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1
Axelsson, Henrik. "Kriminalitetens geografi : vardagsbrottslighetens spatiala fördelning i Borlänge." Thesis, Högskolan Dalarna, Kulturgeografi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:du-3352.
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The aim of this thesis is to describe and analyze the geographical distribution of everyday criminality in the town of Borlänge during the year 2002 and to analyze which measures to be taken in the physical social planning to decrease this everyday criminality there. The term everyday criminality is here to be understood as those categories of crime that appear most frequently in the records of reports to the police every year. Here two kinds of crime have been in focus, thefts from cars and office burglary.In fulfilling this aim two main questions have been answered. The first one is how the everyday criminality was distributed geographically in the town of Borlänge during the year 2002. The second one is which measures to be taken in the physical social planning to decrease this everyday criminality in the town of Borlänge.In order to answer the first question a spatial autocorrelation analysis, Local Moran LISA has been used. This method is based on the measurement Moran´s I and shows the spatial autocorrelation for every single location. To answer the second question three different theories of crime prevention through environmental design have been studied and applied in the analysis. These are Jane Jacobs’ ideas about ”the living city”, Oscar Newman´s ideas about ”defensible space” and Ronald V. Clarke´s theories about crime prevention.The major conclusions that can be drawn from this thesis are that the risk of being exposed to thefts from cars, during the analyzed time period, was highest in Centrum and Hagalund and their surroundings. The lowest risk of being exposed to this type of crime was found in Domnarvet and Islingby, during the year 2002. The highest risk of being a victim of the crime office burglary was found in Hagalund and its surroundings and in the single area of Kvarnsveden. The corresponding lowest risk was found in Lergärdet and its surroundings and in Norra Backa and Kupolen. The measures that should be taken in order to decrease these types of criminality can be divided into overall changes and place-specific changes. When it comes to the crime thefts from cars a more attractive central business district, a better view of parking lots from nearby buildings, dividing of larger parking lot zones into smaller ones, migration of hidden parking lots and stronger access control to parking lots where problems with this kind of crime have occurred have been suggested as overall changes. The corresponding place-specific changes are to remove vegetation that is blocking the view, better lighting and to put up signs with information about increased risk of exposure to crime at parking lots with the most problems. To decrease the amount of office burglaries overall changes as to create a better view of the area from nearby surroundings, move bigger office compartments or divide them into smaller units, rebuild characteristic buildings and increase security by strengthening the access control to offices with these kinds of problems could be useful. Finally there are possibilities to decrease office burglary by using place-specific measures as surveillance cameras combined with signs containing information about these, high fences and better lighting around the buildings where a higher risk of being exposed to this kind of criminality is present.
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De, Bellis Anita Marie, and anita debellis@flinders edu au. "Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility." Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.
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This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care.
Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care.
Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'.
The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision.
The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice.
There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation.
If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.
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Crawford, Gregory Brian, and gregory crawford@adelaide edu au. "Depression in palliative care patients in Australia: identification and assessment." Flinders University. Medicine, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090127.133003.
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Depression is poorly recognised, under-assessed and under-treated in patients receiving palliative care for a life-limiting illness. There are barriers to assessment and diagnosis, and limited access to specialist clinicians who might assist in these complex assessments and who could provide options for treatment.
The three studies presented, using different research methodologies, and using both qualitative and quantitative analysis, seek to clarify these issues and to provide some solutions. A questionnaire was sent to all Palliative Care Services (PCS) in Australia. Questions included what part specialist psychological clinicians played in multi-disciplinary team meetings and in the treatment or coordination of patient care. Very few PCS used a valid screening instrument for psychological distress and very few had regular support from a psychiatrist or psychologist. Many did not have access to social work support.
There are two competing issues with regard to recognising and assessing depression in palliative populations. A rapid reliable screen that points to a likely problem would be useful, but also there is a need to understand something of the patient experience of depression.
In the second study, the one- and two-item screening instruments widely used in palliative care are examined and limitations that have been found in other settings are confirmed. A new novel screening tool is developed from this data and tested empirically. This algorithm is short, has good psychometric properties and is validated for an Australian palliative care population. Depending on the response pattern it is possible to identify that a particular patient has significant symptoms of depression by asking between one and four questions. Professional carer and patient acceptability of the questions is high.
The understanding of the experience and symptom profile of depression in Australian palliative care patients is addressed in the third study. Patients and family carers were recruited prospectively from palliative care and oncology ambulatory clinics of two teaching hospitals in an Australian capital city. The Geriatric Depression Scale (GDS) was administered to the patient and the Collateral Source version of this instrument was asked of the carer. A subset of this sample completed the measures twice. The results using this 30-item scale were then compared with all the known previously published short versions of this scale. Two short forms met as many psychometric criteria as the longer forms. None of the versions of the GDS showed sufficiently high correlations between carer-completed and patient-completed forms. The frequency of symptoms was also assessed. Patients more frequently reported fatigue and anhedonia than depressed affect.
Despite many screening instruments being available for depression, their use is limited in Palliative Care Services. Although these studies have validated several options for Australian palliative care patients, the issues behind the low uptake rates for screening have not been resolved. The final chapter of this thesis constructs known and potential barriers into a logical structure and then offers some solutions to improve access to mental health professionals by considering service models and applying this theory to the problem of depression and its assessment in palliative care populations.
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Bennett, Paul Norman, and paul bennett@flinders edu au. "SATELLITE HAEMODIALYSIS NURSES PERCEPTIONS OF QUALITY NURSING CARE: A CRITICAL ETHNOGRAPHY." Flinders University. Nursing and Midwifery, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090828.154836.
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People living with end stage kidney disease require dialysis or kidney transplantation to maintain life. Of those receiving dialysis in Australia, most people receive this treatment in satellite haemodialysis centres that are nurse-run, community-based clinics. Nurses provide the majority of care in these clinics with little or no on-site medical support, yet there has been minimal research exploring nursing care, or perceptions of nurses, in the satellite haemodialysis context. The major aim of this study was to explore satellite dialysis nurses perceptions of quality care. Fundamental to this aim was the premise that to improve nursing care, nurses need to understand the factors influencing satellite dialysis nursing care.
A critical ethnography exploring the culture of one satellite haemodialysis clinic, focusing on the nurses perception of quality was undertaken, with a focus on issues of power that influenced satellite dialysis nursing care. Over a period of twelve months, interviews with nurses, non-participant observation and document analysis were conducted. Of particular concern was the satellite dialysis nurses struggle with the dominant medical discourse of quantitative measurement of quality. Bourdieus notions of habitus, field and practice provided a vehicle to explore nurses dispositions that operated within the institutional conditions of the medicalised discourse and physical structure of the satellite dialysis environment.
Findings about nurses perceptions of quality dialysis care were categorised into three broad themes: what is quality; what is not quality; and what affects quality. Nurses considered technical knowledge, technical skills and personal respect as characteristics of quality. Long-term blood pressure management and arranging transport for people receiving dialysis treatment were not seen to be quality priorities. The person receiving dialysis treatment, management, nurse and environment were considered major factors influencing and determining quality dialysis nursing care. Acceptance by nurses about their position and their reluctance to challenge medical power was revealed.
Aspects of power and oppression operated for nurses and people receiving dialysis treatment within the satellite dialysis context, and this environment was perceived by the nurses as very different from hospital dialysis units. Bourdieus notions of habitus and subconscious reproduced practices were embedded in the satellite dialysis nurses behaviour and were conveyed to other nurses. In order to improve nursing care in this context, ten recommendations were proposed: 1) implementing a concordance nursing care model; 2) using a goal-setting framework; 3) increasing staff rotation between dialysis units; 4) improving satellite dialysis unit design;
5) educating satellite dialysis nurses in internet and database skills; 6) using new technologies in staff education programmes; 7) recognising increased patient acuity; 8) research exploring residential dialysis facilities; 9) introducing advanced practice nurses in a satellite collaborative model of care; and 10) requiring a structured programme of reflective practice.
Facilitating change in dialysis nursing practice was fundamental to this study and consistent with a critical approach. New understandings for the nurses may not result in practice change however, unless there is a collective review and uptake of these practices. This study offers new knowledge about quality nursing in satellite haemodialysis units, enabling nurses to critically reflect on, and improve, the quality of care they provide.
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Nyrenström, Gidehag Anton. "Do loyal voters care less about the local economy? : An investigation based on municipal elections in Sweden." Thesis, Uppsala universitet, Nationalekonomiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-226567.
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MacGill, Bindi Mary, and belinda macgill@flinders edu au. "ABORIGINAL EDUCATION WORKERS IN SOUTH AUSTRALIA: TOWARDS EQUALITY OF RECOGNITION OF INDIGENOUS ETHICS OF CARE PRACTICES." Flinders University. School of Australian Studies, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090630.142151.
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This thesis is focused on Aboriginal Education Workers (AEWs) who work with, support and care for Indigenous students in schools in South Australia. AEWs work in the border zones (Giroux 2005) between the values of schools and the expectations of Indigenous communities. This thesis highlights how AEWs experience indirect discrimination in the workplace as a result of their complex racialised position. In particular, there is a general absence of recognition of AEWs caring role by non-Indigenous staff in schools.
AEWs are not only marginalised in schools, but also at an institutional level. While AEWs working conditions have improved, the redistribution (Fraser & Honneth 2003, p. 10) of better working conditions has not eliminated indirect discrimination in the workplace. Furthermore, there is little research regarding AEWs in Indigenous education. Thus at three levels, namely school, Department of Education and Childrens Services (DECS) and academia, there is a cyclical pattern that perpetuates an absence of recognition of AEWs.
This thesis uses whiteness theory (Frankenberg 1993) as a theoretical framework to examine this lack of recognition and the consequent low status of AEWs in schools. The thesis emerges from research, experience working as a teacher in a remote Aboriginal school with AEWs, and in-depth semi-structured interviews with 12 AEWs who are working in South Australian state schools. Standpoint theory (Collins 2004; Harding 2004) is used as both a method and methodology in order to understand and map AEWs position in schools. A common theme raised by all of the AEWs in the interviews is the absence of recognition of their work in schools by non-Indigenous staff and the consequent feeling of marginalisation in the workplace. In this thesis the site-specific contexts of the interviewees and the effects of whiteness are examined.
The findings that emerged from the in-depth semi-structured interviews with AEWs were concerned with Indigenous ethics of care models. The narratives from the interviewees who were AEWs revealed how white ethics of care practices in schools de-legitimise Indigenous ethics of care. Furthermore, the discursive regimes that govern school policy and protocol often limit AEWs ability to respond effectively to Indigenous student needs. This thesis highlights the complexities and contradictions of AEWs who are working in the border zones. As a result, AEWs often feel caught between school expectations and community protocols.
This thesis advocates equality of recognition of Indigenous ethics of care practices to address the indirect discrimination that AEWs experience. It concludes with a map for recognition of AEWs' care practices on an institutional level in relation to academia and DECS, and in schools in order to overturn the continual marginalisation of AEWs in South Australia. It argues for a values shift for non-Indigenous teachers and staff in schools and at the institutional levels in DECS and academia. In particular, this involves a values shift by non-Indigenous teachers, academics and policy makers towards an understanding of whiteness. Recommendations are provided in the concluding chapter that signpost possible moves towards equality of recognition of Indigenous ethics of care practices by non-Indigenous staff in schools.
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Antic, Nicholas, and nick antic@health sa gov au. "Simplified Diagnostic and Management Strategies for the Diagnosis and Delivery of Health Care to those with Obstructive Sleep Apnea." Flinders University. Medicine, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20081022.170508.
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Obstructive sleep apnea (OSA) is a prevalent disease. Often resources to provide care for OSA are inadequate, leading to long patient waiting times. Simpler validated methods of care are needed.
In the first study in Chapter 2, the utility of a new high-sampling rate oximeter to diagnose OSA was explored. The home oximetry data collection was robust, with few failures and the data allowed the rule in or rule out of moderate-severe OSA with high degree of certainty. It is concluded that home oximetry could replace polysomnography (PSG) as a diagnostic test in a significant proportion of patients, thus allowing limited resources available for the care of those with OSA to be re-directed e.g. towards providing therapy.
In Chapter 3, the diagnostic information from the oximeter was used to underpin a study designed to demonstrate that a nurse-led model of care could produce health outcomes in moderate-severe OSA not inferior to physician-led care.
A randomised controlled multi-centre non-inferiority clinical trial was performed. 1,427 patients referred to 3 sleep medical centres with possible OSA were assessed. 195 patients were randomised to 2 models of care. Model A, a simplified model, involved home oximetry to diagnose moderate-severe OSA, auto-titrating constant positive airway pressure (APAP) to set a therapeutic constant positive airway pressure (CPAP), with all care supervised by an experienced nurse. Model B involved 2 laboratory PSGs, to diagnose OSA then titrate CPAP, supervised by a sleep physician. The primary endpoint was change in Epworth Sleepiness Score (ESS) measured before and after 3 months of CPAP. A range of other outcome measures were collected.
The change in ESS for nurse-led management (Model A) was not inferior to the physician-led service (Model B) since the lower limit of the two-sided 95% CI did not include -2, the margin of equivalence (difference 0.13, 95% CI -1.52 to -1.25). 11 patients in Model A and 10 in Model B were lost to follow up during the trial. There were no significant differences between Model A and Model B after 3 months of CPAP in any of the other outcome measures, including CPAP adherence at 3 months.
It is concluded that a simplified nurse-led model of care can produce non-inferior results to physician-directed care in the management of moderate-severe OSA.
In Chapter 4 the efficacy of CPAP in normalising or improving subjective and objective sleepiness, quality of life and selected neurocognitive measures was explored. It was shown that only a proportion of patients (60% on ESS, 35% on FOSQ) normalised their scores after 3 months of CPAP therapy. This is important information. As new health care delivery strategies evolve as a result of the data presented in Chapter 3 and elsewhere, it will be crucially important to train new health care professionals in the complexities of OSA management, such that they are aware that the symptoms of patients presenting for OSA investigations can have multiple aetiologies, and may not always resolve by simply applying CPAP.
The data presented in this thesis add to the evidence base in treatment of moderate-severe OSA and will help further evolve health care delivery for this important disease.
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van, Eyk Helen, and helen vaneyk@health sa gov au. "Power, Trust and Collaboration: A case study of unsuccessful organisational change in the South Australian health system." Flinders University. Medicine, 2005. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20060130.095828.
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Internationally, health systems have been undergoing an extended period of endemic change, where one effort at health system reform inevitably seems to lead to further attempts to make adjustments, re-direct the focus of the reform effort, or bring about further, sometimes very different changes. This phenomenon is described as churning in this thesis. Churning is a result of continual efforts to adjust and �improve� health systems to address intractable �wicked� problems, often through applying solutions based on neo-liberal reform agendas that have influenced public sector reform in developed countries since the early 1980s. Consistent with this, the South Australian health system has been caught up in a cycle of change and restructuring for almost thirty years.
This qualitative study explores a case study of unsuccessful organisational change initiated by a group of health care agencies in the southern metropolitan area of Adelaide, South Australia, which took place between 1996 and 2001. The agencies sought to develop and establish a regional health service through a process they called �Designing Better Health Care in the South� which aimed to improve the way that services were provided in the area, and to enable the agencies to manage the increasing budgetary and workload pressures that they were all experiencing. A significant policy shift at the state government level meant that this initiative was no longer supported by the central bureaucracy and could not proceed. The agencies reverted from a focus on regional planning and service delivery to an institutional focus.
The changes that are described within the scope of the case study are universally recognisable, including centralisation, decentralisation, managerialism and integration. The experience of Designing Better Health Care in the South as an unsuccessful attempt to implement change that was overtaken by other changes is also a universal phenomenon within health systems. This study locates the case study within its historical and policy contexts. It then analyses the key themes that emerge from consideration of the case study in order to understand the reasons for constant change, and the structural and systemic impediments to successful reform within the South Australian health system as an example of health systems in developed countries.
As a case study of organisational change, Designing Better Health Care in the South was a story of frustration and disappointment, rather than of successful change. The case study of Designing Better Health Care in the South demonstrates the tensions between the differing priorities of central bureaucracy and health care agencies, and the pendulum swing between the aims of centralisation and regionalisation. The study uses the theory of negotiated order to understand the roles of the key themes of trust, partnership and collaboration, and power and control within the health system, and to consider how these themes affect the potential for the successful implementation of health care reform. Through analysis of the case study, this thesis contributes to an understanding of the difficulties of achieving effective reform within health systems in advanced economies, such as the South Australian health system, because of the complex power and trust relations that contribute to the functioning of the health system as a negotiated order.
The study is multidisciplinary and qualitative, incorporating a number of social science disciplines including sociology, political science, historical analysis and organisational theory. Data collection methods for the study included interviews, focus groups, document analysis and a survey.
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Paech, Susan Elisabeth, and spaech@vtown com au. "TOTALLY DIFFERENT: AN ETHNOGRAPHIC ACCOUNT OF INTELLECTUAL DISABILITY NURSING." Flinders University. Medicine, 2007. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090918.161221.
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This study adopted an ethnographic approach to examine the role of the Registered Nurse (RN) in the intellectual disability sector. The research setting (The Centre) is a residential facility for clients with intellectual disability in the northern suburbs of Adelaide that opened in 1971 and was similar to a hospital with the same hierarchy of nursing. Mental deficiency nurse training was conducted there until the 1990s but that qualification is no longer recognised. The Centre is under the umbrella of a large state disability organisation that is in the process of moving clients of the service from institutions (the Centre) to community living options such as group homes.
The cessation of mental deficiency nurse training and the introduction of deinstitutionalisation were considered to impact on client health and in the late 1990s a 24 hour nursing service was commenced. There was strong anecdotal evidence the service should be evaluated. A review of the literature found some research had been conducted in overseas countries with a focus on deinstitutionalisation but with a paucity of interest in the role of the RN, particularly in Australia.
Ethnography, first used in anthropology as a way of describing different cultures, was chosen as the research methodology because the researcher wanted to discover how the culture influenced the role of the RN. The researcher is an RN employed in the area. As an ethnographer and participant observer, the researcher became the data collection instrument. The entire culture is considered to be the sample in ethnography and data took the form of hundreds of hours of field note entries and interview transcripts.
Following analysis, the findings were presented in themes answering the research question which was in two parts. The first from the perspective of the nurse, client and other health care professionals, what constitutes intellectual disability nursing? and secondly what are the every day rituals, norms and patterns within the disability culture that shape and influence disability nursing for the Registered Nurse?.
Caring for the client who is institutionalised, The RN in the disability sector having certain qualities, Working within a different paradigm, Having to assume responsibility for large numbers of unregulated workers, Having to work alongside many professional groups and Having different educational needs are themes which describe the role. Themes describe the diversity of the role and in describing the registered intellectual disability nurse as different the role is compared with that of the nurse in other settings. The current research revealed there is a need for more health related education for unregulated workers and specific intellectual disability education for registered and enrolled nurses.
Themes that answer the second part of the research question are hierarchical structure, the Registered Nurse's position and role confusion. The non-nursing management at the top of the hierarchical ladder was found to significantly limit the role of the RN who was afforded no opportunity for leadership. Confusion over the RN's role and indeed individual workers' roles was observed at all levels. Findings suggest much stronger nursing leadership is required to provide advocacy and holistic care for the client and education for the carer. An outcome of the current research was the development of a model for intellectual disability nursing (see Table 8-1).
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Todd, Joseph Malcolm. "Social care, contracts and voluntary sector providers." Thesis, Sheffield Hallam University, 2001. http://shura.shu.ac.uk/20443/.
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This thesis concerns the impact of purchase of service contracts on voluntary sector providers of social care. Voluntary agencies in Britain have traditionally received annual grant-aid from local authority social services departments in acknowledgement of the many different care and support services they have provided to the community. However, following the reorganisation of the personal social services in the early 1990s (National Health Service and Community Care Act 1990), this funding mechanism shifted increasingly towards a tighter, contractual, relationship in which expectations about service levels, monitoring arrangements, quality and costs were made explicit and formally agreed. This changes the way in which voluntary sector providers have to work, their relationship with statutory sector agencies and their interface with the wider community. Whilst interest in social care contracting is growing, policy analysts have done little to qualitatively study the contracting process from the voluntary sector perspective. This study aims to bridge this gap. It offers a close examination of twenty-three voluntary sector agencies in four local authorities in England. It sheds light on the impact of replacing grant-aid with contractual income, contributes to the understanding of how voluntary sector providers of social care services experience the contracting process and explores how the local authority-voluntary sector interface is developing. Understanding the voluntary sector perspective on social care contracting can assist statutory sector purchasers to develop systems that best meet both sectors' needs. Prominent amongst the findings are the following: (1) despite the introduction of a 'quasi-market' in social care there was little evidence of a competitive market for contracts between voluntary sector providers; (2) local authorities were inclined to offer service agreements to recognised and trusted voluntary sector providers; (3) the language and legal status of social care contracting is regarded as ambiguous by voluntary managers - different local authorities have adopted distinct language and definitions; (4) the notion that voluntary providers are the preferred providers of local authorities was questioned by a number of statutory sector respondents - there was evidence that statutory sector purchasers were willing to make use of the for profit sector for service provision; (5) whilst some voluntary providers had been able to negotiate successful contracts with purchasers many commented on the conflictual nature of this process; (6) the monitoring of contracts is very mixed and there were concerns over the robustness of local authorities in collecting relevant data.
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Kelly, Janet, and janet kelly@flinders edu au. "Moving Forward Together in Aboriginal Womens Health: A Participatory Action Research Exploring Knowledge Sharing, Working Together and Addressing Issues Collaboratively in Urban Primary Health Care Settings." Flinders University. School of Nursing & Midwifery, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090324.084222.
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This collaborative qualitative research explored ways of improving Aboriginal womens health and well-being in an urban Adelaide primary health care setting. This involved respectful knowledge sharing, working effectively together and addressing issues related to colonisation, discrimination and exclusion. It was identified that while Aboriginal and non-Aboriginal professionals are committed to Closing the Gap in health disparities, many have questioned how best to do so within the current health system. Therefore, this research focused on filling gaps in knowledge about the spaces where Aboriginal community women, and Aboriginal and non Aboriginal health professionals can work collaboratively regardful and regardless of health system polices, programs and practices.
A strong commitment to local community preferences and national Aboriginal health research ethics enabled Aboriginal community women and Aboriginal and non-Aboriginal heath professional co-researchers to be actively and meaningfully involved with me in both the research processes and outcomes. A modified Participatory Action Research (PAR), with repeated cycles of Look and Listen, Think and Discuss and Take Action emerged as an effective model of collaborative practice, suitable for health care and research.
Four unique yet interconnected areas of collaboration developed, each highlighting particular aspects of culturally safe knowledge sharing and collaboration in health care. The first involved working with Aboriginal community women, acknowledging and addressing their most health and well-being priorities related to high levels of stress in their lives. Collaborative action involved creating a womens friendship group, seeking and accessing a range of services, and co-presenting our findings at conferences
The second Collaboration Area offers insights into the practicalities and difficulties experienced by staff as they tried to provide health services for Aboriginal women in a newly developing Aboriginal health organisation. The third Collaboration Area focused on the challenges and benefits of collaboration between sectors, in particular a local high school and the Aboriginal health service. We explored effective ways to work across sectors and engage young Aboriginal women in health programs. The ongoing impact of discrimination, exclusion and colonisation for this next generation of Aboriginal women was highlighted. The fourth Collaboration Area involved wider collaboration and road testing our collaborative methodology in a broader environment. A diverse group of co-researchers came together to plan, implement and evaluate a de-colonising national action research action learning conference embedded in Aboriginal preferred ways of knowing and doing.
Findings are discussed under the three central themes of knowledge sharing, working together and addressing health care access and colonisation and key recommendations for the future are proposed. This research has reinforced the need identified in Aboriginal health documents for policy, program and practice commitment to holistic and collaborative approaches such as comprehensive primary health care and participatory action research. While the National Apology and Close the Gap campaign have provided opportunities for change, these need to be followed by tangible action at all levels of health care.
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Lam, Chun Kwan. "Selection of smart card for metro transport system." access full-text access abstract and table of contents, 2005. http://libweb.cityu.edu.hk/cgi-bin/ezdb/dissert.pl?msc-meem-b19913035a.pdf.
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Thesis (M.Sc.)--City University of Hong Kong, 2005.<br>Title from title screen (viewed on Jan. 10, 2006) "A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Science in Engineering Management." Includes bibliographical references.
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Walters, Lucie, and lucie walters@flinders edu au. "How and Why GPs commit the time to precept medical students." Flinders University. School of Medicine, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20091204.122749.
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This thesis defines the time impact of precepting medical students on rural general practitioners and explains how and why they commit the time to precept. To answer this question, original research was undertaken within the context of the innovative community-based medical education program, the Parallel Rural Community Curriculum (PRCC), using the parallel consulting model. Chapters One to Three detail the context of this study, appraise the existing evidence in the literature, and establish the rigour of the study design. In line with the constructivist theoretical perspective presented by the author, a case study methodology was chosen for this study. The thesis is constructed in two parts.
Results from a prospective cohort study of GPs� videotaped consulting, with and without students, are described in Chapters Four and Five. No increase in consultation time or non-consulting time was found when precepting medical students. GPs� activities changed, suggesting they adapted their behaviour when students were present.
An interpretive study, using a grounded theory approach, was used to explain the �how� and �why� of the research question. Interview data from GP preceptors, practice managers and students was used to construct a transferable explanatory theory as it emerged from the data. These results are presented in Chapters Six and Seven.
The majority of GPs considered precepting more time consuming than consulting alone. This finding was not consistent with the videotaped data. GPs consistently experienced time pressure in their roles due to constant intrusion of competing priorities. This increased when precepting students. Frequent descision making by GPs as a response to their drive to remain on time was found to be a significant contributing factor to the changes found in consultation activities.
Although many types of professional enrichment were identified by GP preceptors as adding value to precepting, the doctor-student relationship was clearly defined as the most important motivator for precepting in this study.
The case study analysis explains how and why this occurred, and documents the maturation of the doctor-student repationship over time in the year long PRCC attachments. Through a grounded theory analysis of the data, four precepting consultation models emerged: student observer, teacher-healer, doctor orchestrator and doctor advisor. In Chapter Eight, the study defines these models in the context of legitimate peripheral participation of a novice member of the rural GP community of practice. The corroborative evidence from the literature suggests that these models may be applicable to other settings, particularly other community-based medical education sites.
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Helton, Carol Norman. "Grief management: Programming for care in the local church." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1998. http://digitalcommons.auctr.edu/dissertations/AAIDP14673.
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This project dissertation, entitled 'Grief Management: Programming for Care in the Local Church', addresses the issue of grief that is caused by the death of a significant other. This work also includes information on the dynamics of grief; grief management resources from psychological, sociological, and theological perspectives. In addition, it gives an overview of the African American church as a resource for grief support.
The dissertation provides a model for programming for grief management and grief support for the Ben Hill United Methodist Church in Atlanta, Georgia.
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Bennett, Christine Russell. "Demographic Variables As Predictors of Local Report Card Designations." Miami University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=miami1276625847.
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Braisher, Mark. "A project in spiritual care in the local church." Theological Research Exchange Network (TREN), 1995. http://www.tren.com.
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Harrington, Zinta, and zintah@bigpond com. "B Cell antigen D8/17 as a marker of susceptibility to rheumatic fever in Australians and The sharp end of the needle: Rheumatic fever prophylaxis and concepts of care for Yolngu patients A thesis in two parts." Flinders University. School of Medicine, 2005. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20060219.200649.
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Aboriginal Australians have some of the world�s highest rates of rheumatic fever. Two approaches to reducing the burden of rheumatic fever are discussed in this thesis. The B cell antigen D8/17 has a strong association with rheumatic heart disease and may be a universal marker of inherited susceptibility to rheumatic fever. Identifying a population at increased risk of rheumatic fever provides an opportunity to focus primary prevention measures. In part one of the thesis I evaluate the accuracy of D8/17 as a marker of past rheumatic fever amongst Australians from the Northern Territory. D8/17 levels were measured and compared in patients with acute rheumatic fever, rheumatic heart disease or past rheumatic fever, first-degree relatives and healthy, unrelated controls. The mean percentage of B cells positive for D8/17 was 83.7%, 38.9%, 20.2% and 11.6% respectively. The difference between the groups was significant (p-value less than 0.0001). A receiver operator curve analysis indicated that 22.1% of B cells positive for D8/17 was the most accurate cut-off to distinguish patients with acute or past rheumatic fever from healthy subjects. These results indicated that the B cell antigen D8/17 is an accurate marker of past rheumatic fever in Aboriginal Australians and could be a helpful addition to the Jones Criteria for strengthening or excluding a diagnosis of acute rheumatic fever. The intermediate levels of D8/17 expression in the relatives of index cases supports the hypothesis that D8/17 is a marker of an inherited susceptibility to rheumatic fever, although prospective trials are required to provide conclusive proof of this hypothesis.
Non-compliance with secondary prophylaxis was suspected to be the cause of increasing rates of rheumatic fever in the Top End. In part two of the thesis I discuss the �problem of compliance� with respect to Aboriginal patients, and investigate the factors that affected the delivery and uptake of prophylaxis for rheumatic fever in an Aboriginal community. Patients, relatives and health practitioners were interviewed on the topic of the care of patients with rheumatic heart disease. The data were analysed using the principles of grounded theory.
The main finding was the desire for more personalised care and support for patients with rheumatic heart disease from the community clinic, rather than simple medical care. These ideas crystallised through two Yolngu terms to describe care: djaka (to physically care for) and gungayun (to encourage). Thus even from the outset there was divergence in the focus of the �consumer�- holistic care - and that of the health-care professional/ researcher � improving the rate of secondary prophylaxis coverage.
With regards to service provision, a significant reason for failure to receive secondary prophylaxis was the differing approaches of urban and community health services, patient mobility, and a differing understanding of the responsibilities of patients and health service providers in the different settings. Other factors pertaining to service provision, such as staff motivation, administrative issues and program coordination affected the uptake of secondary prophylaxis to a lesser extent. With regards to treatment uptake, individual patient factors inhibiting uptake of treatment were apparent in some cases, but treatment refusal was rare. Pain was not found to be a deterrent. No simple relationship was found between treatment compliance and biomedical knowledge of the disease. There was no simple relationship between patient passivity and sense of responsibility that guaranteed compliance.
This study demonstrated that the failure to achieve good uptake of prophylaxis for rheumatic fever related as much to factors of service provision as patient factors and that providing holistic care within a familiar and supportive framework is important to Yolngu patients. However, there are real difficulties for health services as they are currently structured to meet the expectations of patients and families.
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Webber, Graham Ross, and graham webber@bigpond com. "Reiki: Practitioners� Perceptions of the Effectiveness of a Complementary Therapy in the Treatment Regime of People with Dementia." Flinders University. Department of Disabilities Studies, School of Medicine, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061009.093745.
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International and national research has shown that the use of complementary therapies (often referred to in the scientific literature as either alternative therapies or unconventional therapies) is widespread. However, there is little in the scientific literature about the use of complementary therapies in the treatment regime of people with dementia. Specifically, there have been no published results of investigations into the use of Reiki, a holistic complementary therapy, in the treatment regime of people with dementia.
Before proceeding with an in-depth examination into the use of Reiki in the care of people with dementia, a questionnaire containing both closed and open-ended questions was distributed to 162 South Australian High Care Residential Facilities (formerly called Nursing Homes) in 2002. The return rate was 58.0% (n=94) of which 50.0% of the mail out (n=81) was available for analysis. Findings from the questionnaires suggested that a wide range of complementary therapies including aromatherapy, massage, music, behaviour therapy, healing touch, Reiki and Therapeutic Touch (Krieger/Kunz method) were used regularly within South Australian High Care Residential Facilities. Complementary therapies were reportedly used to calm residents, improve behaviour management, enhance the quality of life of residents, promote 1:1 interaction, stimulate the senses, and reduce the need for medication.
Due to 15 facilities reporting the use of Reiki, a series of semi-structured interviews with Reiki practitioners caring for people with dementia was conducted in 2004/2005. Interview participants (n=10) included a representative range of people providing care for people with dementia in eight Nursing Homes in Adelaide, South Australia. Data reduction methods included a quasi-statistical counting of key words and repeated re-readings of the transcripts to discover the essences, abstract the meanings and arrange them into themes and sub-themes.
The results of the interviews suggested that Reiki is an easy to learn and easy to use holistic complementary therapy which has the potential to enhance the quality of life of the persons with dementia, their family members, and their carers. The interview participants reported improved physical, psychological, mental and emotional well-being as well as enhanced relationships and a reduction in negative behaviours following the use of Reiki.
The receipt of the first Jack Loader Scholarship from the Rosemary Foundation for Memory Support Inc. in early 2005 enabled the researcher to transfer to full-time studies from April 2005.
Key Words: aged care; alternative therapies; complementary therapies; dementia; early onset dementia; one to one interaction; quality of life; Reiki; therapeutic touch; unconventional therapies.
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Bahrami, Masoud, and masoud bahrami@flinders edu au. "A Comparison of Patients and Nurses Perceptions of Cancer Patients Quality of Life: A Mixed Research Approach." Flinders University. Nursing and Midwifery, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20080715.125510.
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In attempting to give more years of life to cancer patients, their Quality of Life (QoL) during this time has frequently been compromised. Assessment of patients QoL provide nurses with an opportunity to know about the whole range of patients needs and desires. These information would be potentially very useful for health care professionals particularly nurses for planning, conducting and evaluating the nursing care of cancer patients.
Questionnaire survey research carried out in countries other than Australia identified a varied amount of agreement between cancer patients and nurses about cancer patients QoL. However, based on the literature review, no research study has been found in Australia that provides a detailed understanding of how nurses and cancer patients are similar or different in their perceptions of cancer patients QoL. A research study, therefore, was conducted to answer the following key questions: (a) what differences and/or similarities are there between patients and nurses perceptions of cancer patients QoL; (b) why do these differences and/or similarities exist?
A research study with a mixed approach was undertaken to answer the research questions. In the first phase, a survey by questionnaire was conducted. The main aims were to identify: (a) the level of agreement between cancer patients and nurses scores on the World Health Organisations Quality of Life Brief questionnaire (WHOQoL-BREF); and (b) variables that may influence the level of agreement between them. Each patient and nurse was invited to complete the WHOQoL-BREF questionnaire, which was considered as an appropriate tool for evaluating cancer patients QoL. This questionnaire considers QoL across four domains or dimensions: physical, psychological, social relationship and environmental.
In the first phase of the study, 166 cancer patients and 95 nurses were recruited from three major hospitals in Adelaide, South Australia. The patients had a range of cancer diagnoses with breast cancer being the most prevalent. Most patients were being treated as inpatients with chemotherapy being their primary treatment. The mean age of nurses was approximately 37 years and their clinical experience with cancer patients averaged approximately eight years. Intraclass Correlation Coefficient (ICC) between patients and nurses scores ranged from poor in the social relationship and psychological domains up to moderate in the physical domain indicating that generally nurses were different in their perceptions from those of cancer patients. Another major finding of this phase was that nurses underestimated cancer patients QoL in the social relationship and environmental aspects, which consisted of more personal and private issues.
Having finished the first phase, the second phase was conducted based on the principles of a classical version or mode of grounded theory. The aim here was to include an interpretive perspective and explore the reasons why nurses may differ in their perceptions about cancer patients QoL in comparison to cancer patients. In this phase, three cancer patients and 10 nurses took part in semi-structured interviews. Participants were selected from different inpatient and outpatient oncology services and a palliative setting.
Differences in patients and nurses perceptions about cancer patients QoL and their implications for nursing clinical practice were discussed further in the light of six important categories found in the second phase including: QoL meanings, QoL aspects, Cues-based QoL assessment; Purpose-based QoL assessment; Facilitators of QoL assessment; and Barriers to QoL assessment. It emerged that QoL has individualised meanings and nurses generally have difficulties understanding their patients personal perspective or definition of QoL. Another interpretive outcome that may explain why nurses differed in their perceptions when compared with cancer patients is that nurses assessment of cancer patients QoL in oncology wards is mainly made during their interaction with patients when providing care. Such an assessment has a focus on physical cues and may not facilitate nurses developing a more holistic picture of cancer patients QoL. Participants in the interpretive phase indicated that time limitations, focus on care tasks, and discontinuity of care, all work against nurses developing a more accurate understanding of cancer patients QoL. Conversely, it was found that building a relationship and stronger rapport with patients is the main facilitator in improving nurses understanding of cancer patients QoL.
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Chakrabarti, Indranil. "Local governance : bureaucratic performance and health care delivery in Calcutta." Thesis, London School of Economics and Political Science (University of London), 2002. http://etheses.lse.ac.uk/1650/.
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This thesis is based on a comparative case study of two bustee neighbourhoods located in two separate wards of Calcutta, and of the factors which have affected the performance of public officials providing primary health care services to their inhabitants. It is argued that poor bureaucratic performance and a lack of accountability lie at the heart of problems with the health system in West Bengal. The thesis evaluates the effectiveness of 'governance' reforms, comprising decentralisation and the application of the principles of New Public Management (NPM), on the performance of public officials. NPM and decentralisation apply the core assumptions of neo-classical economics to the study of bureaucratic decision-making. The thesis argues that local officials in Calcutta may not always have chosen to behave in a way which maxmised their personal welfare, but that history, culture and politics may have affected the choices that they made. The thesis questions the view that decentralization necessarily leads to greater community participation challenges contemporary notions of what constitutes 'civil society' and suggests a more nuanced view of the relationship between civil society and good government. It questions NPM's claims to universality, which have resulted in its widespread application without due regard to local context, and argues that NPM inspired reforms have had a limited effect on health officials in Calcutta, in part, because of their failure to address the underlying causes of poor bureaucratic performance. The final chapter argues that the political influence of public sector workers has affected the willingness of the ruling Party to enforce the incentives to improve the performance of health care officials in West Bengal.
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Mallon, James. "Local authority care and academic performance : risk and protective factors." Thesis, University of Bristol, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424596.
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Hollister, Brooke. "Systems advocacy and the local long term care ombudsman program." 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:3324596.
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Yoh, Allison C. "Institutional issues in the adoption of smart card systems among U.S. transit agencies for fare collection." Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1720820011&sid=13&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Dahlström, Margareta. "Service production uneven development and local solutions in Swedish child care /." Uppsala : Distribution, Kulturgeografiska institutionen, Uppsala universitet, 1993. http://catalog.hathitrust.org/api/volumes/oclc/30694948.html.
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Fraser, Kathryn. "The role of professional caregivers : supporting children in local authority care." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/36733/.
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Children looked after by local authorities are considered to be some of the most vulnerable in society, often having experienced histories of abuse, neglect, conflict within their family of origin or other traumas. As a consequence, substitute care e.g. foster care or residential care is often used as a therapeutic intervention. The focus of this thesis is the role that professional caregivers play in supporting children in local authority care. Chapter I provides a critique of the research exploring the efficacy of therapeutic interventions designed to facilitate the attachment relationship between looked after children and their professional caregiver. Due to controversy surrounding the therapeutic application of attachment theory and a number of methodological limitations, a limited evidence-base was found. The clinical implications and directions for future research are discussed. Chapter II investigates Residential Children’s Workers experience of caring for looked after children, from a psychological perspective. Results revealed that their role and relationship with the children in their care, is affected by their emotional and psychological ability to cope with push and pull factors within a complex system. The clinical implications are discussed, and recommendations for future research made. Chapter III explores a reflective account of the author’s experience of both working clinically and carrying out research in this field. As many of the ideas were generated whilst conducting the doctoral research, the author applies the proposed model from the empirical paper to the reflections. Chapter III is written in a first person account.
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Nixon, Catherine L. "Communicating about sexual health and relationships within local authority care placements." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6291/.
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Background: Evidence from population-level studies demonstrates that adolescent sexual health outcomes are associated with social exclusion, and that certain groups, including young people looked after by local authorities often experience poorer sexual health outcomes. The poorer sexual health outcomes observed for looked after young people has led to the Scottish Government recommending that looked after young people be prioritised for the delivery of sexual health and relationships education, and that residential carers, foster carers and social workers should play a key role in the delivery of sexual health and relationships information to looked after young people. This recommendation builds on existing policy initiatives that have emphasised that parents should be routinely talking to their children about sexual health and relationships. Despite a growing research interest in the health of looked after young people, there is currently little known about how sexual health and relationships discussions are undertaken within the care setting. This is because much of the research that has been published to date has focussed upon identifying barriers to communication rather than establishing how communications are shaped by the characteristics of carers, looked after children and the wider context of the care system. In this thesis I hope to address this research gap by exploring what factors shape communications about sexual health and relationships within the care setting, and examining the extent to which connectedness, monitoring and supervision — parenting factors identified as promoting positive sexual health outcomes for adolescents within the wider literature — mediate these discussions. Methods: 54 in-depth qualitative interviews were conducted with looked after young people (aged 14-18), care leavers (aged 16-23), residential workers, foster carers and social workers in one local authority in Scotland between August and December 2011. Data were analysed thematically, with data collected from corporate parents and looked after young people used to compare and contrast experiences of talking about sexual health within the care setting. Findings: The results presented in this study demonstrate that there has been a perceived shift in attitudes towards talking to looked after young people about their sexual health, and that residential carers, foster carers and social workers believe that talking to young people about sexual health and relationships should be a core responsibility of the corporate parent. Despite this, the results of this study demonstrate that talking to young people about sexual health and relationship is a subject that is fraught with tensions, with many of the corporate parents interviewed expressing difficulties reconciling their own views about the appropriateness of talking to young people about sexual behaviours with their professional responsibility to inform and protect looked after young people from risk. Looking specifically at how communications about sexual health and relationships were undertaken within the care setting, the results of this study show that talking to young people in care about sexual health and relationships is mediated by the impact or pre-care and care histories, in particular maltreatment and poor attachment security, upon young people’s understandings of relationships and their ability to trust other people and seek out help and support. Whilst corporate parents emphasised the need for training to help them identify strategies for talking to young people about sexual health and relationships, the results of this study show that corporate parents are already undertaking sexual health and relationships work that is tailored to the age and stage of the child, and is balanced by the provision of monitoring and supervision to minimise risk. Conclusions: The results of this thesis show that discussions about sexual health and relationships need to be underpinned by a trusting relationship between corporate parents and looked after children. As such, an emphasis needs to be placed upon improving young people’s ability to trust other people. Improving permanency for young people in the care system, in conjunction with the development of attachment based sexual health practices, may result in the promotion of positive outcomes for looked after young people. Future policies and training relating to the provision of sexual health and relationships education within the care system should reflect this fact.
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Dickens, Jonathan. "Local authority social workers, managers and lawyers in child care cases." Thesis, University of East Anglia, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426771.
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This thesis discusses the relationships between local authority social workers, managers and solicitors in child care cases under the Children Act 1989. The original focus was social workers and lawyers, but as work progressed the importance of the social services manager became clear. The empirical work involved 54 semistructured interviews with members of the three groups between March 2001 and April 2002. The findings show that the relationships usually worked well enough, but that tensions were never far beneath the surface and could break out in resentment and frustration. The tensions are rooted in the disjunction between the popular mantra 'the lawyer advises, the client instructs' and the much more complex relationships that the professionals experience in practice. Lawyers may give their advice very forcefully, and can sometimes resist instructions; social workers sometimes rely on the lawyers more closely than any of the groups consider ideal. Behind these difficulties lie the diverse and potentially incompatible responsibilities held by each group, competing notions of reasonableness, different approaches to risk and the challenges of managing limited resources. The tensions provoke powerful criticisms of each group by the others - lawyers don't fight hard enough, social workers don't analyse their cases properly, managers don't supervise their staff adequately. Flexibility, tact and communication are required to keep relationships working well. At a theoretical level, the tensions between and within the three groups are seen to reflect and construct tensions between and within three key discourses in contemporary child care work welfare, law and managerialism. The relationships between the three professional groups reproduce the relationships between these three paradigmatic approaches to, and technologies of, social and professional regulation. The implication for professional practice and social policy is to recognise and value the challenging benefits of dynamic interaction between the professional groups and the discourses.
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Obioha, EE, and MG Molale. "Functioning and Challenges of Primary Health Care (PHC) Program in Roma Valley, Lesotho." Ethno Med, 2011. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000710.
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Primary Health Care (PHC) plays a vital role in decentralization of health care services. PHC is designed to
ensure health care coverage at the community level through the involvement of the community in improving their healthy
living. PHC offers treatment and care in continuum that is supported by a facility-linked home- based care system and a
referral system. While PHC is global, its operation and functioning in the area of community health provisioning varies across
communities. The main objective of this study is to find out whether PHC is effective or not in Roma Valley, Lesotho. The study
was carried out in Roma Valley, in the Maseru district of Lesotho. The population for this study includes the nurses under the
department of PHC, village health workers, Chiefs and out-patients from four different villages. Out of this, a sample of thirty
individuals was selected. The data for this study was collected through qualitative research technique, particularly oral interviews
and written records or secondary data sources. The analysis revealed that nurses and village health workers respond to the
social needs and health problems of the community and community members are also involved in improving their health status.
Village health workers face many challenges in their engagement in this system such as not being given incentives for what they
do and often uncooperative disposition of some community members including their leaders. It was also found that they operate
under a lot of stress due to lack of resources.
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Betts, Graeme Stuart. "Inequalities in health : the role of local authorities." Thesis, University of Bristol, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.281887.
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MacArthur, Juliet. "Embedding compassionate care in local NHS practice : a realistic evaluation of the Leadership in Compassionate Care Programme." Thesis, Edinburgh Napier University, 2014. http://researchrepository.napier.ac.uk/Output/7248.
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This thesis offers an original contribution to knowledge through providing a rigorous longitudinal examination of a complex intervention known as the ‘Leadership in Compassionate Care Programme' (LCC) which was designed to embed compassionate care within local NHS practice in a large Health Board in Scotland. To date there has been little research into the impact of dedicated programmes aimed at enhancing compassionate care on an organisational basis. Through the use of Pawson and Tilley's (1997) realistic evaluation framework this study takes the form of a critical exploration of what did and did not support a sustained focus on compassionate care within the participating settings. The findings have important implications for both policy and practice, and the thesis culminates in a series of recommendations for healthcare organisations at macro, meso and micro levels. Concern about the delivery of compassionate care in the NHS has become a major focus of political, public and professional debate during the last ten years. There has been long standing recognition of the clinical and financial pressures within the NHS; however, the scandal of poor care in Mid Staffordshire NHS Trust brought the issue of compassionate nursing practice into sharp focus. This study makes reference to the findings of the original Francis Inquiry (2010) and subsequent recommendations (Francis 2013) and there is no doubt that the current and future landscape of compassionate care is very different to the one encountered at the outset of this inquiry in 2007. This longitudinal qualitative study provides insight into nurses' experiences as they engaged with the LCC Programme and it provides an important understanding of how best to recognise and support existing good practice and achieve sustainable improvements. Data collection was conducted over three years and primarily involved 46 semi-structured interviews with 33 key participants. This led to the development of eight detailed case studies of participating wards and the generation of an analytic framework based on ‘level of adoption' of the LCC Programme. The eventual synthesis of findings across all eight study sites permitted the development of a conceptual model for strengthening organisational capacity for the delivery of compassionate care. The ‘compassionate core' of this model recognises compassionate care as focussed on meeting the needs of patients, of relatives and of staff. My findings point to the fact that embedding and sustaining compassionate care demands a strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development, and effective leadership at all levels.
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Machado, Eduardo Filipe Calado e. "Primary and hospitalar health care: Building a happy marriage." Master's thesis, NSBE - UNL, 2010. http://hdl.handle.net/10362/9862.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics<br>We address the potential integration of the Hospital Dr. Fernando Fonseca E.P.E.
with the Primary Care Units in its geographical coverage area in a Local Health Unit.
We apply semi-structured interviews in order to understand how to best implement
this model of local organization in the referred case. We classify the interviews of
each unit according to pre-determined criteria and suggest measures to be
implemented. Results demonstrate that the hospital is more able to promptly assume
a change process towards the new organizational model when compared to the
primary care units. Moreover, we reached the conclusion that the achievement of the
expected benefits to the whole depends heavily on local characteristics and
implementation process. There is the need to invest in key elements such as the
maintenance and renewal of infrastructures and in a common information system.
Albeit these investments do not assure the achievement of the benefits of an
integrated management system per se, they are essential in the process of
constructing an unique entity.
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Worrall, Philip. "Modelling the demand for long-term care to optimise local level planning." Thesis, University of Westminster, 2015. https://westminsterresearch.westminster.ac.uk/item/q2z96/modelling-the-demand-for-long-term-care-to-optimise-local-level-planning.
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Long-term care (LTC) includes the range of health, social and voluntary support services provided to those with chronic illness, physical or mental disability. LTC has been widely studied in the literature, in particular due to concerns surrounding how future demographic shifts may impact the LTC system’s ability to cater to increasing amounts of patients not withstanding what the future cost impact might be. With that said, few studies have attempted to model demand at the local level for the purposes of informing local service delivery and organisation. Many developing countries with mature and developed systems of LTC in place are under pressure to reduce health care spend, whilst delivering greater value for money. We suggest that the lack of local studies in LTC stems from the lack of a strong case for the benefits of demand modelling at the local level in combination with low quantity and incomplete social care data. We propose a mathematical model to show how savings may be generated under different models of commitment with third party providers. Secondly, we propose a hybrid-fuzzy demand model to generate estimates of demand in the short to medium term that can be used to inform contract design based on local area needs – such an approach we argue is more suited to problems in which historic activity is incomplete or limited. Our results show that commitment models can be of great use to local health care planners with respect to lowering their care costs, at the same time our formulation had wider generic applicability to procurement type problems where commitment size in addition to the timing of commitments needs to be determined.
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Anguish, Penny Marie Irene. "The real business of health care reform, community participation or local production?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ37391.pdf.
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Goodsite, Sandra Sue Skillings. "School Leadership and Strategic Planning: The Impact on Local Report Card Ratings." Bowling Green State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1363604915.
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Hogeterp, Peter C. "Developing a network of lay pastoral care workers in a local church." Online full text .pdf document, available to Fuller patrons only, 2000. http://www.tren.com.
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Wällstedt, Niklas. "Managing Multiplicity : On Control, Care and the Individual." Doctoral thesis, Stockholms universitet, Företagsekonomiska institutionen, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-117034.
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This is a thesis about managing multiplicity. It analyses how people working in municipalities are managing, controlling, and caring for the complex and contradictory world they live in. Building on more than 100 interviews and observations, the thesis examines the multiple realities of those who work in public sector organisations. By studying (1) the work of managers on different organisational levels, controllers, professionals responsible for the care of others and, to a lesser extent, politicians; (2) the management control systems that are used in the work, and (3) the ongoing debates and legislations directed towards the management of care practices, the thesis makes an effort to analyse how the realities of these individuals; those active in controlling and caring, are constructed. The thesis makes several contributions to the literatures on management control and public management. Where earlier studies are either based on a functionalist conception of management control and public management (in which performance measures and control systems are tools in the hands of managers, that enable them to control other practices), or focused on understanding how control contributes to the construction of reality (making reality ontologically coherent, and therefore controllable), the present thesis argues that management can be approached and analysed as a practice devoted to managing ontological multiplicity, rather than as an activity devoted to control other practices or making reality controllable. By using the concept of ontological politics, the thesis shows that control often fails to make reality controllable, which makes the practice of management reliant on alternative ways to manage. The alternative to control that is analysed in the thesis is care, and the thesis argues that care could be seen as a way to manage, rather than as something that should be controlled: care is complementary to control when it comes to management. The thesis explicates how management by care is done in relation to management by control, and how they may become resources for each other in managing the complex and contradictory public sector.<br><p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Accepted. Paper 3: Manuscript. Paper 4: Manuscript.</p>
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Bellamy, Robyn Lyle, and robyn bellamy@flinders edu au. "LIFE HISTORY AND CHEMOSENSORY COMMUNICATION IN THE SOCIAL AUSTRALIAN LIZARD, EGERNIA WHITII." Flinders University. Biological Sciences, 2007. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20070514.163902.
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ABSTRACT
Social relationships, habitat utilisation and life history characteristics provide a framework which enables the survival of populations in fluctuating ecological conditions. An understanding of behavioural ecology is critical to the implementation of Natural Resource Management strategies if they are to succeed in their conservation efforts during the emergence of climate change. Egernia whitii from Wedge Island in the Spencer Gulf of South Australia were used as a model system to investigate the interaction of life history traits, scat piling behaviour and chemosensory communication in social lizards.
Juveniles typically took ¡Ý 3 years to reach sexual maturity and the results of skeletochronological studies suggested longevity of ¡Ý 13 years. Combined with a mean litter size of 2.2, a pregnancy rate estimated at 75% of eligible females during short-term studies, and highly stable groups, this information suggests several life history features.
Prolonged juvenile development and adult longevity may be prerequisite to the development of parental care. Parental care may, in turn, be the determining factor that facilitates the formation of small family groups. In E. whitii parental care takes the form of foetal and neonatal provisioning and tolerance of juveniles by small family or social groups within established resource areas. Presumably, resident juveniles also benefit from adult territorialism. Research on birds suggests that low adult mortality predisposes cooperative breeding or social grouping in birds, and life history traits and ecological factors appear to act together to facilitate cooperative systems.
E. whitii practice scat piling both individually and in small groups. Social benefits arising from signalling could confer both cooperative and competitive benefits. Permanent territorial markers have the potential to benefit conspecifics, congenerics and other species. The high incidence of a skink species (E. whitii) refuging with a gecko species (N. milii) on Wedge Island provides an example of interspecific cooperation. The diurnal refuge of the nocturnal gecko is a useful transient shelter for the diurnal skink. Scat piling may release a species ¡®signature¡¯ for each group that allows mutual recognition.
Scat piling also facilitates intraspecific scent marking by individual members, which has the potential to indicate relatedness, or social or sexual status within the group. The discovery of cloacal scent marking activity is new to the Egernia genus. E. Whitii differentiate between
their own scats, and conspecific and congeneric scats. They scent mark at the site of conspecific scats, and males and females differ in their response to scent cues over time. Scat piling has the potential to make information concerning the social environment available to dispersing transient and potential immigrant conspecifics, enabling settlement choices to be made.
This thesis explores some of the behavioural strategies employed by E. whitii to reduce risks to individuals within groups and between groups. Scents eliciting a range of behavioural responses relevant to the formation of adaptive social groupings, reproductive activity, and juvenile protection until maturity and dispersal are likely to be present in this species. Tests confirming chemosensory cues that differentiate sex, kin and age would be an interesting addition to current knowledge. The interaction of delayed maturity, parental care, sociality, chemosensory communication and scat piling highlights the sophistication of this species¡¯ behaviour.
An alternative method for permanently marking lizards was developed. Persistence, reliability and individual discrimination were demonstrated using photographic identification and the method was shown to be reliable for broad-scale application by researchers. Naturally occurring toe loss in the field provided a context against which to examine this alternative identification method and revealed the need to further investigate the consequences of routine toe clipping, as this practice appears to diminish survivorship.
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Milewa, Timothy. "Local participation in health and social services planning : the limits to local empowerment in a case study of new particpatory structures in Medway-Swale." Thesis, University of Kent, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282486.
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Galfano, Greg T. "Altered standards of care: an analysis of existing federal, state, and local guidelines." Monterey, California. Naval Postgraduate School, 2011. http://hdl.handle.net/10945/10606.
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CHDS State/Local<br>A disaster with mass casualties or event involving a weapon of mass destruction (WMD) is a profound, life-impacting event that can lead to further devastating consequences. Under austere conditions, however, the implementation of altered standards of care can greatly increase the quality of life of individuals injured by such an event. This thesis evaluates, compares, and contrasts, at the various federal, state, and local levels, guidance documents for altered standards of care and presents a policy recommendation for the inclusion of triggers, guaranteed minimums of care, and legal immunity into existing planning guidance documents for altered standards of care at the federal, state, and local levels. In formulating this policy recommendation, consideration was given to ethical values that should be used to develop policies for altered standards of care, which are recommended to guide and support decision making during both preparation and response at different levels of government.
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Willis, Timothy James. "The politics and ideology of local authority health care in Sheffield, 1918-1948." Thesis, Sheffield Hallam University, 2009. http://shura.shu.ac.uk/4073/.
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This thesis examines local authority health policy in Sheffield from 1918 to 1948. Sheffield was the first British city to elect a Labour Council in 1926. The Sheffield Labour Party pursued a policy of municipal socialism campaigning on a platform of service provision to include housing, health, education and transport. Health and hospital policies were closely related. In hospital policy the Council operated within a mixed economy of health care to provide a municipal general hospital service. Voluntary hospitals in Sheffield relied on a contributory hospital scheme after the First World War and sought and received the support of the Labour movement. Before the introduction of the NHS the health and hospital services of the city operated as a system that featured a mix of pragmatism and ideology. The thesis argues that the role of politics and ideology has been overlooked in the history of British social policy. Government files relating to health policy and local government have been used as well as professional journals, local and national newspapers, Council Committee minutes, records of the Sheffield Labour Party and the records of the Sheffield Joint Hospitals Council. The work aims to offer a more detailed and more nuanced understanding of the development of local authority health policy in Sheffield before the NHS, than has previously been available. The case study examines how local social, cultural and political factors influenced the provision of health care. The work contributes to debates on the role of the Medical Officer of Health in the interwar years. The Sheffield example also illustrates how local actors and groups sought to address problems of finance and access in health care using the available policy instruments at a time when health services were locally controlled.
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Lane, Timothy S. "Counseling in the local church the pastor as shepherd and equipper /." Theological Research Exchange Network (TREN), 2006. http://www.tren.com/search.cfm?p036-0370.
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Owusu, Annor Samuel. "Understanding public mental health policy implementation at local level- A case study of one local heath and social care community in Northwest." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498068.
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Rebori, Marlene K. "The effectiveness of citizen participation in local governance : a case study of citizen advisory boards (CABs) /." abstract and full text PDF (free order & download UNR users only), 2005. http://0-wwwlib.umi.com.innopac.library.unr.edu/dissertations/fullcit/3198199.
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Thesis (Ph. D.)--University of Nevada, Reno, 2005.<br>"May 2005." Includes bibliographical references (leaves 125-134). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2005]. 1 microfilm reel ; 35 mm.
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Alvarado, Natasha. "The LoTS (Longer-Term Stroke) care system of care : an evaluation of its local implementation at two community stroke services." Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/5413/.
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The longer-term problems of stroke are well documented but are often poorly addressed by community services. The Longer-Term Stroke (LoTS) care system of care aimed to address this gap through enhancing the practice of health care professionals termed ‘Stroke Care Coordinators’. The system was evaluated in a Randomised Controlled Trial (RCT) that measured patient and carer outcomes in comparison to usual care. These outcomes do not reveal how, why or to what extent the system enhanced the practice of the Stroke Care Coordinators. This study was designed to complement the RCT using a theory-driven approach to explore the implementation and the impact of the system at two community stroke services (both multidisciplinary teams). The theory of change (how and why the system was expected to work) was elicited for comparison against service practice. The study drew on the principles of realist evaluation, which hypothesise that successful outcomes (O) will be realised if appropriate ideas and opportunities (mechanisms (M)) are introduced into appropriate contexts (C). CMO propositions were drawn out from the wider theory for testing at the two research sites. Qualitative methods were employed for data collection including observations of service practice, interviews with stakeholder groups and a review of service documentation. The findings revealed that local facilitators and barriers shaped how the system was implemented, resulting in two distinct applications of the intervention that deviated from the theory of change. The extent to which the system enhanced the Stroke Care Coordinators’ practice was dependent on context e.g. their background and experience. Further to this, the system’s impact was mediated by the information and support available from within the multidisciplinary teams. For this reason, the extent to which the service enhancements realised in practice impacted on the patient and carer outcomes measured was hard to discern.
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Farnfield, Steve. "Being in care : a study of older children's experiences of local authority care using an attachment and object relations perspective." Thesis, University of East London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274631.
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Senkodu, Chandra Segaran. "The use of a single smart card for transit and non-transit systems : a Singapore case study." University of Western Australia. Graduate School of Management, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0145.
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Governments around the world are investing heavily in smart card infrastructure to enhance transport services. Studies show that smart card technology can improve reliability, reduce maintenance costs, provide a longer life span, and allow more applications to be incorporated in a transit card. As a result, policy makers and transport owners are interested in extending the use of smart cards from transit to non-transit systems to capitalise on their investment. However, little is known about the conditions under which customers would adopt transit cards for non-transit transactions. In Singapore, a contactless transit smart card (ez-link card) was launched in April 2002 to replace the magnetic stored-value card, which was commissioned in December 1990. The ez-link card was introduced as an integrated public transport card for use both on buses and Mass Rapid Transit (MRT) and Light Rail Transit (LRT) trains. This study was undertaken to evaluate customers' response to the use of the ez-link card for non-transit transactions. As the ez-link card is an information technology (IT) product and the first of its kind in the Singapore public transport system, there is a need to understand and appreciate how customers would respond to the change in its use. Various theories and models such as the Technology Acceptance Model (TAM), Theory of Diffusion (TD), Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) were reviewed for their potential to understand and predict customers' intentions to use the ez-link card for non-transit transactions. After much review, the TPB was adopted for identifying the research model and hypotheses in this study. The TPB was used to develop the research model and hypotheses comprising one dependent variable (intention INT) and three independent variables (attitude - ATT, subjective norm - SN and perceived behavioral control - PBC). The TPB was also used to design the questionnaire comprising 16 items to collect data from customers using the ez-link card at bus interchanges and train stations located around Singapore. A pilot survey was conducted on 21 respondents using the intercept interview technique. The data were collected and analysed. With slight modifications, the questionnaire was then used with 300 respondents in the final survey. Descriptive and inferential statistics were used to analyse the data collected from 293 respondents (seven were outliers) using the intercept interview technique in the final survey. Regression analysis explained 80% of the variance in the customers' intention to use the ez-link card for non-transit transactions. While the results provided initial support for the TPB, further examination of the data using exploratory factor analysis revealed high correlations between the ATT and SN. This study concluded that a more parsimonious model would only extract two independent variables (Desirability - DES and Perceived Convenience PEC) to predict customers' intention to use the ez-link card for non-transit transactions. DES and PEC were used to develop a new
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Brofferio, Aja. "Reforming Foster Care in California." Scholarship @ Claremont, 2014. http://scholarship.claremont.edu/cmc_theses/863.
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The foster care system is responsible for taking care of society’s most vulnerable children and it is important that the system can be reformed as needed to meet the needs of these children. Institutional reform litigation is an ineffective method of improving the child welfare system and should no longer be relied upon. Although widely used institutional reform litigation is not efficient or effective in improving the foster care system. Litigation is unsuccessful in achieving reform because it does not embrace collaboration, cooperation, or communication but instead fosters a hostile environment in which the agencies under court mandate are expected to enact change. In 2006, two new organizations were established in California, the California Blue Ribbon Commission on Children in Foster Care and the California Child Welfare Council. Both of these organizations created recommendations for improving foster care. Unlike institutional reform litigation, these two organizations worked collaboratively with various agencies and government branches in order to come up with recommendations that were feasible. These two organizations provide a method of reform that is less myopic and more supportive, allowing for meaningful improvements within California’s foster care system.
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Drennan, Vari Macdougal. "Clinicians as leaders in local NHS governance bodies : the case of primary care groups." Thesis, King's College London (University of London), 2005. https://kclpure.kcl.ac.uk/portal/en/theses/clinicians-as-leaders-in-local-nhs-governance-bodies--the-case-of-primary-care-groups(da8a00c2-491c-46ea-ac0b-b8a835a97597).html.
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Lewis, Richard. "Improving London's primary care : centre-local relations in the implementation of national policy objectives." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248237.
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Graver, Lynne Denise. "The evaluation of the local multidisciplinary facilitation teams in primary health care, in Liverpool." Thesis, Liverpool John Moores University, 1999. http://researchonline.ljmu.ac.uk/5066/.
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