Dissertations / Theses on the topic 'Inpatient hospital care'
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Omérov, Majda. "Violence in psychiatric inpatient care /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-850-5/.
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Drager, Katrina A. "Inpatient psychiatric length of stay and readmission rates." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007dragerk.pdf.
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Bechel, Diane Lynn. "The effect of patient-centered care on hospital inpatient cost and quality outcomes the experience in southeast Michigan." Ann Arbor, Mich. : University of Michigan, 1998. http://books.google.com/books?id=bhUvAAAAMAAJ.
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Wong, Oi-ling Irene. "Medical ecology of inpatient service utilization in Hong Kong a population survey /." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971337.
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Elo, Jyrki A. I. "The impact of surgical day care on hospital inpatient utilization in a paediatric population." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27876.
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Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients.
In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend.
The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use.
Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects.
According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Holibaugh, Adam Russell. "Reducing inpatient hospital acquired pneumonia (HAP) using a structured oral care program." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21176.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Hospital acquired pneumonia (HAP) causes significant mortality and morbidity and is now no longer reimbursed by Centers for Medicare and Medicaid (CMS). For all of these reasons, hospitals want to minimize their HAP rates. Aggressive oral care (tooth brushing 3 times a day) has been shown to reduce the incidence of HAP in the intensive care unit setting, but this has not been tested in the acute care setting, in which patients are more stable, less sick, and more ambulatory. In an attempt to address HAP rates in acute care settings, this clinical trial entailed providing all patients in four wards with a 3 times per day tooth-brushing oral care protocol, which was implemented or supervised by the nurses on each ward. Six matched wards on a separate campus that received normal standard of care served as controls. The goal of this clinical trial was to cut the pneumonia rate in half, from 2% to 1%. This clinical trial was conducted to determine whether an oral care regimen would reduce the incidence of aspiration pneumonia over the three months of intervention in the experimental group (HAC) versus the control group (ENC) from Nov 5, 2012 to Feb 15, 2013.
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Haile, Brian. "The costs of adult inpatient care for HIV disease at GF Jooste Hospital." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/9434.
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Bibliography: leaves 49-51.The lack of patient care and utilisation data impairs the ability of hospital and clinic administrators to make informed, data-driven policy choices. This concern is particularly acute with HIV/AIDS, given both the striking growth in the local epidemic over the last two years and the high level of HIV-related health expenditures shouldered by the provincial medical system in the Western Cape province of South Africa. A retrospective chart review was conducted to capture clinical and utilisation data of from a sample of 59 inpatients, who were admitted to a township secondary hospital near Cape Town, South Africa during 1997. Three years of data were abstracted and analysed.
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George, Allison M., and Erin N. Baguley. "Clinical and Economic Characteristics of Inpatient Esophageal Cancer Mortality in the United States." The University of Arizona, 2010. http://hdl.handle.net/10150/623745.
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Class of 2010 AbstractOBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.
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Abrahamsen, Grøndahl Vigdis. "Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-9023.
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There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital. Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis. Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV). Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.
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Ogbuji, Victoria Ngozi. "Improving Spiritual Care in Preoperative Nursing." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7246.
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Spirituality and nursing have been intertwined from the beginning of the profession; however, there is little evidence that clearly defines spiritual nursing care and no standardized practices that can be included in the routine preoperative plan of care for patients undergoing invasive surgical procedures. The purpose of this project was to conduct a systematic review of the literature to define spiritual care and identify specific spiritual nursing care interventions. The biopsychosocial model, Narayanasamy's transcultural care practice model, and Watson's theory of human caring provided the theoretical framework for the project. MEDLINE, PubMed, Wiley online library, SCIENCE, WOS, Cochrane, and SciELO databases were searched for the literature review. Keywords and phrases used included spirituality, spiritual nursing care, holistic health practices, inpatient, hospital, and preoperative care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) II tool was used for data analysis. Interventions found in the literature to be supportive of spirituality included healing presence; providing effective communication; praying with the patient and family or facilitating other religious rituals; using the therapeutic self to be with the patient; listening to and exploring the patients' spiritual perspectives; and showing support and empathy through patient-centered caring, nurturing spirituality, and creating a healing environment. Employing these nursing actions might promote positive social change by contributing to a sense of well-being as patients find meaning and purpose in their illness and life overall, which will promote improved surgical outcomes and better patient satisfaction with care.
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Wood, III John. "The Influence of Emergency Department Wait Times on Inpatient Satisfaction." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1609108/.
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Patient satisfaction dimensions have a wide ranging and significant impact on organizational performance in the healthcare industry. In addition, the Centers for Medicare and Medicaid Services Hospital Value Based Purchasing (HVBP) Program links patient satisfaction to Medicare reimbursement, putting millions of dollars at risk for health systems. A gap in the literature exists in the exploration of how a patient's experience in the emergency department affects their satisfaction with inpatient services. In a multiple regression analysis, the relationship between HVBP Patient Experience of Care and hospital level factors including emergency department wait times are explored. Results indicate a statistically significant relationship between hospital level factors and standardized measure of patient satisfaction with a moderate adjusted effect size (p= <.0001, R2 adjusted= 0.184). Emergency department wait times post physician admit orders were most salient in predicting patient satisfaction scores (rs2= 0.434, β= -0.334, p= <.001). Recommendations to improve emergency department wait times include focusing on key decision points and implementation of electronic systems to support the movement of admitted patients out of the emergency department as quickly as possible.
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Quosdorf, Ashley. "Connecting with Adolescent Mothers: Perspectives of Hospital-Based Perinatal Nurses." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/38838.
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Background: Adolescents are more likely to be dissatisfied with perinatal care than adults. Adolescents’ perspectives of their perinatal care experiences have been explored; however, there are few studies exploring adolescent-friendly inpatient care from nurses’ perspectives.
Purpose: To explore adolescent-friendly care from the perspective of hospital-based adolescent-friendly perinatal nurses.
Research Questions: (1) How and why do perinatal nurses in inpatient settings adapt their practice when caring for adolescents? (2) What are the individual nursing behaviours and organizational characteristics of adolescent-friendly care in inpatient perinatal settings, from the perspective of perinatal nurses?
Methods: I report the qualitative component of a mixed methods study. Open-ended interviews were conducted with twenty-seven purposively-sampled expert nurses. Data were analyzed using Interpretive Description.
Findings: Nurses described being mother-friendly to adolescents by being nonjudgmental, forming connections, individualizing care, and employing behavioural strategies that facilitate relationship-building.
Implications: These findings will inform the development of interventions to facilitate connections between nurses and adolescent mothers.
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Wong, Oi-ling Irene, and 黃愛玲. "Medical ecology of inpatient service utilization in Hong Kong: a population survey." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971337.
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Lovell, Mariann Engelhard. "Factors associated with inpatient tertiary hospital utilization and home care referral in patients diagnosed with Cancer /." The Ohio State University, 1999. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488191667181637.
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Perera, K. Prasadini N. "Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/301686.
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Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.
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Ilkhani, Mahnaz. "The inpatient hospital care delivery to disabled children and young people and those with complex health needs." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/362860/.
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Introduction: Research suggests that parents of disabled children are dissatisfied with inpatient care delivery to their children. Objectives: - To explore the inpatient care of disabled children - To determine the rewards and challenges of working with disabled children and young people and those with complex health needs - To analyse contemporary nursing curricula in order to ascertain areas of teaching pertinent to disabled children and young people and those with complex health needs - To consider compliance with policy benchmarks for disabled children and young people and those with complex health needs Methods: This project is part of a service evaluation for disabled children and their families that utilises different approaches. Three components of the project were designed: 1. To conduct focus group meetings using the Nominal Group Technique (NGT) with nursing staff 2. To conduct an in-depth content analysis of contemporary nursing curricula 3. To conduct an audit of compliance with policy benchmarks for disabled children and young people and those with complex health needs Results: Four themes have been generated from the integrated data analysis of the current service evaluation, namely: effective communication, provision of training, provision of equipment, unfavourable environment. Conclusion: This service evaluation has revealed that nursing staff need to improve their knowledge and expertise in the field of communication with disabled children and their families, and also enhance the quality of care delivered to this population. Additionally, it is vital that more equipment be provided, and the number of expert nursing staff caring for disabled children increased, in order to improve the quality of care for disabled children and their families.
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Fadayevatan, Reza. "Inpatient hospital care for older people : relationship between comprehensive geriatric assessment (CGA), frailty and outcomes in eldery hospitalized patients." Thesis, University of Sheffield, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.443880.
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Wright, Michael Christopher. "Spiritual health care : an enquiry into the spiritual care of patients with cancer within the acute hospital and the specialist inpatient palliative care unit in England and Wales." Thesis, University of Sheffield, 2001. http://etheses.whiterose.ac.uk/3041/.
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Question: What are the features of the spiritual care of patients with cancer within hospice and the acute hospital? Objectives: To identify: guidelines relating to spiritual care, the means whereby spiritual needs are assessed key features of spiritual care, perceptions of spiritual care stakeholders, perceptions of health professionals, patients and relatives. Methods: A mixed method design incorporating three phases. Phase I-a survey of the views of chaplains in 151 hospices and 195 trusts. Phase II -a phenomenological enquiry into the perceptions of spiritual care amongst 16 stakeholders. Phase III -a multiple case study in 4 health settings. Data handling: Phase I data: collected by postal questionnaire; analysed using SPSS. Phase II data: collected by recorded interviews; analysed using NUD*IST software. Phase III data: collected from case studies involving observation, documentation and recorded interviews; analysed using NUD*IST software and biographical and documentary techniques. Conclusions: Spiritual care is founded on the assumption that all people are spiritual beings. It affirms the value of each person and acknowledges the search for meaning in the big questions of life and death. Institutions determine the spiritual needs of patients using both formal and informal means. Such needs are met through the provision of physical resources and human resources. Chaplains figure prominently, although a broad view of spirituality is currently attracting a wider ownership. Within both settings, chaplaincy is almost exclusively Christian. Hospices with funded chaplaincy provide a higher level of service than hospices with voluntary chaplaincy. There is a greater demand for religious care in hospitals rather than hospices. Illness may prompt a patient's spiritual (re-) awakening, articulated through religious imagery possibly stretching back to childhood. Patients' non-religious needs include someone to listen and to 'be there'. Religious (Christian) needs centre around holy communion, prayer and worship.
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Brody, Abraham Aizer. "The effects of an inpatient palliative care team on mortality, utilization, and cost in a large non-profit teaching hospital." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324586.
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Viljoen, Charle André. "Audit of the quality and cost of acute inpatient stroke care in the general medical wards at Groote Schuur Hospital." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21377.
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Introduction: Stroke is the leading cause of death and disability amongst South Africans older than 60 years. The majority of stroke patients in South Africa are managed in general medical wards where little is known about the quality and cost of care. The aim of this study was to determine the cost of stroke care and to identify factors associated with increased expense , as well as to evaluate the quality of stroke care in general medical wards in order to identify areas where quality of care could be improved. Methods: We conducted a retrospective folder review of all acute stroke admissions to the general medical wards at Groote Schuur Hospital from 1 January to 31 December 2012. Patients younger than 45 years and those that received thrombolysis were excluded. The hospital's finance department provided the bed costs, as well as expenditure on consumables, pharmacy, laboratory and radiology for each subject. The quality of care was measured according to the South African Stroke Guidelines. Results: The inpatient care of 261 patients was evaluated. Although neuroradiology was performed on 95% of patients, carotid duplex Doppler ultrasonography and echocardiography were not often done. Although all patients with ischaemic stroke received inpatient antiplatelet or anti - coagulation therapy, not all risk factors were adequately addressed on discharge. The median cost of a stroke admission was R19,072.07 (IQR R10,899.85 to R27,789.43 ). The strongest correlation with cost 12 was with length of stay (LOS), r = 0.9977. The median LOS was 6 days (IQR 3 to 9 days). Using non -¬‐ parametric univariable analysis, clinical factors prolonging LOS were previous stroke ( P = 0.0 2 8) and inpatient complications: fever ( P < 0.0 0 1), urinary tract infections ( P < 0.0 0 1) and acute kidney injury ( P < 0.0 0 1) . The LOS increased as the number of inpatient complications increased (P = 0.059). Mortality was 20% and 68% of patients experienced at least one medical complication during admission. Fever and pneumonia were predict ors of death. Pneumonia was less prevalent amongst patients who were mobilised early (P = 0.002). Early nutritional support was beneficial in reducing the incidence of acute kidney injury (P < 0.001). The median LOS was significantly prolonged by delaying speech therapy (P < 0.001), nutritional support (P < 0.01), physiotherapy (P < 0.01) and occupational therapy (P < 0.001). Discharge to inpatient rehabilitation centres significantly prolonged LOS as compared with patients discharged home (P < 0.001). Conclusions: This is the first study evaluating the cost of acute stroke care in South Africa. Length of stay was the greatest determinant of cost. Improving the quality of care to reduce the number of complications, early referral to allied health professionals and effective discharge planning would result in shorter length of hospital stay and therefore cost saving. There is a need for increased access to stroke unit beds, albeit dedicated stroke beds in the general medical wards, to ensure specialised nursing care and early inpatient rehabilitation to reduce the number of inpatient complications, as well as implementation of protocols to allow for better adherence to national guidelines.
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Jackson, Phillip E. "Analysis of Naval Hospital Long Beach efforts to recoup subsistence cost from referral of active duty members to civilian and VA hospitals for inpatient care." Thesis, Monterey, California. Naval Postgraduate School, 1992. http://hdl.handle.net/10945/23534.
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Approved for public release; distribution is unlimitedThis thesis analyzes the efforts of Naval Hospital, Long Beach to recoup subsistence cost from the referral of active duty members to civilian and Veterans Administration hospitals for inpatient care. The analysis encompasses Fiscal Years 1990, 1991 and 1992 and begins by providing an overview of the Navy Medical Department. Additionally, pertinent background information directly related to the area of research is elaborated on to facilitate understanding. Particular attention is devoted to the Collection Agent, Admissions Office and Command Referral Clerk operations and interactions. Pay Adjustment Authorization procedures are reviewed along with a glance at AQCESS MSA to ascertain whether the current version of software provides the existing capability to account for occupied bed days outside the hospital. A questionnaire is employed to gather the data necessary to evaluate the processes used at the hospital and estimate the amounts available for recoupment. Comparisons of the estimated amounts are contrasted against funding authority and reimbursables. The analysis concludes with a cost and benefit analysis, a brief observation of three other medical treatment facilities, and recommendations..
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Enarson, Penelope Marjorie. "Improving the quality of care for inpatient management of childhood pneumonia at the first level referral hospital : a country wide programme." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96840.
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Thesis (MCur)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Pneumonia is the greatest single cause of mortality in children less than five years of age throughout the world causing more deaths than those due to AIDS, malaria and tuberculosis combined. Approximately 50% of all childhood pneumonia deaths occur in sub-Saharan Africa. Children in developing countries being treated for pneumonia frequently have one or more comorbid conditions which increases their risk of dying. The proper management of the child with severe or very severe pneumonia is essential to reduce case fatality. Standard case management (SCM) of pneumonia, has been shown to be an effective intervention to reduce deaths from pneumonia, but what is lacking is a means of delivering it in low-resource/high burden countries. A major barrier to wide application of this intervention in low-income countries is weak health-care systems with insufficient human and financial resources for implementing SCM to a sufficient number of children at a level of quality and coverage that would result in a significant impact. The objective of this dissertation is to address this issue by investigating ways of improving delivery of standard case management of pneumonia in district hospitals throughout Malawi, a high HIV-prevalent country which would result in a decrease in the in-hospital case fatality rates (CFR) from pneumonia in children less than five years of age. We reviewed the evidence base for SCM. Then we evaluated the development and implementation of a national Child Lung Health Programme (CLHP) to deliver SCM of severe and very severe pneumonia and a programme to provide uninterrupted oxygen supply in all paediatric wards at District Hospitals throughout Malawi. We demonstrated that it was feasible to implement and maintain both programmes country-wide. Thirdly we evaluated the trend in case fatality rates in infants and young children (0 to 59 months of age) hospitalized and treated for severe and very severe pneumonia over the course of the implementation of the CLHP. The findings from this study showed that in the majority (64%) of cases, who were aged 2-59 months with severe pneumonia there was a significant effect of the intervention that was sustained over time whereas in the same age group children treated for very severe pneumonia there was no interventional benefit. No benefit was observed for neonates. Fourthly we investigated factors associated with poor outcome reported in the previous study, in a subset of this cohort to determine the individual factors including demographics of the study population, recognised co-morbidities and clinical management that were associated with inpatient death. This study identified a number of factors associated with poor pneumonia-related outcomes in young infants and children with very severe pneumonia. They included co-morbidities of malaria, malnutrition, severe anaemia and HIV infection. The study found that the majority of reported comorbid conditions were based on clinical signs alone indicating a need for more accurate diagnosis and improved management of these comorbidities that may lead to improved outcomes. Other identified factors included a number of potentially modifiable aspects of care where adjustments to the implementation of SCM are indicated. These included enhancing correct classification of the severity of the disease, the use of correct antibiotics according to standard case management, more extensive availability and use of oxygen together with oximetry to guide its use,. Finally recommendations were made to address the identified reasons for poor outcomes and suggested future research.
AFRIKAANSE OPSOMMING: Pneumonie is die grootste enkele oorsaak van sterftes by kinders jonger as 5 jaar in die wêreld en veroorsaak meer kindersterftes as die menslike immuungebrekvirus (MIV), malaria en tuberkulose saam. Ongeveer 50% van kindersteftes van pneumonie kom in sub-Sahara-Afrika voor. Kinders in ontwikkilende lande, wie vir pneumonie behandel word, het dikwels een of meer bydraende toestande wat die doodsrisiko verhoog. Kinders wie ernstige of baie ernstige pneumonie onderlede het moet korrek behandel word om sterfte te voorkom. Die standaard protokolle om kinderpneumonie korrek te behandel het getoon om effektief te wees om die sterftesyfers te verlaag. In lae inkomste lande bestaan die strategieë nie om die protokolle aan te wend nie. ‘n Groot struikelblok in die aanwending van die pneumonie behandelingsprotokolle in lae-inkomste lande is die swak gesondheidsorgsisteme met onvoldoende menslike en finansiële hulpbronne. Die tekorte gee aanleiding tot die beperkte implementering van pneumonie protokolle wat die omvang en kwaliteit van die pneumonie protokolle beperk en daarom impakteer die protokolle nie op die kindersterftesyfer nie. Die doel van die verhandeling is om hierdie probleem aan te spreek deur navorsing hoe om die pneumonie protokolle landwyd in alle distrikhospitale in Malawi, ‘n land met ‘n hoë MIV prevalensie, aan te wend om sodoende die kindersterftesyfer (kinders jonger as 5 jaar) as gevolg van pneumonie te verlaag. Ons het die getuienis van die pneumonie protokolle ondersoek. Hierna is ‘n nasionale Kinderlong Gesondheidsprogram ontwikkel en landwyd geïmplementeer. Volgens die program is kinders met ernstige en baie ernstige pneumonie volgens Wêreldgesondheidsorganisasie (WGO) protokolle behandel. Ononderbroke suurstoftoevoer in alle pediatriesesale in distrikshospitale in Malawi veskaf. Die navorsing het getoon dat die implementering en instandhouding van pneumonie behandelingsprotokolle is landwyd moontlik. Verder het ons die tendens ondersoek of die kindersterftesyfer in babas en jong kinders (0 tot 59 maande) wat in die hospital opgeneem en behandel is vir ernstige en baie ernstige pneumonie tydens die implementering van pneumonie protokolle verminder het. Die bevindinge van hierdie verhandeling wys dat in die meerderheid (64%) van die kinders tussen 2 en 59 maande met ernstige pneumonie, en met die toepassing van die pneumonie protokolle, statistiesbetekenvol die sterfte syfer verlaag het. Die protokolle vir die behandeling van baie erstige pneumonie het nie dieselfde wenslike effek gehad nie. In neonate (jonger as 2 maande) was daar ook geen verlaging in die sterftesyfer nie. Laastens het ons die redes vir die swak uitkomste ondersoek in ‘n substudie en veral klem gelê op bydraende siektes en kliniesesorg tekorte geassosieer met pneumonie sterftes. Die studie het ‘n aantal faktore geïdentifiseer wat bygedra het tot die sterftesyfer in kinders met baie ernstige pneumonie en in neonate. Die geïdentifiseerde bydraende faktore het malaria, wanvoeding, erge anemie en MIV-infeksie ingesluit. Voorkomende maatreëls moet vir die geïdentifiseerde faktore ingestel word. Aanpassings in die pneumonie protokolle is voorgestel. Ten slotte word aanbevelings gemaak om die geïdentifiseerde redes vir swak uitkomste aan te spreek en verdere navorsingidees word aanbeveel.
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Quirk, Alan. "Obstacles to shared decision-making in psychiatric practice : findings from three observational studies." Thesis, Brunel University, 2007. http://bura.brunel.ac.uk/handle/2438/5464.
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This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and "crisis' situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. 'Meaning' is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is 'insider' knowledge and meanings, in the CA study it is gn the activities that make those meanings possible in the first place. The methodological contribution of the thesis stems from its demonstration of how to produce a coherent, unified research account from two very different versions of qualitative inquiry. Despite the potential for analytic inconsistency, the thesis arguably has far greater force and persuasiveness as a result of the attempt to combine, compare and contrast findings from three studies. It is contended that a sound theoretical base for sociological research may be created by combining Goffman's micro-sociology with Foucault's analyses of disciplinary power/knowledge in one of a number of ways. A Goffmanian 'home base' is adopted for this thesis, with Foucauldian thinking applied to add a historical, 'macro' dimension to the analysis that Goffman's work so conspicuously lacks. Foucault's work also provides the conceptual tools for examining the more subtle form of control through expertise that would be missed in a purely Goffmanian study.
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Gipson, Linda Stephens. "The Impact of Managed Care on the Utilization and Distribution of Inpatient Surgical Procedures with Demonstrated Volume and Outcome Endogeneity." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3118.
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Abstract
Purpose
This study is designed to determine whether managed care has had an influence on the number and distribution of procedures with demonstrated volume and outcome endogeneity in Florida healthcare markets; in addition, methods are developed to determine which measures of managed care activity best predict the impact of managed care on surgical procedure utiliation.
Rationale
A shift in surgical procedure volume on the basis of preferred provider arrangements has the potential to redistribute surgical procedures within hospital markets. The surgical procedures for which such a distribution could have the greatest impact on population health are those for which the volume of cases performed has a strong inverse influence on the outcomes observed. A shift in high risk surgical procedures to low volume hospitals could potentially reduce the number of cases performed at high volume centers and increase cases at low volume centers, adversely impacting quality in both.
Methods
A retrospective population based cohort design is used to capitalize on the variability among Florida metropolitan statistical areas between 1995 and 1999, a period which captured the full business life cycle of managed care plans in Florida. Multiple regression models are used to measure the impact of changes in managed care activity as measured by penetration, index of competition and consolidation on the change in the number and distribution of seven procedures for which volume is associated with patient outcome, controlling for socio-demographic and market factors known to influence surgical procedure utilization. Difference scores derived for each of the model variables were used to measure change from the baseline in 1995 to 1999. Post hoc analysis of the count data models was performed using the cases from all study years in a log linear generalized estimating equation to provide validation of the difference score approach.
Key Findings
Study procedure volume increased over the period, and remained a consistent proportion of the total inpatient surgical procedure volume. Procedure rate remained stable over the study period with substantial small area variation. Change in managed care concentration was consistently and negatively associated with procedure volume at both the MSA (&betaâ&beta = -19.67; p = 0.0489) and hospital level (&betaâ&beta = -4.088; p = 0.0027).Change in the total population and the number of specialty surgeons had a substantial, consistent and positive relationship to change in procedure volume at both the market and hospital level. The change in the index of competition was positively associated with change in hospital market share (&betaâ&beta = 0.1005; p = 0.05); whereas, neither change in managed care penetration nor change in managed care index of competition was predictive of change in procedure volume at the market level. The managed care variables were not correlated when difference scores were tested providing evidence that the managed care variables measure different constructs and behave differently.
Implications
As markets for managed care became more concentrated, the number of surgical procedures with volume and outcome endogeneity declined; the specific reasons for the observed decline require additional study. Competitive managed care markets have a favorable impact on hospital market share for these high risk, high margin procedures. Studies of managed care require consideration of the stage of managed care development in order to understand its influence and the use of difference scores as a method to measure change over time has substantial potential for the study of health care markets.
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Shafi, Mohammed. "Relationship between Patient of Safety Culture and Hand Hygiene among inpatient nurses: a retrospective study from a tertiary care hospital in the Middle East." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1571298284402806.
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Peers, Gordon H. "Home visiting: The effect of a hospital based nurse home visiting programme on the rehabilitation of children following their discharge from a child psychiatry inpatient unit." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1997. https://ro.ecu.edu.au/theses/898.
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The purpose of this study was to examine the effect of a nurse home visiting programme on the rehabilitation of children following their discharge from a dedicated child psychiatry hospital. The research was based on the premise that a nurse home visiting programme may have a positive influence on the outcomes of the rehabilitation of children following their discharge from hospital, if it reduced the need of outpatient appointments with the psychiatrist and the need for children to be re-admitted to hospital.
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Holmgren, Emma, and Hedvig Tell. "Patienters upplevelse av att vårdas på flerbäddssal." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352333.
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Bakgrund: Som sjukvården ser ut idag är det vanligt att patienter vårdas på flerbäddssal vilket kan upplevas olika av patienterna. Det kan uppstå situationer där det är svårt att bevara patienternas integritet och autonomi vid vård på flerbäddssal. Syfte: Syftet med denna studie är att studera patienters upplevelse av att vårdas på flerbäddssal. Metod: Litteraturstudie med kvalitativa artiklar från databaserna Pubmed och Cinahl. Resultat: En sammanställning av tolv artiklar gjordes. Fyra olika kategorier framkom; sömn, avskildhet, samvaro och välbefinnande. Patienter upplevde dels att de kunde bli störda av sina rumskamrater men vissa upplevde också en oro för att själva störa sina rumskamrater vilket påverkade patienternas sömnkvalitet. Gardinerna mellan sängarna på flerbäddssalen upplevdes ibland inte vara tillräckligt avskärmande eftersom rumskamraterna lätt överhörde privata konversationer. Något som uppskattades av patienterna var när sjuksköterskorna ansträngde sig för att bevara patienternas integritet, genom att exempelvis lägga över en extra filt för att minska kroppslig exponering. Patienterna kunde känna en gemenskap sinsemellan på flerbäddssalarna och kunde därmed finna tröst och trygghet i varandra. Slutsats: Att patienten får känna att hen har ett privat utrymme och möjlighet till avskildhet upplevdes vara mycket viktigt vid vård på flerbäddssal. Emellertid upplevdes flerbäddssalen som hemtrevlig av andra patienter som kände ett behov av ett socialt umgänge och det var ofta positivt att ha sällskap av en rumskamrat eftersom patienterna kände en gemenskap och därmed kunde finna tröst och trygghet hos varandra. Eftersom varje individ är unik och upplever situationer på olika sätt kan inte sjuksköterskan förutsätta att alla vill vårdas på samma sätt. En sjuksköterska bör vårda varje patient på ett individanpassat sätt där sjuksköterskan värnar om patientens integritet.Background: As medical care looks today it is common for patients to be treated in a multi-bed room, which can be experienced differently by patients. There may be situations where it is difficult to preserve the patient's integrity and autonomy when being treated in a multi-bed room. Purpose: The purpose of this study was to study the patient's experience of being treated in a multi-bed room. Method: A literature study with qualitative articles from the databases Pubmed and Cinahl. Results: A compilation of twelve articles was made. Four different categories emerged; sleep, privacy, fellowship and well-being. These categories describe the patient's experience of care in a multi-bedroom. Some patients experienced that they could be disturbed by their roommates. However, some patients were anxious about interfering with their roommates themselves, which affected the patient's sleep quality. The curtains between the beds in the multi-bed room were sometimes not sufficiently shielded which lead to the roommates easily overheard private conversations. The patients appreciated when the nurses attempted to maintain patient integrity, for example by adding an extra blanket to reduce bodily exposure. Patients could feel a fellowship with each other in the multi-bed rooms, thus finding comfort and security in each other. Conclusion: The feeling of having a private space and the possibility of privacy was very important when getting care in a multi-bedroom. However, other patients felt that the multi-bedroom was homelike because they enjoyed the social interaction. Therefore, it was often positive to have a roommate. The patients felt a fellowship and thus found comfort and security with each other. Because everyone is unique, they experience situations differently and the nurse cannot assume that everyone wants to be cared for in the same way. A nurse should take care of each patient in an individualized manner where the nurse is responsible for the patient's integrity.
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Miller, Lakisha Chitique. "Medical Resident Turnover and Its Association with Inpatient Mortality in Patient Discharges with a Primary Diagnosis in the Heart Disease, Cancer, or Stroke Diagnostic Groups at U.S. Teaching Hospitals, 2002." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1239044238.
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Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /." Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
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Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Molina, Karine Lorenzen. "A satisfação dos usuários segundo a forma de internação em hospital universitário." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/128955.
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A pesquisa de satisfação é um importante indicador de qualidade. A porta de entrada é vista como um “termômetro” da qualidade do atendimento prestada pelo sistema de saúde. Emergências superlotadas e longos períodos de espera para internações eletivas são uma realidade nos hospitais. Este estudo analisou a satisfação dos usuários segundo a forma de internação – emergência e admissão - em hospital universitário, descreveu o perfil sociodemográfico, comparou a satisfação de usuários, elencou aspectos do atendimento quanto a elogios críticas e sugestões e investigou a influência do tempo de internação na satisfação dos usuários . Integrante de um estudo longitudinal esta pesquisa foi do tipo survey, realizada em um hospital público, universitário e geral no Sul do Brasil. A amostra constituiuse de usuários maiores de 18 anos internados no mínimo 48 horas em unidades clínicas e cirúrgicas. O instrumento de pesquisa constou com variáveis sociodemográficas, de internação, de satisfação e duas perguntas abertas. A coleta foi realizada por telefone no período de 15 a 30 dias após a alta hospitalar. A análise do estudo foi do tipo descritiva e analítica. Foram elegíveis 367 usuários, 174 internaram pela emergência e 192 pela admissão, 52% do sexo feminino, 50,9% adultos e adultos jovens, 51% vivem com companheiro, 47,7% têm mais de 8 anos de estudo, 77,7% foram internados pelo Sistema Único de Saúde e a média de internação foram de 13,6 dias. Para o grupo da emergência 51,7% foram idosos, 51,5% de usuários destacaram elogios e o período de internação teve correlação com as dimensões da admissão (rS=.236), com a equipe de nutrição (rS=.203) e com a alta (rS=.218). Para o grupo que internou pela admissão 57,1% destacaram críticas e o período de internação teve correlação com a admissão (rS=.185). Considerando o desfecho satisfação dos usuários 33,3% responderam estar satisfeitos e 66,1% muito satisfeitos com o atendimento recebido. A única dimensão de satisfação que não teve diferença estatística entre os dois grupos foi a da equipe de enfermagem. Este estudo evidenciou a fragilidade do sistema de saúde frente aos cuidados com os idosos e quanto aos processos de gerenciamento de leitos, mas demonstrou um elevado nível de satisfação dos usuários com a assistência prestada em hospital universitário.A satisfaction survey is an important indicator of quality. The entrance door is seen as a “thermometer” of the quality of care provided by the health system. Overcrowded emergency rooms and long waiting time for elective hospitalizations are a reality in many hospitals. This study analyzed users’ satisfaction according to the type of inpatient stay – emergency or admission – in a university hospital; described their demographic profile, compared the satisfaction of users; presented aspects of care about praises, criticisms and suggestions; and investigated the influence of the length of stay in the satisfaction of users. Belonging to a longitudinal study this research was of a survey type, carried out in a public university hospital in southern Brazil. The sample consisted of users over 18 years old, hospitalized for at least 48 hours in clinical and surgical units. The research instrument consisted of sociodemographic, stay-in and satisfaction variables, and two open questions. The collection of data was carried out by phone in a period of 15 to 30 days after hospital discharge. The analysis of the study was of a descriptive and analytical type. Three hundred and sixty-seven users were eligible, 174 were hospitalized by emergency and 192 by admission, 52% were female, 50.9% adults and young adults, 51% live with a partner, 47.7% have more than 8 years of study, 77.7% were admitted by the Unified Health System (SUS), and the average of hospitalization were 13.6 days. For the emergency group, 51.7% were elderly people, 51.5% of users reported praise and the length of hospitalization had correlation with the dimensions of admission (rS =.236), with the team of nutrition (rS =.203), and discharge (rS =.218). For the group that entered by admission, 57.1% highlighted criticism and the length of hospitalization had correlation with the admission (rS=.185). Considering the outcome “users’ satisfaction”, 33.3% replied to be satisfied and 66.1% very satisfied with the service received. The only dimension of satisfaction that did not show any statistical difference between the two groups was the nursing team. This study pointed to the fragility of the health system in relation to the care of the elderly and bed management processes, but demonstrated a high level of user’s satisfaction regarding the assistance provided in the referred university hospital.
La pesquisa de satisfacción es un importante indicador de calidad. La puerta de entrada es mirada como un “indicador” de la calidad del atendimento ofertada por el sistema de salud. Emergencias superlotadas y largos períodos de espera para ingresos efectivos son una de las realidades en los hospitales. Esto estudio analisó la satisfacción de los usuários según la forma de ingreso-emergência y admisión- en hospital universitário, describió el perfil sociodemográfico, comparó la satisfacción de usuários, levantó aspectos del atendimiento cuanto a elogios, crítica y sugerencias e investigó la influencia del tiempo de ingreso en la satisfacción de los usuários. Integrante de un estúdio longitudinal, esta pesquisa fué del tipo survey, realizada en un hospital público, universitario y general en el Sur del Brasil. La amuestra se constituyó de usuários mayores de 18 años ingresados en el mínimo 48 horas en unidades clínicas y cirúrgicas. El instrumento de pesquisa constó con variables sociodemográficas, de ingreso, de satisfacción y dos preguntas abiertas . La coleta fué realizada por teléfono en el período de 15 a 30 días apos el alta del hospital. La análisis del estúdio fué del tipo descriptiva y analítica, fueron escogidos 367 usuarios, 174 ingresaron por la emergência y 192 por la admisión, 52 del sexo femenino, 50,9% adultos y adultos jóvenes, 51% viven con compañero, 47,7% tienen más de 8 años de estudio, 77,7% ingresaron por el Sistema Único de Salud y la media de ingreso fué de 13,6 días. Para el grupo de emergencia 51,7% fueron ancianos, 51,5% de usuários destacaron elogios y el período de ingresso tuvo correlación con las dimensiones de admisión (rS=.236), con el equipo de nutrición (rS=.203) y con el alta (rS=.218). Para el grupo que ingresó por la admisión 57,1% destacaron críticas y el período de ingresso tuvo correlación con la admisión (rS=.185). Llevando en cuenta el desfecho satisfación de los usuários 33,3% respondieron estar satisfechos y 66,1%muy satisfechos con la atención recebida. La única dimensión de satisfacción que no tuvo diferencia estatística entre los dos grupos fué a de el equipo de enfermeira. Este estúdio demonstró la fragilidade del sistema de salud frente a los cuidados con los ancianos y cuanto a los procesos de gestión de lechos, pero demonstró un elevado nível de satisfacción de los usuários con la asistencia prestada en hospital universitário.
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Silva, Magda Aparecida dos Santos. "Efetividade de duas modalidades de equipe de cuidado no controle de sintomas em pacientes com câncer avançado." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-17042015-130238/.
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Introdução. Embora existam diferentes estratégias para a prestação de cuidados paliativos ao paciente com câncer, pouco se conhece sobre a efetividade desses modelos. Objetivos. Comparar os efeitos da equipe de cuidado paliativo integrada ao cuidado tradicional com o cuidado tradicional sozinho no controle de sintomas em paciente com câncer avançado hospitalizado. Método. Estudo longitudinal composto por dois grupos não randomizados. 73 pacientes foram admitidos para a equipe de cuidado paliativo integrada ao cuidado tradicional (Grupo ECP) e comparados a 75 atendidos no modelo de cuidado tradicional (Grupo CT). Os sintomas foram avaliados pela Escala de Avaliação de Sintomas de Edmonton (ESAS), a satisfação por escala numérica verbal (0-10), a funcionalidade pela Escala de Desempenho Funcional Físico Karnofsky (KPS) e a adequação analgésica pelo Índice de Manejo da Dor (IMD). Os pacientes foram avaliados na admissão, após 24 e 48 horas. O desfecho primário foi a melhora clinica significativa de 2 pontos na intensidade da dor e da náusea em 48 horas, comparados com a admissão. Os dados demográficos, os sintomas e sua redução foram comparados entre os Grupos pelo Teste Exato de Fisher ou Mann Whitney. O Teste de Wilcoxon analisou alterações dos sintomas intragrupos. A regressão múltipla de Poisson controlou fatores de confusão para a melhora do sintoma. O nível de significância adotado foi de 5%. Resultados. A prevalência de sintomas foi alta em ambos os grupos: no Grupo ECP a variação foi de 43.8% (depressão) a 87.7% (sensação de bem estar), e no Grupo CT, de 24% (dispneia) a 85.5% (dor). A magnitude dos sintomas, pelo escore da mediana, foi importante em ambos os Grupos: na admissão, no Grupo ECP, variou entre 5.5 (sensação de bem estar) a 8.0 (ansiedade, apetite, constipação e tristeza), e no Grupo CT, variou de 6.0 (sensação de bem estar e dispneia) a 9.0 (perda do apetite). A mediana de sobrecarga de sintomas, avaliada pelo ESAS, foi de 50.0 em ambos os grupos. Na análise de 24 horas (intragrupo), no Grupo ECP cinco sintomas (dor, náusea, perda do apetite, dispneia, prejuízo do sono) e sobrecarga de sintomas foram reduzidos (p<0.05), enquanto no Grupo Grupo CT três sintomas (dor, náusea e prejuízo do sono) foram reduzidos (p<0.05). Na análise de 48 horas (intragrupo), dez sintomas e sobrecarga de sintomas no Grupo ECP foram reduzidos (p<0.05), enquanto quatro sintomas melhoraram no Grupo CT (p<0.05). A regressão múltipla mostrou que a dor (RR= 2.2 [IC95%1.27-3.81]) e bem estar (RR=4.6 [IC95% 1.34-15.88]) reduziram 2 pontos e foi favorável somente no Grupo ECP. Verificou-se melhor adequação da analgesia no Grupo ECP comparado ao CT (p<0.05). A satisfação do doente foi elevada e similar em ambos os grupos. Conclusão. Os doentes de ambos os grupos mostraram grande sobrecarga de sintomas e somente o sintoma dor foi adequadamente controlado pelo Grupo ECP. Os resultados encontrados demandam análise de fatores da estratégia de tratamento que possam melhorar a efetividade das ações, como avaliação sistematizada dos sintomas em curtos períodos e estratégias que permitam ajuste rápido da terapêutica quando necessário.Introduction. Although there are many different strategies for provision of palliative care to patients with cancer, little is known about the effectiveness of these modalities. Objective.To compare the effects of a palliative care team integrated with traditional care to traditional care alone on symptom control in inpatients with advanced cancer. Method. Longitudinal study composed of two non-randomized groups. Seventy-three patients were admitted to the palliative care team integrated to traditional care (PCT Group) and compared to 75 patients treated in the traditional care model (TC Group). Symptoms were assessed by the Edmonton Symptom Assessment Scale (ESAS), satisfaction with treatment by the verbal numeric scale (0-10), performance status by the Karnofsky Performance Status Scale (KPS) and analgesic adequacy by the Pain Management Index (PMI). Patients were assessed upon admission, and after 24 and 48 hours. The primary outcomes were significant clinical improvements of 2 points in pain intensity and nausea in 48 hours, compared to admission. The demographic data, symptoms, and reduction in symptoms were compared between the groups by using Fisher\'s or Mann Whitneys Exact Tests. The Wilcoxon test examined the intragroup alteration of symptoms. The Poisson multiple regression controlled for confounding factors of improvement in symptoms. A p-value of 0.05 indicated statistical significance for all analyses. Results. The prevalence of symptoms at admission was high in both groups. In the PCT Group, it ranged from 43.8% (depression) to 87.7% (loss of well-being) and, in the TC Group, it ranged from 24% (dyspnoea) to 85.5% (pain). The magnitude of median score of symptoms was substantial in both groups: at admission for the PCT group, it ranged from 5.5 (sense of well-being) to 8.0 (anxiety, appetite, constipation, sadness), while for the TC Group, it ranged from 6.0 (sense of well-being and dyspnoea) to 9.0 (loss of appetite). The median score of the symptom burden assessed by ESAS was 50.0 in both groups. In 24 hours (intragroup), the PCT Group had significant reductions in intensity of five symptoms (pain, nausea, loss of appetite, dyspnoea, and sleep disturbance) and symptom burden, while the TC Group had significant reductions in intensity of three symptoms (pain, nausea, and sleep disturbance). In 48 hours (intragroup), the PCT Group had significant reductions in intensity of ten symptoms and symptom burden and while the TC Group had significant improve in intensity of four symptoms. Multiple regression analysis showed that pain (RR = 2.2 [95% CI 1.27-3.81]) and loss of well-being (RR = 4.6 [95% CI 1.34-15.88]) were reduced by two points and it was significantly more favourable only in the PCT Group. The PMI revealed better adequacy of analgesia in the PCT Group. Satisfaction was high and similar in both groups. Conclusion. Patients with advanced cancer in both groups showed a pronounced burden of symptoms and only pain was properly controlled in the PCT Group. The results indicate that factors that can improve treatment strategy should be implemented to improve the effectiveness of clinical assistance. Examples of factors that can improve treatment are frequent and systematic assessment of symptoms in short periods, and strategies that allow for timely adjustment of therapy when necessary.
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Morreale, Mark J. "Evaluation of a care map for community-acquired pneumonia hospital inpatients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22365.pdf.
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Pham, Le Hung Sirikul Isaranurug. "Oral health care performance for inpatients among nurses at Hanoi City Hospitals, Vietnam /." Abstract, 2008. http://mulinet3.li.mahidol.ac.th/thesis/2551/cd414/5038006.pdf.
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Oliver, David. "The development and evaluation of strategies to predict and prevent falls in elderly hospital inpatients." Thesis, King's College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271463.
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Helmicki, Soni. "Evolution and Devolution of Inpatient Psychiatric Services: From Asylums to Marketing Madness and Their Impact on Adults and Older Adults with Severe Mental Illness." Thesis, University of North Texas, 2017. https://digital.library.unt.edu/ark:/67531/metadc984274/.
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I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe mental illness. The research results suggest a long-stay residential facility, specializing in evidence-based treatment for adults and older adults with severe mental illness, to counter the dire shortage of psychiatric hospital beds.
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Asplund, Sandra, and Annina Riskula. "Hur patienter i livets slutskede upplever omvårdnaden på sjukhus : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3757.
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Bakgrund: När det konstaterats att livsförlängande behandling inte längre är meningsfullt övergår vårdandet till den senare fasen, livets slutskede. Livets slutskede innebär att döden är ofrånkomlig inom en snar framtid och målet med behandling är då att lindra lidande. God palliativ vård bygger på de fyra hörnstenarna symtomlindring, multiprofessionellt samarbete, relation och kommunikation samt stöd till närstående. Tillsammans med ett personcentrerat förhållningssätt kan de fyra hörnstenarna tillämpas av all vårdpersonal i syfte att tillföra patienter ett förbättrat välmående och ökad livskvalitet i livets slut. Syfte: Syftet med denna litteraturöversikt var att beskriva hur patienter som befinner sig i livets slutskede upplever omvårdnaden på sjukhus. Metod: Vald design till uppsatsen var litteraturöversikt och 15 vetenskapliga artiklar ligger till grund för resultatet. Vid artikelsökningen användes databaserna Public Medline [PubMed] och Cumulative Index to Nursing and Allied Health Literature [CINAHL Complete]. Resultatet sammanställdes genom en integrerad analys. Resultat: Resultatet delades upp i huvudkategorier som beskrev patienters upplevelse av sjukhusmiljön, mötet med sjuksköterskan, symtomlindring samt existentiella behov. Tillsammans med underkategorier visar resultatet att patienter som befann sig i livets slutskede över lag var nöjda även om brister kunde pekas ut. De brister som fanns handlade om hur patienter upplevde sjukhusmiljön där exempelvis flerbäddssalar påverkade livskvaliteten på ett negativt sätt. Patienter beskrev även hur sjukvårdspersonal på sjukhuset upplevdes som stressade och oengagerade vilket bidrog till att patienterna kände sig som en belastning. Slutsats: Kunskap om palliativ omvårdnad på sjukhus till de patienter som befinner sig i livets slutskede är, baserat på resultatet i denna uppsats, ett viktigt ämne att belysa. Med en ökad medellivslängd samt ny forskning och teknik för livsuppehållande åtgärder kommer behovet av palliativ omvårdnad efterfrågas i allt större utsträckning. Brist på kunskapen att förmedla god omvårdnad till människor i livets slutskede medför ett försämrat välmående och nedsatt livskvalitet för patienter i det sena palliativa skedet.Background: When it has been established that life-prolonging treatment is no longer meaningful, care goes to the latter phase, the final stage of life. The final stage of life means that death is inevitable in the near future and the goal of treatment is to alleviate the suffering. Good palliative care is based on the four cornerstones of symptom relief, multi-professional collaboration, relationship and communication, and support for close relatives. Together with a person-centered approach, the four cornerstones can be applied by all health care professionals with the aim of providing patients with improved well-being and improved quality of life at the final stage. Aim: The purpose of this literature review was to describe how patients who are at the final stage of life experience nursing care in hospitals. Method: The chosen design for the essay was a literature review and 15 scientific articles which form the basis for the result. In the article search, the databases Public Medline [PubMed] and the Cumulative Index to Nursing and Allied Health Literature [CINAHL Complete] were used. The result was compiled by an integrated analysis. Results: The results were divided into main categories that described the patients' experience of the hospital environment, the meeting with the nurse, symptom relief, and existential needs. Together with the subcategories, the results show that the patients who were in the final stages of life were generally satisfied, although deficiencies could be identified. The shortcomings that could be pointed out were about how the patients experienced the hospital environment where, for example, multi-bed rooms negatively affected their quality of life. The patients also described how they experienced the hospital staff being stressed and disengaged, which contributed to the patient feeling like a burden. Conclusions: Knowledge about palliative care in hospitals for patients at the final stage of life is, based on the results of this paper, an important topic to elucidate. With an increased life expectancy as well as new research and technology for life-sustaining measures, the need for palliative care will be increasingly demanded. Lack of knowledge to convey good care to people at the final stage of life results in impaired well-being and reduced quality of life for patients who are in the late palliative stage.
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Figueredo, Delcina Jesus. "Autocuidado em idosos internados numa enfermaria geriátrica de um hospital-escola: comparação das avaliações subjetivas e objetiva." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5169/tde-20092016-160109/.
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Estudo observacional quantitativo longitudinal prospectivo em idosos e seus cuidadores, de ambos os sexos, internados na enfermaria de geriatria de um hospital-escola, com coleta de dados no período de agosto de 2013 a março de 2014. Objetivo: Avaliar a condição funcional subjetiva e objetiva de idosos internados em uma enfermaria geriátrica; entre os relatos de desempenho no autocuidado e suas necessidades de ajuda. Método: avaliações subjetivas e objetiva, usando o instrumento Performance test of Activities of Daily Living (PADL), com 16 tarefas associado a três itens da Escala de Atividades Instrumentais de Vida Diária (AIVD). Resultados: o sexo feminino predominou dentre os idosos (32 - 58,2%) e os cuidadores (46 - 83,6%); a idade dos clientes variou entre 64 e 99 (x=80) anos, e dos cuidadores entre 37 e 84 anos (x=58,7a); a escolaridade básica foi mais frequente entre os idosos (36 - 65,4%) e a superior (18 - 32,7%) para os cuidadores; quanto ao parentesco dos cuidadores, 30 (54,4%) eram filhas e 12 (21,5%) esposas. Para comparar as funcionalidades subjetivas e objetiva no desempenho do autocuidado, calculou-se o Índice de Concordância (Ind.Con%), que variou de 62 a 93%, com Kappa oscilando entre 0,20 e 0,59. Tanto os idosos como os cuidadores referiram desempenhar as tarefas sem ou com ajuda, porém, na avaliação objetiva, detectou-se maior necessidade de ajuda ou a incapacidade da realização da tarefa. Saliente-se que os idosos se autoavaliaram um pouco melhor que os seus cuidadores. Discussão: Nas avaliações subjetivas idosos e subjetivas cuidadores, em comparação com a objetiva, as respostas dos idosos para o autocuidado foram confirmadas na avaliação objetiva e com os relatos reportados subjetivamente pelos cuidadores. Verificou que o Nível de funcionalidade nos idosos, na maioria foi o nível 3 (fazer sem ajuda) para as atividades de vida diária PADL e atividades instrumentais AIVD. Os relatos subjetivos idosos em comparação com a avaliação objetiva podem apresentar que alguns idosos fazem as atividades sem ajuda, outros com ajuda e aqueles que não fazem as tarefas sozinhos, e, assim, necessitaram de algum tipo de ajuda. As informações subjetivas reportadas pelos cuidadores foram discordantes em comparações com a avaliação objetiva em alguns itens das escalas. Os idosos tendem a se avaliar melhor que seus cuidadores. Os cuidadores reportam que os idosos conseguem realizar a tarefa, mas, na avaliação objetiva, alguns não fazem. Conclusões: Há importantes diferenças entre as capacidades funcionais relatadas pelo próprio idoso e seus cuidadores quando comparadas com a observação direta destas tarefas pelo enfermeiro, o que indica a necessidade de basear as ações e os cuidados muito mais na avaliação direta do que exclusivamente nos relatos dos clientes e de seus cuidadoresProspective, longitudinal quantitative study in elderly people and their proxies, of both genders, admitted at a geriatric ward of a school hospital, whose data collection was August 2013 to March 2014. Objective: to evaluate subjective and objective functional condition of elderly people admitted at a geriatric ward; among the reports of self care performance and their needs for help. Method: subjective and objective evaluations using the instrument Performance test of Activities of Daily Living (PADL), with 16 tasks associated to 3 items of Instrumental Activities of Daily Living (IADL). Results: Female gender was predominant among the elderly (32 - 58.2%) and the proxies (46 - 83.6%); clients´ age varied between 64 and 99 (x=80) years old and their proxies between 37 and 84 years old (x=58.7y); basic education was more frequent among the elderly (36 - 65.4%) and higher (18 - 32.7%) for their proxies. Regarding the family connection of proxies, 30 (54.4%) were daughters and 12 (21.5%) wives. In order to compare the subjective and objective functionalities to perform self care, it was calculated the Concordance Index (CI), which varied from 62 to 93%, whose Kappa was between 0.20 and 0.59. Both elderly people and their proxies referred performing tasks with or without help. However, on the objective evaluation it was detected greater need for help or incapability to perform a task. It must be highlighted that elderly people evaluated themselves a little better than their proxies. Discussion: elderly subjective and proxy subjective evaluations in comparison to objective ones, elderly responses for self care were confirmed in objective evaluation and the reports provided subjectively by their proxies. It was verified that the functionality level of elderly people in majority was level 3 (do it without help) for PADL daily life activities and IADL instrumental activities. Elderly subjective reports in comparison to objective evaluation, it can be seen that some elderly people perform their activities without help, others with help and the ones who don´t perform tasks by themselves required some kind of help. Subjective information reported by proxies was discordant in comparison to objective evaluation in some items of the instruments. Elderly people are more prone to evaluate themselves better than their proxies. Proxies reported that elderly people can perform their tasks, but in the objective evaluation it was not observed. Conclusions: there are important differences between the functional capacities reported by elderly themselves and their proxies when compared to the direct observation of these tasks by the nurse, which points to the need of actions and care more focused on the direct evaluation rather than reports by clients and their proxies
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Rydningen, Lene Christin. "Medicine Management and Administration : How might we improve patient safety through medicine management and administration in inpatient care units in somatic hospitals in Sweden and Norway?" Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-152356.
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Introduction
This thesis explores how we can increase patient safety through medicine management and administration in inpatient care units in somatic hospitals in Sweden and Norway by combining tools and systems which allows nurses to work safely, precicely, and efficiently whenever they are managing or administering medication to patients.
Background
Nurses have the formal, academic, and moral responsibility in medicine management and administration in hospitals (1). The nurse must ensure that the medication is given to the correct patient, that it is the correct kind of medication, correct form, correct strength, correct dose, correct administration method, and that it is given at the correct time (1). Regardless of these 7 points of control, adverse drug events still happen.
Methodology
Through a human centered design approach this thesis explores design challenges and opportunities to how we can improve the medicine managment and administration process within somatic hospitals in Sweden and Norway.
Result
The final design proposal, Memo, suggests an ecosystem which make all medication traceable by incorporating a closed loop medicine management approach, making information accessible and consistent across digital and physical platforms, and having a precise, accessible, and informative electronic medicine list. Memo eliminates risks of medicine errors by designing barriers within the system which make it harder for the nurse to make an error. The aim is to increase patient safety.
Memo is developed together with nurses and pharmacists from 3 different hospitals in Sweden and Norway.
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Gingi, Pelisa. "Factors associated with the psychological response of nurses’ victims of inpatients violence in a psychiatric facility for adults with intellectual disability in cape town." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4024.
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Background and Research Problem: It is well-known that nurses around the world are exposed to various forms of violence at their workplaces. In psychiatric facilities, many of these incidents are perpetrated by patients against nurses. There is a perception that the current legislation and regulations in the country do not adequately protect psychiatric nurses (health care workers in general) against workplace violence. The preliminary literature suggested that most quantitative studies on workplace violence in psychiatric facilities have concentrated on secondary and tertiary psychiatric hospitals looking at the prevalence, the association between demographic factors and violence behaviour, nurses‟
therapeutic responses, and the impacts on the quality of care. Studies on workplace
violence in a psychiatric facility for adults with intellectual disability in the country are limited. Secondly, it appeared from the preliminary literature review that similar studies have not looked at this phenomenon from the individual resilience perspective.Therefore, this study will seek to determine the factors associated with the psychological response of nurses‟ victims of inpatient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Aim: To determine factors associated with the psychological response of nurses‟ victims of in-patient violence in a psychiatric facility for adults with intellectual disability in Cape Town.
Objectives: To describe the (1) individual resilience of nurses working at a psychiatric facility for adults with intellectual disability; (2) psychological response of nurses‟ victims of in-patients‟ violence at a psychiatric facility for adults with intellectual disability; and (3) association between the individual resilience characteristics and the psychological responses of nurses victims of in-patients‟ violence in a psychiatric facility for adults with intellectual disability.Methodology: Descriptive-exploratory design using a quantitative approach was used.All categories of nurses (professional nurse, enrolled nurse and enrolled nursing
assistance) working at the psychiatric facility for adults with intellectual disability were eligible for the study. Convenient sampling was conducted to select 127 participants who met the inclusion criteria. Self-administered questionnaire was used to collect data. Data was analysed using the SAS V9.3 computer programme. Ethical clearance was obtained from University as well as approval from the management of the psychiatric facility prior to approaching the study participants.
Results: The results of the study showed high level of resilience among nurses on
Assessment of Resilience Scale (82.9%, n=104); nurses psychological responses to
violence were equally distributed between avoidance (mean =4.65 and SD=1.36),
intrusion (mean= 4.55 and SD=1.50), hyper arousal (mean=4.46 and SD=1.60) resulting in total mean of 13.67 (SD=4.14) on the revised Impact of Event Scale (IES-R). Measure of association between resilience and the impact of violence on the psychological wellbeing of nurses showed that nurses with high resilience score (82.9%, n=104) fitted the symptoms of PTSD on the IES-R. Spearman Rank correlations (r) analysis showed the total scores of IES-R (r=0.04, p=0.68), avoidance (r=0.01, p= 0.34), intrusion (r=0.08,p=0.34), and hyper-arousal (r= -0.002, p=0.97). Further research looking at the nurses‟ reliance and their responses using resilience theory is needed.Magister Curationis - MCur
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Crispin, Vivianne. "Information exchange between patients and nurses during routine nursing care in ward settings : a qualitative multiple case study." Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/21158.
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Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.
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Spivey, Justin, Heather Sirek, Robert Wood, Kalpit Devani, Billy Brooks, and Jonathan Moorman. "Retrospective Cohort Study of the Efficacy of Azithromycin Vs. Doxycycline as Part of Combination Therapy in Non-Intensive Care Unit Veterans Hospitalized with Community-Acquired Pneumonia." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/3177.
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The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.
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Baldini, Sonia Maria. "Avaliação das reações dos pais à internação do filho em unidade de terapia intensiva e desenvolvimento de uma proposta de apoio psicológico." Universidade de São Paulo, 2002. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-01062007-111724/.
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Objetivos: Realizar uma avaliação das reações dos pais à internação do filho em unidade de terapia intensiva e desenvolver uma proposta de apoio psicológico. Casuística: Foram entrevistados 48 pais em unidade de terapia intensiva pediátrica e 27 em unidade de terapia intensiva neonatal, além dos pais que participaram nos grupos de pais. Métodos: 1) Realização de entrevistas semi-dirigidas com os pais, utilizando questionários previamente elaborados, à admissão do paciente e durante sua internação; 2) Avaliação do nível de ansiedade dos pais à internação do filho, pela aplicação do Inventário de ansiedade traço-estado; e 3) Realização de grupos de pais em unidade de terapia intensiva pediátrica, com a participação de equipe multiprofissional. Resultados: Em ambas as unidades de terapia intensiva as reações mais freqüentemente citadas pelos pais ao início da internação foram de desespero e tristeza, e citaram as necessidades de apoio psicológico como as mais importantes neste momento. Os principais sentimentos relatados no decorrer da internação foram de preocupação, medo e tristeza, e a maioria dos pais em ambas as UTIs ficaram assustados com a aparência do filho. Os níveis de ansiedade mostraram-se significativamente elevados à ocasião da internação do filho, não havendo diferença entre os pais em UTI pediátrica e neonatal. O grupo de pais revelou-se uma técnica eficaz de apoio psicológico em UTI. Conclusões: Há necessidade de apoio psicológico aos pais de pacientes pediátricos internados tanto em UTI pediátrica como neonatal, pelo elevado nível de ansiedade, desespero e tristeza que apresentam à internação do filho. As entrevistas semidirigidas com a aplicação dos questionários propostos para 11 avaliação dos pais mostraram-se estratégias adequadas para a investigação do estado emocional desses pais e constituem formas eficientes de fornecer apoio psicológico durante a realização das mesmas. O grupo de pais possibilitou o contato direto com profissionais de diversas áreas, com disposição a escutá-los, valorizá-los, compreender seus sentimentos e esclarecer suas dúvidas. Permitiu o convívio com outros pais em fases diferentes da mesma situação, mobilizando recursos para lidar com o período crítico da doença e internação e o apoio no processo de luto do filho saudável para conseguirem um vínculo satisfatório com o filho doente. A questão da morte, as dificuldades com a equipe, a falta de apoio de familiares e outras questões extremamente angustiantes puderam ser ampla e abertamente discutidas nos grupos, trazendo esclarecimentos e alívio. A reunião com a equipe após os grupos mostrou-se de extrema importância para a uniformização de condutas, entendimento das reações dos pais, e discussões relativas ao relacionamento entre eles e a equipe. Em relação às entrevistas individuais semi-dirigidas, o grupo de pais mostrou-se uma estratégia complementar, já que os mesmos problemas e queixas são discutidos de formas diferentes nos dois tipos de intervenção.Objectives: Assessment of parents reactions to the admission of their child into an ICU and development of a proposal of psychological support. Sample: 48 interviewed parents in pediatric ICU and 27 in neonatal ICU were included besides the participants of the groups of parents. Procedures: 1) Semi-directed interviews were performed with parents, with the application of previously elaborated questionaires; 2) Assessment of the parents anxiety at the admission of the child in ICU, with the application of the State-Trait Anxiety Inventory; and 3) lead groups of parents were performed in pediatric ICU with the participation of multidisciplinary staff. Results: The most frequent reactions cited by the parents to the admission of the child in an ICU were despair and sadness. Moreover, psychological support was the most essencial need at that moment. The most important feelings cited during hospitalization were worry, fear and sadness, and most parents in both ICU were very scared of the appearance of their children. There was a significant increase in parents anxiety at the admission of the child, and there were no differences between the scores of parents anxiety in pediatric or neonatal ICU. The group of parents was a good technique of psychological support in ICU. Conclusions: Psychological support to parents of pediatric patients admitted to an ICU is necessary, because of high anxiety level, dispair and sadness that parents show at the admission of their child to an ICU. The semi-directed interviews with the appication of the proposed questionaires to the assessment of parents were good techiques for the investigation of the emotional state of these parents and constituted efficient ways of giving them psychological support. The group of parents permitted the direct contact with professionals of various areas, willing to listen to them, value them, understand their feelings and clarify their doubts. They permitted contact with other parents in different phases of the same situation, mobilizing resources for dealing with the critical period of the disease and admission, and giving support in the mourning process of the healthy child so that they could get a satisfactory attachment to the sick one. The subject of death, the difficulties with the staff, the lack of support from relatives and other highly anxious questions could be discussed during the group sessions widely, bringing clarity and relief. The meetings with the staff after the group sessions were very important to unify the procedures, understand the parents reactions, and discuss the relationship between them and the staff. In relation to the individual semi-directed interviews, the parents group revealed a complementary technique, as the same problems and complaints were discussed in different ways in both forms of intervention.
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Lee, Chin-Ling, and 李佳玲. "Characteristics of Hospital Medical Care Cost --- Inpatient Chemotherapy for Example." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/21631354947566364170.
Full textAbstract:
碩士臺中健康暨管理學院
健康管理研究所
93
Motive: Control of medical expense has always been a tough issue faced by developed countries altogether. A variety of payment system set up aims to effectively reduce the increase of medical expense. Cancer has been in the rank of ten major cause of death for several years. Thus, the ratio of medical expense for cancer treatment has been relatively high in the proportion of healthcare medical budget. In particular, according to the list recording the total ratio of individual inpatients, the frequency of cancer inpatients admitted and receiving chemotherapy ranks top four in the year of 90. Hence, proper and reasonable distribution on medical expense is a crucial subject to work on. Nevertheless, different hospitals implement their own management system, which may generate variations on the approaches of medical expense control. Purpose: The purpose of this study aims to discuss the condition in terms of how medical resources of chemotherapy are utilized while different cancer inpatients receive treatment from different hospitals with their own hospital characters. Subjects and Method: The participants of this study include cancer inpatients of lung cancer, breast cancer, and rectum cancer. The researcher, based on the number of times these cancer inpatients admitted to the hospitals and received chemotherapy, analyze and discuss the utilization of medical resources among various hospitals with different characters. T-test, ANOVA, and multiple regression are used as statistical measures. Results: The results show that age of cancer inpatients and degree of illness result into different utilization of medical resources. Provided that cancer inpatients, who suffer from higher degree of illness, stay more days in the hospital, it can cause the increase of such utilization. Moreover, presented from the study, the type, ownership, and regions of the hospitals generate influence on medical treatment expense. In terms of hospital type, the expense of medical center is apparently higher than that of the hospitals of other type. As for ownership, the expense varies due to different types of cancer disease. However, it is also shown that provided that clinics have evidence-based medical as guidelines, the characters of hospitals would not influence doctor’s behaviors. Hence, under such circumstance, the consistency of medical resource utilization is relatively high.
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De, la Rey Ella Stefani. "Attachment styles of children in an inpatient ward of a psychiatric hospital." Diss., 2006. http://hdl.handle.net/2263/23906.
Full textAbstract:
The aim of this study was to investigate the attachment styles of children between the ages of six and twelve years of age who were admitted as inpatients in a children’s ward of a psychiatric hospital. Attachment theory (Bowlby, 1997, 1998) proposes that children develop certain attachment styles towards their primary caregivers from birth through to three years of age, after which the styles remain relatively constant as can be seen through attachment behaviours later on in life. These attachment styles can be secure, insecure-ambivalent / anxious or insecure-avoidant (Ainsworth, Blehar, Waters&Wall, 1978). Green and Goldwyn (2002) also refer to a fourth category that was established through later research on attachment, named disorganised attachment. Psychiatric hospitalisation of a child implies the assumption of psychopathology and through institutionalisation, he or she is literally separated from the primary caregivers and inevitably placed in unfamiliar surroundings with strangers, making it an ideal setting to investigate attachment features. The researcher worked from the supposition that the mere fact of hospitalisation and implied pathology would thus point to insecure attachment styles in these children. A qualitative research design was implemented to gather information regarding the children’s attachment styles. Two projective techniques were used, namely the Children’s Apperception Test and the Picture Test of Separation and Individuation. Analysis of the information consisted of a first- and second-order process of thematic content analysis. The results yielded thirteen categories of experience. An extensive description of each category was provided, and the categories were then related to theory. The results obtained support previous research findings that found that institutionalised children tend to show more insecure attachment styles. The results from this study also indicated that these insecure attachment styles tend to be predominantly insecure-avoidant or insecure-disorganised.Dissertation (MA(Psychology))--University of Pretoria, 2007.
Psychology
unrestricted
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Ang, Neo Kim Emily. "Patient falls in acute care inpatient hospitals : a portfolio of research related to strategies in reducing falls." 2008. http://hdl.handle.net/2440/48333.
Full textAbstract:
Despite a myriad of studies on fall prevention, patient falls continue to be a longterm problem experienced by health care organisations world-wide. Falls impose a heavy burden in terms of social, medical, and financial outcomes, and continue to pose a threat to patient safety. Because the potential for a fall is a constant clinical safety issue in every health care organisation, protecting the patient from falls and subsequent injuries, and ensuring that the patient care environment facilitates, are fundamental aspects in providing quality care. Moreover, the current international focus on creating a culture of quality care and patient safety requires the implementation of fall prevention programs that decrease the risk of falls. As with other international health care organisations, the National University Hospital (where the principal investigator is working), has been challenged with the issue of how to prioritise and implement quality initiatives across all disciplines. Faced with persistent patient falls that affect care outcomes, fall prevention has been a priority initiative at the hospital since 2003. In response, a nursing task force was established in an attempt to resolve this problem. A root cause analysis undertaken by this task force revealed that the hospital protocol on fall prevention was outdated and not evidence-based. Furthermore, many nurses did not understand the importance of fall prevention, while the administration of the fall prevention program was instituted on an ad hoc basis rather than as a standard of care for all patients. The challenge for this task force, as with other health care professionals, was not only in finding an intervention that was effective, but also identifying who would benefit from its implementation. Although the need to apply current best practices to reduce patient falls is clear from the task force results, evidence of the effectiveness of fall prevention interventions in acute care hospitals is lacking in literature. In addition, there are no published studies on fall prevention in Singapore to support changes in nursing practices. Thus, it becomes apparent that research on fall prevention is greatly needed in Singapore so that an evidence-based fall prevention program can be developed. This topic coincides with the Doctor of Nursing course, which requires the student to gain knowledge through scholarly research on contemporary issues in nursing by undertaking two separate projects related to a single area of interest. Undertaking the two research projects on fall prevention in an acute care inpatient hospital as part of the doctoral studies provided an opportunity to address this deficit in a way that could raise awareness of the importance of fall prevention in Singapore hospitals. This research also provides a platform for the first body of research into fall prevention to be conducted within the Singapore health care environment, which is essential, as international studies are not always necessarily applicable to the Singapore context due to differences in educational preparation, skills-mix, organisational culture and nursing practices.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321300
Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008
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Ang, Neo Kim Emily. "Patient falls in acute care inpatient hospitals : a portfolio of research related to strategies in reducing falls." Thesis, 2008. http://hdl.handle.net/2440/48333.
Full textAbstract:
Despite a myriad of studies on fall prevention, patient falls continue to be a longterm problem experienced by health care organisations world-wide. Falls impose a heavy burden in terms of social, medical, and financial outcomes, and continue to pose a threat to patient safety. Because the potential for a fall is a constant clinical safety issue in every health care organisation, protecting the patient from falls and subsequent injuries, and ensuring that the patient care environment facilitates, are fundamental aspects in providing quality care. Moreover, the current international focus on creating a culture of quality care and patient safety requires the implementation of fall prevention programs that decrease the risk of falls.
As with other international health care organisations, the National University Hospital (where the principal investigator is working), has been challenged with the issue of how to prioritise and implement quality initiatives across all disciplines. Faced with persistent patient falls that affect care outcomes, fall prevention has been a priority initiative at the hospital since 2003. In response, a nursing task force was established in an attempt to resolve this problem. A root cause analysis undertaken by this task force revealed that the hospital protocol on fall prevention was outdated and not evidence-based. Furthermore, many nurses did not understand the importance of fall prevention, while the administration of the fall prevention program was instituted on an ad hoc basis rather than as a standard of care for all patients. The challenge for this task force, as with other health care professionals, was not only in finding an intervention that was effective, but also identifying who would benefit from its implementation.
Although the need to apply current best practices to reduce patient falls is clear from the task force results, evidence of the effectiveness of fall prevention interventions in acute care hospitals is lacking in literature. In addition, there are no published studies on fall prevention in Singapore to support changes in nursing practices. Thus, it becomes apparent that research on fall prevention is greatly needed in Singapore so that an evidence-based fall prevention program can be developed.
This topic coincides with the Doctor of Nursing course, which requires the student to gain knowledge through scholarly research on contemporary issues in nursing by undertaking two separate projects related to a single area of interest. Undertaking the two research projects on fall prevention in an acute care inpatient hospital as part of the doctoral studies provided an opportunity to address this deficit in a way that could raise awareness of the importance of fall prevention in Singapore hospitals. This research also provides a platform for the first body of research into fall prevention to be conducted within the Singapore health care environment, which is essential, as international studies are not always necessarily applicable to the Singapore context due to differences in educational preparation, skills-mix, organisational culture and nursing practices.Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008
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Emerson, P. "Inpatient catchment populations of public sector hospitals in Natal/KwaZulu." Thesis, 1988. http://hdl.handle.net/10413/7620.
Full textAbstract:
The Natal/KwaZulu Health Services Liaison Committee (HSLC) has been established to co-ordinate health care delivery in Natal and KwaZulu. This body has defined eight geographical Health Planning SubRegions (HPSRs) (Annexure E) of which each is a unit for planning and prioritising health service delivery in respect of its resident population. The HSLC considered that a study of inpatient catchment populations of hospitals under the control of the statutory Health Authorities would provide information which was essential to the planning processes of those authorities. The Department of Community Health was requested by the HSLC to undertake this study. A previous study, co-ordinated by the Department of Community Health (September 1987), dealt with "Outpatient Catchment Populations of Hospitals and Clinics in Natal and KwaZulu" (E DADA). No previous similar study on inpatients has been undertaken in South Africa. The expansion and improvement of basic services - particularly health care, water supply and basic education - should be perceived as essential elements in a strategy designed to enable all residents of a region to meet basic human needs and enjoy a minimum standard of living. Thus increased efforts have to be made to utilise health care resources effectively and efficiently and to plan future facilities carefully with regard to accessibility and appropriateness . This will require careful and objective management by all Authorities responsible for delivering health care to the people of Natal and KwaZulu. Accurately predicting the utilisation of hospital inpatient facilities is critical to efficient resource allocation in Health Services management. Catchment population studies and cross boundary flow characteristics provide valuable information on the utilisation of available facilities. This information is of value in the development of existing health services and the planning of additional health facilities with regard to size, situation and service type. Studies in other areas on utilisation of health service facilities, suggest that distance strongly influences hospital choice in both rural and metropolitan areas (Inquiry 1984 21(1) : 84-95) and this could explain some of the findings of this study with regard to cross boundary flow between Magisterial districts and HPSRs. For the efficient planning of resources, particularly with regard to situation and size, knowledge of the population size and demographic composition are important, as is a knowledge of the profile of disease in a community. The objectives of this study are directed to making available this information to each of the health authorities responsible for health care delivery and thus, to facilitate the management process.Thesis (M.Med.)-University of Natal, Durban, 1988.
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AbuDagga, Azza. "A multilevel analysis of organizational and market predictors of patient assessments of inpatient hospital care." 2009. http://etda.libraries.psu.edu/theses/approved/WorldWideIndex/ETD-4111/index.html.
Full text
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張湘怡. "The female nurses' space experiences in inpatient care units of Changhua christian hospital in Taiwan." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/75803059950273492997.
Full text