Dissertations / Theses: 'Nursing care delivery system'

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Larsen, Trudean Charlotte. "A study of nurses' empathy in two different nursing care delivery systems." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq24975.pdf.

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Greenberg, Mary E. "The Process of Care Delivery in Telephone Nursing Practice: A Grounded Theory Approach." Diss., Tucson, Ariz. : University of Arizona, 2005. http://etd.library.arizona.edu/etd/GetFileServlet?file=file:///data1/pdf/etd/azu%5Fetd%5F1236%5F1%5Fm.pdf&type=application/pdf.

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Koritor, Christine N. "A study comparing two health care delivery systems, for gerontological patients, and the incidence of hospitalization /." Staten Island, N.Y. : [s.n.], 1994. http://library.wagner.edu/theses/nursing/1994/thesis_nur_1994_korit_study.pdf.

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Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.

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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.

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Myers, Robert A. "Engineering Healthcare Delivery: A Systems Engineering Approach to Improving Trauma Center Nursing Efficacy." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1482419145222356.

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Edgar, Linda. "The relationship between the characteristics of nursing care delivery systems and work-motivation, satisfaction, and intent to leave." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ36974.pdf.

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Miller, Donna Marie. "Establishing Inter Rater Reliability of the National Early Warning Score." Walsh University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1429472548.

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Bosire, Joshua. "Designing an integrated surgical care delivery system." Diss., Online access via UMI:, 2007.

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Johnston, Diann M. "The relationship between RN job satisfaction in a modified primary nursing delivery system and a team nursing delivery system /." Staten Island, N.Y. : [s.n.], 1989. http://library.wagner.edu/theses/nursing/1989/thesis_nur_1989_johns_relat.pdf.

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Phiri, Jane. "Socioeconomic inequalities in Zambia's public health care delivery system." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9458.

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Includes bibliographical references.
In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.

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Enochs, Shannon. "Bridging the Gap between Emotional Trauma Practice Guidelines and Care Delivery in the Primary Care Setting." Thesis, Brandman University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13428017.

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When patients present with complaints of anxiety or depression, providers in the primary care setting often prescribe anxiolytics or antidepressants without conducting an early emotional trauma or adverse childhood experiences assessment. Several studies demonstrate the link between early emotional trauma (EET) or adverse childhood experiences (ACEs) and the increased risk of anxiety or depression as adults. This Clinical Scholarly Project (CSP) implemented the use of the Adverse Childhood Experience (ACE) Questionnaire with patients who had a diagnosis of anxiety or depression in the primary care setting to increase patient access to resources and align clinical practice with practice guidelines. Participants included eight primary care providers, 30 patients and 21 chart review patients. The CSP utilized a quasi-experimental design to determine if the use of the ACE Questionnaire by patients with anxiety or depression would result in patients receiving more community resources (to include counseling), strengthen the provider-patient relationship, increase provider comfort in discussing ACEs with their patients and result in patients receiving care that was evidence based. Patient sample participants received significantly more resources (M = 8.27, SD = 2.27) than the chart audit sample (M = 0.90, SD = 0.30). Patient sample members received an average of eight resources (M = 8.27) and utilized an average of five resources (M = 5.07). Use of the ACE Questionnaire resulted in more trust in provider-patient relationship by patients (80.0%) and the majority of the provider sample more comfortable discussing ACEs after the project (85.7%).

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SANTOS, Heliane Fernandes Lourenço. "Assistência obstétrica sob a ótica de mulheres atendidas no Sistema Único de Saúde em Goiânia, Goiás." Universidade Federal de Goiás, 2011. http://repositorio.bc.ufg.br/tede/handle/tde/716.

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INTRODUCTION: The policy of humanization of prenatal care, labor and delivery within the Health System recommends actions that should guarantee women the benefits of scientific advances, and ultimately, allow and encourage the practice of female citizenship, rescuing empower women in the process parturitivo, ensuring privacy, easy access to consultations and examinations, information and procedures proven beneficial. Avoiding unnecessary interventions, sharing with the mother decisions on measures to be adopted and establishing relationships based on ethical, social and professional (MINISTRY OF HEALTH, 2006). The study aims to analyze the adoption of standards of humane care to prenatal care, labor and birth, from the perspective of women served by the Health System in Goiânia, Goiás METHODOLOGY: A descriptive and exploratory qualitative approach. Data collection took place from May to July 2010 in Goiânia, Goiás For data collection we used semi-structured interview. RESULTS: The profile of the subjects were 21 pregnant women aged 18-31 years, most had high school, lived in a stable income and a minimum wage. Were prepared two thematic categories: Pre-natal care and childbirth and birth. It was found that prenatal was easy access to exams and the Family Health Strategy. However the Centers for Integral Health was difficult to access appointments. It found no or little information about the process parturitivo prevailed and the will or medical decision in choosing the type of delivery. During labor and delivery practices walking, freedom of position, power and right to analgesia were less evident, the right of the accompanying family is still not respected. Breastfeeding was encouraged after birth, rooming-in was seen as a place of abandonment and loneliness. The perception of the mother and birth care in the public health data direct to lack of education of health professionals. CONCLUSION: The data pointed to situations such as difficult access to prenatal care, lack of conduct and procedures to be adopted, absence of women's participation in decision making and lack of support in childbirth, situations that contradict with the policy advocated by humanizing prenatal care, labor and birth.
INTRODUÇÃO: A política de humanização da assistência ao pré-natal, parto e nascimento no âmbito do Sistema Único de Saúde preconiza ações que deve garantir à mulher os benefícios dos avanços científicos, e fundamentalmente, permitir e estimular o exercício da cidadania feminina, resgatando a autonomia da mulher no processo parturitivo, garantindo a privacidade, o fácil acesso a consultas e aos exames, a informação e, procedimentos comprovadamente benéficos. Evitando-se intervenções desnecessárias, compartilhando com a gestante as decisões sobre condutas a serem adotadas e estabelecendo relações baseadas em princípios éticos, sociais e profissionais (MINISTÉRIO DA SAÚDE, 2006). O estudo tem por objetivo analisar a adoção das normas de assistência humanizada ao pré-natal, parto e nascimento, sob a ótica das mulheres atendidas pelo Sistema Único de Saúde, em Goiânia, Goiás. METODOLOGIA: Estudo descritivo e exploratório de abordagem qualitativa. A coleta de dados se realizou no período de maio a julho de 2010 em Goiânia, Goiás. Para coleta de dados utilizou-se entrevista semi-estruturada. RESULTADOS: O perfil dos sujeitos foram 21 parturientes com idade entre 18-31 anos, a maioria tinha ensino fundamental, vivia em união estável e renda um salário mínimo. Elaboraram-se duas categorias temáticas: Assistência pré-natal e O parto e nascimento. Identificou-se que no pré-natal foi fácil o acesso aos exames e consultas na Estratégia Saúde da Família. Entretanto nos Centros de Atenção Integral a Saúde houve dificuldade de acesso às consultas. Constatou-se ausência ou pouca informação acerca do processo parturitivo e preponderou à vontade ou decisão médica na escolha do tipo de parto. Durante trabalho de parto e parto as práticas de deambulação, liberdade de posição, alimentação e direito à analgesia foram pouco evidenciadas, o direito do acompanhamento familiar ainda é pouco respeitado. O aleitamento materno foi incentivado após o parto, o alojamento conjunto foi visto como espaço de abandono e solidão. A percepção da parturiente quanto à assistência ao parto no Sistema Único de Saúde os dados direcionam para falta de educação dos profissionais de saúde. CONCLUSÃO: Os dados apontaram para situações como dificuldade de acesso ao pré-natal, desinformação das condutas e procedimentos a serem adotados, ausência da participação da mulher na tomada de decisão e ausência do acompanhante no parto, situações que contradizem com o preconizado pela Política de humanização ao pré-natal, parto e nascimento.

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Oliveira, Roberto Santos de. "Mapeamento dos serviços de saúde da rede assistencial do município de Nova Iguaçu - análise situacional." Universidade Federal Fluminense, 2010. https://app.uff.br/riuff/handle/1/1226.

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EELVI Ltda
Mestrado Profissional em Enfermagem Assistencial
Estudo descritivo de abordagem qualitativa que realiza o diagnostico situacional da rede assistencial própria do Sistema Único de Saúde no município de Nova Iguaçu. Realiza o mapeamento das unidades de saúde, através de uma ferramenta conhecida como geo-referenciamento. O marco teórico se apoia nas concepções de Cecílio, Merhy, Bodstein, Hartz, Mendes, Buss entre outros; encontra suporte metodologico em Minayo e analisa os resultados a partir das concepções de Levefre sobre o discurso do sujeito coletivo. Como resultados, foram mapeadas 72 Unidades de Saúde: sendo 01 Hospital Geral, 01 Centro de Referencia Materno Infantil, 03 Unidades Mistas, 03 Centros de Atenção Psico-Social, 02 Policlínicas, 01 Centro de Saúde, 01 Posto de Saúde, 24 Unidades Básicas de Saúde, 33 Equipes de Saúde da Família e 03 Unidades da Família. A organização segue os principios estabelecidos pelo Sistema de Saúde, Nova Iguaçu operacionaliza suas ações de saúde principalmente na atenção básica, através da estratégia de saúde da família. Quando confrontamos os resultados encontrados com os parâmetros legais de cobertura assistencial, constatamos que a realidade ainda está aquém do ideal; apesar deste fato, ao situar o município dentro do Estado do Rio de Janeiro, lançando mão de estratégias de avaliação como o Indice de Desenvolvimento Humano, encontramos um crescimento, modesto mas equilibrado entre Estado e União, destacando Nova Iguaçu, através do indicador: Expectativa de vida, que recebe reflexos da assistência prestada à saúde. Conclui identificando o espaçamento geográfico da rede própria, e um esboço da área de cobertura das unidades; percebe-se que são necessárias estratégias de adequação, treinamentos e hierarquização da rede, para utilização da dinâmica de referências e contra-referências, atividades próprias do planejamento em saúde, que vem sendo desenvolvida também pela enfermeira, quando ocupa a posição de gestor. Como contribuição traz as informações coletadas na modalidade de um manual de localização para encaminhamentos entre as Unidades de saúde
A descriptive study of qualitative approach that performs the status diagnosis of the self care network of the Unified Health System in Nova Iguacu. Performs the mapping of health facilities through a tool known as geo-referencing. The theoretical framework is based on the conceptions of Cecilio, Merhy, Bodstein, Hartz, Mendes, Buss and others; finds methodological support in Minayo and analyzes the results starting from concepts of the Levefre on the collective subject discourse. The results were 72 mapped Health Units: 01 the General Hospital, 01 Center Reference Maternal and Child, 03 Mixed Units, 03 Centers for Psycho-Social Care, 02 Polyclinics, 01 Health Center, 01 Health Post, 24 Basic Units Health, 33 Family Health Teams and 03 Units of the Family. The organization follows the principles established by the Health System, Nova Iguaçu operationalized its health activities mainly in primary care through the strategy of family health. When we confront the results with the legal parameters of coverage, we find that the reality is still far from ideal, despite this fact, to be located within Rio de Janeiro county, making use of assessment strategies such as Development human Index, we found a modest growth well balanced between State and Union, highlighting Nova Iguaçu, by indicator: life expectancy, which receives reflections of health care provided. It concludes by identifying the geographic spacing of the health network itself, and an outline of the coverage area of the units, one realizes that strategies are needed to adapt, training and hierarchy of the network, to use the momentum of references and cross-references, activities characteristic of planning health, and that also is being developed by the nurse, when she occupies the position of manager. As a contribution, brings the information collected in the reference guide for tracking referrals between the health units

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Salsamendi, Noreen. "Stress, job satisfaction, and related outcomes in intensive care unit nurses and labor and delivery unit nurses." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1332.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Sciences
Psychology

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Rejzer, Courtney Brynne. "The influence of the acute care nurse practitioner on healthcare delivery outcomes : a systematic review /." Full-text of dissertation on the Internet (211 KB), 2009. http://www.lib.jmu.edu/general/etd/2009/Honors/Rejzer_CourtneyB/rejzercb_honors_11-11-2009.pdf.

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Guise, Andrew George. "South African primary health care in the era of HIV/AIDS treatment and care : understanding the organisation and delivery of nursing care." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://researchonline.lshtm.ac.uk/878726/.

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The integration of Antiretroviral Treatment (ART) for HIV in to South African primary health care (PHC) and task shifting are increasing nurses' role in ART and H/V care. There is evidence this role is motivating nurses to adopt more patient-centred care. This study explored this potential emergence of more patient centred care in PHC in the Free State province, South Africa. A multi-site, mixed-method observational approach was used, building on ethnographic principles. A purposive sample of four clinics, two providing ART and two not, were the focus for observation and interviews through four phases of data collection. Emerging findings were explored in an additional six clinics in later phases of data collection. 34 professional nurses, 6 members of clinic staff and 21 patients were interviewed. A thematic analysis that aimed to develop theory grounded in the study contexts through integrating existing theory with inductively identified themes was used. The study found care is patient centred and integrated to a limited extent, while ART and HIV care are more likely to be patient centred than other aspects of PHC. These care routines are then shown to emerge from nurses' agency mediating different levels of structure: the rules of clinic interaction and then the clinic context. Further analysis of nurses' agency explores how it is shaped by a complex identity and a health system context of constant change. The study provides in-depth understanding of a little explored health services issue, and is the basis for recommendations to support patient centred and integrated care. The analysis supports the reconceptualisation of patient centred care to consider Issues of convenience, as a response to the specific context of nurse-led PHC in South Africa. The study also introduces a structure-agency theoretical framework that can be applied to the context of nurse-led PHC.

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Cattoor, Erin. "The Effectiveness of Cares Dementia Training Modules on Delivery of Person Centered Care Inside a Memory Care Unit| Utilizing the Cares Observational Tool." Thesis, University of Missouri - Columbia, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13877136.

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This study compared the efficacy of using online dementia training modules on both direct and non-direct care providers in long-term care settings and how this impacted their delivery of Person Centered Care (PCC), as well as their knowledge of caring for residents with a diagnosis of Alzheimer Disease (AD), dementia. Traditional educational opportunities for staff working specifically with demented residents inside Memory Care Units (MCU) were investigated, along with an alternative approach of training all staff (to include direct and non-direct care providers). The option of utilizing online dementia training modules for all staff was then evaluated by using an observational Person Centered Care tool, to see if education had made an impact on interactions between staff and the demented residents that they care for. This study utilized a single-group, repeated measures design to test a 10-week, standardized and computerized set of 10 interactive training modules in a 60-bed MCU . Fifty-one observations were made between MCU residents and staff and included in this study, employing a single-group pre-post-posttest design. The findings suggest that online dementia training modules may be beneficial for both knowledge and delivery of PCC to staff in MCUs who care for residents with a diagnosis of AD.

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Vanhook, Patricia M. "State Stroke Systems of Care-Tennessee." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/7449.

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Stoyanov, Joan Ellen. "South African health care practitioners’ experiences of the current health care delivery system in Uthungulu District." Thesis, University of Zululand, 2017. http://hdl.handle.net/10530/1530.

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A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology at the University Of Zululand, 2017
Health is a human need and considered to be a human right across all societies. Access to health care services is not a problem for those who can afford it, but, for those who cannot provide for themselves, legislation needs to protect their rights. Although there is legislation in place to protect these vulnerable populations, it is ultimately the health care practitioners’ job to protect and improve the health of their communities. It is these health care practitioners who were the inspiration for and focus of the present study. The present study emerged as a separate, but expanded version of the researcher’s limited 2011 study, which specifically focused on medical practitioners’ experiences of the current health care delivery system. Results from this 2011 study suggested that a broader spectrum of health care practitioners may be similarly affected by the current health care system and that their experiences may ultimately contribute towards a better understanding of the dynamics within which health care practitioners work and function. Therefore, the present phenomenologically-oriented study aimed to describe, explicate, interpret and analyse the experiences of a broad sample of health care practitioners through their lived, day-to-day realities in both the public and private health care sectors. Data were collected from a non-probability, purposive, convenience sample of 30 adult registered health care practitioners in public and private hospitals, clinics and private practices in the uThungulu District of Kwa-Zulu Natal, South Africa. There were 15 participants from the public and 15 from the private sector. An open-ended questionnaire was used to ascertain and understand their experiences, knowledge and exposure to the relatively new national health insurance (NHI) system, what they perceived as key objectives for effective transformation of the South African health care system, possible reasons for considering emigration in light of the current staff shortages and their views on the new NHI policy, in order to find solutions to problems. The overall data analysis consisted of three levels of subsidiary data analysis, descriptive, social constructionist and interpretive paradigms, each contributing to the whole, both “vertically and horizontally”, where participants’ experiences were described, explicated and interpreted. Research findings indicated persisting large divisions and fragmentation in and between the public and private health care sectors. Yet there was unity in responses concerning the poor and disadvantaged members of society and the challenges of their access to health care services. Sensitivity to human rights standards, past socio-political influences and awareness of health as a human right and need were evident in all participant responses. Valuable solutions to improve the health care delivery system were offered by health care practitioners as key stakeholders in the future of health care delivery in South Africa. Public health care practitioners’ experiences were dominated by overall expressions of unhappiness, anger and frustration related to poor service delivery, lack of resources, inadequate management structures, wages, inadequate consultation, fear for personal (and family) safety and the future of health care. Concern for the poor, vulnerable and the majority of citizens who use health care services, coupled with the burgeoning burden of disease, were perceived as a major stressor and source of anger towards the government and bureaucracy in general. Chronic stress and anxiety, suggestive of burnout and other negative psychological states, were also apparent. The inability to service long patient queues, inadequate communication structures/channels and lack of cohesive team practices, ethics and standards created a sense of emotional overburden and other negative affective states. These, and the uncertain future of health care under the new NHI, exerted extra stress on already overworked health care personnel. Education and effective consultation about the NHI were expressed as being inadequate and incomplete. Despite these factors, health care practitioners offered various valuable solutions and suggestions for the improvement of health care service delivery. Despite also being stressed, participants who work in the private sector were generally happier and they evinced less negative psychological states. Although a stressful environment with its own problems, within the private sector the NHI was considered to be a good concept in principle, although many participants doubted its feasibility and felt that regulatory changes often took place without adequate consultation. Given the nature and transparency of the present study, across multidisciplinary teams of health care practitioners, the researcher is of the opinion that the present study created a platform for discussion and debate around the context of a changing health care system within South Africa’s culturally diverse society. In conclusion, a critical review of the present study and recommendations for management structures, health care practitioners themselves and future research is provided.

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Stoyanov, Joan Ellen. "South African medical practitioners’ experiences of the current health-care delivery system." Thesis, University of Zululand, 2011. http://hdl.handle.net/10530/1087.

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A thesis submitted in partial fulfilment of the requirements for the degree of Masters of Arts in Clinical Psychology at the University of Zululand, South Africa, 2011.
South Africa is at a critical point in the debate about the future of health-care in the occupation-specific dispensation (OSD). It also faces the exodus of valuable human resources that was perceived as greener pastures, as medical practitioners become increasingly dissatisfied with governmental policy, wage negotiations, work-place disillusionment, lack of service delivery, expressions of corruptions, and lack of resources. This research aimed to thematically analyse the experiences, opinions and feelings of medical practitioners in both the public and private health-care sectors as well as explored international trends with the intention of drawing comparisons, highlighting problem areas, and discussion of possible solutions. It was hoped that this research would contribute towards understanding the dynamics that marked the exodus of medical practitioners from South Africa, at a time when change in the health-care system was imminent. In order for the medical practitioners to remain in the current health-care system, a new dialogue would have been opened in which their concerns could be raised and evaluated.

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Mulvanerty, Noreen R. "Impact of healthcare provider education related to safe sleep practices on care delivery| Pilot study." Thesis, Georgetown University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10251871.

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The purpose of this study was to increase the knowledge level and change self-reported behavioral intent among a sample of healthcare providers regarding safe sleep messaging. From 1995 through 2015 in New York City, an average of one infant died every week from unsafe sleeping conditions. One agency in New York City experienced four unsafe sleep infant deaths within two months in 2010. In 2011, the city provided case managers with training on infant safety. Before this training, up to six sleep-related infant deaths were reported annually. The following year, one sleep-related infant death occurred. None occurred during the second year subsequent to the training. Current literature demonstrates healthcare providers have considerable influence on safe sleep messaging. This current study utilized a similar educational training designed for healthcare providers working in an urban health facility.

A single group pre/post-test quasi-experimental design was delivered to 23 participants. The design incorporated an online educational intervention in order to increase healthcare provider’s knowledge level and change their self-reported behavioral intent to educate parents and caregivers on the importance of safe sleep practices. Data were gathered at pre-test and post-test to assess changes.

Final analysis, using a repeated measures general linear model, was carried out on data from the twenty-three participants who returned completed pre- and post-class surveys. There was a statistically significant change in the overall 13-item composite score reflecting knowledge level and change the self-reported behavioral intent from pretest (M=6.13, SD=2.78) to post-test (M=8.78, SD=3.79) at the p <.001 level. These findings support current literature recommendations for healthcare providers to incorporate the safe sleep message into their practice. Nonetheless, supplementary research is needed to conclude whether these results coincide with communities elsewhere and to examine the issues regarding knowledge and behavioral intent regarding safe sleep messaging.

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Hendry, Charles. "Caring for patients - setting priorities : an exploration of the process of prioritising care in nursing." Thesis, Abertay University, 2001. https://rke.abertay.ac.uk/en/studentTheses/b6073061-57ac-40c0-a455-555b62418b1a.

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Caring for patients in an acute medical ward occurs in a complex and dynamic environment. Prioritisation of goals and activities represents one element of effective planning and delivery of care. The importance of priority setting has been highlighted in the nursing literature for over twenty-five years; however, there would appear to be no systematic study of this key skill. This thesis explores priority setting within a novice/expert framework, using a mixed methods approach. In addition to using simulation it investigates real-time priority setting within actual clinical practice. Study one used simulation in four groups with a range of nursing experience. This included one group of non-nurses for comparison. Participants were asked to prioritise twelve care activities presented in a simulated case-load. Analysis demonstrated that the simulation evoked priority setting behaviour, and differences in priority setting were seen. Study two combined the simulated case-load with think-aloud method. Semistructured interview completed the data collection. Findings were consistent with Benner’s ovice/expert framework, suggesting that prioritisation is determined by two main characteristics, the views, values and perceptions of the nurse, and key skills, knowledge and experience. Study three used think-aloud method to examine priority setting in clinical practice, comparing junior student nurses with senior staff nurses. This was supplemented by observation and semi-structured interview. Findings from this study identified differences in cognitive processes, and priority setting strategies. Developing critical thinking skills, expert role modelling, and the use of an active apprenticeship model may facilitate skill acquisition. This thesis highlights the complexity of priority setting in caring for patients in an acute medical ward. It explores the development of this skill in learner nurses, and demonstrated a range of methods for studying decision-making in both simulated and clinical settings.

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Chao, Shir-Ley. "Relationships among patient characteristics, care processes, and outcomes for patients in coronary care units (CCUs)." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276836.

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The purpose of this research was to describe the relationships among patient characteristics, care processes, and care outcomes for patients in a coronary care unit (CCU). The sample consisted of 179 CCU patients. Data collectors reviewed charts and retrieved the chart information needed to measure the operational variables of APACHE II score (Acute Physiology and Chronic Health Evaluation II), years of age, CCU length of stay, nurse to patient ratio, and mortality. Descriptive statistics were used to analyze the demographic data of the patient characteristics. Correlational statistics were used to analyze the five operational variables in the "CCU Patient Outcomes Model." Pearson correlations revealed significant positive relationships between APACHE II score and age and nurse to patient ratio. Point Biserial correlations revealed significant positive relationships between mortality and APACHE II score and nurse to patient ratio. Patient characteristics were related to care processes. Patient characteristics and care processes were related to patient outcomes.

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Cox, Karen R. (Karen Rose). "Effects of a self-care deficit nursing theory-designed nursing system on symptom control in children with asthma." free to MU campus, to others for purchase, 2001. http://wwwlib.umi.com/cr/mo/fullcit?p3036817.

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Banks, Janet. "Carrying the load : nursing care experiences in a public hospital system /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.

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Mahoney, Kevin B. "THE RISE OF MEDICAL CONSUMERISM, SELF-TRIAGE AND THE IMPACT ON THE HEALTHCARE DELIVERY SYSTEM." Diss., Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/501209.

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Business Administration/Interdisciplinary
D.B.A.
The increased out-of-pocket payments required from today’s insurance plan designs is leading to the advent of patients acting more like regular consumers. They are shopping for the best value for their personal spending on healthcare services. This is leading to an increased use of less hospital and health system centric delivery sites. Enabled by the availability of information on the internet, more patients are using alternative settings such as urgent care centers, retail clinics, etc. Specifically, patients are opting for Urgent Care Centers (UCC) in lieu of the hospital emergency room (ER), principally due to higher out-of-pocket costs for unscheduled care but also a desire for a better overall service experience with amenities and a service orientation towards the consumer/patient. This shift in patient behavior raises questions as to how UCCs compare to ERs. To better understand this, two studies were conducted: the first examining the relative patient experience at UCCs versus ERs, and the second examining the effect of UCC visits on overall cost of service. To better understand the patient experience in UCCs compared to ERs, a quantitative analysis of reviews posted on Yelp for hospital emergency room and urgent care center was conducted. UCCs received significantly higher Yelp ratings than emergency rooms. Machine learning was used to determine which topics in Yelp reviews were most closely correlated with 5-star and 1-star ratings. 16,447 ER Yelp reviews were analyzed from 1,566 hospitals, and 84,502 reviews from 5,601 UCCs. There were more 5-star UCC reviews (n=43,487, 51%, p<0.05) compared to 5-star ER reviews (n=4,437, 27%, p<0.05). The study determined that 5-star reviews for ERs tend to focus on clinical care while UCC reviews focused on convenience. Online patient reviews provide an understanding of what patient’s value in their unscheduled care experience offering insights for health systems and providers in planning the future care delivery systems. To determine if urgent care centers are a less-costly substitute service to hospital-based emergency rooms or a complementary, cost-amplifying service, a second study was completed. The study compared the pre- and post-period spending differences, for selected low-acuity patient conditions, between patients who started their treatment at an urgent care center versus starting at an emergency room using difference-in-differences analysis. The study methodology was based on a sample University of Pennsylvania Health System employees and their dependents seen at an urgent care facility or in the emergency room between 2012-2017 with a primary diagnosis among 15 most common low-acuity conditions seen in those settings. The sample included 3,055 episodes with initial index visits in urgent care and 3,650 initial index visits in a hospital emergency room. Patients who visited the ER spent $1,323 (p < 0.0001) more than those who visited urgent care centers within 30 days following the visit, and $2,152 (p < 0.0001) more within 6 months following the visit. Visiting the emergency room corresponded to a 68.0% greater change in pre- to post-index period cost when evaluating the first 30 days and 40.0% comparing costs over 6 months. Thus, this study demonstrated the significant cost advantage of urgent care centers for treating selected conditions as compared to a hospital emergency rooms when the unit of analysis is total health care spending at 30-day and 6 months.
Temple University--Theses

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Havaei, Farinaz. "The effect of mode of nursing care delivery and skill mix on quality and patient safety outcomes." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59936.

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Aims: This study examined the effect of various components of a model of nursing care delivery, the mode of nursing care delivery and nursing skill mix on (a) quality of nursing care (i.e., nurse reported quality of nursing care and nursing tasks left undone), (b) patient adverse events, and (c) nurse outcomes (i.e., job satisfaction and emotional exhaustion) after controlling for nurse demographic characteristics, work environment and workload factors. This study also explores the moderating effects of mode of nursing care delivery and skill mix on the relationship between workload factors and the five outcome variables. Background: Research into redesigning care delivery has typically focused on only one care delivery component at a time (e.g., skill mix). There exists little research focusing on both components, and controlling for one factor while the other is investigated to determine quality of nursing care delivery and nurse and patient outcomes. Method: This cross-sectional exploratory correlational survey study drew upon secondary data from 416 direct care registered nurses (RNs) from medical-surgical settings. Results: Nurses working in a team-based mode of care delivery reported a greater number of nursing tasks left undone compared to those working in a total patient care mode of delivery. Nurses working in a skill mix with licensed practical nurses (LPNs) reported a higher frequency of patient adverse events compared to those working in a skill mix without LPNs. Two moderating effects were found. At higher levels of acuity, nurses in a team-based mode of care delivery reported a higher frequency of patient adverse events than did nurses in a total patient care mode of delivery. At higher levels of acuity, nurses working in a skill mix with LPNs reported lower levels of emotional exhaustion than nurses in a skill mix without LPNs. Conclusion: Models of nursing care delivery components influenced quality and safety outcomes. Implications: To be effective, a team-based mode of care delivery requires collaborative teamwork. Policy makers, administrators and healthcare providers should work together to clarify and optimize the scopes of practice for RNs and LPNs.
Applied Science, Faculty of
Nursing, School of
Graduate

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Xaba, Anna Nnoi. "Perceptions of registered nurses on the factors influencing service delivery regarding expansion programmes in a primary health care setting." Diss., Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-02172009-150243/.

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Wang, Shihua. "The experiences of Chinese immigrant women with the health care delivery system in Canada." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0025/MQ36382.pdf.

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Cavenaghi, Suzana. "A spatial-temporal analysis of fertility transition and health care delivery system in Brazil /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.

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Guillen, Linda Diane. "Curriculum for an online course in technical communications using the I-CARE delivery system." CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1851.

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Currey, Judy A., and mikewood@deakin edu au. "Critical care nurses' haemodynamic decision making." Deakin University. School of Nursing, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050728.094123.

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For cardiac surgical patients, the immediate 2-hour recovery period is distinguished by potentially life-threatening haemodynamic instability. To ensure optimum patient outcomes, nurses of varying levels of experience must make rapid and accurate decisions in response to episodes of haemodynamic instability. Decision complexity, nurses characteristics, and environmental characteristics, have each been found to influence nurses' decision making in some form. However, the effect of the interplay between these influences on decision outcomes has not been investigated. The aim of the research reported in this thesis was to explore variability in critical care nurses' haemodynamic decision making as a function of interplay between haemodynamic decision complexity, nurses' experience, and specific environmental characteristics by applying a naturalistic decision making design. Thirty-eight nurses were observed recovering patients in the immediate 2-hour period after cardiac surgery. A follow-up semi-structured interview was conducted. A naturalistic decision making approach was used. An organising framework for the goals of therapy related to maintaining haemodynamic stability after cardiac surgery was developed to assist the observation and analysis of practice. The three goals of therapy were the optimisation of cardiovascular performance, the promotion of haemostasia, and the reestablishment of normothermia. The research was conducted in two phases. Phase One explored issues related to observation as method, and identified emergent themes. Phase Two incorporated findings of Phase 1, investigating the variability in nurses' haemodynamic decision making in relation to the three goals of therapy. The findings showed that patients had a high acuity after cardiac surgery and suffered numerous episodes of haemodynamic instability during the immediate 2-hour recovery period. The quality of nurses' decision making in relation to the three goals of therapy was influenced by the experience of the nurse and social interactions with colleagues. Experienced nurses demonstrated decision making that reflected the ability to recognise subtle changes in haemodynamic cues, integrate complex combinations of cues, and respond rapidly to instability. The quality of inexperienced nurses' decision making varied according to the level and form of decision support as well as the complexity of the task. When assistance was provided by nursing colleagues during the reception and recovery of patients, the characteristics of team decision making were observed. Team decision making in this context was categorised as either integrated or non integrated. Team decision making influenced nurses' emotions and actions and decision making practices. Findings revealed nurses' experience affected interactions with other team members and their perceptions of assuming responsibility for complex patients. Interplay between decision complexity, nurses' experience, and the environment in which decisions were made influenced the quality of nurses' decision making and created an environment of team decision making, which, in turn, influenced nurses' emotional responses and practice outcomes. The observed variability in haemodynamic decision making has implications for nurse education, nursing practice, and system processes regarding patient allocation and clinical supervision.

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Jain, Tarun. "Electronic Data Capture System for Heart Failure Disease Management Program in Skilled Nursing Facility." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1412698796.

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McCullough, Kylie. "The delivery of Primary Health Care in remote Australian communities: A Grounded Theory study of the perspective of nurses." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2153.

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Around 85% of Australia’s landmass is remote and sparsely populated. Across these vast areas of desert, wilderness and tropical islands, nurses provide the majority of health care services. The residents of Australia’s remote communities have poorer health status than their metropolitan counterparts. The proportion of Indigenous people is high and health and social disadvantage is widespread. The characteristics of each remote community are unique and often reflect challenges associated with distance to tertiary health services and limited health resources. As a result, nursing practice within this context is very different to other nursing contexts. Despite recognition of Primary Health Care (PHC) as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses use the PHC model in practice and research pertaining to this nursing context is limited. This study was conducted from a Constructivist Grounded Theory perspective to generate a substantive theory. Data were collected through 23 telephone interviews and an expert reference group. This study adds previously unknown information to the body of work about remote area nursing. The context of providing PHC in a remote setting was described as social with a focus on illness prevention and equality of care. Participants described personal satisfaction as a feeling of making a difference to the health and wellbeing of the community. However, the core issue participants faced was the inability to provide PHC. Four conditions that impacted on the core issue, were described as: understanding of the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process labelled doing the best you can with what you have emerged as the way participants dealt with the inability to provide PHC. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home‐making in a work environment. The outcome of this process was considered to be making compromises to provide PHC. This study proposes a substantive theory to understand and explain Australian remote nursing practice. Recommendations include further exploration, testing and refinement of the substantive theory. The implications for practice include development of education and support programs and the findings promote the case for providing additional resources to health services in remote areas in order to support nurses in providing PHC.

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Devika, Janae Alyna. "Implementing an Online Education and Reminder System to Aid a Clinic's Dietary Intervention Program." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/311578.

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Obesity and diet-associated chronic illnesses are a major burden on the health of the U.S. population. Healthcare providers are challenged with the treatment of patients with chronic illness but are not equipped to manage and influence patient lifestyle choices. Effective, long-term behavior change using interventions such as a dietary program can be costly and time consuming. Pioneer Comprehensive Medical (PCM) is a small clinic located in Draper, Utah that uses a dietary intervention program to improve patient health, but program application is inconsistent, patients feel ill equipped to make changes, and attrition is high. Like many small clinics, PCM has limited resources to adopt new policies and programs. This practice inquiry (PI) proposes to address this practice gap with behavior change theory as a foundation (Chapter 1) and improving the program at PCM with a quality improvement (QI) process using a Plan-Do-Study-Act (PDSA) model. In the "Plan" phase (Chapter 2), a systematic review of the research literature determined the key components for effective dietary interventions. Six characteristic features found in these interventions include: self-efficacy building education, web-based delivery, sequential delivery of information, consistent messaging with reminders, a supportive social environment and individually-tailored feedback. The "Do" phase (Chapter 3) is the design of a program delivery method that incorporates the findings from the literature. The "Study" phase (Chapter 4) is the design of a pilot study to assess the usability, feasibility, and sustainability of the program. The "Act" phase (Chapter 5) is the implementation plan for all PCM patients based on findings in the pilot study and to assess the impact of the program. This final phase will provide detailed data to assess the short, intermediate, and long-term outcomes of the program.

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Hogan, Georgiana, Janice Lazear, Jean Croce Hemphill, Catherine Hebert, and Emily Wood. "Constipation in the Long-Term Care Resident." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/4.

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An evidence-based clinical practice guideline was developed to prevent and manage constipation in the long-term care (LTC) resident. Constipation is a prevalent condition in the LTC resident. Guidelines do not address this vulnerable population. Constipation may result in poor nutritional status, quality of life along with increased health care costs and hospitalizations. A literature review was completed and evidence was evaluated and included into the initial draft recommendations. The guideline was reviewed for content validity using a Delphi Committee of clinical experts in gastroenterology, geriatrics, and pharmacy. The updated guidelines were presented to an interdisciplinary team of long-term care residents. Participants were asked to review and complete a survey regarding clinical applicability of the guideline. Thirty-one interdisciplinary members participated in the education session and 30 surveys were received. Overall, the interdisciplinary team members agreed or strongly agreed the guideline was clinically applicable. Finally, the guideline was evaluated by a group of doctoral prepared practicing nurse practitioners using the AGREE II instrument. The scores were >80% in every domain, with an overall score of 91%, indicating the guideline is high in quality. Development of this guideline signifies an initial step in the management and prevention of constipation in the LTC resident.

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Stevens, Brent Alan. "Improving the Quality of Electronic Documentation in Critical Care Nursing." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3636.

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Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General systems theory and the Donabedian model of health care quality provided the framework for the project. Electronic databases PubMed and the Cumulative Index of Nursing and Allied Health were searched for articles addressing electronic nursing documentation practices. The Cochrane systematic review methodology was used to analyze the articles. Articles were excluded if published before 2001 or not in the English language. The search revealed 860 articles of which 35 were included in the final review. Most studies were quasi-experimental involving multiple interventions such as clinical decision support (CDSS), education, and audit and feedback specific documentation foci. The most reported outcomes were an improvement in documentation completeness and correctness. A multifaceted intervention strategy consisting of CDSS, education, and audit and feedback can be used to improve electronic documentation completeness and correctness. Policies and procedures regarding documentation practice should support the intended outcomes. Electronic documentation systems can improve completeness, but care should be taken not to depend on the quantity of documentation alone. Further research may shed light on the importance of concordance or plausibility, and the truth of documentation and ultimately how that can impact social determinates of health and social change.

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Pinkoane, Martha Gelemete. "Incorporation of the traditional healers into the national health care delivery system / Martha Gelemete Pinkoane." Thesis, North-West University, 2005. http://hdl.handle.net/10394/1725.

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Kurtzman, Ellen T. "Delivery of High Quality Primary Care in Community Health Centers| The Role of Nurse Practitioners and State Scope of Practice Restrictions." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3746006.

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In response to the increased demand for primary care in the United States—a byproduct of a growing elderly population and insurance expansion under the Affordable Care Act (ACA)—the total number and capacities of community health centers (HCs) is expected to grow. While HCs have historically depended on physicians to deliver the majority of their care, more and more, they are shifting to non-physician clinicians, especially nurse practitioners (NPs); yet, little is known about the quality of care delivered by NPs in HCs or about the role state occupational restrictions have on these practitioners or their patients.

Using quasi-experimental methods and data from the community health center subsample of the National Ambulatory Medical Care Survey (NAMCS), this dissertation explores three distinct, but related, research questions regarding NP-delivered care in HCs—its effectiveness and comparability to physician care, the extent that tradeoffs in the quantity and quality of care are made, and the real-world risks and benefits of states easing their scope of practice restrictions. Findings, which suggest that NP care is comparable to physician care in most ways and that the quality of NP-delivered care does not significantly vary irrespective of states’ NP independence status, have important implications for policy and practice.

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Yang, Wai-lam Caroline. "Exploring the expanded role of nurses in coronary care." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31973024.

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Roger, Kathleen Mary Louise. "A nursing workload manager for a patient data management system /." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61047.

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This thesis presents the design and implementation of a Nursing Workload Manager module for a Patient Data Management System in an intensive care unit. The Nursing Workload Manager aids in the planning and documentation of the nurse's workload. It automates the generation of the nursing care plan and automatically assigns a score to the care plan based on a nursing workload measurement system. In the thesis a literature survey of patient data management systems, nursing workload measurement systems and system evaluation methods is presented. This is followed by an overview of the work environment of an intensive care unit. The functionality of the Nursing Workload Manager is described and details of the software environment and application implementation are discussed. Finally, the results of a user evaluation of the module are presented, and future work on the module is discussed.

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Ngum, Awasom fru. "Cultural Barriers in Healthcare Delivery from the Perspective of Patients." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-442091.

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Background Many patients especially from minority backgrounds are typically faced with cultural barriers during health care encounters and this hinders the delivery of culturally competent healthcare. This study seeks to understand how cultural barriers faced by patients are crucial in attaining the delivery of culturally competent healthcare. Aims The aim of this study is to examine cultural barriers in the delivery of healthcare services from the patient’s perspective. Method The method is a literature review based on qualitative primary research. Ten articles were selected from the CINAHL, PUBMED and Google scholar databases. All articles selected were published between 2010 and 2020. The quality of the articles used were assessed using a review template for qualitative studies. Data was analysed using the literature review matrix method. Results The results suggest that four main cultural barriers from the perspectives of patients impacted healthcare delivery. These cultural barriers included the following; communication problems arising during verbal and nonverbal interactions, mistrust and discrimination arising as a result of previous contact with the health care system, socio-economic status and finally low propensity to seek healthcare. Conclusion To conclude it is evident that patients face a plethora of cultural barriers during their interactions with health care services and their experiences can be shaped by a number of variables and factors. These cultural challenges hinder accessibility to proper health care services might lead to inequality in the provision of health care services.
Bakgrund Många patienter, särskilt de med minoritetsbakgrund, står vanligtvis inför kulturella barriärer när de blir bemötta av hälso-och sjukvårdspersonal. Detta hindrar utformandet av kulturellt kompetent vård. Studien syftar till att förstå hur kulturella barriärer som patienter står inför är avgörande för att uppnå kulturellt kompetent omvårdnad. Mål Syftet med denna studie är att undersöka kulturella barriärer vid leverans av vårdtjänster ur patientens perspektiv. Metod Metoden är en litteraturstudie baserad på kvalitativ primär forskning.Tio artiklar valdes från databaserna CINAHL, PUBMED och Google. Alla utvalda artiklar är publicerade mellan 2010 och 2020. Kvaliteten på de artiklar som valdes är granskade med hjälp av en granskningsmall för kvalitativa studier. Data analyserades med hjälp av litteraturgranskning enligt en matrismetod. Resultat Analysen och resultaten från studien tyder på att fyra huvudsakliga kulturella barrier ur patientens perspektiv hade avgörande inverkan på bemötandet inom vården. Dessa kulturella barriärer inkluderade följande; kommunikationsproblem som uppstår under verbala och icke-verbala interaktionen, misstro och diskriminering till följd av tidigare kontakt med hälso- och sjukvården, socioekonomisk status och slutligen låg benägenhet att söka vård som är vanligt för människor med samma kulturella bakgrund. Slutsats Avslutningsvis är det uppenbart att patienter möter kulturella barriärer under sin interaktion med vården och deras erfarenheter kan formas av ett antal variabler och faktorer. Dessa kulturella utmaningar hindrar adekvat tillgång till hälso sjukvård och kan leda till ojämlikhet i tillgången till hälso- och sjukvårdstjänster.

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Senot, Claire. "Combining Conformance Quality and Experiential Quality in the Delivery of Health Care." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1397407599.

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Rodney, Paula Ann. "The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/421.

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The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015 Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

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Zia, Vivian. "A computerized nursing workload management system in a pediatric ICU." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0007/MQ29638.pdf.

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Walts, Lynn Maddox Walker George M. "Patient classification system : an integrated method for measuring nursing intensity and optimizing resource allocation /." See options below, 1992. http://proquest.umi.com/pqdweb?did=745208811&sid=2&Fmt=2&clientId=68716&RQT=309&VName=PQD.

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Chien, Hui-Wen. "Understanding the Nursing Home Care Processor: An Ethnographic Study." University of Sydney, 2009. http://hdl.handle.net/2123/6389.

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Doctor of Philosophy
Aim and significance: The aim of this research was to explore the phenomenon of Australian nursing home care from the perspective of those who provide and receive it. Its focus is on the processes of ‘quality care’ provision and the meanings and evaluations that care providers attach to their work. In other words, its purpose was to shed light on the practices based on a conceptualisation of care that is entwined with the mechanisms of ‘care’ production and identity creation, or what actually happens in the daily life of the complex social phenomenon that is a nursing home. A related aim was to add to understandings of clinical nursing competence and develop tools that will assist nurses to conceptualise and implement positive change in this setting. Background: The provision of care to our elderly has become a major concern with the ageing of the world population. This is occurring in the context of decline in the capacity of families to take on the responsibility of elder care, and of increasing commercialisation of medical care. Governments have responded by shifting their responsibilities from direct care provision to become auditors of the business of care provision that is supported by public funding. However poor care delivery has largely been hidden from the public gaze. Governments present themselves as having systems in place, creating the illusion of rational control; in reality, like the market economy, there is a ‘black box’ of unknown factors driven by human impulse. The aim of this study was to open up the black box of ‘quality care’ to direct observation, drawing insights from the literature on organisational culture and with a focus on the frontline worker and the construct of quality assurance. Specific research objectives were to: • Document the beliefs and attitudes of care providers towards elderly people in general and the needs of nursing home residents in particular • Elicit the range of meanings and evaluations that care providers attach to their work • Describe their constructions of ‘care’ and ‘quality of care’ and the organisational factors they believe to impact (positively and negatively) on their ability to provide it. • Through in-depth understanding of a particular setting, generate grounded theoretical insights into the phenomenon of quality of residential care that are more widely applicable Method: The study adopted a paradigmatic bricoleur approach, seeking to develop connections between a diverse range of methodologies. These included combinative ethnography, phenomenology, hermeneutics and traditional grounded theory. Conceptual insights were drawn from organisational studies, psychosocial nursing and coping theory. The research site was an Australian for-profit suburban nursing home. The student investigator conducted more than 500 hours of participant observation, recording extensive field notes which were analysed through the perspective of a hermeneutic middle way horizon that directed an augmented constant comparison traditional grounded theory approach. Additional data were collected through formal indepth interviews with six key stakeholders. Interviews were tape recorded, transcribed in full and analysed to reveal themes that were brought within a hermeneutic circle that spiralled recursively from the whole to the part and back to the whole. Findings: Eight key interrelated factors in the production of care within the nursing home were identified: internal and external accountability (the accreditation system); economic considerations; management and training; advocacy; characteristic of residents; care providers’ working conditions and environmental stressors; organisational culture; and the work/care styles of individual care providers. I have categorised the latter into two main types: ‘tortoises’ and ‘hares’. This typology is then used to generate a process-driven schematic diagram that tracks a hypothetical novice care provider through the process of learning how to produce ‘care’. Specifically, I found that nursing home ‘care’ is the outcome of a complex social process involving the interplay between resident, relative, care provider, proprietor, quality assessors and government within the phenomenon of the nursing home. Such care, indeed the phenomenon of the nursing home itself, is not a stable, controllable entity but is in a constant state of flux – what I refer to as a moral ecology. In their everyday practice, care providers devise a construction of ‘quality care’ that is more clearly grounded in their own worldviews and the development of the own identity than in the formal quality assurance system of standards, guidelines and evaluations. Conclusion: Understanding the ‘black box’ of processes that produce care is the key to identifying courses of action that will improve care outcomes. The study findings also question the validity, assumptions and significance of the accreditation system, which only identifies some of the component variables, disregarding both the complexity within the ‘black box’ and failing to acknowledge that the quality of care outcomes is overwhelmingly dependent on individual care providers.

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Thrasher, Evelyn Byrd Terry Anthony. "Examining strategic fit for the interorganizational network an empirical investigation of the health care integrated delivery system /." Auburn, Ala., 2006. http://hdl.handle.net/10415/1300.

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Doerge, Jean Boehm 1951. "Cost effectiveness of nurse case management compared with an existing system of care." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/292108.

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Abstract:

The study evaluated the cost-effectiveness of community based Nurse Case Management (NCM) utilizing existing hospital information systems data. Program outcomes of intensive NCM were compared with those of existing hospital programs for a group at high risk for readmission. Thirty-one elderly patients were assigned to one of three groups. A retrospective pretest-posttest design was used and multivariate analyses were performed. Outcomes were measured at six month intervals before and after NCM. The intensive NCM group had a higher length of stay and inpatient costs than the other two groups. Direct costs of NCM were estimated at $1.55 per active case per day. The study found that cost-effectiveness of NCM cannot be determined accurately unless health risk assessments are quantified, NCM is clearly translated into categories of intervention, and direct costs of NCM are measured consistently. These factors must be integrated into routine hospital information system reports.

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Ginos, Elizabeth. "The perceived role of wellness health coaches in delivering care to employees and their spouses with chronic conditions in a health care system in the Midwest." Thesis, Blessing-Rieman College of Nursing, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1570472.

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Abstract:

The focus of recent attention in healthcare is the increasing population of people with chronic condition and the increasing cost of managing the health of this population. To improve care outcomes and increase cost effectiveness of managing the health of these patients their care needs to be directed by evidence-based approaches. One of these approaches could be wellness health coaching directed toward helping patients self-manage their chronic condition. The problem however, is that the research on the role of wellness health coaches with helping patients self-manage their chronic condition is limited. Therefore, research that focuses on the role of wellness health coaches and their approaches to facilitate self-management are needed.

To gain understanding of the role and approaches of these wellness health coaches a phenomenological method was used. By personal interviews with six wellness health coaches, the researcher sought to answer the two research questions by describing their perceived role and their approaches to facilitate self-management of individuals with chronic conditions.

Wellness health coaches in this study perceived their roles as educators, motivators, guides, supporters, facilitator, collaborator, and coordinator. With all their clients they help set goals and develop a plan to meet their goals. The wellness health coaches' approaches to help improve their clients' self-management skills include providing them with written educational materials, resource information, and other tools such as websites on health information. All of these wellness health coaches' activities are aimed at empowering their clients to be able to improve their lifestyle and overall health.

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Dissertations / Theses on the topic 'Nursing care delivery system'

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