requirements for the degree of Masters of Nursing (Honours). Includes bibliographical references and appendices.

In global terms, Saudi Arabia is a rapidly developing country. As such, its food industries have yet to fully implement the food safety management systems common in the EU. In the hospitals sector, the Ministry of Health intends to implement Hazard Analysis Critical Control Points (HACCP) system to provide safe meals for patients, staff and hospital visitors. The aim of this study was to evaluate the readiness of the Saudi Arabian hospitals to implement HACCP by assessing the pre-requisites programmes in their foodservices departments. An audit form was used in four hospitals in Riyadh. Questionnaires were also used to assess self-reported behaviour, knowledge and attitudes of 300 foodservices staff. Lack of training was known to be a major omission in the pre-requisite programs (PRP’s) of all hospitals. Therefore a bespoke food safety training program was developed and delivered to food handlers in the participating hospitals. An assessment was then made to determine whether this intervention had any effect on their knowledge, attitude to food safety and self-reported behaviour. The results show that, the prerequisite programs were not implemented properly in the participating hospitals. Also, foodservices staff had a poor knowledge with regard to food safety. However, staff knowledge was significantly improved following the training (p. value < 0.05) and their level of knowledge remained stable after six months. Participants’ behaviours and attitudes also improved after the training. This indicates that, training has a positive impact on food handlers knowledge, practices and attitude.

This thesis was born from a concern the researcher had with regard to negative reports in the media emanating from 4 babies that died at Cecilia Makiwane Hospital Peadiatric ICU unit due to power supply failure. The most significant of these negative reports was in 2007 when the Daily Dispatch ran a series of articles regarding what they termed avoidable deaths over the last 14 years. The ease with which staff communicated with the media together with the high absenteeism rate and high turnover was a cause for concern. When the researcher analysed the history of the problem, it immerged from the respondents’ responses that the rationalistion process undertaken by the Eastern Cape Department of Health (ECDoH) was a significant root cause to the problem. The literature review focused on three areas viz.: Organisational Culture, Organisational Change, Foundations of Satisfaction. This focus was used to confine the problem to a manageable project but secondly each of the aspects are interwoven. Routledge (2010) notes that culture is the reflection of the values advocated by a founder or leader by way of his/her day to day actions. This is done by the leader creating a perception or viewpoint that assists the employees to achieve the organisation’s mission, vision and goals. In any organisation change is a constant and it needs to be effectively managed. With government institutions like the East London Hospital Complex (ELHC) directives come from the top and are implemented by an unprepared and untrained leadership and management cadre and clear communication of vision and objective of the desired outcomes never happens. The aim of the research was to: describe the existing Organisational Culture present at ELHC (Perform an organisational diagnosis); describe the impact of change (rationalisation) and to analyze why there was such a high staff turnover. It is clear from the results of the survey conducted that significant dissatisfaction prevailed relating to how the institution was managed. Dissatisfaction amongst the health professionals was general but also specific to the following: leadership and management issues, fairness, remuneration and lack of resources. The recommendations therefore focused on developing management and leadership within the proposal of Dubrin’s model (2001).

En partant d’une description des nombreux changements de la pratique médicale depuis quelques décennies, la thèse étudie divers aspects constitutifs du malaise du médecin. L’accroissement de la puissance médicale qu’a permis la technoscience est analysée et remise dans un contexte plus large où les technologies de l’information ont une grande place. L’augmentation considérable des connaissances pose un problème de maîtrise de la science médicale. La multiplicité des observations fait qu’il y a discordance de certaines d’entre elles avec les théories médicales largement acceptées. De cette manière, le gain d’efficacité est associé à une perte de la cohérence du discours médical. Le rôle du médecin disparaît derrière la technique, qui semble pouvoir, seule, rendre tous les progrès accessibles. Le médecin devient alors un simple distributeur de services et, à ce titre, développe parfois des offres de pratiques sans fondement, voire dangereuses.

Le pouvoir du médecin est évoqué, et se ramène in fine à la fourniture d’un diagnostic et d’une explication de sa maladie au patient. Le rôle des explications particulières que donne le médecin au malade est exploré à la lumière d’une conception narrative et évolutive de la vie humaine. Le rôle du médecin apparaît alors comme d’aider le patient à réécrire a posteriori le fil d’une histoire qui apparaît initialement comme interrompue par la maladie.

Le rôle social de maintien de l’ordre de la pratique médicale est alors évoqué. Ensuite, par une approche descriptive du phénomène religieux, on montre que la médecine du XXIe siècle a les caractéristiques d’un tel phénomène. Entités extrahumaines, mythes, rites, tabous, prétention à bâtir une morale, accompagnement de la vie et de la mort, miracles, promesse de salut, temples, officiants sont identifiés dans la médecine « classique » contemporaine. Seule la fonction de divination de l’avenir d’un homme précis est devenue brumeuse, la technoscience permettant régulièrement du « tout ou rien » là où auparavant un pronostic précis (et souvent défavorable) pouvait être affirmé.

L’hypothèse que la médecine est devenue une religion du XXIe siècle est confrontée à des textes de S. Freud, M. Gauchet et P. Boyer. Non seulement ces textes n’invalident pas l’hypothèse, mais la renforcent même. Il apparaît que le fonctionnement de l’esprit humain favorise l’éclosion de religions et donc la prise de voile de la médecine. La dynamique générale de la démocratisation de la société montre que la médecine est une forme de religion non seulement compatible avec une société démocratique, mais est peut-être une des formes accomplies de celle-ci, où chaque individu écrit lui-même sa propre histoire.

Le danger qu’il y a, pour le patient comme pour le médecin, si ce dernier accepte de jouer un rôle de prêtre, est ensuite développé. Enfin, la remise dans le cadre plus général de l’existence humaine, l’évocation de la dimension de révolte de la médecine, de son essentielle incomplétude, l’acceptation d’une cohérence imparfaite permettent au médecin de retrouver des sources de joie afin de, peut-être, ne tomber ni dans un désinvestissement blasé, ni dans un cynisme blessant.

From a description of the many changes medical practice has undergone for a few decades, the work goes on to study many sides of the modern doctor’s malaise. The gain of power made possible by technoscience is put on a larger stage where information technologies play a major role. The abundance of knowledge makes health literacy more difficult. the great number of observations makes discrepancies with general theories more frequent. The gain in power is associated with a loss of coherence of the medical speech. The doctor’s role vanishes behind technology that seems to be the only access to all medical progresses. Doctors becomes mere service providers and go on to offer unvalidated or even harmful services on the market.

Modern medical power resumes into the explanations and diagnosis given to the patient. The role of medical explanations is explored through an evolutive and narrative vision of human life. The duty of the doctors then appears to allow a new narration of the self that bridges the gap disease introduced into the patient’s life.

The role of medicine in maintaining social order is mentioned. Through a sociological approach of the religious phenomenon, one can see that XXIst century medicine is such a phenomenon. Medicine knows of extrahuman entities, myths, rites, taboos, miracles, temples; priests are present in modern mainstream medicine. Some want to derive objective moral values from medicine, and it brings companionship to man from birth to death. The only departure from old religions was the weakened ability to predict the future of an individual patient: for some diseases for which survival was known to be very poor, the possibilities are now long-term survival with cure, or early death from the treatment.

The hypothesis that medicine is a religion is confronted to texts from Freud S. Gauchet M. and Boyer P. Not only do they not invalidate the hypothesis, but they bring enrichment to it. Brain/mind dynamics is such that the appearance of religions is frequent, and makes the transformation of medicine into a religion easier. Society’s democratisation confronted to religion’s history shows that medicine is the most compatible form of religion within a truly democratic society, where each individual writes his own story.

To become a priest brings some dangers for the patient, but also for the doctor. These dangers are discussed. This discussion is put into the larger context of human life. The revolt dimension of medicine is discussed, as is its never-ending task. Their acceptance, as that of a lack of total logical coherence can open the possibility for the doctor to enjoy his work, without being neither unfeeling nor cynical.

Doctorat en philosophie et lettres, Orientation bioéthique
info:eu-repo/semantics/nonPublished

Dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, 2009
Background: In order to develop a balanced healthcare system, healthcare integration and inter-professional communication is important and allows for optimum healthcare benefits for a patient and improves cost-effectiveness. The chiropractic profession has been trying to improve inter-professional communication with the medical profession. Kimberly Hospital Complex (KHC) is a tertiary provincial hospital situated in the Northern Cape and since 1998, a permanent chiropractic post exists at this hospital, making it the only state hospital in South Africa with a full-time chiropractic clinic and post. Purpose: To determine the knowledge and perceptions of the medical staff about chiropractic at KHC. Method: This study was achieved by means of a questionnaire, which was modified to suit a South African context by means of a focus group. The questionnaire was personally delivered to 975 medical staff members at KHC. A response rate of 30% (n = 292) was achieved and the data was analysed using SPSS version 15 (SPSS Inc., Chicago, III, USA). Results: The mean age of the respondents was 37.3 years and most were female (78.9%, n = 289). Doctors (62.5%, n = 54) and therapists (61.6%, n = 10) had a higher knowledge percentage score than nurses (48%, n = 213) or other healthcare professions (56.8%, n = 15). Doctors (77.8%, n = 42), therapists (100%, n = 10) and other healthcare professions (69.2%, n = 9) were more inclined to think that chiropractic is an alternative healthcare service, while nurses perceived chiropractic as a primary healthcare service (43.3%, n = 91). Many respondents were unaware of the fact that Diagnostics, Emergency Medical Care, Pharmacology and Radiology are included in the chiropractic curriculum and that chiropractic leads to a Master’s degree. Seventy five percent (n = 203) believed that chiropractors are competent in the general medical iv management of patients, but they would still rather refer patients to physiotherapists and orthopaedic surgeons. Despite the poor level of knowledge of chiropractic, 79.2% (n = 224) believed that it is sufficiently different from physiotherapy to warrant two separate professions and few (24%, n = 69) perceived it as unscientific. A large proportion of the respondents (80.3%, n = 228) believe that chiropractic is not well promoted in South Africa and only 20.8% (n = 59) felt that they know enough about the profession to advise a patient. The majority wanted to learn more about the chiropractic profession (95.8%, n = 277), especially pertaining to the scope and the treatment employed by chiropractors. Seventy-nine percent (n = 212) believed that patients benefit from chiropractic at KHC and 95.4% (n = 268) felt that South African hospitals would benefit from chiropractic care. Conclusion: Due to the poor level of knowledge at KHC, an educational drive should be employed to educate the medical staff in order to increase their understanding of chiropractic and to aid chiropractic integration into the state hospital system of South Africa.

Yes
People with dementia occupy up to one quarter of acute hospital beds. However, the quality of care delivered to this patient group is of national concern. Staff working in acute hospitals report lack of knowledge, skills and confidence in caring for people with dementia. There is limited evidence about the most effective approaches to supporting acute hospital staff to deliver more person-centred care. This study aimed to evaluate the efficacy of a specialist training programme for acute hospital staff regarding improving attitudes, satisfaction and feelings of caring efficacy, in provision of care to people with dementia. A repeated measures design, with measures completed immediately prior to commencing training (T1), after completion of Foundation level training (T2: 4–6 weeks post-baseline), and following Intermediate level training (T3: 3–4 months post-baseline). All participants received the 3.5 day Person-centred Care Training for Acute Hospitals (PCTAH) programme, comprised of two levels, Foundation (0.5 day) and Intermediate (3 days), delivered over a 3–4 months period. Staff demographics and previous exposure to dementia training were collected via a questionnaire. Staff attitudes were measured using the Approaches to Dementia Questionnaire (ADQ), satisfaction in caring for people with dementia was captured using the Staff Experiences of Working with Demented Residents questionnaire (SEWDR) and perceived caring efficacy was measured using the Caring Efficacy Scale (CES). The training programme was effective in producing a significant positive change on all three outcome measures following intermediate training compared to baseline. A significant positive effect was found on the ADQ between baseline and after completion of Foundation level training, but not for either of the other measures. Training acute hospital staff in Intermediate level person-centred dementia care is effective in producing significant improvements in attitudes towards and satisfaction in caring for people with dementia and feelings of caring efficacy. Foundation level training is effective in changing attitudes but does not seem to be sufficient to bring about change in satisfaction or caring efficacy. Keywords

Objectives: To identify the perceptions of community hospital physicians on computerized physician order entry. Design: Multi-method approach consisting of a mail survey of 659 community hospital physicians with active admitting privileges at three PeaceHealth, Inc., along with follow-up personal interviews with stratified random selection from completed survey. Measurements: Perceptions were assessed by means of a mail survey that asked physicians to rank themselves on a scale that represented the five adopter categories contained in the Diffusion of Innovation (DOI) change theory, along with several questions regarding computer use and attitudes toward potential effects of computers and CPOE on medicine and healthcare. Physicians representing four of the five adopter categories were interviewed to assess general perceptions and perceived attributes of innovations, an another construct within the DOI theory. Results: The response rate was 41%. Medical specialty, years in practice, and gender were found not to influence attitudes toward use of computers or, more specifically CPOE in medicine and healthcare. However, more medical specialists favor CPOE implementation at PeaceHealth than expected. Self-ranking on the DOI five adopter categories appears to influence attitudes toward use of computers in medicine and healthcare with positive trends in improving quality, rapport, and patient satisfaction mainly in the Innovator, Early Adopter, and Early Majority categories. A positive trend was seen in the relationship between CPOE's potential effects on improving patient care, not interfering with communication, and improving patient satisfaction with negative relationships with impact on physician workflow and enjoyment of medical practice. A relationship is seen between the five adopter categories and favoring CPOE implementation at PeaceHealth. The perceived attributes of innovations of Ease of Use, Result Demonstrability, and Visibility were supported by interview responses. Relative Advantage seemed to be supported by other questions. The concept of Compatibility was also supported. No steps of the processes of change construct within the Transtheoretical Model were identified during the interviews. Conclusions: This study appears to refute the suggestion that there might be a difference between medical specialists and surgical specialists, age, or gender in their support of computers and specifically CPOE. These data appear to support the Diffusion of Innovation theory is appropriate to consider in investigating CPOE and its diffusion among community hospital physicians. Implementing CPOE according to adopter categories would provide the option for interested physicians to use CPOE, to use CPOE on certain hospital units or patients, and to expand its use before making mandatory. Communication should be targeted toward the adopter categories rather than mass media and emphasize the perceived attributes of innovation.
Graduation date: 2004

碩士
國立臺灣大學
醫療機構管理研究所
87
The purposes of this study were to investigate the knowledge and the attitudes of nursing staff to the “ Labor Standards Law ”, and the attitudes to the strategic responses taken by hospitals. The study was designed in a cross-sectional survey and in-depth interviews. Eight hospitals’ human-resource directors were interviewed on the subject. Questionnaire was mailed to 1700 randomly selected nursing staff. The survey was done from March 7 to April 13,1999. Totally there were 250 valid responses. The study results showed that the majority of the nursing staff knew the “Labor Standards Law ”quite clearly. The score of knowledge toward the law of the nursing staff were positively associated with the age, the seniority, being nursing director and being married. The majority of the nursing staff thought the laws are reasonable. Besides, the majority of the nursing staffs thought that the strategies taken by hospital were reasonable, except the “over-time pay” and “ working in the night”. The majority of hospitals didn’t organize the “retirement pension reserve monitor committee”. And the hospital managers made the rules of job without discussing with their members. According to the investigated results, the study suggests that hospital managers should exactly comply with the “Labor Standards Law”, and train their members to fit their jobs better. As for the competent authorities, they should exactly execute the law, and they should amend the law to fit better for the health care industry. Finally, the study suggests that future researchers could study other members who were also affected under the law.

The purpose of this study was to examine the relationship between perceived availability of opportunities for promotion, training, career progression, existing management style and voluntary staff turnover intention among the nurses working in Mengo Hospital. A quantitative, descriptive correlational design was used. Data collection was done using structured questionnaires. Full time staff nurses (N= 235) were surveyed. The findings revealed that all the four variables were significantly and negatively correlated to the intention to leave and predicted 16.8 percent of the variance in intention to leave scores. Management style was the strongest predictor of intent to leave (14.5%). Nurses perceiving their managers as participatory had lower intention to leave. To retain qualified personnel, hospital administrators should focus on participative management style and career development programs that address the needs of the staff and the hospital
Public Health
M.A. (Public Health)

Midwifery is the backbone of women and child healthcare. The shortage of staff in maternity units is a crisis faced by many countries worldwide, including South Africa. This study aims to investigate and explore the perceptions of midwives on the shortage and retention of staff in a public institution. An explorative, descriptive generic qualitative design method was followed. Non-probability, purposive sampling technique was used. The study was conducted at one tertiary hospital in the district of Tshwane, Gauteng Province. A total of 11 midwives were interviewed. Thematic coding analysis was followed in analysing data. Midwives are passionate about their job, despite the hurdles related to their day-to-day work environment. They are demoralised by a chronic shortage of staff, and feel overworked. Staff involvement in decision-making processes is a motivational factor for midwives to stay in the profession.
Health Studies
M.A. (Public Health)

It is important for nurses to show acceptable behaviour when interacting with the patients. The purpose of this study was to explore and describe the factors that contribute to nurses’ negative behaviour when rendering patient care and to determine the effects of nurses’ behaviour on patient outcomes. The study used a non-experimental explorative and descriptive quantitative design. Data collection was done using a structured questionnaire. The sample comprised of 64 respondents which consisted of 25 registered nurses and 39 enrolled nurses. The study found that besides the known contributing factor, that is, the shortage of nurses, further identified contributing factors to nurses’ negative behaviour when rendering patient care are failure to retrain nurses identified with negative behaviours, poor condition of employment and patients’ behaviours and cultural beliefs. These results suggested a need to train more nurses, improve conditions of employment, as well as support and retrain nurses identified with negative behaviours.
Health Studies
M.A. (Public Health)

The shortage of nurses in any health care setting increases workloads and complicates workflow. In South Africa the shortage is exacerbated by multiple factors, one of which is the emigration of nurses to countries that offer better benefits and working conditions. The purpose of the study was to explore and determine the views of nurse managers regarding staff turnover and retention, and to recommend effective measures to improve the retention of nurses. The inquiry was conducted in a KwaZulu-Natal hospital, a natural setting for the participants. The study utilized a qualitative, explorative, descriptive design. The population of this study comprised of 36 nurse managers. Purposive and convenience sampling techniques were applied to select a sample of 18 nurse managers. Data were collected through focus groups. Data were transcribed and analysed thematically, emerging patterns were noted. The researchers examined these categories closely and compared them for similarities and differences. identifying the most frequent or significant codes in order to develop the prominent categories. These were summarised in a narrative form. Four themes emerged from the findings: the staff turnover challenge; current retention strategies; measures to improve retention and strengthening management. The shortage of nursing staff was critical at this selected hospital, and this situation could be considered to be a microcosm of what is happening in public health care sectors in South Africa. Various measures were put in place to curb the high turnover. However, these measures had a fair to low level of success. Therefore, improved retention strategies are required to reduce the staff turnover. It is evident from the findings that needs to be done to investigate, plan and implement effective measures that are likely to retain nursing staff and recruit more nurses into the profession.
Health Studies
M. A. (Nursing Science)

The initial purpose of this study was to describe and analyse the language situation at Baragwanath Hospital. This was seen as a microcosm of the language situation in urban South Africa. As such, this study set out to identify problems and offer suggestions in resolving the difficulties experienced in communication in this hospital as well as in other medical institutions in the rest of the country. Before attempting such an investigation, a sound theoretical framework had to be established. In order to gain familiarity with the research field, concepts on sociolinguistics had to be researched and described. In order to apply particular concepts to the situation under investigation, the concepts had to be defined and interpreted first. This study has made a contribution to the theoretical debate regarding various sociolinguistic concepts, in that it has shown how these concepts apply to the South African situation. The next step in the research process involved making a decision about which method would be most appropriate for collecting data. Therefore, various approaches were investigated in order to find the appropriate one. The techniques of data collection and the recruitment of respondents had to be refined before the main data collection process could begin. Then began the journey of discovery. The detailed description of the language situation at Baragwanath Hospital presented in chapter 3 forms the crux of this study. This is the first time that such a comprehensive, qualitative description of the entire language situation in this hospital has been done. An appropriate method for data analysis had to be devised. This entailed various levels of analysis and interpretation. A description of the language situation at Baragwanath Hospital would have been incomplete without presenting a few of the various scenarios that took place in this hospital. Many important conclusions were reached during the course of the research. The most important of these were: 1. A huge communication problem exists at Baragwanath Hospital. 2. Either interpreters will have to be hired to overcome this problem; or nurses will have to be paid more for their interpreting services.
African Languages
D. Litt. et Phil.