Dissertations / Theses on the topic 'Hunter Area Health Service'

This study aimed to investigate the cultural competence and transcultural nursing experiences of community nurses in a local health service area in response to increasing demographic change and cultural diversity. In response to a dearth of evidence-based transcultural nursing research in the Irish context, this work-based project primarily explored practice, service delivery and professional development within an individual and localised service context. The study was informed by my own professional role as a Clinical Nurse Specialist working with asylum seekers in the Health Service Executive organisation. A flexible research design was employed, using a mixed methodology of quantitative and qualitative methods. To determine levels of cultural competence, quantitative data was collected and analysed using a specialised cultural competence assessment tool (CCAT Survey Questionnaire) and software. A total population of 44 nurses (N=44) were surveyed in Liffeyside health service area. 54.4% (n=24) completed and returned the CCAT survey. It revealed that nurses in this study were ‘culturally aware’ in accordance with the specific assessment criteria used. The main findings from the study stem predominantly from the qualitative research and the interpretative analysis, in which a number of themes and sub-themes emerged. Qualitative methods consisted of semi-structured individual interviews using a purposive sample from the community nursing population of the area. This allowed for more in-depth exploration of nurses’ transcultural experiences. Nurses tended to be unfamiliar with the professional discipline and practice of transcultural healthcare. Community nurses mostly acquired their transcultural knowledge from their work but tended to undervalue this type of knowledge. Overall, community nurses appeared interested in offering culturally competent care and were aware of the importance of developing and maintaining therapeutic relationships with ethnic minority service users. Although keen to offer an equality of service, the data demonstrated personal, professional and organisational barriers that led to tensions and ambiguity that impacted on nurses’ capacity to further develop their cultural competence. When working with ethnic minority clients, nurses appeared conflicted and complacent at times. In the main, nurses were content to ‘just get by’. Nurses were uneasy with some aspects of working with cultural diversity, for example, in the area of the use of language and terminology and this appeared to affect their confidence in addressing issues. A reluctance by nurses to name, acknowledge and challenge racism as a specific form of discrimination within the community nursing service was evident. Opportunities to improve and build on the development of cultural competence within this environment were identified. A number of practical suggestions for nurses and management are recommended, including practical guidelines, structured formal transcultural placements, education and interdisciplinary collaborative work and research.

Background Each neonatal death counts, as recognised by the Every Newborn Action Plan (ENAP). This is an important aspect in attaining the third Sustainable Development Goal by 2030. Accurate neonatal mortality data as well as an understanding of the causality and context is essential to plan interventions to reduce neonatal deaths and attain the third Sustainable Development Goals (SDG) of a neonatal mortality rate of less than 12 per 1000 livebirths by 2035. Objectives The objectives of this study were: (i) to determine neonatal mortality occurring in and out of health facilities in the Metro West GSA using the three audit programmes; Perinatal Problem Identification Programme (PPIP), Child Healthcare Problem Identification Programme (Child PIP) and Forensic Pathology Services (ii) to ascertain the cause of death specific neonatal mortality (iii) to describe the avoidable factors in each death as coded by the three audit programmes (iv) to make recommendations for the alignment of existing audit databases to obtain accurate neonatal statistics for the Metro West GSA. Methods This was a retrospective descriptive study of neonatal deaths undertaken in the public healthcare setting in the Cape Town Metro West GSA from January 2014 till December 2017. Existing data from PPIP, Child PIP and the CDR/FPS was used. Neonatal deaths were defined as in the first 28 days of life where there had been signs of life at delivery and a birthweight greater than 500g. Neonatal deaths were excluded where birth had occurred outside of the GSA or in the private health care setting. The audit data with regards to cause of death and avoidable or modifiable factors was obtained for each death. Results From a total of 134843 live deliveries, 1243 neonatal deaths were identified: 976(78%) from PPIP, 58(5%) from Child PIP and 209 (17%) from CDR/FPS. Sixteen per cent of the deaths occurred outside of healthcare facilities. The neonatal mortality rate (NMR) for PPIP was 7.2, Child PIP 0.43 and CDR 1,6 per 1000 livebirths. When the audit systems were combined, the annual NMR over the study period varied from 8.05 to 10.1 with a mean of 9.2 per 1000 livebirths over the entire period. Seventy-eight per cent of the deaths occurred in the early neonatal period with a mean early neonatal mortality rate of 7.2 per 1000 livebirths. The mean late NMR was 2 per 1000 livebirths. Where all neonatal deaths were considered for those more than 500g, the main cause of death was immaturity related, then infection related followed by congenital disorders and then hypoxia related. Seventy-four per cent of deaths occurred in those less than 2500g at birth and 41% were less than 1000g and defined as extremely low birthweight. In the group of neonates greater than 1000g, the main cause of death was infection related deaths, closely followed by congenital disorders and then hypoxia, followed by immaturity. Most of infection related deaths were collected by the CDR and Child PIP. A third of Child PIP and PPIP deaths and half of the CDR deaths were coded as avoidable. The prevalence of deaths due to abandonment either by passive or active neonaticide contributed towards the higher proportion of preventable deaths in the CDR group. Conclusions The burden of deaths due to immaturity is high and may be attributed to the finding that 41% of neonatal deaths were in the ELBW group. Current viability criteria that aim at optimum use of resources may improve survival amongst this group. Infection related deaths were shown by this study to have a greater burden than recorded from PPIP data; most of these deaths were derived from Child PIP and CDR data. Also, where 10% of neonatal deaths were sudden unexpected deaths (SUDIs), a better understanding and definition of this group is urgently required as many of these deaths were subsequently found to be secondary to lower respiratory infections. It is further relevant that where 20% of CDR deaths or 3% of all the study deaths were due to active and passive neonaticide, this entity should be monitored and investigated. The study showed that the GSA has achieved the SDG for NMR of less than 12 per 1000 livebirth. However, a mean NMR of 9.2 per 1000 livebirths is not comparable to other upper middle-income countries. As 38% of the deaths were coded as avoidable, appropriate programmes to address these factors could reduce the NMR to 5.7 per 1000 livebirths. A strong recommendation from this study would be to use all three audit systems to calculate the NMR, understand the causes of neonatal deaths and plan programmes to improve neonatal survival in this GSA.

Background: The South Western Sydney Area Health Service (SWSAHS) contains many areas of socio-economic disadvantage and ethnic diversity. It has a high incidence of lung cancer, which is the leading cause of cancer deaths. The aims of this study were to document lung cancer patterns of care (POC) for SWSAHS residents, compare POC before and after the opening of an oncology centre in SWSAHS and compare POC with other areas in NSW. Methods: The study population consisted of SWSAHS residents diagnosed with lung cancer in 1993 and 1996. A clinical audit of medical records was performed to extract details on patient demographics, management of lung cancer and outcomes. Collaborating investigators performed identical studies in the Northern Sydney Area Health Service (NSAHS) and the Hunter Area Health Service (HAHS) for lung cancers diagnosed in 1996. Results: The SWSAHS study population comprised 527 patients. Nine percent did not have a pathological diagnosis. Twelve percent did not see a lung cancer specialist. Twenty-eight percent did not receive any treatment throughout the course of their illness. The median survival was 6.7 months and five-year actuarial survival was 8% (95% CI 6%-10%). Increasing age and poorer performance status were associated with a lower likelihood of obtaining a pathological diagnosis, specialist referral and treatment. Socio-economic factors did not influence POC. The establishment of an oncology center resulted in more referrals to medical oncologists and palliative care services. Other aspects of POC and survival were similar. Variability in POC was noted between SWSAHS, NSAHS and HAHS. HAHS residents were almost twice as likely not to have pathological confirmation of diagnosis or treatment. Despite this survival was not significantly different. Conclusions: This study has identified deficiencies in the management of lung cancer. To improve outcomes, referral to specialists and utilisation of treatment, particularly radiotherapy and chemotherapy, needs to be increased. Ageist and nihilistic attitudes need to be overcome. Prospective data collection is necessary to ensure quality of patient care. The formation of national guidelines for the management of lung cancer will play an important role in achieving better outcomes.

Frailty poses a complex challenge for some people through their experience of ageing. In Wales, devolution requires organisations to use a whole systems approach with a model of partnership to deliver public services. An integrated care approach is offered to meet the service user focus or ‗value demand‘ which impacts on clinical, professional, organisational and policy levels within the system. Therefore, the aim of this study was to explore whether there was a difference between integrated health and social care day services and non- integrated health and social care day services. In doing so, answering the questions, how were these services different, what were the differences as perceived by the participants, why were they different, what could be learned from this study and how could health and social care services integrate in practice? The study utilized Gadamer‘s interpretative hermeneutics with a single intrinsic case study design. Using this approach ensured that the unique voice of the individual lived experience was heard and interpreted within the whole system of the study. The participants were service users, carers and staff in a day hospital, an outpatient clinic, day centre, reablement team and a joint day care facility. The methods included a survey questionnaire (SF12v2 and London Handicap Scale), in-depth interviews, observations; and historical and service documents; and reflective diary. Data collection occurred January 2005 to December 2006. Quantitative and qualitative data were analysed separately. The qualitative data was analysed using Gadamer‘s five stage approach developed by Fleming et al (2003) and Nvivo 7.0. The embedded quantitative data was analysed using SPSS version 13.0. Triangulation was achieved through the use of a meta matrix which merged the qualitative and quantitative data. The difference between integrated and non integrated services is expressed through the four themes, ‗the study participants‘, ‗commissioning and decommissioning integrated services‘, ‗the journey within day services‘, ‗navigating services and orchestrating care‘. The four themes were developed through a strategy used for interpreting the findings, which was to follow the study questions, propositions and ‗emic‘ questions. The differences between the integrated and non integrated services were in the meaning of their purpose, culture, level of integration, team orientation of practice and the model of service user/carer relationship observed within the services. The thesis identified challenges in respect of integrated working such as concept confusion, negative experiences of care for frail or older people, a vertical gap in knowledge transfer between strategic organisation, the operational services and service users. Mapping each service level of integration and team orientation to the model of service user and carer relationship, found that the level of team orientation and integration does not appear to be proportionate to the service user and carer relationship. The thesis concludes that in order to attempt to answer the question as to whether these day services can integrate in the practice, all levels of the system should focus on the service user/carer relationship. We need to understand service user diagnosis, how its characteristics and effect are interpreted by the service user, carer, professional and wider society in relation to independence and autonomy. It argues that knowledge emerges at this micro level (service user and carer relationship) and how we engage with this relationship and manage the knowledge we gain from it (both vertically and horizontally), will lead us to understand how we can ensure that integration occurs and that services in the future are person focussed.

Background: CDC reports that the highest percentage of newly identified HIV positives are among transgender people. They are overburdened by HIV and relatively under-researched in studies and underserved by healthcare providers.

Methods: A secondary data analysis was performed using data from a special needs assessment survey of HIV positive transgender people conducted in 2012 by the Houston Area Ryan White HIV Planning Council. Pearson’s chi-squared (&khgr;²) or Fisher’s exact test was conducted to assess whether HIV service utilization and barriers vary statistically by demographic characteristics. Variables with statistically significant levels less than 0.25 (P < 0.25) were selected to enter into the multivariable logistic regression models. Multivariable logistic regression with backward elimination process was used to identify the significant demographic variables that are associated with HIV service utilization and barriers.

Results: HIV positive transgender people with unstable housing status were less likely to use health insurance assistance services (P=0.012); but more likely to use substance abuse treatment services (P=0.017) and nutrition services (P=0.001) than those who owned or rented housing. They were also more likely to have difficult accessing primary health care services than those who owned/rented housing (P=0.007).

HIV positive African American transgender people were more likely to use mental health services than their white counterparts (P=0.019) and the unemployed were more likely to use mental health services than the employed (P=0.002).

More educated HIV positive transgender people were more likely to use case management services (P=0.039) and less likely to have difficulty accessing them (P=0.019) than the less educated. They had lower odds of difficulty in accessing primary HIV care (P=0.018) than the less educated.

Older transgender people (age group between 25-44) were more likely to use legal services than the younger ones (age group 18-24) (P=0.021).

Conclusion: Socioeconomic status may influence the utilization and barriers of HIV services among transgender people in the Houston Area. Housing assistance program need to be tailored to reach HIV positive transgender people of low socioeconomic status. Culturally appropriate and comprehensive transgender HIV care is recommended to meet the needs of transgender minorities in the area.

Thesis (M.P.H.)--University of Sydney, 1999.
Title from title screen (viewed Apr. 16, 2008). Submitted in fulfilment of the requirements for the degree of Master of Public Health to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Degree awarded 1999; thesis submitted 1998. Includes bibliography. Also available in print form.

The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning.

Thesis (M Med(Family Medicine))--University of Limpopo (Medunsa Campus), 2010.
Background: In spite of the substantial progress made in the development and implementation of many strategies necessary for effective tuberculosis control, the disease continues to be the leading cause of death, and in Africa, because of the expanding HIV epidemic, there has been an increase of HIV associated TB. In 2005 African health ministers declared TB a regional emergency. Although TB treatment is free and Lesotho has 100% DOTS coverage, the country still reported an incidence of 485 per 100,000 population (2005) and a treatment success of 74%, which is still lower than 85% WHO target. Objective: This six-month study at Scott Hospital Health Service area in Lesotho was undertaken to assess the outcome measures of strategies instituted to improve the tuberculosis control programme and determine the effect on TB treatment outcome indicators and TB/HIV integration. xi Methodology: The study design was a quantitative, descriptive study. The principal researcher and a research assistant used a questionnaire to collect data from the outpatient, TB suspect and treatment registers. Study population and sample: The subjects of the study were all adult new sputum- smear positive TB patients enrolled and registered in the Scott Hospital Health Service area TB register from 1st January to 30 June 2006. Results and discussion: A total of 100 new sputum smear positive adult TB patients presenting at Scott Hospital during the research period formed the sample group of this study. This included 47 female and 53 male patients. Their ages ranged from 18 years to 84 years with the mean age of 42 years. Majority 52 (52%) were in the age group 20-39 years, followed by 27 (27%) in age group 40-59 years and 19 (19%) in the age group 60-79 years. There was a high TB/HIV co-infection of 40 (81.6%) among the 49 (49%) who accepted HIV counseling and testing. Active screening of patients for TB resulted in 378 (86.3%) of the 438 TB suspects having their sputa tested. Of these, 100 (26.5%) were new sputum smear positive. Good xii adherence and treatment supervision resulted in sputum conversion rate of 89 (89%). Rigorous implementation of the DOTS strategy showed increased treatment outcomes: cure rate of 76 (76%) and treatment success of 85 (85%). These results were similar to findings of other studies carried out in Cambodia, Tanzania and Rwanda to assess TB programme performance following introduction of improvements. Conclusion: This study demonstrates that implementation of activities consistent with new stop TB DOTS strategy to improve TB control is possible in a rural setting and leads to improvement in TB case detection and treatment success and a decrease in both defaulter and death rates.

Addressing inequities in health both within and between countries has attracted considerable global attention in recent years. In theory, equity remains one of the key policy objectives of health systems and underpins the allocation of health sector resources in many countries. In practice, however, current evidence demonstrates that only limited progress has been made in terms of bridging the health inequity gap and improving the health of the least advantaged. The persistence of inequities in health and health outcomes raises concerns about how governments and health authorities distribute limited health resources to improve the health of the poor and most vulnerable and thereby promote equity. This thesis is about equity and allocation of financial resources in the health system of New South Wales, one of the eight states of Australia. It investigated the extent to which there has been a movement towards equity in resource allocation to Area Health Services under the NSW Health Resource Distribution Formula and whether this has been reflected in equitable resource allocation within Area Health Services. It considered only resources allocated through the NSW Department of Health. The study employed a combination of qualitative and quantitative methods to gather and analyse data. The qualitative component analysed data gathered through semi–structured interviews with policy makers, health executives, managers, and other stakeholders to establish the resource allocation processes and the factors upon which the allocation decisions were based. The quantitative component analysed health expenditure and health needs data to assess the extent to which allocation of resources from the State to Area Health Service levels has been equitable in terms of reflecting the level of health needs. Two indices were constructed and used as proxies for health needs. Principal component analysis was used in the construction of one of the indices, using demographic, socio–economic and health-related data. The other index was developed using a combination of premature mortality and morbidity data. The quantitative study spans the two decades 1989/90 to 2006/07, with a more detailed analysis of material for the years 2003/04 to 2006/07. The findings of the study show a considerable degree of inequity in resource allocation with several Area Health Services (AHSs) receiving less than a fair share of funding for the years analysed, although some movements towards equity were evident. This contradicts the general impression that the introduction of the resource distribution formula in NSW has significantly improved equity in resource allocation. In general, funding allocation at the State level correlated significantly with population size but not with health needs of the eight AHSs in NSW. Similarly, within the AHSs, allocation of funds was based on programs and services and not on health needs. Key issues that emerged from the qualitative data as affecting the equity with which health funds are allocated in the NSW health system include limited use of the resource distribution formula at the state level, lack of an effective resource allocation tool to guide the distribution of funds within AHSs, and insufficient emphasis on equity at the AHS level. It is crucial that these and several other issues identifies in the study are addressed if current inequities in funding and in health outcomes generally are to be effectively reduced.

The presence of a strong primary health care (PHC) system is crucial to improving not only the average levels of health of a population, but also health equity. While Australia has universal health care and a strong PHC system, service organisation and delivery characteristics vary according to the local context. However, the nature and extent of this variation and the way in which it modifies receipt of care in relation to a person’s socioeconomic position (SEP) is not well characterised. This thesis aimed to address these evidence gaps and, in so doing, identify avenues for policy and practice intervention for improving the equity of health care use. First, measures of service characteristics that reflect the core domains of strong PHC systems—accessibility (availability, affordability and accommodation), comprehensiveness and coordination—that can be viewed to operate at the small-area level were constructed. This was done using data available at the Statistical Area Level 3 for New South Wales, from a range of sources. There was marked geographical variation in these measures, and data and conceptual limitations warranted caution when applying some of them to PHC-related outcomes. Second, variation in receipt of PHC and the association with PHC service characteristics were quantified using 2006–2008 survey data from the 45 and Up Study linked to Medicare Benefits Schedule claims data and the constructed area-level PHC measures. Four outcomes were examined; frequency of GP use and three measures of quality—length of consultation, continuity of care and care planning. A series of two-level (individuals within areas) multilevel logistic regression models were run, separately by region (major cities, inner regional and outer regional/remote), and with cross-level interaction terms, to examine the effect of service characteristics on socioeconomic variation in receipt of care. Both GP use and quality of care varied between areas, within each region. People living in areas where care was more affordable (that is, more bulk-billing or less out-of-pocket expenses), or that had more after-hours or chronic disease care, had greater GP use and better quality of care. Generally, for a given level of need, persons of low SEP had more GP care (both GP use and quality of care) compared with their high-SEP counterparts. In major cities, increasing affordability or more after-hours services within an area was associated with a larger increase in GP care for persons of high SEP, compared with persons of low SEP. In contrast, in regional and remote areas, increasing affordability or more after-hours services within an area was associated with larger increases in use and a larger increase in long consultations for those who were low SEP compared with those who were high SEP; that is, these PHC characteristics were pro-low SEP. Using the same data and analytical approach, use of specialist care was also shown to vary between areas; however, in contrast to GP care, specialist use was pro-high SEP. The findings suggest that in major cities, PHC initiatives that promote affordability, accommodation and comprehensiveness of services within areas are working well from an equity perspective. On the other hand, in regional and remote areas there are clear opportunities for improving receipt of care for those who are disadvantaged through current policy initiatives. The inequitable use of speciality care sits in stark contrast to GP care, with significant potential for health gains by redressing this.

A qualitative study was conducted to explore the process of smoking pre-initiation, initiation, maintenance and cessation for 16-17 year old, second generation Somali, Bangladeshi and White British, male and female smokers. The participants were all regular smokers (which was classified as smoking at least one cigarette a week) and were recruited from a deprived inner city borough via opportunistic and snowball sampling. Six focus group interviews were conducted with 5-6 participants in each focus group. The groups were split according to ethnic background and gender and the interviews lasted for approximately an hour. The data was analysed using grounded theory. Three core categories were identified for the different stages of the smoking process; 'construction of smoking fantasy' was representative of the pre-initiation state, 'construction of smoking reality' for the initiation stage and 'negotiating smoking reality' for the maintenance stage. The experience of cessation was encompassed in the maintenance stage. The over-arching core category for all three stages was 'negotiating smoking 'fantasy and reality'. Overall the experience of smoking was similar in many ways between the different groups but there were also distinctions. These distinctions centred around the greater influence of socio-cultural factors, such as religion, on the Somali and Bangladeshi participants and the influence of traditional smoking gender norms on the experience of Somali females and Bangladeshi females. The importance of conducting research with hard-to-reach groups, and the applicability of findings for healthcare services working with the Somali and Bangladeshi population, was discussed.

The applicability of SERVPERF as a tool for judging the quality of services used by biomedical information professionals was tested using standard statistical procedures. Data was gathered nationally via a combination of electronic and non-electronic forms, from Area Health Education Center (AHEC) information professionals and the results consolidated to provide information for the study. It was determined that SERVPERF was applicable in making judgements about service quality for AHEC information professionals. Their perceptions about service quality tended to have a greater influence than did their level of actual satisfaction on whether or not they planned to use a particular service in the future. There is currently no validated tool available to ascertain the quality of services offered to these valuable members of the rural health care team. This dissertation proposes to provide such a tool, and to serve as a guide or template for other professionals seeking a means to judge service quality in their own disciplines.

Thesis (M.S.) -- Worcester Polytechnic Institute.
Keywords: Poisson-Gamma Regression; MCMC; Bayesian; Small Area Estimation; Simultaneous Inference; Statistics Includes bibliographical references (p. 61-67).

Thesis (MMed) -- Stellenbosch University, 2010.
Bibliography
Objective: The objective of this retrospective cohort study is to assess whether demographic and anthropometric parameters, laboratory tests, co-morbidity, co-infection, treatment regimen, IRIS and adherence to treatment predict the expected response to HAART and differences if any, in the pattern of response as measured by CD4 count, weight gain and haemoglobin levels in two cohorts of patients in Roma, The Kingdom of Lesotho. Method: Data were collected randomly from a computerised database of the Antiretroviral Centre of the hospital and two cohorts of 151 subjects in each of the two arms of the study were identified from hospital records from January 2008. Each of these subjects was followed up over a period of 12 months with data obtained for at least 2 visits within the 12 month span. Data were obtained at baseline, 3 months and also at 6 and 12 months marks. Data on characteristics were compared between the two arms. Variables that may be potential confounders were identified and univariate and multivariate logistic regression analyses were carried out to establish differences independent of confounding factors for the combined endpoints as well as for each endpoint separately. Results: In all 302 patients had their records analysed and comparison of clinical and immunological response patterns in patients taking AZT and TDF-containing ART regimens and the possible prediction of which the regimen would be better and within which population. Despite the perceived mismatch between two NRTIs it can be concluded from the results of this study that, overall, the inclusion of AZT in treatment regimen showed a modest protective effect over the TDF counterpart as measured by the endpoints of the discriminative powers of the Receiver Operating Curves of the explanatory variables being 66% , 77% and 66% for CD4, Haemoglobin and Weight respectively, and 63%, 70% and 65% for the same variables in the AZT and TDF arms of the study respectively. Conclusion: In a population of HIV patients on treatment in resource-limited settings AZT-containing regimens appear to show a slight improvement over the TDF-containing ones.

There is a need for research to understand change processes and knowledge management in health service organisations, and indeed public sector organisations in general. This research seeks to explain how knowledge becomes formulated and thereby mobile, and also how practice has come to be established, visibilised and thereby sustained in a specific context. Exploring practice within a health service organisation, and in particular a public health service organisation, is a particular feature of this research. The research demonstrates how collaboration becomes necessitated under pressure of enacting increasingly complex work activities, an outcome being changing practices and extended accountability relationships which enacts discipline while realising expertise. Using an ethnographic approach, the research explores how the practice of early childhood nursing in the South Western Sydney Area Health Service became a specialised expert undertaking. The research examines how change has occurred, whereby early childhood nursing was refined from being one part of the generalist community nursing practice to being a specialised practice through the increasing technologisation of practice. The technologisation of practice refers to the artefacts, conduct and the processes through which the conceptualisation and enactment of early childhood nursing has become increasingly standardised. Through the technologisation of practice explicit knowledge becomes distributed within the artefacts for practice and tacit knowing becomes distributed across, and is continually enacted by, the collaboration of the practice community. There are four interrelated aspects to the technologisation of practice. Firstly, the technologisation of practice involves standardising the conceptualisation and enactment of practice through constructing a multi-dimensional practice resource within a community of practice. Secondly, the technologisation of practice involves the mobilisation and refinement of the multi-dimensional practice resource to realise a practice network involving extended relationships of accountability. These relationships of accountability are within a profession and also with other professionals. Thirdly, the technologisation of practice involves the ongoing enactment of accountability in a collaborative community of practice. The research shows that a team can become a collaborative community by constructing an accountability context, reorganising and facilitating the team, and then amalgamating the organising and service delivery activities through integrating formal meetings and informal interactions. Fourthly, the technologisation of practice involves the collaborative community assemblage and/or appropriation of further technologies into practice thereby strengthening the local and extended relationships of accountability and expanding the boundaries of practice. The research describes how the technologisation of practice is the enactment of a number of mutually enabling practice dualities, which together simultaneously discipline and realise expertise. The interrelated practice dualities are individual-community, subjective-objective, local-global, formal-informal and governmentality-communal self-governance. The situatedness of practice is shown to necessitate a subjectivity-objectivity duality, whereby individual and communal experience is drawn upon to see through the otherwise opaque nature of statistics and information. The alignment of practice with the broader organisation and professional colleagues realises a local-global duality, whereby the community's local understandings are informed and shaped by distant issues. The formal-informal duality is a mechanism by which practice is increasingly collaboratively conceptualised and enacted, and thereby standardised. Individual and communal 'expertise' becomes realised through the assemblage and appropriation of organising and transforming tools and artefacts, or alternatively technologies. At the same time, the community in defining the use of such technologies as competent practice is disciplining their own conduct. Through this action a governmentality-communal self-governance duality is realised as the nursing community pursues expertise while disciplining themselves; by engaging in collaborative interactions and using standardised technologies the community constructs and makes visible their knowing, practice and expertise.

Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations.  The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services.   Conclusions                                                                                         There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups.  Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services.
Aging and Living Conditions Program
Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec

 This research will investigate job design, workplace interaction and job satisfaction among the various classification of nurses employed at the Rankin Park Unit, John Hunter Hospital. This topic was chosen as the researcher believes and supported by Yoder & Heneman (1975) that the level of staff job satisfaction is reflected in the quality of care that is given to clients, and that improved career pathways and job design directly impact on staff morale and ultimately staff satisfaction. The research into job design, workplace interaction and job satisfaction among nursing staff within the Rankin Park Unit was carried out over a one year period. The instruments of survey, Job Characteristics Inventory (J.C.I.) andL Satisfaction Survey (J.S.S.), were administered to a sample of 181 nurses from the institution. This quota was representative of the various classifications of nurses within the Rankin Park Unit, including; Professional (Registered Nurses, R.N.), Technical (Enrolled Nurses, E.N.), and Service (Assistant In Nursing, A.I.N.) members. Definitions of these titles are located in Appendix A (Definitions of terms and Abbreviations). The responses were analysed and presented in thesis form, to both Central Queensland University and the Hunter Area Health Service. The responses to the instruments of survey and analysis of results give significant insight into areas of possible improvement in job design and job delineation for nurses, thereby flowing on to improved job satisfaction and improved productivity. The information stemming from this research will assist nursing staff at all levels, in association with Institutional Management to map career paths for nurses employed within the Hunter Area Health Service.  

碩士
國立宜蘭大學
資訊工程學系碩士班
103
As cloud computing and wireless body sensor network (WBAN) technologies mature, relevant applications have grown more and more popular in recent years. The healthcare field is one of the popular applications for this technology that adopts sensor devices to sense signals of negative physiological events, and to notify users. The development and implementation of long-term healthcare monitoring that can prevent or quickly respond to the occurrence of disease and accidents present an interesting challenge for computing power and energy limits. This study proposed a green cloud-assisted healthcare service on WBAN, and considered the sensing frequency of the physiological signals of various body parts, as well as the data transmission among the sensor nodes of WBAN. The cloudassisted healthcare service regulates the sensing frequency of nodes by considering the overall WBAN environment and the sensing variations of body parts. The experimental results show that the proposed service can effectively transmit the sensing data and prolong the overall lifetime of WBAN.

The purpose of the study was to explore and describe the existing relationship between traditional healers and nurse practitioners in Maseru Health Service Area in Lesotho and also to determine why people consult traditional healers. Qualitative and quantitative methods were used to investigate the relationship between traditional healers and nurse practitioners and also to determine why people utilize the services of traditional healers. The study was limited to Maseru Health Service Area in Lesotho. Data was collected from twenty-seven (27) nurses from nineteen (19) clinics and from thirty (30) traditional healers from the same health service area. Data from traditional healers was collected using semi-structured interviews while nurse practitioners were given a questionnaire to complete. The study revealed that there was no formal relationship between traditional healers and nurse practitioners. Support for traditional healers was revealed to be limited, for example, only four (14.8%) nurses had a programme for traditional healers while twenty ( 66.7%) traditional healers did not have any contact with nurse practitioners. Involvement of traditional healers in primary health care at grassroots level has therefore been very minimal. The reasons why people utilize traditional healers were found to be as follows: • When people think they have been bewitched. • Traditional healers can tell the actual cause of disease • Failure of modern practice • For social problems According to the study, both traditional healers and nurse practitioners felt that collaboration between traditional healers and nurse practitioners was essential because it would enable planned referral of patients from one group to another where necessary; it would also facilitate exchange of ideas and knowledge for the benefit of the people served. Recommendations on collaboration and on support systems are given in Chapter Six.
Health Studies
D. Litt. et Phil. (Nursing Science)

碩士
國立屏東科技大學
高階經營管理碩士在職專班
94
The purpose of this study is to discuss the factors of service demand that are valued by customers in elderly health caring center. By reviewing related literatures, we have determined the content of care services includes the demand in terms of the elderly health caring environment, as well as the demand in terms of professional services needed. Through factor analysis, the aspects of important factors in service demand are extracted and discussed. The result shows that the demand of caring environment includes four factors namely: spatiality, leisure, convenience of transportation, as well as comfort and safety. The demand of professional services needed includes three factors namely: staff characteristics, staff specialties, and service activities. In order to understand the cognitive differences between the workers and customers in caring center towards service demand, using independent t test. The result indicates that significant differences exist between customers and workers toward spatiality and staff characteristics. Lastly, in order to provide businesses with management advices, this study groups the customers into four patterns namely: high service demand, service oriented, low service demand, and environment oriented, based on the caring environment and professional services needed. Focusing on the customers of different patterns, this study provides business owners with several management advices. These advices will provide business owners with references in allocation of staff, decision on resource supply, and providing suitable services in elderly health caring center.

Submitted in fulfillment of the requirements for the degree Masters in Management Sciences: Marketing, Durban University of Technology, Durban, South Africa, 2017. .
The increasing interest in people’s wellbeing has seen the growth of health and fitness centres (HFC) all across South Africa. It has been a decade since Virgin Active and Planet Fitness expanded their business into townships, with this endeavour resulting in the opening of HFC in Khayelitsha and Soweto. The motivation behind this study is therefore to examine the effect of service quality on customer satisfaction in the HFC industry in Ntuzuma, Umlazi, Kwa-Mashu, Clermont, and Phoenix, all townships in the greater Durban Area. Thus, the main purpose of this research is to ascertain service quality at selected HFC in townships within the greater Durban area. Interest in service quality has grown over the last decade due to increasing competition, which has led managers to finding ways of improving profitability. One area of interest is service quality and how it affects customer satisfaction and its impact on the bottom line, which is why ascertaining service quality at selected HFC in the greater Durban area’s townships is significant. The study was descriptive, quantitative and cross-sectional in nature, probing the effect of service quality on clients’ customer satisfaction. From these findings the Health and Fitness Centres can identify more specifically the failures in its service quality and seek to improve upon them. Service quality dimensions that are deemed to be good predictors of service quality for members of the HFCs offering have been related to factors such as the “Tangibility”, Reliability”, “Responsiveness”, “Assurance” and “Empathy. It is hoped that the results obtained will aid to support these centres in adopting practical customer service quality measures that will assist them to succeed in the highly competitive health and fitness industry.
M

Student Number : 0008922X - MPH research report - Faculty of Health Sciences
The use of the mobile clinics for rendering health care services in South Africa is part of the services rendered according to the Primary Health Care Service Package that was officially published in 2001. Mobile clinics have been found to be instrumental in rendering of health care especially in the rural and semi- rural areas. In the majority of these areas, the mobile clinic is the only source of health care provision at community level. Lack of well developed infrastructure and poor roads contribute to inaccessibility of health care services in rural and semi-rural areas. Health programmes are often of poor quality or offer incomplete services. Factors such as lack of knowledge of available health care services, satisfaction with the quality and range of services provided, and unavailability of the mobile clinic service when there is a health need, can result in the mobile health care clinic being less utilized. The purpose of the study was to address the following question: What are mobile clinic users’ opinions on health care service provision in the Muldersdrift area Gauteng Province? To answer the question three research objectives were formulated. These were to: describe the mobile clinic users’ level of service utilization, to assess their level of knowledge of available health care services and to determine their level of satisfaction with the services provided. To achieve the study objectives, an exploratory, descriptive survey was used as the research design. Three sampling techniques were used in this study. Cluster sampling was used for developing sampling framework for the 35 mobile points. Stratified sampling used to stratification of the mobile points. A non- probability convenience sampling was then used for final selection of the nine mobile clinic points and for selection of a sample size of 94 mobile clinic users’ to be included in the study. Data were analysed using the Statistical Package 7.0. The results show that the mobile clinic service was optimally utilized, 59% had used the service more than thrice within a period of six months. The majority of participants (89.3%) had knowledge of all the services being offered on the mobile clinic. Very few respondents (19.5%) were aware of the availability of HIV and AIDS counseling and testing on the mobile clinic. All most all the respondents (98.9%) were satisfied the range of services offered on the mobile clinic. Almost half (48.9%) were not satisfied with the service being offered once a month, (4.4%) with the attitude of the staff, (5.3%) with treatment of common ailments and (2%) said the mobile clinic service was bad.

Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015.
The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics
An electronic copy of the Thesis is currently unavailable.

博士
東海大學
社會工作學系
107
This study aims to investigate the use of health services by people with mental disorders. The research was based on stratified cluster sampling from a total of 19 mental rehabilitation institutions in Taoyuan, Taichung, Tainan and Kaohsiung. The subjects were stabled, understandable and willing to fill out the questionnaires. The method of collecting data was from a self-made questionnaire. During the investigation period from April to June 2018, a total of 361 copies were distributed, and of the number of copies 333 questionnaires were effectively recovered, while 28 copies were abandoned. The SPSS for windows 20.0 tool (Chinese version) was used for descriptive and inferential statistical analysis. The research structure refers to Andersen's fourth-stage health service model, which incorporates the factor of time, and collects data at three intervals: the period of not having received medical care(S1), the period of medical treatment(S2) and the period of having entered the mental institute(S3). The study discovered that mentally disabled people who differed in gender, age, education, marriage, employment status, and degree had different approaches with using the health care services. Moreover, the nine variables of sex, age, psychiatric oriented services in S2, frequency of psychiatric treatment in S2, income influence factor, period of no medical treatment, sleep influence factor, the type of help in S1-S2, and number of those who seek help were predictive of the health outcomes of individuals, which positively correlated with the number of frequent psychiatric returns. The significance of this study shows that people with mental illness at the rehabilitation institutes have their own views on when to use the health care services. With the understanding of the overall factors that may influence the use of the services, we recognize the overall manner of which the service is used. All and all, proposals were made on the mental health policy, rehabilitation institute and on research as follows:1.With the mental health policy, continue to promote the education on mental health and provide attention to special needs group, as well as strengthen the integration of various service systems. 2.In terms of mental rehabilitation institutions: a better nighttime atmospheric quality should be developed, and emphasis should be placed on factors affecting the use of service. Long-term care and community resources should be connected to improve follow-up services of middle-aged and elderly, as well as broaden the elements of mental rehabilitation. 3.In terms of research, the scopes of research with supporting mentally disabled are being expanded to the extent where it can be included data from key person.

碩士
大葉大學
運動事業管理學系
95
The purpose of this research was to investigate Service Quality、Customers′ Val-ues(practical values、hedonic values) and Consuming Behaviors for the health and fit-ness club members, and furthermore to analyze the relationships between club mem-bers′ Customers' Values and Degree of Service Quality Satisfaction, Customers' Values and Consuming Behaviors. 486 valid questionnaires were collected. Descriptive Statis-tics, Factor Analysis and Pearson Product-Moment Correlation Analysis were used to analyze research data, the findings were：1. the club members was somewhat satisfied with service quality (mean was 3.7175); 2. the club members was somewhat satisfied with customers′ values (mean was 3.6121); 3. the frequency of exercise for the major-ity of club members were once a week(38.3%), and the expenditure per month was un-der NT$1,000 for the majority of members(45.1); 4. there were positive relationships between members’ practical values and degree of service quality satisfaction, and be-tween hedonic values and degree of service quality satisfaction; 5.there was a positive relationship between practical values and frequency of exercise, and there was no sig-nificant relationship between practical values and expenditure per month; there was a negative relationship between hedonic values and frequency of exercise, but a positive relationship between hedonic values and expenditure per month.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Emergency Medicine Johannesburg, 2015
Background: There has always been anecdotal reports that the ED is busier during the holidays and this increase in utilization is due to an increased incidence of trauma. Methods The retrospective data was collected from the Study Hospital’s Database and from the billing records of the doctor practice managing the ED. The data included all patients attending the Study Hospital ED during November 2011 (Non-holiday Period) and between the 10th December 2011 and 8th January 2012 (Holiday Period). Results: It was noted that the age, gender and racial profile of the patients attending the ED during the Holiday and Non-holiday Periods were similar. However there was a 39.9% increase in ED utilization during the Holiday Period. The Holiday Period was also associated with increased utilization by tourists (29.9% vs. 8.2%); with a slightly lower incidence of trauma (23.4% vs. 24.6%); with patients presenting with less urgent Triage Scores; fewer patients arriving at the ED via ambulance (3.2% vs. 7.2%) and a lower admission rate (10% vs. 17.5%). Conclusions: There was a significant increase in the utilization of the Study Hospital ED during the Holiday Period. This increased utilization was due to an increase in visitors to the Umhlanga area during the Holiday Period and was associated with an increased presentation to the ED of low acuity patients probably as a result of a lack of availability of their GP.

This qualitative study explores the experiences of adult mental health service users as well as their families upon discharge of service users, to their families in the Durban area, from Ekuhlengeni Care Centre (ECC) during May 1999 to December 2001. In so doing, the aim was to ascertain the nature of mental health service users' adjustment to living in the community, their impact on the home environment, to identify gaps in community care and to provide suggestions on resolving these gaps. The study was guided by a qualitative research paradigm and utilized an exploratory descriptive research design. Availability sampling was used. Unstructured face-to-face, in-depth interviews were conducted with four mental health service users (MHSUs) and six family members. The results of the study reveal the many dilemmas that both MHSUs and their relatives experience because of the lack of support and services available in the community. There is overwhelming evidence to suggest that the environment is ill suited at all levels to meeting the needs of MHSUs and their relatives. This study examines the challenges experienced by MHSUs and their relatives and makes recommendations for practice and policy that can contribute to improved service delivery.
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

碩士
國立臺北教育大學
課程與教學研究所
96
The purpose of this study is to understand teachers’ professional competence and demand for in-service training. The subjects of this research are 192 full-time teachers in the health and physical education learning area in Small-scaled elementary schools in Taipei County. 184 valid questionnaires were returned. (92.86%) Data obtained in this study were analyzed by descriptive statistics, t-test, one-way ANOVA, and Pearson Correlation. The results were shown as following: 1. According to the small-scaled elementary school teachers’ self-evaluation, they claim their professional competence achieve high-intermediate level in the health and physical education learning area in Taipei county. 2. The male teachers’ professional competence in physical education area is significantly higher than that of female teachers. And teachers who majored in physical education have better professional competence than those whose major are not physical education. Moreover, P.E. teachers’ profession ability is significantly higher than that of homeroom teachers. However, age, seniority, teaching stage, and teaching subject showed no significant difference in the results of self-evaluating ranking. 3. The demand for in-service training of small-scaled elementary school teachers in health and physical education learning area in Taipei County was rated middle-level. The learning content that the teachers require most is the teaching materials and methods for prevention and treatment of disease, integrating implications and technology into instruction, and health-related physical fitness. The types of learning activities include sport spectator, teaching praxis, and experience-sharing between experts and scholars. 4. Age and seniority showed significant difference in the results of the demands for in-service training. Teachers over 51 years old have stronger demand for in-service training than those at other ages. Based on the comparison of seniority, teachers who have taught for 16 years or more have more intense motivation of in-service training than those who have 6-10 years teaching experience. However, gender, education background, position, teaching stage, and teaching subject showed no significant difference in the results of demands for in-service training. 5. There was low-correlated between the professional competences and the demands for in-service training.

碩士
美和科技大學
健康照護研究所
100
Abstract Research Purpose There are six research aims in this study: (1) recognizing the distributions of demographic variables, regional variables, health functional status, and medical services among senior residents of long-term care institutes in Kaohsiung and Pingtung area; (2) recognizing whether health function status and medical services will be affected by demographic variables of senior residents among senior residents of long-term care institutes in Kaohsiung and Pingtung area; (3) recognizing whether health functional status and medical services will be affected by regional variables of senior residents among long-term care institutes in Kaohsiung and Pingtung area;(4) recognizing whether medical services will be affected by which variable of health functional status of senior residents among long-term care institutes in Kaohsiung and Pingtung area; (5) recognizing whether demographic variables and regional variables will be affected by health functional status of senior residents among long-term care institutes in Kaohsiung and Pingtung area; (6) recognizing whether demographic variables, regional variables and health functional status will be affected by medical services of senior residents among long-term care institutes in Kaohsiung and Pingtung area. Material and Methods This research adopts the cross-sectional research design, residents who were over the age of 65 years old and lived within the long-term care institutes in Kaohsiung and Pingtung area were invited as research samples. There are 1,038 senior residents were selected as study samples; 320 residents were selected from the Kaohsiung area and 718 residents were selected from the Pingtung area to conduct secondary data analysis. This research proposes 7 hypotheses based on Andersen＇s behavioral model. According to the opinion of “Quantitative research method”, both descriptive statistics and inferential statistics (Chi-square test, Logistic regression analysis) were performed to conduct research hypothesis. Research Results Results of this research indicate that the usage of medical services will be affected by demographic variables, regional variables and health functional factors among the 1,038 samples, personal characteristics, It also found that through Logistic regression analysis, the variables of “regional”, “gender”, “cognitive functional scores”, “Barthel Index”, “disease”, “language impairment”, and “hearing impairment” can be significantly influenced by the usage of medication. In addition, the variables of “regional”, “marital status”, “cognitive function scores”, “Barthel Index”, “disease”, “language impairment”, “visual impairment”, and “skin integrity” can be significantly influenced by the usage of tube. Moreover, the variables of “regional”, “age”, “Barthel Index”, and “skin integrity” can be significantly influenced by the usage of special care. Conclusion and Suggestions In short, results of this research provide a clearer direction for clinical caretakers to plan and offer references for improving and reducing the degradation of senior residents’ health and providing advance intervention to increase their health functional status. In addition, results of this research could be regarded as a referee for planning the procedure of care plan in clinical services; it also could be referred in long-term caring issues and subsequent to relevant research of long-term care. Finally, the ultimate goal of this research is to provide a evidence-based information for improving the life quality of senior citizens within long-term care institution and providing them a better care. Keywords：nursing institutes, senior residents, health function status, usage of medical services.

Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash
449 per 100 000 women from 1992 to 2006, and 38 &ndash
46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours
an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented
refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area.

碩士
東海大學
社會工作學系
107
The tribal cultural health station is the important place to take care of the aboriginal older. Because of the difference of the cultural appearance in every aboriginal, it is important to have better understanding about the influence of aboriginal culture on care service. The purpose of this study is below: 1.To explore the current working implementation of the care-worker in the tribal cultural health station. 2.To explore the cultural characteristics inside care services in the tribal cultural health station. 3.To give suggestion of thinking of cultural caring in management for the tribal cultural health station in the future. This current research is a qualitative method design with depth interview approach and invited 6 care-workers ,who worked in tribal cultural health stations for Paiwan older, as the research participants. This current research found: (1) The tribal cultural health station provides general care service and develops new services for the cultural habits, such as All-in-One services, dining car. (2) Aboriginal culture influence on service time and content. Service time is changed by agricultural culture, weddings, funeral, and traditional festival. Service content merge with traditional culture. Finally, according to the research, the researcher provides suggestion for relevant rules.

碩士
國立聯合大學
經濟與社會研究所
101
Whenever I see the tragedy or the news that occurred due to family member’s excessive pressure on long-term care, I have some questions in my mind. Taiwan have positively constructed the healthy city and carried out the policy of the elders’ home care service for many years. Why the same problems of long-term care often happened? My hometown is in Miaoli County and the percentage of the elders is very high. Is the policy of home care service for the Hakka disable elders really helpful? Does it satisfy them? Does it help the caregivers of the disable elders to discrease the pressure and advoid the trage happen? The purpose of this study is to discuss whether the disable elders in Miaoli County are satisfied with the home care services and the different home care service items. This study tries to make the government or the home care providers understand more about the users’ satisfaction, and make more helpful plans of home care service in the future. In order to learn more about the demands of disable elders, the researcher do the literature review of the theory of aging and long-term care. The home service policies of different countries and the theory of satisfaction are also reviewed. In this study, the questionnaire is based on the home care service questionnaire of Ministry of the Interior. To know the background of disable elders, there are some questions about personal data and health situations in the questionnaire. The research field is mainly in the Hakka area in Miaoli County, and the samples include 318 disable elders. The software used for analyzing the data is SPSS (version 18.0), and the analysis methods of the data include Descriptive Statistical Analysis and Chi-square test. The main findings of this study are summarized below: 1.Disable elders’ individual backgrounds don’t affect the overall satisfaction of home care service, but there is a significant difference between the different home care service providers and the overall satisfaction. 2.The variable of different caregivers significantly influences the satisfaction of the service hours. There is significant difference between the individual social welfare identity and the satisfaction of the service hours. 3.The significant difference is found between health situations of disable elders and the overall satisfaction. Also, instrumental activities of daily living (IADL) influnce the overall satisfaction significantly. 4.There is a significant difference between activities of daily living (ADL) or instrumental activities of daily living (IADL) and the satisfaction of the service hours. 5.99.4% disable elders are satisfied with the overall satisfaction of home care services and the different home care service items .

Background: A randomised control trial (RCT) was conducted in the Torres Strait and Northern Peninsula Area (NPA) Health Service District (HSD) during the period 1998-2000. The main intervention strategy for this trial was the introduction of a simple recall/patient reminder system in Primary Health Care Centres (PHCCs) in an attempt to improve the organisation and management of diabetes care. After a twelve-month period, there was a significant reduction (40 per cent) in the number of patients admitted in the intervention sites between baseline and followup. However, as hospitalisation data was derived from the PHC clinic records, it has been suggested that this methodology may have underestimated both the number of patients and hospital episodes captured in the RCT study population.

Aim: To conduct a retrospective re-evaluation study of the hospitalisation component of the original RCT in an attempt to better assess the impact of the clinic recall system for patients with diabetes in the Torres Strait and NPA, 1998-2000. All patients from the RCT were to be tracked manually through three local public hospitals for hospitalisation episodes in a bid to validate the total number of admissions for these Torres Strait Islanders (TSIs) with diabetes.

Methods and Subjects: Subjects included all those patients suffering with diabetes living in the Tones Strait and NPA whose PHC records had been audited during the original RCT. Instead of using PHC clinic patient files, hospital -based patient information systems were used (as a different data source) in order to validate the number of admissions for each individual from the trial. Analysis of the data used the same methodology as the RCT (that is, communities were clustered into intervention and control sites) in order to interpret results in terms of whether or not the implementation of a recall system in the intervention sites had any impact on the hospitalisation rates of patients with diabetes in the Torres Strait.

Results: In comparison with the RCT, the new hospitalisation study found some degree of underestimation in the number of patients identified as having hospitalisations and secondly, considerable underestimation in terms of the number of hospital episodes found. At baseline, the hospital -checking methodologyidentified one extra person and 102 additional episodes of care. At followup, this new methodology found an extra 30 persons and an additional 119 episodes of care. In comparison to the RCT, the new study showed an overall 6.7 per cent increase in the number of individual patients detected having had an admission in the study period. However, there was a large 47.1 per cent increase in extra hospital episodes detected across both audit timeframes.

Discussion: This study supports the main findings of the original RCT. That is, the new study also found a reduction in the proportion of patients hospitalised for any kind of `diabetes -related condition' in the intervention sites between baseline and followup. This reduction was slightly less at 29 per cent in the intervention sites (compared to 40 per cent in RCT across intervention sites) for 'total diabetes -related conditions,' however this new study finding was not statistically significant. The re-evaluation study also found that at followup, those in the intervention sites were 19 per cent significantly less likely to be hospitalised for a diabetes -related condition than those in the control sites (compared with a significant 40 per cent in the RCT). Therefore, admissions for diabetes -related conditions can be reduced or avoided through better organisation and a systematic approach to the management of PHCCs. Although hospital -based information systems may have been more sensitive in detecting patients with hospitalisation episodes and additional episodes for known patients, the tracking of individuals through the public hospital system (without a unique identifier) was problematic and time consuming.

Conclusion: The main aim of the RCT was to improve the organisation and management of PHC in the Tones Strait, in terms of clinical management for the large number of diabetic clients that are served. The original RCT findings suggested that improvements in diabetes care in the intervention sites such as the introduction of a patient recall system was successful in reducing the numbers of patients subsequently admitted to hospital. The re-evaluation study of hospitalisations using a different methodology has also been successful in recording a reduction in the number of people with diabetes being hospitalised from the intervention sites despite a 47 per cent increase in the number of hospital episodes being detected overall.

The purpose of this quantitative, descriptive study was to identify shortcomings in the implementation of the Batho Pele Principles in a public hospital. Findings were obtained from a range of patients who had been admitted to specific units for three or more days, and more evidence was gathered from articles in mass media. Data was collected through a structured questionnaire from one hundred respondents (n=100) and analysed by means of descriptive statistics. The research findings revealed that none of the Batho Pele Principles were implemented effectively and that patients in general were not satisfied with treatment in public hospitals. Shortcomings are attributed to insufficient management skills and knowledge on different levels of the health care system, as well as a lack of awareness among patients of their rights and responsibilities in health care.
Health Studies
M.A. (Public Health)