Dissertations / Theses: 'Medical specialist'

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Forrest, Mia. "Swedish Obesity Specialists : Obesity and its Treatment at a Specialist Clinic in Stockholm." Thesis, Stockholm University, Department of Social Anthropology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-31035.

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Swedish Obesity Specialists examines how obesity is conceptualized as a medical condition by the staff working at an obesity clinic in Stockholm Sweden. Through eight weeks of participant observations and eight semi-structured interviews this thesis answers the question of how specialist working in the field of obesity construct obesity as a medical site. The thesis aims at understanding how obesity is becoming an issue for medicine, further how obesity’s entry into medicine creates new understandings of the body and medical treatments. Through the theoretical concepts of global assemblages and bio-power I argue that obesity as a disease is defined through seemingly objective criteria aimed at defining a population of sufferers, simultaneously for obesity to be viewed as disease scientifically valid treatments on an individual level must be put into place. By viewing obesity’s entry into medicine as a process of shared consensus, this thesis examines the relationship between global levels of knowledge production and their application and negotiation at one clinic treating obesity. Here expert knowledge and governance are integrated to create both treatment and an idea of what obesity as a medical condition is. In this thesis I argue that the application of expert knowledge and global criteria leads to unexpected views on what can be conceived as medical treatment. Further the thesis discusses how the body of the patient becomes reinterpreted once obesity becomes a medical condition.

Key words: Obesity, medical expertise, global assemblages, governance, lifestyle alteration

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Betina, Ludmila, and Heléne Persson. "SJUKSKÖTERSKORS BEDÖMNING AV SPECIALIST-SJUKSKÖTERSKORS KOMPETENS INOM PSYKIATRISK VÅRD." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26171.

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Bakgrund: Bristen på specialistsjuksköterskor inom psykiatri är stor, men ändå efterfrågas inte kompetensen av arbetsgivaren. Förslag att minska antalet specialistutbildningar har lagts fram varav psykiatri är en av dem. Syfte: Syftet med studien var att undersöka hur sjuksköterskor bedömer specialist-sjuksköterskors kompetens inom psykiatrisk vård. Metod: En kvantitativ webbaserad studie genomfördes med totalt 110 sjuksköterskor med erfarenhet från psykiatrisk vård. Resultat: Den specialistutbildade sjuksköterskan bedöms ha en högre kompetens än grundutbildade sjuksköterskor av samtliga, men med lika uppgifter och ansvar. Självskattning hos specialister är högre. Erfarenhet är av stor betydelse för kompetensen. Slutsats: Kompetensen hos specialist-sjuksköterskor bedömdes vara högre än hos grundutbildade sjuksköterskor, men arbetet och ansvaret är detsamma. Det finns behov av att arbetsgivare tydligare tillvaratar kompetensen hos specialistutbildade sjuksköterskor. Synliggörandet av den specifika kompetensen kan då på sikt resultera i fler specialister inom psykiatrin.
Background: The shortage of specialist nurses in psychiatry is great, but the skills are still not required by the employers. Proposals to reduce the number of specialist courses have been made, of which psychiatry is one of them. Objective: The aim of the study was to investigate how nurses assess specialist nurses´ competence in psychiatric care. Method: A quantitative web based study was conducted with a total of 110 nurses with experience from psychiatric care. Results: The specialist registered nurse is judged to have a higher competence than registered nurses, but with equal tasks and responsibilities. Self-esteem among specialists are higher. Experience is of great importance for the competence. Conclusion: The competence of specialist registered nurses was assessed to be higher than that of registered nurses, but work and responsibilities are the same. There is a general need for employers to more clearly utilize the competence of specialist nurses. The visibility of the specific competence can then in the long run result in more psychiatry specialist nurses.

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Wong, Ming-yan Sharon, and 黃明欣. "Management of access to Hong Kong public specialist out-patient services." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48426180.

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Introduction Accessibility to care is a key measure for quality health care. Waiting list resulted due to disequilibrium between demand and supply. Waiting time is a common issue in public health care services. Long waits and delays dissatisfy patients, affect clinical outcome and increase health care costs. Access management is therefore important to enhance patient safety, increase satisfaction and reduce service inefficiency. In Hong Kong, waiting lists for public specialist out-patient services have been increasing over the past years. Promotion of appropriate referrals and appropriate utilization between primary and secondary care was identified as one of the current strategies for service demand management. Referral guidelines were introduced to define the clinical conditions to be referred. Appropriate work up and trial of treatment was recommended before referral to specialist care. They were translated into standard referral letter templates and built into the existing electronic medical record system as an execution platform to facilitate workflow and enhance compliance. This electronic referral system was piloted since January 2010 in Department of Accident of Emergency and General Out-patient Clinic at one local public hospital in Hong Kong. Methods The objective of the study was to evaluate the effectiveness of current strategy in access management to public specialist out-patient services. All new case referrals to Medical and Surgical Specialist Out-patient Clinics (SOPC) of the pilot hospital from January 2010 to December 2010 were examined. While, the new case booking data from January 2009 to December 2009 in respective units of the same hospital was used as control group for comparison. Potential changes in number and distribution of new case bookings at medical and surgical SOPC as well as their corresponding waiting time were looked into. Comparison of referral pattern before and after the implementation of new referral system was performed. Results Changes in referral pattern in terms of distribution of triage categories have been observed. Number of semi-urgent cases was significantly increased in 2010 compared with 2009 in both Medical and Surgical SOPC (p=0.006 and p=0.048). Shortening of overall median waiting time was also seen in both Medical and Surgical SOPC of the pilot hospital in 2010. Consistent reduction with statistically significance was noted in all triage categories of both specialist clinics, except urgent cases in Surgical SOPC. Larger effect was seen in non-urgent cases, with 9 weeks and 4 weeks shortening of waiting time in Medical and Surgical SOPC respectively. For overall distribution of waiting time, persistent multimodal patterns were observed in both Medical and Surgical SOPC during the study period. Major peaks were identified within 2 and 8 weeks time of appointment, while scattered clustered bookings were seen along the timeline with waiting time up to years. Discussion The observed result was reinforcing the direction on current strategy, despite direct causal relationship could not be established at the moment. Changes in referral pattern could possibly be explained by the behavioral change of clinicians upon referral and triage of patients due to the introduction of the new referral system. Potential Hawthorne effect during the pilot period should therefore be considered. In view of the complexity and interconnectedness of various service components in the health care system, further studies should be of value to identify the change agent in the system and look into the efficiency gain as well as outcome improvement. Long term and regular monitoring mechanism of waiting time with specific set of performance indicators has to be in place for continuous quality improvement. Taking the public health approach by applying operational studies and simulation models should therefore be the way for further improvement of operational efficiency and service planning in the whole public health system. Conclusion Appropriateness of referrals and utilization between primary and specialist services was introduced for access management of public specialist out-patient services in Hong Kong. Changes in referral pattern with shortening of waiting time were observed. In order to manage the accessibility issue effectively, a balanced approach on demand, queue and capacity management was suggested to be adopted at the organizational level. Collaboration across sectors particularly with the direction to strengthen primary care would also be needed globally at the system level for a healthy, equitable and sustainable system.
published_or_final_version
Public Health
Master
Master of Public Health

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Yi, Yuxiang, and 易宇翔. "Factors affecting adherence to new specialist outpatient appointments among elderly patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B2662798X.

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Lane, Cathie Anne Clinical School St George Hospital Faculty of Medicine UNSW. "Optimising Australian postgraduate medical education and training in nephrology." Awarded by:University of New South Wales. Clinical School - St George Hospital, 2009. http://handle.unsw.edu.au/1959.4/44662.

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The optimal manner in which to train nephrologists has not been studied. The objectives of this research were to determine:- 1. The educational and historical basis underpinning the Australian nephrology training program. 2. The drivers surrounding a career choice in nephrology. 3. What constitutes an ???ideal??? nephrologist and how nephrologists spend their work time, thereby identifying skills and attributes to be fostered in training. 4. Impediments to training, including examination of the available workforce. Five sub studies were undertaken, utilising a combined quantitative and qualitative approach (mixed methods): 1) A national Basic Physician Trainee (BPT) questionnaire, 2) a national nephrology workforce study, and in-depth interviews of: 3) nephrology patients, 4) nephrology trainees and 5) practicing nephrologists. New findings arising from this research reveal: doctors choose nephrology as a career if exposed to the specialty in a positive manner with good role models, however, there are a range of modifiable factors that make nephrology unattractive to many BPTs; workload is high, impacting negatively on training and trainee recruitment; Nephrologists spend most time in the management of dialysis and transplant patients but have a range of other roles in day to day practice, essential information to develop a competency based training program; availability of nephrologists for training is suboptimal and will likely worsen; Patients and doctors apply and weight parameters differently when defining an ???ideal nephrologist???. Both groups believed that specialist knowledge remains an essential requirement but patients focused more on good communication skills. This research provides evidence that the training program should incorporate training in advanced communication and basic research skills and promotion of an holistic approach to patient care. There is no formal alignment of training with assessment. Trainees and nephrologists believe that feedback is critical to learning, yet the assessment process is not underpinned by sound educational principles. This can be rectified using the findings of this research in conjunction with curriculum development and performance assessment. This research should provide an approach to the examination of training that is applicable to many internal medicine specialties. Importantly, nephrology training can now be improved with sound educational principles, underpinned by the findings of this research.

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Au, Yeung Kin-nam Simon. "Managerial perspective cost analysis of non-attendance in specialist outpatient clinics (SOPD) and reasons behind /." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B3197143X.

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Lannie, Antonia Lydia. "Experiences of the older person with cancer : a qualitative study of medical and specialist ward settings." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/544b9190-2798-4ff8-8e90-7898de5cd4d5.

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This thesis combines two research strands: cancer patients’ experiences and care of the older person. Previous cancer research has identified that health care professionals may treat older people with cancer differently, perceiving them as having less power; offering fewer treatment options; and less access to specialist cancer care. This qualitative study seeks to illuminate and compare the experiences of patients and health care professionals in two contrasting hospital wards (specialist and medical). This study considers how cancer patients manage their psychological and social needs. It also explores the challenges for health care professionals. Purposive sampling captures diversity of patient and health care professionals’ perceptions. Semi-structured interviews were conducted with patients and focus groups and semi-structured interviews with professionals. Analysis highlighted commonalities and also different emphasis accorded to issues such as societal perceptions, expectations of care, life stage, relationships, identity, and emotions. The hospital serves as a ‘halfway house’ for patients, allowing them to work through challenges in a ‘protected’ environment. However, health care professionals had difficulties addressing the future and managing some therapeutic opportunities. These are discussed using the thematic codes of ‘professional etiquette’, and types of emotional engagement with patients. Although older people with cancer are often perceived as a homogenous group they may have varying psychosocial needs. Moreover, patients’ understanding is frequently more sophisticated than professionals acknowledge. Finally the thesis will discuss the implications of this research for professional education, assessment and provision of care for the older person with cancer.

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Au, Yeung Kin-nam Simon, and 歐陽健男. "Managerial perspective: cost analysis of non-attendance in specialist outpatient clinics (SOPD) and reasonsbehind." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B3197143X.

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Yeung, Sze-ying. "A case control study of the referral pattern and patient non-attendance in medical and surgical specialist outpatient clinics in Hong Kong." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724293.

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Goldberg, Sarah. "Confused older patients' experiences of care on a specialist medical and mental health unit compared with standard care wards." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/13107/.

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There are concerns about cognitively impaired older patients’ experiences of general hospital care. Nottingham University Hospital developed a medical and mental health unit (MMHU) as a demonstration model of best practice dementia care. This thesis describes a controlled clinical trial comparing patients’ experiences of care on the MMHU to standard care wards. Patient experience was measured using the structured non-participant observational tool Dementia Care Mapping. Observations lasted 6 hours during which a score was recorded every five minutes for the patient’s mood and engagement and activity, together with incidents of enhancing and detracting staff behaviours. Noise (alarms, background noise and co-patients calling out) was recorded. 90 (46 MMHU, 44 Standard care) patients were observed between March and December 2011. At admission, most characteristics of patients on MMHU and standard care were similar. However, patients observed on MMHU had more behaviour disturbance, more often were care home residents and were less disabled than those observed on standard care. Patients on MMHU experienced a median 11% (95% Confidence Interval (CI) 2%, 20%) improvement in the proportion of time in positive mood and engagement (79% versus 68%); a median 3 (95%CI 1, 5) more enhancers (4 versus 1); a median 13% (95%CI -17%, -7%) less time noise could be heard (79% versus 92%) but a median 15% (95%CI 1, 23%) increase in proportion of time co-patients called out (21% versus 6%). Patients on MMHU had a better experience of care than those on standard care wards in terms of their mood and engagement, number of enhancers and improved noise levels, but experienced more co-patients calling out. This is the first study measuring an intervention to improve cognitively impaired older patients’ experiences in the general hospital and the first study to use the Dementia Care Mapping tool to evaluate an intervention in this setting.

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Wagner, Becca R. "The Integration of Child Life in the Medical Diagnosis Camp Setting." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1470313013.

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Yeung, Sze-ying, and 楊思瑩. "A case control study of the referral pattern and patient non-attendance in medical and surgical specialist outpatient clinics inHong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724293.

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MacVane, Fiona Ellen. "Midwifery knowledge and the medical student experience : an exploration of the concept of midwifery knowledge and its use in medical students' construction of knowledge during a specialist obstetric rotation." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4904.

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The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

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MacVane, Fiona E. "Midwifery knowledge and the medical student experience. An exploration of the concept of midwifery knowledge and its use in medical students' construction of knowledge during a specialist obstetric rotation." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4904.

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The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

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Wong, Wing-yee Victoria. "Patterns of doctor-shopping behaviour in non-attenders of specialist out-patient clinics in Hong Kong is it related to patients' health perception? /." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971350.

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Almathkuri, Jalal Haris. "Investigating the motivation behind language alternation in the multilingual medical workplace : a study of language practices at King Abdul Aziz Specialist Hospital, Saudi Arabia." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/417871/.

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This study investigates the use of Language Alternation (LA) between Arabic and English by the employees of King Abdul Aziz Specialist Hospital (KASH) from a socio-cultural perspective in order to explore the motivation behind LA practices in this multilingual medical workplace. There were 75 participants including doctors, nurses, and administrative employees. Most of the participants are Saudis, however some of them are nationals of other Arab countries and others are nonArab, in both cases having different linguistic and cultural backgrounds. Data for this qualitative study were collected through observations, recording of naturally occurring interactions, and individual semi-structured interviews. The duration of the recorded material is nearly 35 hours. Using a combination of Interactional Sociolinguistics (Gumperz 1982), Politeness Theory (Brown & Levinson, 1987 and Scollon, et al., 2012), and Accommodation Theory (Giles & Powesland, 1975; Giles, 1973; Giles et al., 1987 and Giles, et al., 1991) as a theoretical framework, the findings from the data were grouped in themes and analysed in order to find out the reasons for and functions of LA. The results of the analysis indicate that the use of LA among the employees of KASH was generated by two major types of factors: institutional factors, due to which participants appeared to switch from one language to another because of conditions and/or constraints arising from the institutional setting, and cultural factors, which appeared to result in participants alternating between Arabic and English due to certain cultural beliefs and norms delineating cultural differences and overcoming cultural issues arising from the use of a foreign language. The major findings of this study include that LA is used to resolve communication difficulties, to facilitate effective communication using particular technical concepts and expressions, to negotiate power, hierarchy and personal relationships, to avoid using certain Arabic terms that are regarded as sensitive by some listeners, and to preserve the meaning of certain terms and expressions by using them in one particular language rather than the other, especially those regarded as formulaic chunks with specific cultural significance. The study concludes with research implications, implications for medical authorities and educators, and recommendations for future research.

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Larsson, Jan. "Anaesthetists and Professional Excellence : Specialist and Trainee Anaesthetists’ Understanding of their Work as a Basis for Professional Development, a Qualitative Study." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4518.

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Vaflor, Amy Louise. "Advanced Practice Registered Nurses and Medical Executive Committee Membership: A Quality Improvement Proposal." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1616670175777308.

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Åkesson, Ida, and Malin Wilding. "Läkares erfarenheter av Regionalt läkarstöd till ambulanssjukvården : En kvalitativ intervjustudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-62440.

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Bakgrund: Regionalt Läkarstöd (RLS) har utformats för att säkra prehospital involvering från läkare. Dagens ambulanssjukvård ställer höga krav på att bedöma och triagera patienter till rätt vårdnivå. Till sin hjälp i sitt dagliga arbete med detta behöver sjuksköterskan en läkare som är väl insatt i verksamheten. Syfte: Att beskriva läkares erfarenhet av att fungera som rådgivare till sjuksköterskor inom ambulanssjukvården Metod: Kvalitativ intervjustudie med tio läkare som tjänstgör som RLS. Analysen genomfördes med en kvalitativ innehållsanalys. Resultat: Resultatet beskrivs med de fyra kategorierna Teamsammanhållning, Frustration, Bristande ansvarskänsla och Lyhördhet, som speglade läkarnas erfarenheter av att vara telefonstöd till sjuksköterskor. Ett latent huvudbudskap identifierades som Skör tillit. Att som en del i teamet finnas som stöd och rådgivare till sjuksköterskor i ambulanssjukvården upplevdes som positivt och funktionen ses som relevant och viktig. Det krävs en god teamsamverkan mellan professionerna för en patientsäker vård och för att uppnå det utkristalliserades tillit som en nyckelfaktor. Konklusion: En telefonbaserad bakjourslinje dit sjuksköterskor kan vända sig för råd och stöd är en relevant funktion för läkarna, där de känner sig som en del i det prehospitala teamet. I arbetet med bättre teamsamverkan inkluderande god kommunikation för säker vård, är gemensamma möten och övningar en viktig del för att ge professionerna en chans att mötas som personer och främja ökad förståelse för varandras kunskap och utforma gemensamma mål.
Background: Regional Medical support has been designed to ensure an involvement of doctors in the prehospital field. The current system for ambulance care raise high demands to ensure a correct patient assessment and triage to the right level of care, and for their assistance in this daily work, the nurse needs a doctor who is very knowledgeable in the organization. Purpose: To describe doctors’ experience of functioning as advisors for nurses working in the ambulance. Method: A qualitative research design was conducted including interviews with nine doctors serving as Regional Medical support. The content analysis was conducted according to a qualitative content analysis method. Result: The analysis resulted in the four categories team spirit, frustration, lack of sense of responsibility and responsiveness, which mirrored the doctors’ experiences of acting as a phone support for specialist nurses on the ambulance. An underlying main message was identified as delicate trust. To be part of the team and act as a support and advisor for nurses working on the ambulance was perceived as positive, relevant and important. Good teamwork between the professions is required to guarantee patient safe care, and to obtain that, trust came through as a key factor. Conclusion: For the nurses to have an on call doctor that they can reach on the phone for support and advice was seen as a relevant system for the doctors, where they feel as a part of the prehospital team. In the continuous work for better teamwork, including good communication for safe care, it's important with common gatherings and training sessions to give the professions a chance to meet in person and gain a better understanding for each other’s roles, and enunciate common goals.

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黃穎兒 and Wing-yee Victoria Wong. "Patterns of doctor-shopping behaviour in non-attenders of specialist out-patient clinics in Hong Kong: is itrelated to patients' health perception?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971350.

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Hillström, Moa. "När barn far illa : - BHV-sköterskors uppfattningar av stöd." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-16866.

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Bakgrund: Antalet barn som far illa ökar samtidigt befaras det finnas ett mörkertal av barn som far illa men som aldrig upptäcks eller uppmärksammas. Detta tros bero på att inte tillräckligt många upprättar orosanmälningar till Socialtjänsten. Att upprätta en orosanmälan kräver stöd och en yrkesgrupp som särskilt berörs av detta är de sköterskor som arbetar inom BHV. Syfte: Att belysa BHV-sköterskors uppfattningar av stöd i arbetet med barn som far illa. Metod: Sju BHV-sköterskor intervjuades. Datamaterial analyserades med fenomenografisk ansats. Resultat: Tre beskrivningskategorier och nio underkategorier utformades. Resultatet visar att stöd är ett begrepp med flera innebörder. Det belyser också betydelsen av stöd samt vilka konsekvenser uteblivet stöd kan få. Organisatoriska faktorer påverkar BHV-sköterskans stöd och kan utgöra ett hinder i BHV-sköterskans arbete och uppfattning av stöd. Konklusion: Stöd kan vara avgörande för BHV-sköterskans arbete och omvårdnadsansvar. Uteblivet stöd skulle kunna få förödande konsekvenser. Utvecklad samverkan genom ett multiprofessionellt team ger stöd åt BHV-sköterskan och förbättrar samtidigt vårdkedjan för de barn som far illa. Organisatoriska faktorer påverkar BHV- sköterskan vilket bör tas i beaktning vid utformning och utveckling av vården.
Background: The number of maltreated children are increasing and a great number of cases are estimated to never be detected or noted. This is believed to be caused by not enough reports to the Social Services which requires courage and support. A professional group that is affected by this are child health care nurses. Aim: To enlighten child health care nurses’ perceptions of support in working with maltreated children. Method: Seven child health care nurses were interviewed. The data were analysed through a phenomenographic approach.Results: Three description-categories and nine subcategories were formed. The results enlighten that support is a concept of several meanings, the meaning of support and what consequences lack of support can lead to. The results also show that organizational factors impact the support of the child health care nurse. Conclusion: Support can be a deciding factor in the child health care nurse’s work and responsibilities. Lack of support could have devastating consequences. A developed multi-professional team offers support to the child health care nurse and simultaneously improves the chain of care for the maltreated children. Organizational factors affect the child health care nurse, which should be taken into consideration in designing and developing health care.

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Nilsson, Jenny, and Veronica Hansson. "Överlämning från barn- och ungdomspsykiatrin till vuxenpsykiatrin." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26181.

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Psykisk ohälsa ökar bland unga vuxna och därtill behovet av att olika aktörer samverkar. Barn- och ungdomspsykiatrin arbetar med barn- och ungdomar som har psykisk ohälsa. Ungdomar som är i behov av fortsatt psykiatrisk vård överlämnas till vuxenpsykiatrin efter 18års ålder. Överlämningen från barn- och ungdomspsykiatrin tenderar att bli särskilt svår för ungdomar med neuropsykiatriska funktionsnedsättningar. Syfte: Syftet var att undersöka sjuksköterskors uppfattningar om överlämning från barn- och ungdomspsykiatrin till vuxenpsykiatrin. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes. Totalt intervjuades åtta sjuksköterskor yrkesverksamma inom barn-och ungdomspsykiatrin eller vuxenpsykiatrin. Intervjuerna analyserades med konventionell innehållsanalys och manifest ansats. Resultat: Tre kategorier som svarade på syftet identifierades, nämligen oklara direktiv, vuxen på en dag och en god process. Slutsats: Bristande överlämning var en återkommande uppfattning bland sjuksköterskorna men också en oro över att ungdomarna inte var redo för överlämningen vid 18års ålder. Ökat samarbete från barn- och ungdomspsykiatrin till vuxenpsykiatrin var önskvärt av samtliga sjuksköterskor för att säkerställa patientsäkerheten.
Mental illness is increasing among young adults and the need for different actors working together. Child and adolescent psychiatry work with children and adolescents who have mental illness. Young people who need continued psychiatric care are transmitted to adult psychiatry after 18 years of age. The transition from child and adolescent psychiatry to adult psychiatry tends to be particularly difficult for adolescents with neuropsychiatric disabilities. Aim: The aim was to examine nurse’s perceptions of the transition from child- and adolescent psychiatry to general adult psychiatry. Method: A qualitative interview study with semi-structured interviews was conducted. In total, eight nurses working in child and adolescent psychiatry or adult psychiatry were interviewed. The interviews were inductively analysed with conventional content analysis and a manifest approach. Result: Three categories that responded to the aim were identified; unclear directives, adult in one day and a good process. Conclusion: Deficient transition was a recurring opinion among nurses, but also a concern that young people were not ready for transition at the age of 18. Increased collaboration from child- and adolescent psychiatry to adult psychiatry was desired by all nurses in order to ensure patient safety

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Petersson, Lisa, and Sara Samuelsson. "Att vara specialistsjuksköterska inom medicinsk vård : En digital studie." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-41669.

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Bakgrund: Specialistsjuksköterskor har en central roll i upprätthållandet av en god och patientsäker vård. I nuläget tillvaratas inte specialistsjuksköterskans kompetens, vilket har minskat yrkets attraktivitet. Det finns ingen kompetensbeskrivning framtagen för specialistsjuksköterskor med inriktning medicinsk vård, vilket bidrar till svårigheten att definiera yrkesrollen. Syfte: Syftet med studien var att undersöka hur specialistsjuksköterskor med inriktning medicinsk vård beskriver sin yrkesroll och kompetens. Metod: En digital studie med specialistsjuksköterskor inom medicinsk vård i södra delen av Sverige. En kvalitativ innehållsanalys med induktiv metod genomfördes. Resultat: Analysen resulterade i två generiska kategorier: Att växa in i rollen som specialistsjuksköterska och Att höja kvaliteten i vården genom kunskap. Specialistsjuksköterskorna beskrev sig ha en fördjupad kompetens efter utbildningen, vilket ledde till en mer avancerad praktik och en större trygghet i rollen. Med en djupare förståelse för vården som helhet följde också en större frustration, exempelvis kring organisatoriska hinder för en god omvårdnad. Specialistsjuksköterskorna roll innebar bland annat att ta ansvar för att bedriva en god och säker vård, att genomföra förbättringsarbeten, sprida evidensbaserad kunskap och vara ett stöd till kollegor. Slutsats: Resultatet indikerar att förändringar i organisationen behövs. Specialistsjuksköterskor behöver mer tid och resurser för att kunna utöva omvårdnad på avancerad nivå och för att deras unika kompetens skall komma patienten till ännu större gagn. Studien har gett en indikation om vad yrkesrollen och kompetensen som specialistsjuksköterska inom medicinsk vård innebär men ytterligare förtydligande av yrkesrollen krävs.
Background: Specialist nurses have a central role in maintaining good and patient-safe care. At present, the specialist nurse's competence is not properly utilized, which has reduced the profession's attractiveness. There is no description of competence produced for specialist nurses of medical care, which contributes to the difficulty of defining the professional role. Aim: The aim of the study was to investigate how specialist nurses of medical care describe their professional role and competence Method: A digital study with specialist nurses of medical care in the southern part of Sweden. A qualitative content analysis with an inductive method was carried out. Results: The analysis resulted in two generic categories: Growing into the role of specialist nurse and Improving the quality of care through knowledge. The specialist nurses described themselves as having in-depth competence after their education, which led to a more advanced practice and greater security in the professional role. With a deeper understanding of care as a whole came a greater frustration, among other things about organizational barriers to good care. The role of specialist nurse in medical care involved taking responsibility for conducting good and safe care, carrying out improvement work, disseminating evidence-based knowledge and being a support to colleagues. Conclusion: The results indicate that changes are needed at the organizational level. Specialist nurses need more time and resources to be able to practice nursing at an advanced level and for their unique skills to benefit the patient more. The study has given an indication of what the professional role and competence as a specialist nurse in medical care entails, but further clarification of the professional role is required.

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Sukkar, Malak, and sukkarm@stvmph org au. "Executives' Decision Making in Australian Private Hospitals: Margin or Mission?" RMIT University. Graduate School of Business, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20081031.162754.

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This thesis examines decision making at executive level in Australian private hospitals as a social phenomenon, since individuals draw meaning from their own biographical and social environmental experiences. The researcher interpreted the constructed realities of the factors influencing executives' decisions within the context of private hospitals - a field that is rarely examined through the lens of social research. Using an Interpretivist research paradigm, the researcher conducted semi- structured and in-depth interviews with sixteen executive members who are experts in their field and represent both sectors of the private hospital industry: private for-profit and private not-for-profit. The data generated was transformed into technical accounts using an abductive research strategy and adopting Schütz's notion of first-order and second-order constructs. Using Giddens' Structuration Theory, that stressed the fundamental role of the human agent, the structure and their mutual dependence, the researcher moved beyond the interpretation of individuals' meanings, to incorporate the structure as an entity that can be formed and reformed. The researcher interpreted social actors' constructed meanings of these social phenomena in their work environment to form the elements of a two-dimensional decision making model at organisational level, incorporating the present with the future and the internal with the external factors. On an individual level, three different approaches to decision making were identified, based on whether executives perceived the decision making phenomenon as intuition, as a reasoned process or as an expected outcome. While being from a limited research sample, the findings of this study suggest that the paradox of mission / economic decisions restrained executives in the not-for-profit sector from strengthening their hospitals' financial performance, putting at risk, therefore, their ability to achieve social dividends as a way to proclaim their mission. On the other hand, in the for-profit sector, shareholders' dividends appeared to be a strong catalyst for attaining profit maximisation when making decisions. In both settings, the findings suggest that the role of stakeholder theory is questionable, particularly when executives remained hesitant to involve medical specialists, whom they considered to be major stakeholders and profit generators for private hospitals. This attitude appeared to be constant, despite the changes identified in executives' individual approaches to decision making. However, early signs of shifts towards adopting more commercially and socially accountable decisions were apparent in not-for-p rofit and for-profit sectors respectively. The thesis sets out recommendations to assist executives in managing the different factors that interplay to form executives' decisions. The importance of having a mission in business longevity and the integration, as opposed to alignment, of strategic goals with business operations when making executive decisions in private hospitals was highlighted. The implications for both sectors are described and recommendations for further research are suggested.

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Van, Heerden Andries Johannes. "Medical practitioners and medical specialists : profile and key factors for South Africa." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/5536.

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Thesis (MBA (Business Management))--Stellenbosch University, 2008.
ENGLISH ABSTRACT: Recent years have been witness to the co-existence of incredible advances in human well-being and healthcare development on the one hand and extreme deprivation and a significant drop in numerous health indicators on the other. Central among this paradox lies the key to accessible, comprehensive and dedicated healthcare - the health workforce and the numerous factors impacting on health professionals and health professional data. Key to health care human resource planning is a comprehensive understanding of the environment and demands that health professionals are faced with. This must be supported by knowledge of the profile of health professionals in a specific country and should lead to detailed health resource planning, based on benchmarks and analytical interpretation of the factors that both determine and influence the number of health professionals. This research report provides an abbreviated background to the local and international health sectors, profiles the current number and distribution of medical practitioners and selected medical specialists in the country and internationally, identifies the key factors for consideration in projecting the number of medical practitioners and medical specialists required for South Africa and proposes a framework for taking the process forward. The research showed that, while there are positive aspects to the South African health professional environment, the country faces dire regional disparities and does not compare favourably to many of its international peers in terms of health professional resources. The key aspects that influence health human resources were identified and it became clear that sustainable and comprehensive health resource planning is not a mere matter of ratios, but is indeed dependent on a number of critical success factors. It is critical that health human resource planning in South Africa requires urgent and comprehensive attention. Failure to address this urgently will result in a health care system continuing to struggle to meet the health care needs of the population. A structured approach is possible, but requires dedication and careful planning.
AFRIKAANSE OPSOMMING: Die laaste paar jare is gekenmerk deur die kontras van indrukwekkende vooruitgang in lewenskwaliteit en gesondheidsorg aan die een kant en ekstreme tekortkominge en die verswakking van gesondheidstatistieke aan die ander. Sentraal tot hierdie paradoks is die sleutel tot toeganklike, omvattende en toegewyde gesondheidsorg - die gesondheidswerkers en die vele faktore wat gesondheidswerkers en - data beinvloed. Die kern van gesondheidsorg menslike hulpbronne beplanning is 'n omvattende begrip van die omgewing en vereistes waaraan gesondheidswerkers blootgestel word. Dit moet ondersteun word deur in diepte kennis van die gesondheidswerker profiel binne in 'n spesifieke land en behoort te lei tot gedetaileerde gesondheidsorg menslike hulpbronne beplanning, na aanleiding van toepaslike verwysingsraamwerke en 'n analitiese interpretasie van die faktore wat die aantal gesondheidswerkers beide bepaal en noodwendig beinvloed. Hierdie navorsingsverslag verskaf 'n sinoptiese agtergrondskets van die nasionale en internasionale gesondheidsektore, gevolg deur die profiel (getalle en verspreiding) van die algemene praktisyns en geselekteerde mediese spesialiste, beide in Suid Afrika en internasionaal. Dit identifiseer die belangrikste faktore vir oorweging in die projeksie van die aantal algmene praktisyns en mediese spesialiste benodig en sluit af met 'n voorgestelde raamwerk vir voortgesette omvattende beplanning. Die navorsing het getoon dat, alhoewel die Suid Afrikaanse gesondheidswerker omgewing deur positiewe aspekte gekenmerk word, die land steeds onderworpe is aan daadwerklike streeks ongelykhede en boonop nie besonder positief vertoon teenoor ander soortgelyke lande nie. Die kern kwessies wat gesondheidswerkers beinvloed is geidentifiseer en dit is duidelik dat onderhoudende en omvattende gesondheidsorg beplanning nie bloot die toepassing van ratios is nie, maar dat dit onderhewig is aan 'n groot verskeidenheid kritiese sukses faktore. Dit is van kritiese belang dat gesondheid menslike hulpbronne beplanning in SA daadwerklike aandag geniet. Die nalaat van hierdie verantwoordelikheid, sal lei tot 'n gesondheidsisteem wat nie in staat is om aan die behoeftes van die land te voldoen nie. 'n Gestruktureerde benadering is moontlik, maar verdien toewyding en beplanning.

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Larsen, Anton, and Andrea Marklund. "Kroppsspråk, handpåläggning, hängslen och livrem : ambulanspersonalens upplevelse av att bedöma och vårda patienter vid språkförbistring." Thesis, Sophiahemmet Högskola, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3115.

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Bakgrund: Sverige har genomgått en förändring i demografi där en allt större del av befolkningen inte har svenska som modersmål. Samtidigt går ambulanssjukvården från att vara en transportfunktion där destinationen alltid varit akutsjukhus till att vara patientens första möte i en obruten vårdkedja. I detta nya uppdrag ingår att inhämta information, bedöma, vid behov behandla och slutligen transportera eller hänvisa patienten till rätt vårdnivå. Grunden för detta är en korrekt anamnes, bedömning och triagering.Detta ställer krav på individanpassad och differentierad vård. Språkförbistring på sjukhus har visat sig resultera i ökad handläggningstid, en större mängd undersökningar och fler vårdskador. Prehospitalt har forskning på språkförbistring inriktat sig på larmsamtal. Syfte:Syftet med denna studie var att undersöka ambulanspersonalens upplevelse att bedöma och vårda patienter vid språkförbistring.Metod: Syftet besvarades genom en kvalitativ studie med induktiv kvalitativ innehållsanalys. Deltagarna utgjordes av sex ambulanssjuksköterskor och två ambulanssjukvårdare som alla hadeerfarenhet av att bedöma och vårda patienter vid språkförbistring. Intervjudeltagarna rekryterades genom bekvämlighetsurval från ett mellansvenskt län. Data inhämtades med semistrukturerade enskilda intervjuer och analyserades med hjälp av induktiv innehållsanalys. Resultat: Fyra huvudkategorierframträdde. En mer fysisk bedömning beskrev hur ambulanspersonalen vid språkförbistring i större utsträckning nyttjade yttre, fysiska attribut för att göra en skattning av patientens kontaktorsak och allvarlighetsgrad. Att kommunicera annorlunda rörde hur vårdarna sökte kommunicera med patienten trots språkförbistring. Att handlägga utan information avhandlade information som ambulanspersonalen trots försök upplevde svår att klarlägga samt hur detta påverkade deras handläggning av patienten. Slutligen presenterades kategorin att skapa en relation vid språkförbistring som belyste hur intervjudeltagarna upplevde att deras mellanmänskliga vård påverkades vid språkförbistring. Slutsats:Studiens resultat påvisar att ambulanspersonals upplevelse av bedömning och vård vid språkförbistring karaktäriseradesav osäkerhet och en önskan om att kompensera för informationsluckor. Denna kompensation yttrade sig genom en noggrannare, bredare fysisk undersökning och bedömning samt en handläggning och vård som arbetar efter modellen ”hängslen och livrem”. Detta upplevdes också som begränsande då vårdarna avhöll sig från vissa åtgärder, såsom smärtstillning eller omstyrning till närakut, primärvård eller geriatriskt sjukhus. Då patienten var kritiskt sjuk upplevde inte personalen att omhändertagandet skiljde sig mot ett möte utan språkförbistring. Vid de tillfällen patienten inte var uppenbartakut sjuk upplevde personalen att de inte kunde ge samma möjligheter till en individanpassad vård och handläggning.En del av denna problematik skulle kunna adresseras genom ett utökat och anpassat besluts- och översättningsstöd för ambulanspersonalen.
Background: Sweden is going through a demographic change in which a larger part of the population no longer has swedish as its first language. At the same time the ambulance service is transforming from a purely transporting service to an integrated part of the patients overall healthcare. This new mission involves to gather information, to assess, when needed to treat and finally to transport or direct the patient to the most suited level of care. This process is based on a correct patient history, assesment and triage. Previous research has shown that language barriers in hospitals result in an increased risk of delays, costly examinations and injuries. Prehospital research on language barriers have traditionally focused on the emergency phone-call. Aim: The purpose of this study was to explore ambulance staffs experiences and perceptions of assessing and caring for patients where language was a barrier. Method: This was a qualitative study using a qualitative content analysis. Participants included six Swedish ambulance nurses and two ambulance nursing assistants who all had experience in assessing and caring for patients where language had been a barrier.Participants were recruited based on convenience. Data was collected through semi-structured interviews and analysed using inductive content analysis. Results:Four main categories emerged. A more physical evaluation encompassed how the providers increased the importance of outside physical attributes to assess the patients condition and level of urgency. To communicate differently comprised hos staff despite language barriers sought to communicate with the patient. To process without information described information that staff despite attempts were unable to map and how this affected their assessment and decision-making. The final category regarded to create a relationship through the language barrier and how participants perceived that their interpersonal carewas affected by language difficulties. Conclusion: The ambulance staff perceived and experienced the assesment and care where language was a barrieras characterised by a higher degree of uncertainty and a wish to compensate for alack of information. This compensation manifested itself through a more thorough, wider physical examination and an assessment based on the principle of ”belt and suspenders”. This was perceived as a limitation as staff abstained from certain actions, such as administering pain relief or directly admitting the patient to primary care or a geriatric ward. The assessment and care for the critically ill patient did not differentiate from that of the everyday case. The moderately ill patient however was perceived as not to be given thesameoptions to an individually adapted care and handling. Part of this problematique could be adressed through an expanded and adapted language- and decision making-tool for the crews.

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GAUTHERIE, PASCAL. "Aspects actuels de l'enseignement des specialites medicales en allemagne." Université Louis Pasteur (Strasbourg) (1971-2008), 1992. http://www.theses.fr/1992STR1M176.

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Modas, Diana Andreia Santos. "Cuidados de enfermagem ao cliente internado na UCPA submetido a cateterização vesical." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2016. http://hdl.handle.net/10400.26/14233.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
O presente documento reporta ao relatório de trabalho de projeto realizado no âmbito do curso de Mestrado em Enfermagem Médico-Cirúrgica (EMC), que contempla o Projeto de Intervenção em Serviço (PIS), englobando a metodologia de projeto, o qual consistiu na elaboração da Norma de Procedimento (NP) relativa aos cuidados de enfermagem ao cliente na cateterização vesical na Unidade de Cuidados Pós-Anestésicos (UCPA), suportada na evidência científica; e o estágio efetuado no âmbito médico-cirúrgico, com o objetivo do desenvolvimento de competências para a aquisição do grau de Especialista em EMC e Mestre concretizado através do Projeto de Aprendizagem Clínica (PAC). O estágio decorreu na UCPA do Hospital X, tendo-se prestado cuidados de enfermagem a clientes de todas as especialidades cirúrgicas, incluindo a vertente de cirurgia de ambulatório e de urgência. Procurando promover-se o bem estar e diminuição do desconforto e sofrimento da pessoa, preveniram-se e trataram-se complicações, maximizando-se a sua recuperação pós-operatória. Relativamente à metodologia de projeto, com o PIS elaborou-se a NP relativa aos cuidados de enfermagem ao cliente na cateterização vesical na UCPA, uma problemática da área de EMC, com base na evidência científica existente, cumprindo-se o processo da ADAPTE Collaboration, adaptando-se as recomendações, obtidas através da revisão de literatura efetuada, que eram transponíveis para a Unidade. Posteriormente, realizaram-se ações formativas à equipa de enfermagem para concretização da implementação da norma no serviço, uniformizando-se deste modo, a prestação de cuidados a estes clientes, promovendo-se um cuidado seguro e de qualidade. Durante este percurso foi possível desenvolver competências científicas, técnicas e humanas para prestar cuidados de enfermagem especializados na área da EMC, desenvolvendo-se um processo de aprendizagem autónomo e auto-orientado. O enfermeiro mestre e especialista em EMC presta cuidados de saúde ao cliente, realiza investigação, gestão e aplica o processo de tomada de decisão, com conhecimentos e competências especializadas, promovendo-se deste modo, a qualidade dos cuidados prestados.
The present document reports about the project work done in line with the Masters Course of Medical-Chirurgical Nursing (MCN) which contemplates the Service Intervention Project, that applies the project methodology in elaborating the Procedural Standard relative to nursing care to the medical client in using urethral catheters in the Post-Anaesthetic Care Unit (PACU), based on scientific evidences; and the Medical-Chirurgical internship that took place with the aim of developing further knowledge and skills in achieving the level of MCN Specialist and Master through the Clinical Learning Project. The internship took place in the PACU unit of the Hospital X, having been provided nursing care to clients of a large variety of medical specializations, including emergency and internment care. With the objective of promoting the well being and the reduction of pain and suffering in the subject, possible complications and recovery problems were prevented and precautions were taken maximising the patients post-procedure recovery. Regarding the project methodology a Procedural Standard was created using a Service Intervention Project stating the care to be given to patients in need of nursing care which included urethral catheters inside the PACU, which comprised one of the obstacles in the MCN area of application, as stated in the existing scientific referential documentation, in this way the process of ADAPTE Collaboration was applied, adapting recommendations from relevant literature which could be applied to the unit. Based on this evidence sessions of learning were prepared and lectured to the nursing team as a way of achieving the implementation of said Procedural Standard in the PACU Service, and, in this way, creating a standard for the nursing cares to provide to the clients and promoting a safe and high quality nursing care. During this period it was possible to develop new scientific, technical and personal skills in providing specialised nursing care in the field of MCN, applying an autonomous and self oriented learning process. The master nurse and MCN specialist provides nursing care to the client, investigates, manages and applies the decision making process, with specialised knowledge and skills, in this way promoting the quality of the nursing care.

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Stenlund, Andreas, and Stefan Birko. "Förekomst och förebyggande av hot och våld mot ambulanspersonalen i norra Sverige." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74912.

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Hot och våld mot ambulanspersonal har visat sig vara ett växande problem och påverkar möjligheten att ge god omvårdnad till patienten. Förekomsten av hot och våld prehospitalt har inte studerats i Sverige i samma utsträckning som i andra länder. Syftet med denna studie var att belysa förekomsten av hot och våld mot ambulanspersonalen i norra Sverige och hur detta kan förebyggas. Detta undersöktes med en webbaserad kvantitativ tvärsnittsstudie av enkätdesign med möjlighet till fritextsvar. Denna studie visade att majoriteten (80,4%) av ambulanspersonalen hade blivit utsatt för verbala hot någon gång under de senaste tre åren. 26,8 % av ambulanspersonalen skattade att de hade blivit utsatta för fysiskt våld under samma period. En statistiskt signifikant skillnad mellan män och kvinnor när det gäller deras skattning av att ha blivit utsatta för fysiskt våld kunde påvisas. En majoritet av ambulanspersonalen svarade att de aldrig hade utsatts för sexuellt ofredande de senaste tre åren. Kvinnor skattade i högre grad än männen att de blivit sexuellt ofredade och skillnaden var signifikant. Utifrån frågan om vilken typ av problematik som är vanligast, gällande personer som utövat fysiskt våld, framkom att personer som intagit både alkohol och droger/narkotika skattades som överrepresenterade. Denna studie genererar kunskap om vikten av att ha stöd från arbetsgivare och ett gott samarbete med andra myndigheter, exempelvis polis. Att göra riskbedömningar och att använda sig av lågaffektivt bemötande där det finns risk för hot och våld kan förebygga detta. Det är av fortsatt vikt att följa och studera utvecklingen av hot och våld mot ambulanspersonal och arbeta med hur detta kan förebyggas.

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Carter, Jennifer. "Child life specialists' perspectives in supporting adolescents struggling with medical non-compliance." Thesis, Mills College, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1557343.

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The current study sought to examine child life specialists' perspectives on supporting adolescents struggling with medical non-compliance. The intent of the study was to identify various factors involved in adolescent medical non-compliance and to examine the role of the child life specialist in supporting this population. Eighty-five certified child life specialists were surveyed regarding their work with adolescents and the strategies used to support adolescents struggling with medical non-compliance. The issues surrounding medical non-compliance were examined as well as child life specialist education and how capable child life specialists felt in their ability to support this population. Results support previous literature suggesting a negative impact of typical adolescent development on medical compliance. In addition, results revealed the multidisciplinary team approach and family dynamics as being barriers to supporting adolescents' struggle with medical non-compliance. These findings support the need for additional education to better equip child life specialists in their work with this population.

Keywords: child life specialists, adolescents, medical non-compliance, medical non-adherence

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Mariano, Miguel. "Uniformização de Cuidados de Enfermagem na Abordagem ao Grande Queimado na Sala de Reanimação." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10460.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médicocirúrgica
O trabalho desenvolvido ao longo dos estágios, culminaram neste relatório de trabalho de projeto, este teve por base uma metodologia de investigação, centrada num problema real identificado, tendo a posteriori sido implementadas estratégias e intervenções com o objetivo da sua resolução. A metodologia aplicada atravessou varias etapas entres elas, o diagnóstico da situação, planeamento, execução, avaliação e divulgação tendo sempre como ponto de partida pesquisa e analise baseados numa pratica fundamentada na evidencia. Os acidentes por queimadura são bastante frequentes e estão associados a elevada morbilidade e mortalidade. O número de doentes portugueses queimados é elevado. A identificação e tratamento precoce das lesões de queimadura, a ressuscitação hemodinâmica, o controlo da dor e a referenciação para centros com experiência no tratamento do grande queimado podem melhorar o prognóstico dos doentes. É de extrema importância uma prestação de cuidados de elevada qualidade ao grande queimado na sala de reanimação, como tal a primeira abordagem deve ser iniciada o mais precocemente possível, uma vez que aumenta consideravelmente a sobrevida dos utentes e diminui possíveis sequelas. Por ser uma área de interesse, onde após terem sido efetuadas entrevistas não estruturadas com a chefe e sub-chefe de serviço, assim como aplicados questionários aos enfermeiros do serviço, constatou-se que havia uma lacuna de conhecimentos na abordagem ao grande queimado. Este relatório traduz, o trabalho desenvolvido no conjunto dos estágios que permitiu desenvolver competências comuns e específicas do enfermeiro especialista e de mestre em enfermagem médico-cirúrgica.
Abstract: The work developed during internship, culminated in this report. It has in it's basis a research methodology, centered in a real life situation, having subsequently been implemented strategies and interventions with the goal of resolution. The methodology applied had several stages like: the diagnosis of the situation, planning, implementation, evaluation always taking as a starting point research and analysis based on a evidence fundamented practice. Burn accidents are quite common and are associated with high morbidity and mortality. The number of burned Portuguese patients is high. The early identification and treatment of burn injuries, hemodynamic resuscitation, pain control and referral to centers experienced in the treatment of severe burn can improve the prognosis of patients. It is very important the provision of high quality care to the major burn in the resuscitation room, such as the first approach should be initiated as early as possible, since it significantly increases the survival rate of patients and decreases possible after-effects. Since it is an area of interest, which after being made unstructured interviews with the chief and deputy chief of service, as well as questionnaires to the service nurses, it was found that there was a knowledge gap in addressing the major burn. This report represents the work in the interships that allowed the development of common and specific skills of the nurse specialist and master in medical-surgical nursing.

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Rosa, Carla Custódio. "A Segurança passa pela Prevenção." Master's thesis, Instituto Politécnico de Setubal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10465.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
No presente relatório pretendemos demonstrar, num processo de análise e reflexão, todo o percurso académico realizado no âmbito do Curso de Mestrado em Enfermagem Médico- Cirúrgica, durante o qual realizamos estágios numa Unidade de Cuidados Intensivos Coronários (UCICOR), desenvolvemos um Projeto de Intervenção em Serviço (PIS), pela metodologia de trabalho de projeto, e um Projeto de Aprendizagem Clínica (PAC). O PIS intitulado “A Segurança passa pela Prevenção” aborda a problemática de ocorrência de quedas do cliente hospitalizado no Serviço de Cardiologia/UCICOR. Estes incidentes são uma realidade das instituições de saúde e um indicador de qualidade dos cuidados de enfermagem. A realização deste projeto possibilitou-nos intervir na componente da segurança do cliente, através da adoção de um conjunto de estratégias pela equipa de enfermagem, nas quais evidenciamos a avaliação do risco de queda dos clientes e o envolvimento dos mesmos na prevenção e redução da ocorrência de quedas. A sua fundamentação teórica assenta na Tipologia dos Vinte e Um Problemas de Enfermagem de Faye Glenn Abdellah. O PAC constituiu-se como essencial na promoção de boas práticas profissionais, que visam a qualidade dos cuidados, dando resposta ao desenvolvimento de Competências Comuns e Específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica, desenvolvidas no estágio III. Na Pessoa em Situação Crítica, ao nível da prevenção e controlo da infeção implementamos o procedimento “Boas Práticas no Despejo do Saco de Drenagem de Urina”. Na Pessoa em Situação Crónica e Paliativa direcionamos a nossa intervenção para o cuidador do cliente com Insuficiência Cardíaca. Assim, neste relatório, procuramos evidenciar como os aportes teóricos lecionados e os projetos desenvolvidos em contexto de estágios, na procura da excelência no exercício profissional, promoveram a aquisição e desenvolvimento das Competências Comuns do Enfermeiro Especialista, das Competências Específicas do Enfermeiro Especialista e Mestre em Enfermagem Médico-Cirúrgica.
Abstract: In this report we intend to demonstrate, in a process of analysis and reflection, the entire academic course conducted in the context of a master’s degree in Medical-Surgical Nursing. For this purpose we did various internships at the Coronary Intensive Care Unit (CICU) as well as developed, using a project work methodology, an Intervention Project in Service (IPS) and a Clinical Learning Project (CLP). The IPS, entitled "Security is achieved through Prevention" concerns the occurrence of falls in patients admitted into the Cardiovascular Service /CICU. These incidents are a fact in health institutions and an indicator of nursing care quality. The achievement of this project had enabled us to participate in the field of patient security through the adoption of a set of strategies by the nursing team, in which we emphasized the assessment of the patient fall risk and the involvement of the patient himself in the prevention and reduction of falls. Its theoretical foundation is based on the Faye Glenn Abdellah’s Typology of the Twenty-One Nursing Problems. The CLP was established as essential in promoting good professional practice, that aim the quality of care and responds to the development of both Common and Specific Skills of the Nurse Specialist in Medical-Surgical Nursing. These skills were developed during the internship III. In a Critical Situation, at a level of prevention and control of infection, the procedure implemented is "Good Practices in the Disposal of the Urine Drainage Bag". In a Chronic and Palliative Condition we direct our intervention to the caregiver of the patient with Heart Failure. In short, this report seeks to show how the theoretical contributions and projects, developed in the context of internships, as well as the search for excellence in professional practice, promoted the acquisition and development of both Common and Specific skills of the Specialist Nurse and the Master in Medical-Surgical Nursing.

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Eldridge, Houser Jennifer L. "Health educators’ perceived preparedness to provide the centers for Medicare and Medicaid services’s Annual Wellness Visit." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/6941.

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The Annual Wellness Visit (AWV) is a benefit available to Medicare beneficiaries. This benefit has the potential to address many areas of prevention in one focused visit to the primary care clinic, yet it is currently being provided to only 19% of Medicare beneficiaries. This research attempted to examine the extent to which certified health education specialists (CHES) have provided and perceive themselves to be prepared to provide the preventive health services (PHS) within the AWV, along with seven additional preventive counseling services (PCS). A web-based survey assessed the perceived preparedness of health educators, specifically CHES (N=998), to deliver these PHS. The results of these surveys include the development of a single factor internally consistent scale to measure perceived preparedness for the PHS within the AWV. They reveal health educators were least prepared to assist with end-of-life-planning and conduct a basic hearing test. No association was found for education level and perceived preparedness; however, prior experience did account for a significant amount of the variance in perceived preparedness to provide AWV services. Lastly, when compared to historical data regarding physician’s perceived preparedness to provide PCS, health educators were more prepared to counsel on diet and exercise and less prepared to counsel on six other PCS. These results may aid in the understanding of whether CHES perceive they are prepared to provide (PHS) and demonstrate the experience CHES have with each of these PHS.

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Macedo, Rolanda. "Integração de Enfermeiros no Bloco Operatório: O Primeiro Passo para Cuidados de Excelência." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10454.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
O presente Relatório de Trabalho de Projeto surge no âmbito do 3º Curso de Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Saúde do Instituto Politécnico de Setúbal e a sua construção, apresentação e discussão pública visam a obtenção do grau de Mestre nesta área científica. Os objetivos deste relatório passam por apresentar o PIS – Projeto de Intervenção em Serviço e o PAC – Projeto de Aprendizagem Clínica, e descrever e analisar o desenvolvimento das competências adquiridas como Enfermeira Especialista e Mestre em Enfermagem Médico-Cirúrgica. No âmbito dos estágios realizados no Bloco Operatório do Centro Hospitalar X foram desenvolvidos, segundo a metodologia de trabalho de projeto, dois projetos: um Projeto de Intervenção em Serviço sobre “Integração de Enfermeiros no Bloco Operatório – O Primeiro Passo para Cuidados de Excelência”, cuja realização nos permitiu criar e implementar um programa de integração de novos enfermeiros no Bloco Operatório, com o objetivo de melhorar a qualidade e a segurança das integrações, sendo que foi um contributo para uma eficaz integração, facilitadora e potenciadora de uma prestação de cuidados de excelência; e um Projeto de Aprendizagem Clínica, centrado no desenvolvimento dos domínios nas áreas da prevenção e controlo de infeção, da resposta na catástrofe e emergência multivítima e do cuidar da pessoa em situação crítica e em situação crónica e paliativa. Ambos os projetos contribuíram para o desenvolvimento das competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico- Cirúrgica, designadamente em Enfermagem em Pessoa em Situação Crítica e em Pessoa em Situação Crónica e Paliativa, bem como as competências de Mestre em Enfermagem Médico-Cirúrgica. Ao longo do Relatório, descrevemos o percurso efetuado no Curso e respetivos estágios, analisando os seus aportes no desenvolvimento de competências especializadas e de mestre em enfermagem, contribuindo para a melhoria contínua da qualidade dos cuidados prestados, dentro do alvo desejável da excelência na profissão de Enfermagem.
Abstract: This Project Work Report comes out as part of the 3rd edition of the Medical- Surgical Nursing Master’s degree in the School of Health, Polytechnic Institute of Setúbal. Its construction, presentation and public discussion aims the achievement of a Master’s degree in this scientific area. The objectives of this report are to present the IPS – Intervention Project in Service – and the CLP – Clinic Learning Project – and describe and analyze the development of skills acquired as Specialist Nurse and Master in Medical-Surgical Nursing. Two projects were carried out during the internship: an Intervention Project in Service entitled as "Integration – The First Step to Excellence Care", which allowed us to create and implement a program for the integration of new nurses in the operating room, which has been a contribution to an effective integration, promoting and enabling the provision of a care of excellence; and a Clinic Learning Project, aimed at developing the skills of a Specialist Nurse regarding the prevention and control of infections, the answer in disaster situations and multi victim emergencies, and the care of someone in critical and in chronic and palliative situations. Both projects contributed to the development of the common and specific skills of the Specialist Nurse in Medical-Surgical Nursing, namely in the care to the Patient in Critical Situation or in Chronic and Palliative Situation, as well as the development of the skills of Master in Medical-Surgical Nursing. Throughout the Report, we will describe the route followed during the Course and respective internships, analyzing their contributions to the development of expertise and mastership in Nursing, and to the continuous improvement of the quality of care provided within the desirable goal of excellence in the Nursing profession.

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Amaral, Guida. "As competências do enfermeiro especialista na promoção do processo de ensino aprendizagem dos estudantes do curso de licenciatura em enfermagem." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2016. http://hdl.handle.net/10400.26/17785.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
O presente relatório de trabalho de projeto foi realizado no âmbito do curso de Mestrado em Enfermagem Médico-Cirúrgica (EMC), e contempla o Projeto de Desenvolvimento Académico (PDA) e o Projeto de Aprendizagem Clínica (PAC). O estágio decorreu num Serviço de Urgência (SU), de um hospital na margem sul. No PDA procuramos dar resposta a uma nossa inquietação, acerca do papel de enfermeiro especialista em EMC como promotor da aprendizagem. Realizamos uma Revisão integrativa da literatura (RIL) com o objetivo de identificar quais os aspetos considerados pelos estudantes de enfermagem (EE) e pelos enfermeiros orientadores (EO), como influenciadores da aprendizagem em contexto de prática clínica (CPC). Emergiram 6 categorias de aspetos que influenciam a aprendizagem: Acolhimento, Organização do ensino clínico (EC), CPC, Processo de ensino-aprendizagem, EO e EE. O enfermeiro especialista, pelas competências comuns especializadas que possui, pode ter um papel facilitador do processo de ensino-aprendizagem em CPC dos EE do CLE, pela sua intervenção junto às equipas de enfermagem, nomeadamente do âmbito de: Preparação e organização do EC em CPC; Acolhimento e integração do estudante no CPC; Acompanhamento e monitorização do EC em CPC. Durante este percurso conseguimos desenvolver competências cientificas, técnicas e humanas para prestar cuidados especializados na área da EMC. O enfermeiro mestre e especialista em EMC presta cuidados de enfermagem ao doente em situação critica e com doença crónica, incapacitante e terminal, realiza investigação, gere os cuidados e tem capacidade de tomada de decisão em situações complexas, utilizando os seus conhecimentos e competências especializadas e promovendo a qualidade na prestação de cuidados.
This project report report was carried out under the Master's course in Medical-Surgical Nursing (MSN), and includes the Academic Development Project (ADP) and the Clinical Learning Project (CLP). The Internship took place in the emergency room (ER),of an hospital on the south of Portugal. The ADP seek to address our concern about the role of nurse specialist in MSN as a learning promoter. We performed an integrative literature review (ILR) in order to identify the aspects considered by nursing students (NS) and the guiding nurses (GN) as learning influencers in the context of clinical practice (CCP). Emerged six categories of aspects that influence learning: Reception, organization of clinical teaching (CT), CCP, teaching-learning process, GN and NS. The nurse specialist, by common expertise they have, may have a facilitating role in the teaching-learning process in CCP for NS, for their intervention in the nursing teams, in particular under: Preparation and organization of the CT in CCP ; Reception and integration of the NS in the CCP; Tracking and monitoring of CT in CCP. During this way we have developed scientific, technical and human skills to provide specialized care in the MSN. The nurse master and specialist in MSN provides nursing care to the patient in critical situation and in chronic, debilitating or terminal illness, conducts research, manages care and has decision-making capacity in complex situations, using their knowledge and expertise skills, to promote quality in the nursing care.

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Souza, Ademar Rosa de. "Estudo comparativo avaliando três modalidades de diagnóstico médico parecer médico, buscas no Google e sistema especialista de apoio à decisão médica /." Botucatu, 2020. http://hdl.handle.net/11449/192224.

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Orientador: Luís Cuadrado Martin
Resumo: O conhecimento sobre qualquer patologia pode ser facilmente encontrado na internet, mas dificilmente encontra-se alguma ferramenta que faça a análise e o raciocínio entre os dados de um paciente e se obtenha o diagnóstico mais provável. Em nosso cotidiano, em virtude de uma maior demanda na área da saúde, existe uma necessidade crescente de diagnósticos médicos rápidos e precisos. Em virtude disso, foi elaborado um Sistema de Apoio à Decisão Médica com o intuito de otimizar e agilizar de forma confiável os diagnósticos médicos. A ideia é dar qualidade e agilidade à prática médica, adotando a tecnologia como ferramenta básica: “Quem tem mais informação, tem melhores condições para escolher e tomar decisões”. Na construção deste sistema, foram utilizados um banco de dados relacional (MySQL) e aplicadas técnicas de inteligência artificial, tais como: a construção de Árvores de Decisão, Aprendizado não supervisionado e a utilização das Redes de Bayes (onde estão envolvidos domínios de conhecimento com significativo grau de incerteza, como é o caso da área médica). Através da união destas técnicas, são feitas a seleção e classificação das doenças mais prováveis, onde as mesmas podem ser examinadas com mais detalhes pelo médico, garantindo assim uma maior segurança na escolha dos possíveis diagnósticos. Visando uma maior abrangência e rapidez na disseminação do conhecimento humano, o sistema foi disponibilizado via internet (www.danton.med.br). Para a concepção do projeto foi reali... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The knowledge about any pathology can be easily found on the internet, but it is difficult to find any tool that makes the analysis and reasoning between the data of a patient and obtain the most probable diagnosis. In our daily lives, due to a greater demand in the health area, there is a growing need for fast and accurate medical diagnoses. As a result, a Medical Decision Support System was developed in order to reliably optimize and streamline medical diagnostics. The idea is to give quality and agility to medical practice, adopting technology as a basic tool: “Who has more information, has better conditions to choose and make decisions”. In the construction of this system, a relational database (MySQL) was used and artificial intelligence techniques were applied, such as: the construction of Decision Trees, Unsupervised Learning and the use of Bayes Networks (where knowledge domains are involved with significant degree of uncertainty, as is the case in the medical field). Through the union of these techniques, the selection and classification of the most probable diseases are made, where they can be examined in more detail by the doctor, thus ensuring greater security in the choice of possible diagnoses. Aiming at a greater scope and speed in the dissemination of human knowledge, the system was made available via internet (www.danton.med.br). To design the project, a prospective, randomized, crossover and open study was carried out; in which 3 groups of doctors (called gr... (Complete abstract click electronic access below)
Doutor

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Newton, Andrew. "Ambulance Service 2030 : the future of paramedics." Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/15437.

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Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

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Marshall, Martin Neil. "A study of the professional relationneral practitioners and specialists." Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264930.

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Xu, Meng. "Specialised transcription factories." Thesis, University of Oxford, 2008. http://ora.ox.ac.uk/objects/uuid:a41d3243-c233-491a-916b-4e329cace434.

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The intimate relationship between the higher-order chromatin organisation and the regulation of gene expression is increasingly attracting attention in the scientific community. Thanks to high-resolution microscopy, genome-wide molecular biology tools (3C, ChIP-on-chip), and bioinformatics, detailed structures of chromatin loops, territories, and nuclear domains are gradually emerging. However, to fully reveal a comprehensive map of nuclear organisation, some fundamental questions remain to be answered in order to fit all the pieces of the jigsaw together. The underlying mechanisms, precisely organising the interaction of the different parts of chromatin need to be understood. Previous work in our lab hypothesised and verified the “transcription factory” model for the organisation of mammalian genomes. It is widely assumed that active polymerases track along their templates as they make RNA. However, after allowing engaged polymerases to extend their transcripts in tagged precursors (e.g., Br-U or Br-UTP), and immunolabelling the now-tagged nascent RNA, active transcription units are found to be clustered in nuclei, in small and numerous sites we call “transcription factories”. Previous work suggested the transcription machinery acts both as an enzyme as well as a molecular tie that maintains chromatin loops, and the different classes of polymerases are concentrated in their own dedicated factories. This thesis aims to further characterise transcription factories. Different genes are transcribed by different classes of RNA polymerase (i.e., I, II, or III), and the resulting transcripts are processed differently (e.g., some are capped, others spliced). Do factories specialise in transcribing particular subsets of genes? This thesis developed a method using replicating minichromosomes as probes to examine whether transcription occurs in factories, and whether factories specialise in transcribing particular sets of genes. Plasmids encoding the SV40 origin of replication are transfected into COS-7 cells, where they are assembled into minichromosomes. Using RNA fluorescence in situ hybridisation (FISH), sites where minichromosomes are transcribed are visualised as discrete foci, which specialise in transcribing different groups of genes. Polymerases I, II, and III units have their own dedicated factories, and different polymerase II promoters and the presence of an intron determine the nuclear location of transcription. Using chromosome conformation capture (3C), minichromosomes with similar promoters are found in close proximity. They are also found close to similar endogenous promoters and so are likely to share factories with them. In the second part of this thesis, I used RNA FISH to confirm results obtained by tiling microarrays. Addition of tumour necrosis factor alpha (TNF alpha) to human umbilical vein endothelial cells induces an inflammatory response and the transcription of a selected sub-set of genes. My collaborators used tiling arrays to demonstrate a wave of transcription that swept along selected long genes on stimulation. RNA FISH confirmed these results, and that long introns are co-transcriptionally spliced. Results are consistent with one polymerase being engaged on an allele at any time, and with a major checkpoint that regulates polymerase escape from the first few thousand nucleotides into the long gene.

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Arksey, Hilary. "Interactions and influences between lay and expert groups in the construction of medical knowledge : the case of RSI." Thesis, Lancaster University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306876.

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Saias, Helder André Vermelho. "Transição segura de cuidados do doente crítico." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/28665.

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Mestrado em Enfermagem, Área de especialização: Enfermagem Médico-Cirúrgica
Este relatório de estágio surge como etapa final da conclusão do ciclo de estudos, referente ao curso de Mestrado em Enfermagem na Área de especialização em Enfermagem Médico-Cirúrgica: A Pessoa em Situação Crítica. Tem como principal objetivo refletir e analisar criticamente as atividades desenvolvidas no processo de aquisição de competências comuns e específicas do enfermeiro especialista em Enfermagem Médico-Cirúrgica: A Pessoa em Situação Crítica, assim como as competências de Mestre em Enfermagem. No presente relatório de estágio, encontra-se descrito todo o processo relativo ao Projeto de Intervenção em Serviço, levado a cabo no estágio Final do curso de Mestrado, que decorreu numa Unidade de Cuidados Intensivos Coronários, onde se implementou a metodologia ISBAR nos momentos de transição de cuidados do doente crítico, assumindo-se como um papel importante na melhoria da segurança do doente, assim como um elemento importante na continuidade dos cuidados, evitando possíveis eventos adversos e visando uma transição segura de cuidados do doente crítico. A análise reflexiva efetuada constituiu por si só um importante elemento de crescimento profissional e pessoal, considerando-se adquiridas as competências que conferem o título de enfermeiro especialista em Enfermagem Médico-Cirúrgica: A Pessoa em Situação Crítica, assim como as competências inerentes à atribuição do grau de Mestre em Enfermagem.
This internship report appears as the final step of the conclusion of the cycle of studies, referring to the Master's degree in Nursing in the area of specialization in Medical-Surgical Nursing: The Person in a Critical Situation. Its main objective is to reflect and analyse critically the activities developed in the process of acquiring common and specific competencies of the specialist nurse in Medical-Surgical Nursing: The Person in Critical Situation, as well as the competencies of Master in Nursing. In the present report of the internship, all the process related to the Intervention Project in Service, carried out in the final stage of the Master's course, has been described, which took place in a Coronary Intensive Care Unit, where the ISBAR methodology was implemented in the moments of care transition of critical patient, assuming itself as an important role in improving patient safety as well as an important element in the continuity of care, avoiding possible adverse events and aiming for a safe care transition of critical patient. The reflexive analysis carried out was an important element of professional and personal growth, considering the acquired competencies that confer the title of specialist nurse in Medical-Surgical Nursing: The Person in Critical Situation, as well as the competencies inherent in the attribution of the Master's Degree in Nursing.

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MacKay, Michael Hubbard. "The rise of a medical speciality : the medicalisation of elite equine care c.1680-c.1800." Thesis, University of York, 2009. http://etheses.whiterose.ac.uk/14229/.

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There are currently very few historians of veterinary medicine and outside of their scholarship there is almost nothing that has been written about veterinary history in the past thirty years. This is despite the fact that medical historians have created a large body of scholarship since the 1980s, including studies of political movements, social and cultural histories, histories of ideas of the medical profession, histories of specific diseases and histories of science. The lack of veterinary history is also striking because there has been a plethora of research corning from the field of human/animal relations. Furthermore, the history of animal care before formal veterinary education (1790s) is even more neglected and the scholarship that does exist is over forty years old and generally anachronistic-save the work of Louise Curth. This is all despite the outstanding changes that were occurring during the eighteenth century in Britain. Part of the reason that the current interpretations of eighteenth-century animal care are so anachronistic is due to the focus of historians upon the emergence of the London Veterinary College (1792) as an enlightened step toward progression. This is far from correct because a new medical specialty emerged in animal care over a century before the College. This thesis shows that those involved in the gentlemanly practice of farriery created a new specialised field of farriery that was much more medical. Like midwifery, oculism and dentistry, equine medicine became a new medical specialism. This is demonstrated by analysing elite farriery literature published between 1550 and 1800, by reconstructing the identity of eighteenth century farriery practitioners (especially those that claimed to be gentlemen), by uncovering the practice of these elite practitioners in horse hospitals and anatomy lectures. These findings suggest a new narrative of the history of animal care, showing that veterinary medicine was a product of the larger changes in equine medicine occurring well before the 1790s.

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Grazina, Vera. "Avaliação funcional das pessoas internadas no serviço de cirurgia geral: aplicação da escala de Barthel." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2016. http://hdl.handle.net/10400.26/11692.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
Este relatório surge no âmbito do Curso de Mestrado em enfermagem Médico-Cirúrgica (EMC) e tem como finalidade apresentar reflexivamente o percurso conducente ao desenvolvimento de competências de enfermeiro especialista (comuns e específicas) e de Mestre. Para isso, foi utilizada a metodologia de trabalho de projeto, integrando dois projetos distintos: projeto de intervenção em serviço (PIS) e projeto de aprendizagem clínica (PAC), desenvolvidos ao longo dos estágios realizados num serviço de cirurgia geral (SCG). O PIS, formulado sob a premissa de que uma eficaz gestão dos cuidados está numa das bases da qualidade dos mesmos, incidiu sobre a necessidade de uniformizar procedimentos relativamente à avaliação funcional das pessoas internadas no SCG. Este, veio permitir, através de formação e criação de documentos normativos e orientadores desta prática, promover a qualidade dos cuidados de enfermagem através da otimização da intervenção dos enfermeiros no domínio da avaliação funcional da pessoa internada no SCG. Foi nosso referencial teórico a Teoria do Défice do Auto-Cuidado de Orem, com enfoque na importância de direcionar os cuidados prestados às necessidades de cada pessoa, partindo de uma avaliação funcional, dotada de objetividade através do uso de escalas validadas, como a escala modificada de Barthel. Por sua vez, no PAC projetaram-se atividades específicas, das quais se destacam: participação num exercício de simulação de inundação numa unidade de cuidados intermédios e realização de respetivo poster de divulgação; realização de ação de sensibilização aos familiares das pessoas internadas no SCG, sobre importância da higienização das mãos na visita; e realização de um poster sobre hipodermoclise, classificado em 2º lugar num encontro de enfermagem. Neste documento analisamos crítica e reflexivamente ambos os projetos, e os contributos dos mesmos no desenvolvimento das competências supra-citadas.
This report is set within the context of the Medical Surgical Nursing (MSN) Master’s Degree, in order to reflexively present the route which led us to the development of specialist (either common or MSN specific) and Master nurse skills. Therefore, we used the project methodology, integrating two distinct projects: intervention project in service (IPS) and clinical learning project (CLP), both developed throughout the internship in a general surgery service (GSS). The IPS was formulated under the premise that effective care management is one of the bases of its quality, and focused on the need to standardize procedures for the functional evaluation of people admitted to the GSS. Through training and creation of normative and guideline documents, the IPS has promoted the quality of nursing care by optimizing the nurses’ involvement in the functional evaluation of the hospitalized patient in GSS. Our theoretical framework was the Orem’s Self-Care Deficit Theory, focusing on the importance of care directed to the needs of each person, and based on a functional evaluation, endowed with objectivity through the use of validated scales such as the modified Barthel index. In turn, on the CAP we designed specific activities, among which the following are highlighted: participation in an exercise of flood simulation in an intermediate care unit and the development and disclosure of the respective poster; performing of an awareness session to the relatives of those admitted to the GSS, about the importance of hand hygiene in the visit; and creating a poster on hypodermoclysis, that was ranked 2nd in a nursing meeting. In this document we analyze critically and reflexively both projects, and their contributions to the development of the above-mentioned skills.

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BRICOTEAU, DIDIER, and STEPHANE HODEN. "Une nouvelle specialite medicale : la sante publique, pour quoi faire ? debouches pour les internes de sante publique en france en 1990, prospective." Lille 2, 1990. http://www.theses.fr/1990LIL2M295.

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45

Batista, Catarina da Conceição Candeias Barreto. "Intervenções de enfermagem na redução de complicações ao doente com entubação endotraqueal." Master's thesis, Instituto Politécnico de Setúbal, Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/29375.

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Mestrado em Enfermagem, Área de especialização: Enfermagem Médico-cirúrgica
O presente relatório surge no âmbito do 2º Mestrado em Enfermagem em associação, ministrado na Escola Superior de Saúde do Instituto Politécnico de Setúbal. A Teoria das Transições da Afaf Meleis serviu de linha orientadora a este trabalho. Sendo o seu principal objetivo expor todo o processo de desenvolvimento de competências específicas e comuns do enfermeiro especialista e as competências de mestre. Realizando-se uma análise e reflexão acerca do desenvolvimento da aquisição de competências do enfermeiro especialista. O grau de mestre em enfermagem carece dum conhecimento aprofundado no domínio da sua área de especialização. Durante estágio II comtemplou-se a realização dum projeto de intervenção em serviço, segundo a metodologia de projeto, de forma a responder a um problema identificado num contexto de estágio. Com este pretende-se a implementação duma norma – Cuidados de Enfermagem a pessoa com TET, de modo a uniformizar a prática na UCI. O projeto de intervenção contribuiu para o desenvolvimento de competências do enfermeiro especialista, nomeadamente no domínio da gestão de cuidados e da melhoria contínua da qualidade.
This report is presented in the scope of the 2nd Masters in Nursing in association, taught at the higher health school of the Polytechnic Institute of Setúbal. The Afaf Meleis Transition Theory served as a guideline for this work. Being your main goal to expose the entire process of developing specific and common skills of specialist nurse and master skills. An analysis and reflection about the development of skills acquisition of the specialist nurse. The master's degree in nursing requires in-depth knowledge in the field of its area of expertise. During stage II, a project of intervention in service according to the project methodology was contemplated, in order to respond to a problem identified in an internship context. With this it is intended the implementation of a standard - Nursing Care the person with TET, in order to standardize the practice in the ICU. The intervention project contributed to the development of skills of the specialist nurse, namely in the field of care management and continuous quality improvement.

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46

Batista, Catarina da Conceição Candeias Barreto. "Intervenções de enfermagem na redução de complicações ao doente com entubação endotraqueal." Master's thesis, Universidade de Évora, 2019. http://hdl.handle.net/10174/26703.

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Mestrado em Enfermagem, Área de especialização: Enfermagem Médico-cirúrgica
O presente relatório surge no âmbito do 2º Mestrado em Enfermagem em associação, ministrado na Escola Superior de Saúde do Instituto Politécnico de Setúbal. A Teoria das Transições da Afaf Meleis serviu de linha orientadora a este trabalho. Sendo o seu principal objetivo expor todo o processo de desenvolvimento de competências específicas e comuns do enfermeiro especialista e as competências de mestre. Realizando-se uma análise e reflexão acerca do desenvolvimento da aquisição de competências do enfermeiro especialista. O grau de mestre em enfermagem carece dum conhecimento aprofundado no domínio da sua área de especialização. Durante estágio II comtemplou-se a realização dum projeto de intervenção em serviço, segundo a metodologia de projeto, de forma a responder a um problema identificado num contexto de estágio. Com este pretende-se a implementação duma norma – Cuidados de Enfermagem a pessoa com TET, de modo a uniformizar a prática na UCI. O projeto de intervenção contribuiu para o desenvolvimento de competências do enfermeiro especialista, nomeadamente no domínio da gestão de cuidados e da melhoria contínua da qualidade.
This report is presented in the scope of the 2nd Masters in Nursing in association, taught at the higher health school of the Polytechnic Institute of Setúbal. The Afaf Meleis Transition Theory served as a guideline for this work. Being your main goal to expose the entire process of developing specific and common skills of specialist nurse and master skills. An analysis and reflection about the development of skills acquisition of the specialist nurse. The master's degree in nursing requires in-depth knowledge in the field of its area of expertise. During stage II, a project of intervention in service according to the project methodology was contemplated, in order to respond to a problem identified in an internship context. With this it is intended the implementation of a standard - Nursing Care the person with TET, in order to standardize the practice in the ICU. The intervention project contributed to the development of skills of the specialist nurse, namely in the field of care management and continuous quality improvement.

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Todd, Catherine Angela. "A clinically valid simulator with tactile sensing to train specialists to perform cochlear implantation." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20070208.171637/index.html.

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ZRIBI, MOURAD. "Les fonctions speciales et les representations des groupes pour la reconnaissance de formes application a l'imagerie medicale." Rennes 1, 1997. http://www.theses.fr/1997REN10159.

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Cette etude montre la possibilite d'application des fonctions speciales et des representations des groupes en reconnaissance de formes. En ce qui concerne les fonctions speciales, nous avons propose un nouvel algorithme em (estimation-maximisation) non parametrique base sur la methode des fonctions orthogonales. Cet algorithme a pour but d'identifier le melange non parametrique, ce qui revient a l'estimation d'un nombre fini mais variable de parametres. L'application de cette methode en segmentation bayesienne non supervisee des images a deux avantages. D'une part, elle ne suppose pas des hypotheses sur le type de lois du melange et d'autre part, la generalisation au cas multivarie peut se faire sans peine ce qui permet de realiser aisement les segmentations contextuelles. Par l'approche de la theorie des representations des groupes, des descripteurs invariants et stables par rapport au groupe des deplacements de l'espace euclidien a trois dimensions pour des objets a niveaux de gris sont construits. L'expression de ces descripteurs est obtenue par la definition d'une pseudo-transformee de fourier sur ce groupe verifiant le theoreme du retard generalise. Ces descripteurs ne verifient pas le critere de completude de crimmins. Ceci n'est pas un inconvenient majeur car pour une large classe d'applications, ces descripteurs invariants sont suffisants. De plus, ces descripteurs invariants ne supposent aucune connaissance prealable sur le type de forme a etudier et prennent en compte l'information contenue dans la texture de l'objet. Nous exploitons les liens entre ces invariants et les transformees de fourier usuelles, pour construire un algorithme de calcul rapide. Ces nouvelles techniques sont introduites pour la modelisation des images medicale volumiques. Cette modelisation conduit a une importante compression des donnees et permet de quantifier les differences entre les representations de plusieurs objets de maniere plus precise.

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URBAIN, BERNARD. "Le certificat d'etudes speciales de stomatologie a lyon : historique et bilan." Lyon 1, 1988. http://www.theses.fr/1988LYO1M233.

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Ali, Irena Malgorzata, and n/a. "The impact of information provided by medical libraries on clinical decision making : A study of two hospitals." University of Canberra. Information, Language & Culture Studies, 1996. http://erl.canberra.edu.au./public/adt-AUC20060530.115422.

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A quantitative survey was conducted in two Canberra hospitals that aimed at ascertaining the impact of information provided by medical libraries on clinical decision making. Specifically, this research study investigated clinical, cognitive and quality value of information provided by the medical librarians to the management of patients and doctors' ability to handle clinical cases differently as a result of such information. Furthermore, the relative value of information received from the library was assessed by comparing it to the value of information received from other sources in dealing with clinical problems. The research involved medical specialists and registrars affiliated with these hospitals. Doctors were asked to select any clinical situation which they frequently or currently encounter and for which further information would be useful to them. Once their information requests were identified, they were then asked to present such requests to the hospital library. In order to avoid any special treatment, participants were urged not to identify themselves to the library staff as partaking in the study. It was important that participants did not search for the information themselves. The doctors were asked to evaluate the material provided by the library in relation to clinical care and, thereafter, complete a short questionnaire. This research took place between October 1994 and March 1995. The questionnaires were sent to 288 doctors. This represented the total population of specialists and registrars affiliated with both hospitals at the time of the study. Analysis of the results is based on a 34% useable response rate. Medical specialists were by far the higher number of respondents (70%) as compared with registrars (30%). Eighty-one per cent of the doctors said that the information provided by the library refreshed their memory and 82% said that it would contribute to better quality of medical care. Eighty-six per cent indicated that some of this information was new to them and 99% said that the information provided was up to date. Ninety-four per cent said that the information provided by the library was of clinical value to them. As the result of the information provided by the library 75% of respondents would either definitely or probably handle some aspects of the clinical situation differently than they would have done it otherwise. The level of importance of the change for the optimal care of patients was assessed with 54% regarding it as important, 42% as moderately important. Specifically, as the result of the information provided, the doctors were able to change the following: diagnosis 10%, choice of lab tests 20%, choice of other diagnostic investigations 24%, choice of drugs 27%, choice of other management 58%, reduce length of hospitalisation 10%, post-operative care of patients 25%, advice given to patients 47%. On the basis of the received information the doctors were able to avoid the following: hospitalisation of patients 11%, risk of hospital acquired infection 8%, surgical intervention 19%, tests or other investigation 23%, additional out-patient visits 12%. Discussions with colleagues were reported to be most valued sources of information for the purpose of clinical decisions (59%), followed by diagnostic imaging (49%), librarian (45%), lab tests (42%) and patients' medical records (30%). The librarian's role as contributing to the process of clinical decisions was rated highly with 88% ranking it as either important or moderately important. The results of significance p test statistic performed at 0.05 significance level suggested that, for this study, there was a significant relationship between the frequency of library use and doctors' ability to change the choice of laboratory tests, diagnostic investigations, and the choice of prescribed drugs. The results of this research study demonstrate that medical librarians can positively contribute to clinical management of patients by providing timely and accurate information. Further research is recommended in order to determine the impact of the whole range of library services on health care outcomes.

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Dissertations / Theses on the topic 'Medical specialist'

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