Academic literature on the topic 'Medicine, Preventive – Australia – Psychological aspects'

Objectives: To explore how recalled childhood adversity affects trait measures of personality in three age cohorts of an Australian adult population and to examine the effects of particular adversities on adult personality traits. Method: A total of 7485 randomly selected subjects in the age bands of 20–24, 40–44 and 60–64 years were interviewed at the outset of a longitudinal community study of psychological health in the Canberra region of Australia. In the initial interview, subjects answered 17 questions about domestic adversity and three questions on positive aspects of upbringing to age 16 years. Personality traits were measured by Eysenck Personality Questionnaire, Behavioural Activation and Inhibition Scales, Positive and Negative Affect Scales and a measure of dissocial behaviours. Results: Higher levels of childhood adversity substantially increase the risk of high neuroticism (OR = 2.6) and negative affect (OR = 2.6), less for behavioural inhibition (OR = 1.7) and for dissocial behaviour (OR = 1.7). No significant effect is seen for extraversion, psychoticism or behavioural activation. Age and gender had little effect on the pattern of risk. Maternal depression has significant and substantial independent effects on measures of neuroticism and negative affect as well as most other measures of personality. Conclusion: Childhood domestic adversity has substantial associations with clinically important aspects of personality: neuroticism and negative affect. Only small effects are seen on behavioural inhibition and dissocial behaviour, and no significant effect on extraversion and behavioural activation. These unexpected findings contradict clinical belief. Maternal psychological ill-health is pre-eminent among adversities predicting later disadvantageous traits, even for those traits that had only the slightest association with childhood adversity. Consequences of childhood adversity prevail throughout the lifespan in men and women equally. The study underlines the importance of childhood domestic adversity and especially maternal psychological ill-health as a target for preventive intervention for psychological difficulties at all ages.

Objective: To identify characteristics that could distinguish males who completed suicide by hanging from males who completed suicide by firearms and non-domestic gas, and to suggest suicide prevention strategies targeted at hanging. Method: Using the psychological autopsy design, males who used hanging, firearms and non-domestic gas were compared on a range of variables covering social, psychological, and health related factors and aspects of the suicide incident. The sample consisted of 950 males who suicided in Queensland, Australia, between 1994 and 1996. Results: Compared with males who used firearms and non-domestic gas, males who used hanging were significantly younger, less likely to have left a suicide note, and more likely to have been diagnosed with a psychotic disorder. Compared with males who used firearms, males who used hanging were significantly more likely to have made prior suicide attempts and have had no physical illness. Compared with males who used non-domestic gas, males who used hanging were significantly more likely to have lived with others, have had prior legal trouble, and have suicided at their residence. Conclusions: The results are discussed in terms of the availability and socio-cultural acceptability of methods. The authors suggest a possible relationship between impulsive traits and method choice. This proposition requires further investigation using alternative methodologies. Some suicide prevention measures targeting hanging suicides are discussed in light of the results.

The thesis is devoted to exploration of theoretical and applied aspects of psychology and pedagogical of personnel management in organizations. The psychological and pedagogical roots of management, methodology and structure of proactive approach, psychological and pedagogical features of realization of aims and functions of proactive approach to management are analyzed and summarized. Psychological and pedagogical resources of improvement of organizations management on the basis of principles of humanistic individual approach, optimization and systems analysis are investigated. Psychological and pedagogical conditions of optimization of the main components of organizations personnel management system – selection, motivation, personnel development and monitoring are revealed. Conception of organizations personnel' professional selection based on the ground of registration of person's readiness for training and professional activity is proved. The author suggested psychological and pedagogical means of optimization of interpersonal interaction between managers and subordinates, defined psychological and pedagogical conditions of team building, leadership, preventive measures against conflicts and distresses. Several theoretical and methodological approaches for effective realization of the different elements of proactive management are established, especially while choosing the optimal complex of diagnostics instruments for defining the level of objective and subjective person's readiness for education and professional activity; determination of group roles and team formation; organizing of trainings of motivation and self development, preventive psychological procedures; establishing of training and retraining system for police managers. Psychological and pedagogical basis of managers' training for proactive management has been developed. A conceptual notion for defining of proactive management processes has been systematized; the key terms of pedagogical psychology and psychology of management have been defined more exactly.

Introduction: Measures to prevent dental diseases are included in the list of medical care provided by dentists. Modern socio-economic transformations, including in health care, have contributed to the gradual evolution of the patient from the recipient of medical care to the consumer of services. The aim: To study the position of patients regarding the need and effectiveness of preventive dental care. Materials and methods: Study was conducted among 310 patients who were admitted in various municipal and state medical institutions, dental clinics and private dental offices in Uzhhorod. The average age of respondents is 26 years. The survey was conducted using questionnaires. Results: 90% of respondents are willing to pay for dental treatment based on the use of innovative technologies; 64% of people refer to paid services aesthetic therapeutic treatment; 87% of patients agree to pay for orthopedic treatment and 48% - for surgical intervention. Only 16% of respondents consider additional professional hygiene services and ready to pay for it themselves. Survey data show that 43.2% of patients give a doctor the main role in the treatment process. 42.8% of respondents need medical help in the form of advice or counseling for a decision on treatment. 14% of patients prefer to choose their own medical care and control the treatment. Conclusions: Dental prophylactic measures that are implemented in the practice of regulating social and labor relations, the presence of relationships between the physician and the patient develop by socio-psychological laws.

Pregnancy is a period of great transformations, with changes not only in the woman's body, but also changes in the psychological, family, and social aspects, with the possibility of developing disorders. Concerning psychic aspects, over time a little or no importance was given, considering the current biomedical model. In view of this scenario, the psychological prenatal care appears to complement the traditional prenatal care, turning even more to humanization during the process of pregnancy, childbirth and parenthood. In this sense, this study aims to analyze how psychological prenatal care can be an integral care strategy for maternal health. The methodology of this research consists of an Integrative Literature Review. The databases used were Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Health Sciences Literature (LILACS) and Electronic Psychology Journals (PePSIC). The following descriptors were used: “psychological prenatal care”, “psychology and pregnancy” and “psychological disorders in pregnancy”. The results show the PNP (Psychological Prenatal Care) a possibility of integral care to the maternal health, as it is established as a preventive program in relation to psychological disorders resulting from the pregnancy-puerperium cycle, especially in regard to postpartum Depression, and complementary to the traditional prenatal care.

The urgency of the problem is determined by the danger of drug addiction among Ukrainian adolescents, the lack of attention paid by parents to the study of this problem, and the lack of proper attention to this issue in most Ukrainian schools. Research in this area is driven by the need to identify the main social and psychological aspects that motivate adolescents to use drugs, in order to create conditions in society that prevent the spread of drugs among the youngest populations. Aim of the work is to determine the dominant psychological and social factors that motivate adolescents to start using drugs. Material and Methods. Analytical and logical research methods, systematic and comparative analysis were used to comprehensively consider and describe the factors that motivate adolescents to use drugs, despite the danger to their health and life. Results and Discussions. A high degree of risk of adolescent drug addiction has been established, which is accompanied by a significant decrease in the average age of adolescents taking drugs for the first time. The issues of social and psychological aspects of adolescent drug addiction, problems of relations in society and families, where adolescents start using drugs are considered. The types of family relations and the nature of intra-family relations, in which adolescent drug use begins, were studied. The main social and psychological factors that push modern youth to take drugs have been identified. Conclusions. Adolescent drug addiction in Ukraine remains a serious problem that requires proper attention and assessment by modern society. Effective measures to combat the dangerous phenomenon are: introduction of a system of preventive talks to explain the nature of drug addiction and the dangerous consequences of drug use for life and health; joining student youth to sports and a healthy lifestyle by reviving the system of intra-school, district, regional competitions in various sports; transformation of adolescents' consciousness towards their own development as opposed to the prospect of their drug degradation. Key Words: family relations, teenager, social environment, drugs, psychology of relations, family.

The article is devoted to the issue of professional deformation of employees of internal affairs bodies and prevention of its occurrence and development. The subject of the study are regulations, scientific publications and conditions for the organization of work on the prevention of professional deformation of employees in the internal affairs bodies of the Russian Federation. The methodological basis of the research is an interdisciplinary approach that allows accumulating the achievements of scientists from different fields – pedagogy, psychology, management and law. During the research, analysis, synthesis, comparison, observation, study of experience, special legal methods of cognition were used. The reasons for the appearance of professional deformation of employees of internal affairs bodies are considered. Special attention is paid to the stages of formation of professional deformation of employees of internal affairs bodies. In order to reduce the risk of exposure to the development of occupational deformation, the authors state the need for timely prevention of occupational deformation and offer its possible options. The scientific novelty of the study lies in the complex of preventive measures proposed by the authors that contribute to the prevention of professional deformation of employees of internal affairs bodies. The authors come to the conclusion that for the successful implementation of preventive measures to prevent the development of professional deformation, it is necessary to expand the staff of the psychological service, develop the institute of mentoring, develop and adopt programs for the prevention of professional deformation of employees in specific departments of internal affairs bodies, taking into account the specifics of their activities, improve pedagogical and other conditions for the prevention of professional deformation of employees of internal affairs bodies. The results of the study will be useful to specialists of personnel and psychological services, the management staff of the internal affairs bodies, as well as specialists in educational work of higher educational institutions that train future employees of the internal affairs bodies of Russia.

This research explores the employability of Chinese international graduates in the Australian labor market. It captures the significance of six forms of capital (i.e., human, social, cultural, psychological, identity, and agentic) to Chinese international graduates when they develop their careers in Australia. The research employed Bourdieu’s theory of practice and a capitals-based approach as the theoretical framework. Data were collected via an online survey (N=203) and in-depth interviews (N=14). The findings reveal that in addition to getting employments in Australia, the graduates also benefited from developing and utilizing these six capitals in terms of sustainable employments, professional growth, and well-being. As such, this research argued for a broad definition of employability which include different capitals as the inputs and different aspects of employability outcomes as the outputs, namely, employment outcomes, sustainable employments, professional growth, and well-being. The findings also implied that various stakeholders should share responsibilities to support international students in building multiple capitals.

Prerequisite. Since the advent of nuclear energy, industry and weapons, a possibility of radiation events i.e. incidents and accidents had emerged. Given the presence of radioactive iodine as part of environmental contamination, the response of authorities and medical services consists, in particular, in carrying out the emergency iodine prophylaxis among specialists and general population. And along with the fact that emergency iodine prophylaxis is a generally accepted measure in radiation events accompanied by the release of radioactive iodine, some methods of its implementation were and remain in certain sources and instructions/recommendations contradictory and even false. Such inconsistency increases the potential risks of health effects of radioactive iodine and exacerbates the sense of fear and uncertainty among the population involved in the incident. Objective: to consider and review the essence of emergency iodine prophylaxis during radiation events, physiological aspects of iodine metabolism in the body, properties of individual iodine prophylaxis agents that are recommended, and to justify the rationality of using some of them along with absurdity/inadmissibility of others; substantiate the creation of a unified preventive information strategy regarding the event in order to reduce anxiety and other negative psychological consequences among the affected population. Materials and methods. The review was performed by searching the abstract and scientometric databases and printed publications. Results. In the event of serious radiation events at nuclear power plants and industry facilities, radioactive iodine is highly likely to enter the environment. With the threat of radioactive iodine incorporation or with its incorporation that has already begun, it is absolutely necessary to carry out the emergency iodine prophylaxis. Such prevention should be carried out with stable iodine preparations such as potassium iodide or potassium iodate in special pharmaceutical formulas. Dosing of drugs in age and population groups should be carried out by specialists in radiation medicine and radiation safety in accordance with internationally recognized guidelines. The use of iodinecontaining food additives, iodine solution for external use and Lugol’s solution is categorically unacceptable due to complete ineffectiveness, impracticality of implementation, and sometimes due to the threat of serious harm to health. Conclusions. Clear preparedness plans for possible radiation accidents and incidents, as well as successfully implemented appropriate preventive measures, including emergency iodine prophylaxis, are crucial for the effective and successful response to such events. Emergency iodine prophylaxis during radiation events should be carried out exclusively under the guidance of specialists in radiation medicine and radiation safety using special pharmaceutical formulas of potassium iodide or potassium iodate in doses recognized by the international scientific community. Other means of emergency iodine prophylaxis, including «handicraft»/home preparations, are absolutely unacceptable. Implementation of this protective measure should be accompanied by a coordinated information campaign in order to minimize purely radiation risks and to preserve the psychological well-being of the population. Key words: radiation events, radiation accident, radiation incident, nuclear industry, nuclear power, radioactive iodine, exposure, emergency iodine prophylaxis, stable iodine, potassium iodide, potassium iodate, psychological well-being of population.

Background: The 12-month prevalence of musculoskeletal disorders related to work (MDRW) in nurses rests between 71.8% to 84%, so it is urgent to develop preventive intervention programs with the purpose of avoiding negative physical, psychological, socioeconomic, and working aspects. There are several intervention programs aimed at preventing musculoskeletal disorders related to work for nurses, but few have successfully proven results. Despite the evidence pointing to the benefits of multidimensional intervention programs, it is essential to determine which interventions have positive effects on the prevention of this kind of disorder to create an effective intervention plan. Aim: This review intends to identify the different interventions adopted in the prevention of musculoskeletal disorders related to work in nurses and to compare the effectiveness of these interventions, providing the appropriate and scientific basis for building an intervention to prevent musculoskeletal disorders in nurses. Method: This Systematic Review was guided by the research question, “What are the effects of musculoskeletal disorders preventive interventions on nursing practice?” and carried out in different databases (MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials, SCOPUS, and Science Direct). Later, the results were submitted to the eligibility criteria, the appraisal quality of the papers, and the data synthesis was performed. Results: 13 articles were identified for analysis. The interventions implemented to control the risk were: training patient-handling devices; ergonomics education; involving the management chain; handling protocol/algorithms; acquiring ergonomics equipment; and no-manual lifting. Conclusions: The studies associated two or more interventions, the majority of which (11 studies) were training-handling devices and ergonomics education, therefore emerging as the most effective instruments in the prevention of MDRW. The studies did not associate interventions that cover all risk factors (individual, associated with the nature of the work, organizational, and psychological aspects). This systematic review can help with making recommendations for other studies that should associate organizational measures and prevention policies with physical exercise and other measures aimed at individual and psychosocial risk factors.

This study explores the health beliefs and preventive health behaviours of older Hong Kong Chinese people resident in Australia. Participation in physical activity was used as the case study. There were two frameworks used to shape the research. Because of their perceived influence on the health beliefs and practices of Hong Kong Chinese people, the traditional Chinese philosophies of Confucianism, Taoism, and Buddhism provided the philosophical framework. The Theory of Planned Behaviour provided a theoretical framework for understanding the target group's preventive health behaviour. Data was collected by means of in-depth interviews, participant observation and case study. Twenty-two informants were interviewed, their transcripts analysed, summarised and typologised, identifying six states of physical activity participation. Findings demonstrated that this target group possessed a holistic view of health, with food taking a special role in preventive care and self-treatment at times of illness. The Cantonese terms used to denote “physical activity” caused confusion among the target group. Most interpreted it as meaning deliberate planned body movement, strength-enhancing activities or exercise, although some did see it as including mundane daily activities and chores. Lack of time, no interest and laziness were reported as the main reasons for low participation in deliberate planned physical activity. Cultural, social and environmental determinants were the intrinsic and extrinsic factors influencing attitudes toward physical activity, as well as perceived social supports and perceived control over physical activity participation barriers. To a large extent, these interactive determinants of health were rooted in the three traditional Chinese philosophies mentioned above. The thesis concludes by arguing that rather than simply advocating activities designed for other populations, health promotion strategies and education need to create links to the traditions of this target group and also clarify their conception of physical activity.

Doctor of Philosophy
This study explores the health beliefs and preventive health behaviours of older Hong Kong Chinese people resident in Australia. Participation in physical activity was used as the case study. There were two frameworks used to shape the research. Because of their perceived influence on the health beliefs and practices of Hong Kong Chinese people, the traditional Chinese philosophies of Confucianism, Taoism, and Buddhism provided the philosophical framework. The Theory of Planned Behaviour provided a theoretical framework for understanding the target group's preventive health behaviour. Data was collected by means of in-depth interviews, participant observation and case study. Twenty-two informants were interviewed, their transcripts analysed, summarised and typologised, identifying six states of physical activity participation. Findings demonstrated that this target group possessed a holistic view of health, with food taking a special role in preventive care and self-treatment at times of illness. The Cantonese terms used to denote “physical activity” caused confusion among the target group. Most interpreted it as meaning deliberate planned body movement, strength-enhancing activities or exercise, although some did see it as including mundane daily activities and chores. Lack of time, no interest and laziness were reported as the main reasons for low participation in deliberate planned physical activity. Cultural, social and environmental determinants were the intrinsic and extrinsic factors influencing attitudes toward physical activity, as well as perceived social supports and perceived control over physical activity participation barriers. To a large extent, these interactive determinants of health were rooted in the three traditional Chinese philosophies mentioned above. The thesis concludes by arguing that rather than simply advocating activities designed for other populations, health promotion strategies and education need to create links to the traditions of this target group and also clarify their conception of physical activity.

It is a widely held view in Poland that for centuries those in power have promoted heavy drinking among their subjects in order to achieve their various goals and that this contributed to the development of Polish drinking patterns. There is some empirical evidence that the political economy of alcohol in Poland promoted heavy drinking among the Polish population. Drinking alcohol in Poland was an important aspect of social situations. The most popular beverage was vodka(s). Social pressure to drink in the extreme was attributed to the tradition of hospitality. Cultural norms encouraged very heavy drinking among men and imposed heavy social sanctions on women who were supposed to display virtues of abstinence. The typical model of drinking was intermittent very heavy drinking, leading to intoxication on most occasions. These norms reinforced the notion that "we can drink more because we are Poles" and the view that safe drinking messages are designed for other nations because "Poles are accustomed to drinking strong alcohol, unlike others". Adult male informants reported drinking much less in Australia than in Poland. The biggest change was a lack of social pressure to drink. Although men claimed that they drink less, some still drink in an unsafe manner. These were largely those whose English skills restricted their employment and friendship networks. Women, on the other hand, admitted that in Australia they drink more often and more alcohol at a sitting than in Poland. Although informants did not mention any alcohol-related family problems in Australia, others reported alcohol related violence within some families. Some safety messages about alcohol do not reach this sample of people. Many view drink driving rules as purely revenue raisers for the government. However, advice from their medical practitioners to reduce their alcohol intake for serious health reasons is given more credibility. Young Polish Australians formed two groups in their attitude to drinking. The first group consisted of people who attended tertiary educational institutions and consumed alcohol in a similar fashion to other Australian students. It is likely that the university environment influenced their drinking patterns. Those who witnessed drinking at home and perceived it as a good thing, modelled their drinking on their parents' and other adults at home. Others, who perceived their parents as non-drinkers, learned to drink from their friends and displayed similar drinking patterns to their peers. The second group was older; some were in the workforce and manifested drinking patterns akin to those in the general Australian population in the same age bracket. Both groups of these young Polish Australians were much more aware of alcohol health messages and more likely to modify their behaviours such as not to drink and drive, than was the older population. However, other drinking related health warnings were largely disregarded. This research demonstrates the negative impact of reduced government funding for English programs and ethno-specific services for migrant groups. More research is needed on migrant drinking in Australia, specifically among those groups whose drinking continues to be problematic.

Background: Motivation plays a vital role in dental students' learning experience and wellbeing. Self-determination theory differentiates between autonomous and controlled motivation and amotivation, where autonomous motivation corresponds to the most selfdetermined form of regulation. Previous research has found that several social educational factors, mediated by students' satisfaction of their basic psychological needs of feeling autonomous, competent and related to important others, predicts autonomous motivation. In turn, autonomous motivation leads to more positive educational outcomes compared to controlled motivation or amotivation. So far, however, few studies have investigated the process of motivation in health professions education from the perspective of the Selfdetermination Theory. A systematic review was conducted within this thesis, identifying determinants, such as an autonomy supportive learning climate and feedback, that predicted students' autonomous motivation. No studies were found that tested mediation effects between determinants and motivation. In turn, students' self-determined motivation was found to predict different affective, behavioural and cognitive outcomes. These studies, however, came mainly from medical education. Despite its relevance for students' development, very little is known about the process of motivation in dental students. This indicates a need to understand its various aspects, which may lead to evidence-based interventions to foster students optimal functioning. Purpose: To test a model of academic motivation in dental education by analysing the associations between autonomy-support and quantity and quality of feedback, as determinants, and self-determined motivation, mediated by students' basic psychological needs satisfaction. This, followed by testing the associations between self-determined motivation and the behavioural outcomes of deep and surface study strategies and academic performance, and the affective outcomes of vitality and self-esteem. Finally, we aimed to test whether the model worked different for female and male students, and by year of curriculum. Methods: We conducted a correlational cross-sectional survey study at the dental school of the University San Sebastian in Chile. All dental students from year 1 to 6 were invited to participate and to answer a questionnaire package containing demographic data and previously validated self-reported instruments. Data on academic performance were obtained from the administrative department. Data analysis involved five phases. First, internal consistency of all measures was assessed by means of Cronbach alpha. Second, descriptive and group comparisons were computed by means of independent t-test to assess gender differences and MANOVA to assess year-of-curriculum differences. Third, bivariate correlations were assessed amongst all measures. Fourth, mediation was tested through a series of regression analyses. Finally, the entire model was assessed by means of structured equation modelling, for the overall student sample as well as for the subgroups of females and males and different years of study. Data were analysed with the PASW and AMOS software. Results: A total of 924 students (90.2% response rate) agreed to participate and completed the questionnaires. Cronbach's alpha values of all instruments ranged from .641 to .912. Students' autonomous motivation for attending university was higher than controlled motivation and amotivation, showing an overall self-determined profile. Females endorsed higher than men both autonomous and controlled motivation, while men endorsed amotivation higher. The overall motivation profile, however, did not show significant gender differences. Across the six years, students showed an overall self-determined profile, in which autonomous motivation decreased when transitioning to clinical years, to rise again in the final year. The contrary was found for students' amotivation scores, while controlled motivation declined as they entered clinical-based years. Bivariate correlations showed that both determinants were positively correlated with students' basic psychological needs satisfaction and with autonomous motivation. In turn, the latter was positively associated with behavioural and affective outcomes. All these associations showed a decreasingly positive correlation from autonomous motivation to amotivation. Mediation regression analyses showed both determinants predicting dental students' autonomous motivation, however, this influence was not direct, it was mediated by students' perceptions of the satisfaction of their basic psychological needs. Finally, structured equation modelling indicated that the data fitted the model well, and showed both determinants positively predicting students' satisfaction of their basic psychological needs, which positively influenced autonomous motivation over controlled motivation. In turn, the gradual shift from controlled to autonomous motivation positively predicted affective and behavioural outcomes. Moreover, the associations followed a similar pattern, with minor deviations, when tested by gender and by year of study. Discussion and conclusion: In the context of this research, dental students' autonomous motivation was indirectly predicted by the social educational factors of teachers' autonomysupport and quantity and quality of feedback, being mediated by students' satisfaction of their basic psychological needs. Students' acting out of autonomous motivation showed enhanced deep study strategies and better academic performance, experienced higher vitality and self-esteem, and showed lower surface study strategies. This suggests that autonomous motivation leads to important outcomes, decreasing from controlled motivation to amotivation. Whilst students in different years of study showed an autonomous motivation profile, there were important differences that showed that students' transition from basic/preclinical to clinical years influenced their motivation and should therefore be taken into account when planning interventions to enhance students' motivation. Results are discussed in light of self-determination theory and considering its implications on curriculum development, teaching and learning, clinical training, assessment, faculty development, peer-assisted-learning and dentist-patient relationship. Significance: This is the first study, in health professions education, to test a Selfdetermination theory-based model including determinants, mediators, motivation and outcomes. This research also expands to dental education the study of motivation based on an empirically verified psychological theory. The results provide strong support for the Selfdetermination theory of motivation in dental education and provide acceptable evidence that the quality of motivation and satisfying students' psychological needs are important in determining positive educational outcomes amongst dental students. Therefore, many successes and failures in a number of elements of dental and health professions education may be understood through the lens of this theory. As such, efforts should be made in various aspects of dental education to support learners' sense of autonomy, competence and relatedness, which may have an extensive influence on dental education and on students' wellbeing. Future research should confirm or refute our results in other dental education settings.

As a medical practitioner, predominantly working in Australian public hospitals, I have always been interested in the factors that shape and influence my and my colleagues’ performance in the practice of medicine. In 2011, the Australian Government instituted a range of reforms to the public health-care system, including some directed at improving access for patients to Emergency Departments, which had, over many years, become increasingly overwhelmed by the number and complexity of presentations. This included a target of four hours within which patients in Emergency Departments were to be discharged, admitted or transferred to alternative institutions. These reforms generated widespread strong emotional responses from medical and other health staff with whom I worked, and I was prompted to consider the origins of these powerful human reactions to the administrative intervention. Emergency Departments are often described, derisively, as chaotic working environments. However, this epithet may instead be describing something quite profound about the ontological nature of hospitals and Emergency Departments — that they are, indeed, non-linear dynamical physical systems in which phenomena of complexity exist. Other human-centred interactional and transactional systems have been successfully examined from a complexity perspective, including economics and human physiology. Framing inquiry into Emergency Departments, and the humans who encounter each other within them, from a complexity perspective might also then prove useful in defining and characterising the complex and manifold relationships and interactions between people, technology and systemic organising principles. This health services research evaluates the lived experience of four medical practitioners through the paradigm of phenomenological inquiry, as actors on a performance landscape of clinical encounters and as key sources of information about the structure and functions of that performance manifold. Inquiry into and analysis of these rich descriptive data yield strong inferences that non-linear dynamics are operating across scales — from the cellular to the organisational. The complexity perspective provides a unifying explanatory power for making sense of how energetic transactions and transformations between patients, health-care practitioners, technology and the hospital system unfold to result in the recovery from injury and trauma. Specifically, literature on interoception suggests that human biological systems are exquisitely sensitive to changes in dynamic steady-states that might indicate increased entropy. This inquiry suggests that suffering is a phenomenological experience of sudden increases in entropy. An explanatory model in complexity, using the Second Law of Thermodynamics in open systems, suggests that entropy — that is, suffering — can be understood as being transferred and expelled from patient to doctor. Framing in this explanatory model would suggest that the patient-doctor relationship is a powerful systemic attractor in a dynamic system. Elaborating this construct of energetic dynamics further suggests that insertion of system controllers, such as time-based targets, can have profound non-linear effects on the function of these dynamics and, hence, the outcomes of these patient-doctor encounters. The implications of this inquiry include a new and powerful reframing of the ontological characterisation of the practice of medicine in Emergency Departments in terms of nonlinear open thermodynamic functions operating at distance from equilibrium. It recommends a more thoughtful consideration of human experiences such as suffering and its relief. Giving priority and visibility to suffering within health-care, a recrudescence of times past when technology in medicine was limited, may elucidate ways of practising that improve patient experiences and health outcomes. Furthermore, the findings suggest that medical practitioners, health workers and administrators are called on to deeply consider embracing complex dynamics as problem framing references, and to engage with methodologies that build better theories about the nature of phenomena under investigation. Rather than seeking to diminish or extinguish the complexities of Emergency Departments, researchers and practitioners might acknowledge and engage with the next wave of complexity-informed health-care research to better understand how and why health-care relieves suffering and restores human function.

This phenomenological study examined the experiences of women in midlife. The primary purpose of the study was to develop and describe a model of health promotion that will facilitate self-care of women in midlife to support them in the attainment of wholeness. A theory-generative, qualitative, explorative, descriptive and contextual design was utilized to achieve the objectives of the study, namely to explore and describe women's experience of midlife transition; classify concepts of the model; describe the structure and process of a model for support of women during midlife transition, and develop guidelines for operationalization of the model. The study was undertaken in one of the northwest states of the United States of America. Purposive sampling of eight women included women between the ages of 40 and 55 years of age. Women who had undergone surgical menopause were excluded as the influence of prolonged hormone replacement therapy was seen as a bias. Data was collected by using an unstructured interview technique. Data was analyzed according to Tesch's protocol (in Cresswell, 1994:155). Guba's model (in Krefting 1991:215) was utilized to ensure the trustworthiness of the study. Ethical issues were considered throughout and these are reflected in chapter one of the thesis. The study identified two themes: (1) how the women experienced midlife and (2) how they managed it. The experiences of midlife were expressed in physical, psychosocial and spiritual changes while the management of the process was accomplished in two ways, namely self-care and the services of healthcare professionals. The researcher identified that health promotion was essential to facilitate the self-care practices of women in midlife. Essential and related attributes of health promotion were identified, analyzed and synthesized to define health promotion. The process of health promotion was then defined with a description of the structure and process of the model. Concepts identified were classified, defined and placed into relationship statements after which the model was described and evaluated. Guidelines to operationalize the model were then formulated to assist health professionals to support women in self-care for the attainment of wholeness.
Health Studies
D.Litt et Phil (Health Studies)

This chapter describes how the actions of the medical environment is aiming to improve the health of society can and must be seen on many levels. The author refers to the organizational, ethical, legal and psychological aspects. Also covered are not only patients' education, but also the scope of functioning healthcare organization, which adapts to the needs of the changing environment e.g. requirements of the patient, the development of technology, advances in medicine. Public health problems appear as complex components of the system and cannot be dealt with by a single, simple intervention, whether perceived by the prism of a single feature or element, but must be perceived as influencing factors in the system e.g. several attributes, factors. These together may potentially be used in the future to generate better health outcomes or the functioning of the entire health system in the areas of health sciences, medicine or public health.

This chapter describes how the actions of the medical environment is aiming to improve the health of society can and must be seen on many levels. The author refers to the organizational, ethical, legal and psychological aspects. Also covered are not only patients' education, but also the scope of functioning healthcare organization, which adapts to the needs of the changing environment e.g. requirements of the patient, the development of technology, advances in medicine. Public health problems appear as complex components of the system and cannot be dealt with by a single, simple intervention, whether perceived by the prism of a single feature or element, but must be perceived as influencing factors in the system e.g. several attributes, factors. These together may potentially be used in the future to generate better health outcomes or the functioning of the entire health system in the areas of health sciences, medicine or public health.