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1
Ottosson, Ulrika, and Siri Rönnlund. "Implementation of a Mobile Healthcare Solution at an Inpatient Ward." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279145.
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Healthcare is a complex system under great pressure for meeting the patients’ needs. Implementing technology at inpatient wards might possibly support healthcare professionals and improve quality of care. However, these technologies might come with issues and the system might not be used as intended. This master thesis project investigates how healthcare professionals communicate at an inpatient ward and how this might be affected by implementing a Mobile Healthcare Solution (MHS). Further, it sought to question why healthcare professions might, or might not, use the MHS as a support of their daily work and what some reasons for this might be. Research methods were of qualitative approach. Field studies were performed at an inpatient ward and further, two healthcare professionals were interviewed. Grounded Theory (GT) was chosen as a method to process the data and obtain understanding for communication at the inpatient ward. The results showed that healthcare professionals communicate verbally, written and by reading, using different tools. The most prominent ways of communication were verbally, where it was common to report or discuss about a patient. The means for communication did not get drastically affected by implementing the MHS and reasons for this were of social, technical and organizational types. Some reasons for not using the MHS were habits and due to healthcare professionals perceiving the MHS as more time consuming than manual handling. However, a specific investigation of whether this might affect the usage of the MHS is yet needed
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Lloyd-Evans, B. "Acute inpatient mental health wards and inpatient alternatives : a quantitative comparison of the care provided." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/19216/.
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Background: Literature indicates widespread dissatisfaction with UK acute psychiatric wards. Patients report boredom and insufficient time with staff. Residential alternatives to acute wards have been developed. Aims: 1) To review literature for the effectiveness and acceptability of alternatives 2) To identify or develop measures of content of care for acute inpatient and residential crisis services 3) To compare the content of care at alternatives and standard services and understand its relationship to patient satisfaction. Hypotheses tested were that alternatives provide greater total care, more social and psychological interventions but fewer physical and pharmacological interventions than standard wards. Method: A systematic review of studies evaluating alternatives was conducted. Measures of content of care were reviewed. New measures were developed (CaSPAR, CaRICE and CCCQ-P) and their psychometrics explored. Data were collected from 4 alternatives and 4 standard services using CaSPAR (n=224), CaRICE (1 recording week per service), CCCQ-P and CSQ (n=314). The relationship of service type, patient characteristics and CCCQ-P scores to patient satisfaction was explored. Results: The limited current evidence does not contra-indicate alternatives and suggests patient satisfaction may be greater at community alternatives than standard wards. No study hypotheses were corroborated. Sub-group analysis indicated community alternatives provided more psychological and less physical and pharmacological care than standard wards. All CCCQ-P variables were significantly associated with patient satisfaction. Patient satisfaction was greatest at community alternatives. It remained significantly greater at alternatives than standard wards after adjusting for CCCQ-P variables. Discussion: Community alternatives are a promising service model. Their greater acceptability than standard wards was not explained by measured differences in care. Intensity of care may influence patient satisfaction more than the types of intervention provided. Increasing staff-patient contact should be an aim for alternative and standard services. There may be differing, valid perspectives about what constitutes care: multi-methods assessment is required.
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Nord, Catharina. "The visible patient. Hybridity and inpatient ward design in a Namibian context." Doctoral thesis, KTH, Infrastructure, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-3671.
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Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced.
This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment.
The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded.
The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated.
An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.
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Collins, Antony. "Exploring psychological processes in reflective practice groups in acute inpatient wards." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10342/.
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Section A consists of a critical review examining the research evidence relating to the effectiveness of reflective practice groups for staff in psychiatric inpatient settings, and the role of psychologically trained practitioners in providing facilitation using psychological formulations. Section B. The role of applied psychologists working in inpatient services is developing with a greater emphasis on providing support and consultation to staff teams. The research suggests that psychologically trained practitioners who facilitate reflective practice groups using psychological formulations can assist staff in developing a deeper understanding of patients’ difficulties, with the potential for improved treatment outcomes. This study aimed to address some of the gaps in the research by exploring the experiences of acute psychiatric inpatient ward staff attending reflective practice groups facilitated by psychologically trained practitioners. Using semi-structured interviews, nine multidisciplinary staff from four acute wards participated in the study. Grounded theory methodology was applied to investigate how staff experienced, processed, and operationalised psychological knowledge in their clinical practice. The results suggested staff increased their psychological understanding through a process of guided reflection, development of theory-practice links, and validation. This enhanced a capacity for mentalization, which generated a more compassionate and empathic stance. The clinical, theoretical and research implications are presented. Section C presents a critical appraisal of the research process.
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Nyberg, Tove, and Madeleine Nilsson. "Experiences in the care of malaria infected children in a pediatric inpatient ward in Tanzania." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192595.
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Background: The number of children under the age of five who dies of malaria per thousand births is sixteen in Tanzania. Even though improvements have been made there are still many challenges in the care of malaria infected children. Aim: The aim of this study was to investigate the experiences that nurses and relatives to malaria infected children have regarding the pediatric malaria care at Kilimanjaro Christian Medical Centre, Tanzania. Method: Semi structured interviews were conducted among three nurses and three relatives to malaria infected children within a pediatric ward at Kilimanjaro Christian Medical Centre, Tanzania. The interviews were recorded, transcribed and then analysed. Result: All the nurses agreed that the major challenge in the care of malaria infected children is the lack of knowledge from the relatives about prevention of malaria. This results in a lack of adherence among the relatives concerning prevention. The relatives agreed about their lack of knowledge about malaria and they wished for more education. They also considered the workload to be an issue for the nurses at the ward. The availability for the child to get treatment depends whether they are from a rural area or city. Conclusion: To continue the fight against malaria among children it is of great importance to focus on the relatives lack of knowledge about malaria, the workload issue and the long distance to hospital.
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Law, Naomi. "Individual and organisational challenges for personalised care on an inpatient ward : the staff team perspective." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12793/.
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Criticism of NHS acute psychiatric care has been high within patient experience research, compounded by critical press coverage of inpatient wards. Government policy requires staff to deliver compassionate, personalised care, but there is little research considering staff’s perspectives and experiences of the work. This study aimed to construct a grounded theory of acute psychiatric staff’s experiences, with particular attention to what might facilitate or block compassionate patient care. Semi-structured interviews were conducted with ten ward staff (three men, seven women) across a range of disciplines. Data were analysed using constructivist grounded theory. The model constructed captures the dynamic interactions between eleven categories: Being in a chaotic environment, Feeling limited, Struggling to improve without support, Building patient relationships, Enjoying the work, Staying vigilant, Taking an emotional toll, Putting up a barrier, Supporting each other, Seeing tensions and differences, and Acting as one team. The study concluded that staff described feeling motivated to engage with patients but restricted by practical and emotional demands. While support was provided by colleagues and formal structures, staff could not always make full use of them. Suggestions for future research and clinical practice include changes to practical demands on staff, as well as attitudes towards reflective practice.
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Obi-Udeaja, Jane. "Patient centred physical restraint : a case study of two NHS mental health inpatient wards." Thesis, Middlesex University, 2016. http://eprints.mdx.ac.uk/19415/.
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The nursing staffs who work in the NHS mental health in-patient wards sometimes physically restrain their patients. Whilst there are studies that have looked at the different aspects of the use of physical restraint, none has specifically investigated the experiences and perceptions of the staff on the use of the patient centred model of physical restraint in managing untoward incidents in the setting. As a trainer on the General Services Association model of physical intervention, I worked collaboratively with staff from two NHS mental health inpatient wards, users of physical restraint techniques, to explore their experiences, perspectives and indeed the effectiveness of the patient centred approach to physical restraint in their respective wards. Following a review of the relevant literature, the choice of a qualitative type of investigation based on the unmodified Husserlian phenomenological framework was made. To complement this style of investigation, focus group and semi-structured interviews were used to collect primary data from the study participants. Phenomenological recommendations were adopted in the analysis of data. Six core themes including: physical restraint of a patient is for safety and patient centred practices during restraint process emerged from the huge data. The findings confirmed that patient centred approach to physical restraint was effective with the patient groups in the participating wards. Participants emphatically stated that the model enabled a quick retrieval of the therapeutic relationship with their patients. This is in keeping with the ethos of mental health care which is reliant on therapeutic relationship with the patient.
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Fausset, Ann. "Current psychological interventions on acute inpatient wards : an exploration of service users' experience of mindfulness." Thesis, Staffordshire University, 2015. http://eprints.staffs.ac.uk/2240/.
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This thesis focuses on understanding psychological interventions in acute inpatient services. A review of the literature highlights some benefits of psychological interventions on acute wards both for service users (SUs) enhancing their wellbeing and acquiring new learning and also economically, reducing admissions and the number of inpatient beds. It is acknowledged that research in this area is limited and therefore to better understand SUs experience of psychological interventions on acute inpatient wards, a study was completed focusing on SUs experience of a mindfulness intervention. Using Interpretative Phenomenological Analysis (IPA), the resultant themes included a process towards self-actualisation, mentalization, locus of control and cognitive strategies. These findings are discussed in relation to clinical implications for health care professionals on acute inpatient wards. It is highlighted that SUs would benefit from having choices of interventions such as mindfulness, and that these interventions are delivered as a ward ethos in which both staff members and SUs engage in the practice of mindfulness. The researcher mindfully reflected on the research journey considering reflexivity, epistemology and ethical issues.
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Addison, Victoria Nola. "The use of repertory grids to explore nursing staff's construal of adult service users admitted to a psychiatric inpatient ward." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/the-use-of-repertory-grids-to-explore-nursing-staffs-construal-of-adult-service-users-admitted-to-a-psychiatric-inpatient-ward(c25a0605-d578-46a8-99ea-013af6bdb1fa).html.
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Acute inpatient mental health nursing staff provide mental health care for individuals when they are most vulnerable and unwell. The therapeutic relationship can facilitate positive changes and recovery for individuals. Therefore, understanding nursing staff’s attitudes is paramount. In this thesis, the attitudes of nursing staff towards those experiencing mental health difficulties was explored. In the systematic review, the attitudes of European nursing staff supporting those experiencing severe mental health difficulties were synthesised and evaluated. A total of 14 cross-sectional studies met the inclusion criteria. The review identified that the role of personal experiences of mental health difficulties through friends or family members was shown to elicit more positive attitudes. Overall attitudes amongst nursing staff were varied, and factors that influenced these attitudes were less clear and consistent. The limitation of using cross-sectional questionnaires to explore attitudes was also discussed. Moreover, recommendations regarding further research priorities as well as clinical implications were identified. Nursing staff’s attitudes towards adults who were either ‘informal’ voluntary clients or those who had been admitted under the Mental Health Act (1983) to an inpatient ward were explored in the empirical paper. The attitudes of nursing staff have the potential to impact on the development of therapeutic relationships and therefore upon treatment outcomes. Repertory grid interviews were completed with twelve nursing staff. All staff made critical judgements about some of their clients; however, staff who used more dimensions to construe clients made less clear distinctions between clients and non-clients. The findings highlight the need for support mechanisms that enable staff to formulate clients’ difficulties and explore the complexity of interactions. The implications of these results are discussed, as well as future research directions. The final paper consists of a critical reflection of the research and the research process. This includes an evaluation of the decision making processes and discussion of the strengths and weaknesses of this research.
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Stenhouse, Rosemary Clare. "Unfulfilled expectations : a narrative study of individuals' experiences of being a patient on an acute psychiatric inpatient ward in Scotland." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/4071.
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This study examines people’s experiences of being a patient on an acute psychiatric inpatient ward in Scotland. Within the existing research base few studies focus on the patient’s experience of acute psychiatric inpatient care, and none of these is set in Scotland. Those that do, indicate that the patient experience of acute psychiatric inpatient care is often negative. The theoretical perspective of this study conceptualises experience as represented in narrative form, thus the data take the form of narratives. Thirteen participants were recruited through the acute ward. Each participant participated in two unstructured interviews focussed on gathering narratives of their experience. Data analysis was holistic, guided by Gee’s (1991) socio-linguistic theories. This holistic analysis culminated in the presentation of each participant’s narrative in poetic form. From the holistic analysis I identified three themes - help, safety and power - that were evident in the analyses of all participants’ interviews. The theme of help represents participants’ expectations that they will receive help on the ward, and their experiences of trying to get this help. Safety represents participants’ expectations pertaining to the ward’s function in keeping them safe, their experience of threat and strategies to keep safe. The theme of power represents participants’ experiences of power relations within the acute ward. I conclude that participants’ experiences of being a patient on the ward are characterised by feelings of frustration, concerns about safety, and the perceived need to focus on self-presentation as they attempt to reach their desired goal of discharge.
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Campbell, Roslyn. "Service attachment : the relative contributions of ward climate perceptions and attachment anxiety and avoidance in male inpatients with psychosis." Thesis, University of Leicester, 2009. http://hdl.handle.net/2381/31255.
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Part One: Literature Review.;Title: The Influence of Ward Atmosphere on Male Inpatients with Psychosis.;The purpose of this review was to examine the literature relating to the influence of ward atmosphere on inpatients with a diagnosis of psychosis. A systematic search strategy was used to identify the relevant literature. A methodological critique and data synthesis of all studies fulfilling the inclusion criteria was then conducted. Nineteen studies in total were critically evaluated. The results highlighted that the ward atmosphere can have a positive impact on patient outcomes such as psychotic symptomatology, mood, attitude, and more general functioning, when it is enhanced to better suit the needs of those with psychosis. Furthermore, many studies highlighted that an ideal ward atmosphere for individuals with a diagnosis of psychosis is calm and supportive and has low levels of "anger and staff control". However, many of these studies had their own limitations, such as small sample sizes and lack of longitudinal studies. More research is needed within this area, particularly with regards to more UK based longitudinal studies with larger sample sizes.;Part Two: Research Report.;Title: Service Attachment: The Relative Contributions of Ward Climate Perceptions and Attachment Anxiety and Avoidance in Male Inpatients with Psychosis .;Present literature suggests that the relationship between mental health services and their clients is becoming increasingly important, particularly since current thinking pertains to the idea that mental health care institutions can represent a positive attachment figure for inpatients. Service attachment relates to mental health services' ability to meet the attachment needs of patients through the provision of a "secure base", which the attachment literature suggests should be the prime function of mental health services. This "secure base" provision is an important consideration, particularly for forensic inpatients where there is a predominance of insecure attachment styles, fragmented attachment histories, and frequent episodes of distress related to their diagnosis of psychosis. The purpose of the current cross-sectional study was to assess whether inpatient perceptions of the ward climate, or their level of attachment anxiety and avoidance, had a greater contribution to their attachment to a service. Male inpatients with a diagnosis of psychosis (N = 76) residing in four regional Medium Secure Units completed questionnaire measures of service attachment, attachment style, and ward climate. Variables were analysed using Pearson product-moment correlations and hierarchical multiple regressions, controlling for negative affect. Results indicated that perceptions of the ward climate contributed more significantly than attachment anxiety and avoidance to service attachment. Furthermore, the element of the ward climate relating to positive therapeutic relationships between staff and patients was more contributory to service attachment over other aspects of the ward climate. The results also highlighted a strong influence of state negative affect on all the measures within the current study highlighting that negative affect should be considered as a main variable in future research rather than solely as a control. Clinical implications relating to the importance of considering the ward environment in inpatient settings and the role of staff supervision and training is discussed.;Part Three: Critical Appraisal.;A reflection on the overall research project is provided. Issues relating to gaining access to and working with this population are discussed.
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Malgas, Fikile Nelson. "Exploration of nurses' experiences of the assessment and management of patients at risk of absconding from an acute psychiatric ward in the Western Cape." University of the Western Cape, 2017. http://hdl.handle.net/11394/5682.
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Magister Curationis - MCurUnlawful absence of patients from the acute psychiatric ward increases concern on the part of the professionals responsible for their care. Patients who abscond from psychiatric hospitals represent a risk of potential harm to patients or the general public. Consequences of absconding may include physical harm and prolonged treatment time, as well as considerable economic cost to the family and government. The aim of the study was to explore and describe the nurse's experiences of assessment and management for patients at risk of absconding from an acute psychiatric ward in the Western Cape. A qualitative approach using an exploratory descriptive design was applied to conduct this study. The target population was mental health nurses working in acute psychiatric wards where patients were at risk of absconding. A sample of ten (n=10) mental health nurses was purposively selected to participate in the study. Semistructured interviews were used to collect the data from participants. Data collection continued until data saturation was reached (until no further new information emerged). Data was analysed manually by coding, categorizing and identifying similar patterns. Trustworthiness of the study was ensured through addressing the confirmability, transferability; credibility and dependability. Ethics approval was obtained from the University Research Ethics Committee and Ethics Committee of the Department of Health and the selected psychiatric hospital. The ethical principles of the right to self-determination, withdrawal from the research study, privacy, autonomy and confidentiality, fair treatment, protection from discomfort and harm, and obtaining informed written consent were adhered to. Three themes emerged from the data: risk assessment, risk management, and increased observations. The results of the study was discussed with relevant recent literature evidence. The qualitative research is limited to few study sample size, and the results cannot be generalized to other similar population.
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Burger, Leigh-Ann. "Music therapy groups for adolescents in oncology inpatient wards : the affordances of vocal improvisation for the expression of social resilience." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/63818.
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This dissertation is a qualitative study of how vocal improvisation within music therapy groups may afford the construction of social resilience for in-patient adolescents in oncology wards. The study was conducted at the Pediatric Oncology Unit at the Steve Biko Academic Hospital in Pretoria. The case study involved six daily group music therapy sessions, with four to eight participants. The primary music therapy technique was vocal improvisation to assess how the participants perform themselves as resilient (or not). Excerpts of video recordings were analyzed through Gee’s (2005) suggestion for discourse analysis. Session notes were written as an additional data source to contextualize the excerpts. Through discourse analysis, four primary discourses were identified: participant as patient, participant as adolescent, cultural adolescent, and participant as Hip-hop musician. These enabled the participants to explore their performance of selves in various ways. It was concluded that vocal improvisation in group music therapy enabled the expression of lack of resilience, as it received those feeling less resilient and provided them with safety and containment. It also offered the participants a means of instant coping within the various discourses that were identified. Vocal improvisation in this context also afforded the participants a space to adapt to their challenges as they explored various types of participation by learning from past experiences/ways of being, and adjust accordingly. Finally, the participants could transform through the changing relationships within the group itself, and how these social changes offered a social environment that afforded the resilience of the whole group.Mini Dissertation (MMus)--University of Pretoria, 2017.
Music
MMus (Music Therapy)
Unrestricted
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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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Goulding, Lucy. "The quality and safety of healthcare provided to hospital inpatients who are placed on clinically inappropriate wards." Thesis, University of York, 2011. http://etheses.whiterose.ac.uk/2400/.
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Background: Almost all NHS hospitals regularly place patients on wards that are not clinically appropriate if there are no beds available on the correct specialty ward. Such patients are commonly called outliers. Approximately one in ten NHS inpatients experience an adverse event that causes them harm as a direct result of the care they receive while in hospital. It was hypothesised that placement on a ward that is not clinically appropriate for patients’ needs could act as an underlying (latent) condition which may increase patients’ susceptibility to adverse events. Methods: A descriptive quantitative study of the outliers and other inpatients in a single large NHS Foundation Trust was conducted using routinely available data. The aims were to investigate: the trend of outliers over the course of one year, age, gender, specialty, internal transfers between wards, length of stay in hospital and mortality. Two separate qualitative interview studies were conducted at the Trust to ascertain NHS staff members’ and patients’ perceptions and experiences of the quality and safety of care received by outlying patients. Results: Medical and elderly outliers increased over the winter months. Outliers were transferred between wards a significantly greater number of times than other inpatients. Multivariate analyses demonstrated no differences in age, gender, or mortality; however, outliers stayed in hospital significantly longer than other inpatients and outliers were significantly more likely to come from medicine than from any other specialty. Both staff and patients identified a number of factors which may contribute to healthcare errors experienced by outlying patients. Placement of patients on clinically inappropriate wards creates competing demands on staff members’ time and consequently results in delays, poses a number of communication barriers, compromises input from knowledgeable staff, may provide an unsuitable ward environment, and can be inappropriate for individual patients’ needs. Conclusions: The placement of patients on clinically inappropriate wards is a specific patient safety concern and constitutes a latent condition which may expose patients to a number of contributory factors that underlie adverse events. The quality of care may be compromised as outliers are often prioritised beneath other inpatients.
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Selam, Hail Lillet, and Annika Lembrin. "Patienters upplevelser av vården på psykiatriska vårdavdelningar : en litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6736.
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Bakgrund: Inom psykiatrisk vård är det viktigt att respektera patientens personliga förväntningar och mål för att uppnå goda behandlingsresultat och för att patienterna ska känna sig tillfreds med den vård de erhåller. Sjuksköterskan bör underlätta för patienter att kommunicera om sina besvär, stödja patienten att analysera destruktivt beteende, stödja patienten att skapa en normal daglig livsföring samt främja patientens integritet och egenvård. Trots detta upplever inte patienterna att detta uppfylls alla gånger. Syfte: Syftet med denna litteraturöversikt var att undersöka patienter med psykisk ohälsa med fokus på deras upplevelser av vården på psykiatriska vårdavdelningar. Metod: I denna litteraturöversikt har författarna använt tio vetenskapliga artiklar för att besvara syftet. Dessa har granskats för att förstå skillnader och likheter och sedan delats in i teman. Resultat: Tre teman och tre underteman påvisades i denna litteraturöversikt. Ett tema var patienters upplevelser av att bli eller inte bli behandlad med respekt med undertemana patienters upplevelser av stigmatisering samt patienters upplevelser av vårdande miljö. Det andra temat var upplevelser av personalens förhållningssätt med undertemat patienters upplevelser av vårdande relationer. Det tredje och sista temat var patienters upplevelser av trygghet. Diskussion: I diskussionen diskuterar författarna patienters upplevelser på psykiatriska vårdavdelningar samt hur dessa påverkar dem. Författarna kom fram till fyra områden; patienters upplevelser av maktlöshet vid stigmatisering, vårdandets och miljöns påverkan på känslor av trygghet, självbestämmandets betydelse samt betydelsen av delaktighet. Dessa områden diskuterades och jämfördes med befintlig forskning och knöts an till Phil Barkers tidvattenmodell.Background: In psychiatric care, it is important to respect the patients’ personal expectations and goals in order to achieve good treatment outcomes and to make patients feel satisfied with the care. The nurse should help patients to communicate about their inconveniences, support the patient to analyze destructive behaviors, support the patient to create a normal daily life routine and promote patients’ integrity and self-care. However, patients do not experience this in psychiatric care. Aim: The aim of this literature review was to explore patients with mental illness focusing on their experiences of care in psychiatric care units. Method: In this literature review the authors used ten scientific papers to answer the aim of the review. These articles have been examined to understand differences and similarities and then the authors performed a thematic analysis. Results: Three themes and three subthemes were identified in this literature review. The first theme was patients’ experiences of being or not being treated with respect with the associated subthemes patients’ experiences of stigmatization and patients’ experiences of the health care environment. The second theme was the experience of the staff's attitude with the associated subtheme patients’ experiences of caring relationship. The third and last theme was patients’ experiences of safety. Discussion: The authors discussed patients' experiences in psychiatric care units and how these experiences affect the patients. The discussion emphasized four areas; patients experiences of powerlessness in stigmatization, the healthcare’s and the environment's impact on feelings of safety, the importance of self-determination and the importance of participation. These areas were discussed and compared to existing research and also linked to Phil Barker's tidal model.
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Crona, Cecilia. "Sjuksköterskors erfarenheter av KBT i samtalet i psykiatrisk heldygnsvård : Utifrån manualbaserad KBT." Thesis, Röda Korsets Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-4015.
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Background: It has been under discussion in Sweden that the psychiatric inpatients ward is in the need of developing more content and structure. Earlier science shows that implementation of new conversations methods has been appreciated and developing for both nurses and patients. There is also obstacle for nurse`s to prioritize time for conversations with their patients. Aim: The aim was to explore nurse`s experiences of using a manual based CBT in conversations with patients in psychiatric inpatient ward. Method: Research design was interviews with qualitative approach and thematic analysis, inductive approach. Six nurses who worked in a psychiatric inpatients ward were interviewed. Results: The results of the study were summarized in to two main themes; Feelings in work as a nurse and the nurse in the professional role. Six under themes was conducted into the two mentioned main themes. Its presenting feelings connected to these conversations with CBT methodand about the professional working role. It was described useful in the daily work and agood support for the patient recovery, person-centered treatment and difficulties associated to the implementation of the new work. Conclusion: Cbt makes it possible to make in dept-care relationship, strengthens patients' recovery and provides structure for the conversation which also requires support and adaptation for making it useful in the daily work.Bakgrund: Det har diskuterats i Sverige om att den psykiatrisk heldygnsvården är i behov av utveckling vad gäller innehåll och struktur. Tidigare forskning har visat att införandet av samtalsmetoder har varit uppskattat och utvecklande för både sjuksköterskor och patienter. Det finns också hinder för sjuksköterskor att prioritera tid för samtal med patienter. Syfte: Syftet med denna magisteruppsats var att utforska sjuksköterskors erfarenheter av att använda sig av manualbaserad KBT i samtalet med patienter i psykiatrisk heldygnsvård. Metod: Designen var intervjustudie med kvalitativ ansats och tematisk analys med induktiv approach. Sex sjuksköterskor intervjuades och de var yrkesverksamma på psykiatriska heldygnsvårdsavdelningar. Resultat: Resultatet presenteras i två huvudteman; Känslor i arbetet som sjuksköterska och sjuksköterskan i sin professionella roll. Sex undertemandelades in under de två huvudkategorierna. Det presenteras känslor kopplade till sjuksköterskans arbete med KBT metoden i samtalet likväl som det handlade om den professionella yrkesrollen. Det beskrevs som hjälpsamt för patienters återhämtning, personcentrerat bemötande samt vissa svårigheter kopplat till det nya arbetssättet. Slutsats: KBT möjliggör fördjupad vårdrelation, stärker patienters återhämtning och ger struktur för samtalet. Vilket ocksåbör backas upp med stöd omkring införandet och med viss anpassning för att det skall bli användbart i det dagliga arbetet.
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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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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.
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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
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Chou, Huang-Chih, and 周煌智. "Violent Behavior Incidence in Psychotic Inpatients and Related Risk Factors Including Ward Crowed Environment." Thesis, 1997. http://ndltd.ncl.edu.tw/handle/71001952601830022284.
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WANG, YUN-CHUN, and 王允駿. "The Action Research of AAC for Improving Communication Ability of Conscious Tracheostomized Inpatients in Respiratory Care Ward." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/v2tf36.
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碩士國立臺北護理健康大學
語言治療與聽力研究所
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The study aimed to investigate the results of enhancing communication ability of conscious tracheostomized inpatients in respiratory care ward by applying augmetative and alternative communication (AAC). The action research method was used in the study. Researcher investigated the communication needs and communication problems of participant with observation and interview. Then researcher used indivisual AAC intervention plans for participant to solve the communication problems. The findings of the study were as follows: 1. The communication needs of participant were usually communicating physical problems and daily needs. 2. The main communication problem of participant was speech limitation due to cuff inflated. 3. After the intervention, participant could use AAC to communicate messages without cues. The messages were in correct grammar. Communication rate was increased. Participants could convey more messages. It approved that the communication ability of participant was enhanced. Therefore, the study integrates the findings and trys to provide a suitable AAC intervention process for conscious tracheostomized inpatients in respiratory care ward. It can provide to hospital staffs and researchers for clinical use.
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Chen, Wei. "Simulation of 48-Hour Queue Dynamics for A Semi-Private Hospital Ward Considering Blocked Beds." 2016. https://scholarworks.umass.edu/masters_theses_2/317.
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This thesis study evaluates access to care at an internal medicine unit with solely semi-private rooms at Baystate Medical Center (BMC). Patients are divided into two types: Type I patient consumes one bed; Type II patient occupies two beds or an entire semi-private room as a private space for clinical reasons, resulting in one empty but unavailable (blocked) bed per Type II patient. Because little data is available on blocked beds and Type II patients, unit-level hospital bed planning studies that consider blocked beds have been lacking. This thesis study bridges that gap by building a single-stream and a two-stream discrete micro-simulation model in Excel VBA to describe unit-level bed queue dynamics at hourly granularity in the next 48-hour time horizon, using historical arrival rates and census-dependent discharge rates, supplemented with qualitative results on complexity of patient-level discharge prediction. Results showed that while we increase additional semiprivate beds, there was notable difference between the traditional single-stream model and the two-stream model concerning improvement in bed queue size. Possible directions for future research include patient-level discharge prediction considering both clinical and nonclinical milestones, and strategic redesign of hospital unit(s) considering overflows and internal transfers.
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VALEŠOVÁ, Hana. "Společný ošetřovatelský lůžkový fond z pohledu sestry a managementu." Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-175391.
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Merged nursing inpatient ward is in the last few years becoming a trend of smaller, but also medium-sized hospitals. Due to the restructuring of beds of acute inpatient care in the Czech Republic, separate inpatient wards are merged to one joint ward, in the context of surgical as well as internal medicine. Merged inpatient ward is a combination of various disciplines (specialisms) of inpatient care under one senior consultant, or there is a common nursing ward, where senior consultants of individual disciplines are retained, while nursing care is merged. The main reason for the establishment of a merged inpatient ward is the optimization of beds and the related effective use of bed capacity in connection with an effort to preserve access to health care. The aim of the thesis Merged Nursing Inpatient Ward from the Perspective of Nurses and Management was to evaluate the contribution of a merged nursing inpatient ward, to identify the reasons for the project and the complications that accompanied the project. This research should analyze the problems in nursing care in connection with the origination of the project, to assess the demands of nursing on the ward and map errors in the field of nursing care in the context of the realization of the project. The thesis should evaluate interdisciplinary collaboration and map the occurrence of conflicts in a multidisciplinary team. During the survey it was found that the main reasons for the project were the financial savings associated with the restructuring of acute care beds in the Czech Republic. The establishment of a merged nursing inpatient ward helped the hospital to keep some expertise and it unified nursing care of the separate wards. In connection with the establishment of a joint nursing care, some complications and disadvantages that accompanied the project initially were analyzed. The survey showed how sensitively employees responded to the major change in the organization and how the cooperation between superiors and subordinates functioned. The study analyzed in what form the selection of employees for a common bed fund was realized and whether managers themselves could choose subordinates for their departments. One part of the research was the evaluation of the quality of nursing care on the merged inpatient ward, which showed that the establishment of the project did not have a negative impact on the quality of nursing care. In contrast, nursing care was united and there was also unified organization of nursing on the ward. The research evaluated the feedback from the subordinates to the top managers which was implemented through meetings and sessions. The survey refers to the greater workload on nurses in the working process on the merged ward. The origin of the project had an impact on the creation of new multidisciplinary teams and interdisciplinary collaboration. The project of a joint nursing inpatient ward was realized that the hospital can continue to provide quality health services to all patients. Research has shown that although the project had certain disadvantages and complications, it was certainly beneficial for the organization. The conclusions of the thesis may be presented in seminars, conferences and may be offered to professional journals for publication. The results of the research can help organizations that are going to realize the project of merged nursing inpatient ward.