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Dissertations / Theses on the topic 'Patient care'
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Kshetri, Kanak Bikram. "Modelling patient states in intensive care patients." Thesis, Massachusetts Institute of Technology, 2011. http://hdl.handle.net/1721.1/76985.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2011.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 71-74).
Extensive bedside monitoring in hospital Intensive Care Units (ICU) has resulted in a deluge of information on patient physiology. Consequently, clinical decision makers have to reason with data that is simultaneously large and high-dimensional. Mechanisms to compress these datasets while retaining their salient features are in great need. Previous work in this area has focused exclusively on supervised models to predict specific hazardous outcomes like mortality. These models, while effective, are highly specific and do not generalize easily to other outcomes. This research describes the use of non-parametric unsupervised learning to discover abstract patient states that summarize a patient's physiology. The resulting model focuses on grouping physiologically similar patients instead of predicting particular outcomes. This type of cluster analysis has traditionally been done in small, low-dimensional, error-free datasets. Since our real-world clinical dataset affords none of these luxuries, we describe the engineering required to perform the analysis on a large, high-dimensional, sparse, noisy and mixed dataset. The discovered groups showed cohesiveness, isolation and correspondence to natural groupings. These groups were also tested for enrichment towards survival, Glasgow Coma Scale values and critical heart rate events. In each case, we found groups which were enriched and depleted towards those outcomes.
by Kanak Bikram Kshetri.
M.Eng.
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Blackwelder, Reid B. "Patient-Centered Care." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6982.
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Söderholm, Werkö Sophie. "Patient patients? : achieving patient empowerment through active participation, increased knowledge and organisation /." Stockholm : School of Business, Stockholm University, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7261.
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Almemani, Basima Abdalla Husein. "Pharmacogenetics in patient care." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546000.
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McHenry, Kristen L. "Safety and Patient Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2537.
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McHenry, Kristen L. "Safety & Patient Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5443.
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Petit, Amanda. "Patient-Provider Communication in Patients with Inflammatory Bowel Disease." Ohio University Honors Tutorial College / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ouhonors1528924843222824.
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Baker, Diane. "Does team patient care mean better patient outcomes?" Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10161771.
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Traditional patient care in the U.S. has been fragmented and redundant, resulting in high healthcare costs and poor patient outcomes. New team patient care models are being attempted to improve outcomes and lower the cost of care. Models of integrated and coordinated care, including the Patient-Centered Medical Home model, have demonstrated some improvements, especially for chronically ill patients. Membership in a Health Maintenance Organization (HMO) and presence of a diabetes diagnosis is tested and results for the chronically ill are discussed.
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Marepula, Lindiwe Oscarine. "Patient satisfaction with the care provided in a psychiatric hospital in Cape Town." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/3698.
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Magister Curationis - MCurBackground: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002.Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town.Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital serviceMethod/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire.The study made use of 120 participants between the ages of 18 and 60.Findings: Generally respondents were satisfied with the care provided in thispsychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to.Conclusions: General inpatient satisfaction in psychiatric hospital care was good.However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.
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Tobiano, Georgia Ann. "Patient Participation in Nursing Care: A Focused Ethnography." Thesis, Griffith University, 2016. http://hdl.handle.net/10072/365834.
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Patient-centred care has been recognised internationally as a way patients can participate in their nursing care to potentially improve their safety, yet widespread understanding of patient participation and ways to promote it is lacking. Further, nurses’ behaviours sometimes conflict with their reported support for patient participation. The aim of this study was to understand patient participation in nursing care in medical wards and the barriers to and facilitators of patient participation. This study was a focused ethnography. Two hospitals participated in the study. Site 1 was located in Queensland and catered for public patients, while Site 2 was located in Victoria and catered for private patients. The setting for this study was four medical wards, two from each hospital. Patients and nurses were observed in practice and participated in semi-structured interviews. Observational field notes were analysed using both deductive and inductive content analysis. Interviews were transcribed and analysed using inductive content analysis. Deductive analysis of observations of practice showed that the most frequent types of participation were in the categories ‘having dialogue with health care staff’ and ‘sharing knowledge’. Patients participated less frequently in the categories ‘partaking in planning’ and ‘managing self-care’. Inductive analysis of field notes demonstrated that nurses exerted control over care, evident in the category ‘maintaining control of work’. Findings from 20 patient interviews, revealed four categories. In the category ‘valuing participation’ patients spoke about wanting to participate and seeing it as beneficial. The categories ‘exchanging intelligence’ and ‘on the lookout’, were ways patients reported participating in care. The final category ‘power imbalance’, revealed patients’ difficulty in enacting participation.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
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Abrahamsen, Grøndahl Vigdis. "Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-9023.
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There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital. Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis. Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV). Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.
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George, Mercy. "Patient Navigation Program in Oncolgy Clinical Practice." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5193.
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Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer patients improved patient outcomes. The systematic review, guided by Watson's theory of caring, included 11 studies published between 2010 and 2017 identified through Cochrane Library, CINAHL, ProQuest, PubMed, and Joanna Briggs Institute. Initially a total of 679 articles were identified; however the number reduced by removing duplicates and after review of titles and abstracts. The remaining articles were then evaluated by the level of evidence based on the Manly and Fineout-Overholt's guide on hierarchy of evidence. The results identified in this systematic review showed patient navigation can improve care coordination and patient satisfaction. This review offers findings on the impact of cancer care coordination and patient satisfaction, which may be used by healthcare leaders when determining how to improve cancer care and as a result may provide positive social change. If the organization implements a patient navigator program, it is expected that this change would benefit patients, families, healthcare providers and the organization.
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Roe, Brenda Hilary. "Catheter care and patient teaching." Thesis, University of Manchester, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327917.
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Hyde, E., and Maryann L. Hardy. "Patient Centred Care & Considerations." CRC Press, 2020. http://hdl.handle.net/10454/18565.
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Garris, Bill R., and Amy J. Weber. "Putting the Patient Back in Patient Care: Health Decision-Making from the Patient’s Perspective." NSUWorks, 2018. https://nsuworks.nova.edu/tqr/vol23/iss2/1.
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This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and deeply held reasons people gave as they made decisions concerning their health, eating and exercising. We propose this model, grounded in informant stories, as a heuristic, to guide further inquiry. From these stories, the patient is seen as more active and the interrelated influences of knowledge, agency, and purpose, synergistically interact to explain changes in health behaviors.
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Garris, Bill R., and Amy Weber. "Putting the Patient Back in Patient Care: Health Decision-Making from the Patient’s Perspective." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5343.
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This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and deeply held reasons people gave as they made decisions concerning their health, eating and exercising. We propose this model, grounded in informant stories, as a heuristic, to guide further inquiry. From these stories, the patient is seen as more active and the interrelated influences of knowledge, agency, and purpose, synergistically interact to explain changes in health behaviors.
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Park, Joseph Seung Young. "Predicting intensive care unit patient outcomes through patient similarity." Thesis, Massachusetts Institute of Technology, 2019. https://hdl.handle.net/1721.1/123036.
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This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Thesis: M. Eng. in Computer Science and Molecular Biology, Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2019
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 85-86).
An ICU stay involves invasive treatments, and frequently, the decision to continue therapy is made with limited information based on the physician's personal experience. This thesis proposal describes a tool to assist this decision by identifying similar patients and using their outcomes for prediction. We used the eICU Collaborative Research Database (eICU-CRD) v2.0 for the project. Different time varying and time constant features about the patient's demographics and clinical trajectory was used as input data, such as patient age and longitudinal blood pressure measurement. Using this information, a Cox Proportional Hazards model was built to map the multivariate time series of input data to a univariate time series, which was used to match the patient to a cohort of similar patients. Based on the cohort, this model predicted the probability of a healthy discharge by using the aggregate outcome of the cohort for prediction.
by Joseph Seung Young Park
M. Eng. in Computer Science and Molecular Biology
M.Eng.inComputerScienceandMolecularBiology Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Hodkinson, Peter William. "Developing a patient-centred care pathway for paediatric critical care in the Western Cape." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/17259.
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Includes bibliographical referencesBackground: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.
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Mathews, Maria. "Factors influencing patient care seeking behaviour in primary care." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq53762.pdf.
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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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Ahmed, Rukhsana. "Assessing the role of cultural differences on health care receivers' perceptions of health care providers' cultural competence in health care interactions." Ohio : Ohio University, 2007. http://www.ohiolink.edu/etd/view.cgi?ohiou1178244318.
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Fung, Shuk-ching Corina. "Needs assessment for schizophrenic patients in an out-patient clinic /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B24391049.
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Sladdin, Ishtar K. "Advancing Patient-Centred Care in Dietetics." Thesis, Griffith University, 2019. http://hdl.handle.net/10072/386542.
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Patient-centred care (PCC) is an integral component of high-quality care and has been associated with significant benefits for patients. Despite the increasing emphasis on ensuring healthcare systems are patient-centred, limited research has been conducted on this topic in dietetics. Dietitians play an important role in the management of chronic, lifestyle-related diseases, particularly in the primary care setting. There is potential for patient-centred practices to lead to enhanced care by dietitians and ultimately better outcomes for patients.
To enhance understandings of PCC in dietetics, the aims of this research were to synthesise literature relating to PCC in dietetics and identify any gaps requiring further exploration; explore patients’ perceptions and experiences of PCC in dietetics; develop and psychometrically test a patient and dietitian-reported inventory to measure PCC in dietetics; and compare patients’ and dietitians’ experiences of PCC. These aims were addressed in three phases of research.
In Phase I, a systematic literature search was conducted to identify studies that involved dietitians and/or patients who had participated in an individual dietetic consultation and related to one or more dimensions of PCC. Twenty-seven studies met the inclusion criteria and were analysed using meta-synthesis. Six themes arose: establishing a positive dietitian–patient relationship; displaying humanistic behaviours; using effective communication skills; individualising and adapting care; redistributing power to the patient; and lacking time for PCC practices. Findings suggested that research relating to PCC in dietetics was sparse, with only a small number of studies directly referring to PCC in their aims. The application of PCC in dietetics had not been widely investigated and no study specifically aimed to examine patients’ understandings of PCC.
In Phase II, qualitative semi-structured interviews were conducted with a purposive sample of 11 adult patients who had participated in at least one dietetic consultation, had received nutrition care for the management one or more medical conditions and were English speaking. Participants were sought from dietitian-specific primary healthcare clinics using the patient database of a large primary healthcare service in Queensland, Australia. Participants’ perceptions and experiences of PCC were explored, and data were analysed thematically. The results highlighted that patients valued PCC highly. Patients wanted dietitians to develop a holistic understanding of their background and the underlying factors influencing their health; tailor advice and strategies to patients’ unique circumstances; be invested in their wellbeing; and be involved in decision-making. Some participants perceived care as generic and non-individualised and thought that dietitians controlled the encounter, limiting patient involvement. These findings contributed to the development of a conceptual model of PCC in dietetics.
In Phase III, a patient and dietitian-reported inventory of five valid scales was compiled to reflect the conceptual model. The scales were the Communication Assessment Tool; 9-item Shared Decision-Making Questionnaire; Patient-Doctor Depth of Relationship Scale; SPNCS Seeing the Individual Patient sub-scale; and the PCPI-s Providing Holistic Care sub-scale. Between November 2017 and May 2018, the inventory was distributed as a survey to adult patients who had attended at least one individual dietetic consultation with an accredited practising dietitian (APD) working in primary care, and APDs with experience working in primary care. Six dietetic practices across Queensland (n = 3), New South Wales (n = 2) and Victoria (n = 1) participated in the recruitment of patients. Dietitians completed an e-survey that was initially distributed by the Dietitians Association of Australia. Subsequent strategies employed to enhance the response rate included an invitation via the Dietitian Connection weekly e-newsletter and dietitian specific social media sites. Exploratory factor analysis was performed using principal component analysis. Cronbach’s alpha, inter-item correlations and corrected item-total correlations were computed to evaluate the internal consistency of each scale. Data from the cross-sectional survey were analysed using the Mann-Whitney U test to compare patients’ and dietitians’ median scale scores to identify any differences between participants’ perspectives of PCC.
One hundred and eighty dietitians and 133 patients completed the survey. Five factors were extracted, and Cronbach’s alpha values ranged from 0.73 to 0.91 and 0.87 to 0.97 across factors for the dietitian and patient versions respectively. Most items had strong loadings on only one factor. Factors were labelled shared decision-making; holistic and individualised care; patient–dietitian communication; knowing the patient/dietitian; and caring patient–dietitian relationships. Results suggested good preliminary validity and internal consistency for both inventories. Patients’ scores were significantly higher than dietitians’ for ‘shared decision-making’ (p=.004), but significantly lower for ‘providing holistic and individualised care’ (p=.005), ‘knowing the patient/dietitian’ (p=.001) and ‘caring patient–dietitian relationships’ (p=.009) suggesting small but important divergences between patients’ and dietitians’ experiences.
This research contributes novel and important findings relevant to PCC in dietetics. Patients clearly value PCC, but do not always perceive that dietitians adopt this approach in practice. Strategies to enhance dietitians’ PCC should particularly focus on ensuring care is holistic and individualised, and good patient–dietitian relationships are established. Finally, the conceptually grounded inventory has promising preliminary validity and reliability. This research provides a solid foundation for future work in advancing PCC in dietetics.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School Allied Health Sciences
Griffith Health
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Pollock-Robinson, M. Catherine. "Family-centered care, patient-centered care, and culturally competent care common themes and background meanings /." Pullman, Wash. : Washington State University, 2009. http://www.dissertations.wsu.edu/Thesis/Spring2009/m_pollockrobinson_042409.pdf.
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Keall, Robyn Marie. "Enhancing existential and spiritual care for palliative care patients from both the patient and nurse perspective." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12445.
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Existential and spiritual care is an important but undertreated area of palliative care. This thesis explored some tools and approaches, which may assist with addressing existential/spiritual concerns from both the nurse and patient perspective. Aims: Firstly to critically appraise the literature on therapeutic life review in the palliative care setting, secondly to explore the efficacy and feasibility of a therapeutic life review intervention called Outlook, and finally to explore how Australian palliative care nurses address existential/spiritual concerns with their patients and their views on existential/spiritual interventions in general and Outlook in particular. Methods: A systematic review, an 11 subject study of Outlook intervention with both quantitative and qualitative analysis and semi-structured interviews of 20 experienced palliative care nurses were undertaken. Results: There is limited but promising data about therapeutic life review. The Outlook intervention is acceptable and feasible when delivered by an experienced palliative care nurse. Patients were able to comfortably share their stories, legacies and needs for forgiveness. The nurses identified facilitators, barriers and strategies to providing holistic care and although lacking experience, positively appraised Outlook intervention. Conclusion: Providing existential and spiritual care to patients may be enhanced by the use of validated tools, facilitators and strategies.
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Naidoo, Melissa. "Family and patient perception of physiotherapy care rendered to patients in the cardiothoracic intensive care unit." University of the Western Cape, 2018. http://hdl.handle.net/11394/6978.
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Magister Artium - MABackground: Physiotherapists are involved in the management of patients in the cardiothoracic Intensive Care Unit (ICU). Patient and family perception of care has become an important measure in evaluating the quality of care, including care in the intensive care setting. Overall Aim: To explore and describe the family and patient perception of physiotherapy care rendered in a public sector cardiothoracic ICU in the Western Cape, South Africa. Method: This study was conducted in two phases. Phase 1 (scoping review) identified and described available outcomes for measuring family perception of ICU care by searching six databases from inception to the 20th June 2018. Results from the scoping review informed the discussion schedule for the first primary study of Phase 2. Phase 2 (two exploratory descriptive qualitative primary studies) explored and described i) family perception and ii) patient perception of physiotherapy care in a cardiothoracic ICU. Audio-taped, individual face to face semi-structured interviews were conducted with family and patient participants that met the inclusion and exclusion sampling criteria (purposive sampling). Data was transcribed verbatim and analysed using deductive-inductive thematic content analysis. The data was coded, categorised and themes were generated. Trustworthiness of the data was ensured through methods addressing credibility, dependability, confirmability and transferability. Results: A total of ten full text studies were included in the scoping review. Included studies were published between 2006 and 2017, were conducted in both developed and developing countries, in different ICUs (except cardiothoracic ICU)and all used different quantitative outcome measures to measure family perception of ICU care. Thirteen cardiothoracic ICU patients and their respective family members partook in the studies describing patient and family perception of cardiothoracic ICU physiotherapy care. The median patient age was 62 years; the mean ICU length of stay 6 days and the median family age was 55. Themes arising from the family perception of care data analysed included: i) understanding of physiotherapy care (the role of the physiotherapist, perceived benefit of physiotherapy and communication), family involvement in physiotherapy care (physical presence during physiotherapy sessions and decision-making), and satisfaction of physiotherapy ICU care. Themes arising from patient perception of care data analysed included: i) Physiotherapy management of patients, ii) The Physiotherapists – skill, iii) knowledge and professionalism, iv) Continuity of Care, v) Tangibility, vi) Physiotherapy benefits, vii) Decision-Making, viii) Communication, ix) Satisfaction of Physiotherapy ICU care. Overall, family and patients were satisfied with the physiotherapy care in the cardiothoracic ICU. However, there were areas of improvement such as the understanding of physiotherapy care, communication, family involvement in the physiotherapy care and decision-making. Conclusion: While there are multiple quantitative measures for measuring family perception of ICU care there is no “gold” standard measure that has been identified. A qualitative measure and research design would allow richer in-depth information on family perception of ICU care. The findings from the family and patient perception of cardiothoracic ICU physiotherapy care are influenced by many factors. While family and patients perceive cardiothoracic ICU physiotherapy care both positively and negatively, the majority of patient and family were satisfied overall with the care the patient received. Family perception of ICU physiotherapy care should be evaluated in order to identify areas for improvement in quality of care and could add to the body of evidence in ICU physiotherapy practice.
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Penfold, Christopher M. "Patient copayments in primary medical care." Thesis, Cardiff University, 2011. http://orca.cf.ac.uk/54411/.
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This research was carried out to assess the feasibility of studying the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care. Quantitative methods were used to investigate the impact of primary dental care copayments on patients and to compare predictors of primary medical and dental care uptake. Qualitative methods were used to investigate attitudes towards copayments for NHS primary health services and their extension to include primary medical consultations. Regression models, chi-square analyses and ANOVA were applied to the England and Wales sub-sample of nationally representative self-report data from the 1998 Adult Dental Health Survey (ADHS) (n=3628) to investigate the impact of copayments on primary dental care uptake. Regression models and chi-square analyses were applied to the England and Wales sub-sample of nationally representative self-report data from the 1997/98 British Household Panel Survey (BHPS) (n=8526) and the 1998 ADHS (n=3641) to compare predictors of primary medical and dental consultations. Semi- structured interviews were undertaken in Bristol and Somerset with purposively sampled frequent and infrequent primary medical care users (n=19). Predictors of primary medical and dental care utilisation differed across predisposing, enabling and illness level factors. Private and NHS dental copayments were perceived to be expensive and this perception was associated with lower preventive-led dental consultation rates, but not with treatment-led consultation rates. Copayments for services affected the nature of the patient-practitioner relationship. Findings were inconclusive regarding the effect of copayment exemption status on people's decisions to consult a dentist and on dental treatments received. It was not feasible to study the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care.
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Andiric, Linda Reynolds. "Patient Education and Involvement in Care." UNF Digital Commons, 2010. http://digitalcommons.unf.edu/etd/272.
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A study conducted on patients who underwent total knee arthroplasty indicated that participants who were offered preadmission education for their procedure had statistically better outcomes than patients who had not attended an educational class. The study further focused on patients’ confidence in their ability to take control of their health situations as well as the effect of encouragement and motivation to provide active involvement. Two surveys, the Krantz Health Opinion Survey and the Multi Dimensional Health Locus of Control, were used to assess patients’ innate desires to be involved in their care and if they felt they could render any control themselves on their health.
The study showed a statistically significant better outcome when patients received education prior to their procedure. When patients were encouraged and motivated to participate and take control of their rehabilitation after knee surgery, the outcomes were better than with education alone. It is a worthy endeavor therefore for education to be provided before total knee arthroplasty and to identify those patients who need additional encouragement to gain confidence in their abilities in order to positively affect their outcomes. Providing healthcare professionals information about patients’ innate traits regarding their desire or self-confidence to engage in their care could also be useful to allow caretakers to work with patients in the most advantageous manner to achieve better outcomes.
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Nilsson, Andreas. "Patient-controlled sedation in procedural care." Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-112372.
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The need for procedural sedation is extensive and on the increase in numbers of patients. Minor treatments or diagnostic procedures are being performed with inadequate sedation or even without any sedatives or analgesics. Also, sedation techniques that support advanced, high-quality, in-patient care procedures representing easy performance and rapid recovery are requested for increased effectiveness. In this doctoral thesis, patient-controlled sedation (PCS) using propofol and alfentanil for surgical and diagnostic procedures was studied. The overall aim was to study aspects of safety, procedural feasibility and patients’ experiences. The main hypothesis was that PCS using only propofol is a safe and effective method for the induction and maintenance of moderate procedural sedation. The studies included were prospective, interventional, and in some cases, randomized and double-blinded. Data on cardiopulmonary changes, level of conscious sedation (bispectral index and Observer’s assessment of alertness/sedation [OAA/S]), pain, discomfort, anxiety, nausea (visual analogue scales), interventions performed by nurse anaesthetists, surgeons’ evaluation of feasibility, procedure characteristics, recovery (Aldrete score) and pharmacokinetic simulation of concentrations of drugs at the effect site supported the analysis and comparison between PCS and anaesthetist-controlled sedation and propofol PCS with or without alfentanil. PCS can be adjusted to cover a broad range of areas where sedation is needed, which, in this thesis, included burn care, gynaecological out-patient surgery and endoscopic procedures for the diagnosis and treatment of diseases in the bile ducts (endoscopic retrograde cholangiopancreatography [ERCP]). PCS for burn wound treatment demands the addition of alfentanil, but still seems to be safe. PCS was preferred by the patients instead of anaesthetist-controlled sedation. The addition of alfentanil to PCS as an adjunct to gynaecological surgical procedures also using local anaesthesia increases the surgeon’s access to the patients, but impairs safety. Apnoea and other such conditions requiring interventions to restore respiratory function were seen in patients receiving both alfentanil and propofol for PCS. Patients’ experiencing perioperative pain and anxiety did not explain the effect-site concentrations of drugs. Different gynaecological procedures and patients’ weights seemed to best explain the concentrations. For discomfort and pain during the endoscopic procedure (ERCP), propofol PCS performs almost the same as anaesthetist-performed sedation. Overall, as part of the pre-operative procedures, PCS does not seem to be time-consuming. In respect to the perioperative perspective, PCS supports rapid recovery with a low incidence of tiredness, pain, and post-operative nausea and vomiting (PONV). The data suggest that PCS further needs to be adapted to the patient, the specific procedure and the circumstances of sedation for optimal benefit and enhanced safety.
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Rose, Douglas, Leonard Brian Cross, and Ivy A. Click. "The Patient-Centered Care Committee (PC3)." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6396.
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Blackwelder, Reid B. "Patient-Centered Care: Transforming Our Practices." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6984.
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Burke, Marianne D. "Clinical Evidence Technologies and Patient Care." ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/1022.
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ABSTRACT
Clinical evidence technologies (CETs) are information sources derived from medical research literature that may assist health care providers in continued learning, decision-making, and patient care. Examples of CETs include: MEDLINE/PubMed and Cochrane Reviews, research journal literature, print and electronic medical texts, clinical topic summaries, guidelines, and interactive decision tools. Clinicians utilize CETs to find answers to questions that arise during patient care. However, it was unclear if CETs had a measurable impact on provider practice or patient outcomes.
A literature review identified twenty-two articles evaluating CETs’ impact. Study designs included surveys, observational studies, randomized controlled trials and quasi-experimental methods. The review revealed mixed evidence of CET impact on provider-level outcomes such as improved diagnoses and treatments, and on patient level outcomes such as length of hospital stay and mortality. Additional research was needed to determine whether certain CETs or CET types have impact on patient care outcomes in clinically targeted areas.
We conducted a cluster-randomized controlled trial (CRCT) to evaluate the effect of a dermatology-focused CET (VisualDx) when used by primary care providers. We found no difference in the patient skin disease outcomes of resolution of symptoms and return visits for the same problem in that trial. Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (Hazard Ratio=0.92; 95% Confidence Interval (CI)=0.70, 1.21; P=0.54). Patient follow-up appointments did not differ significantly between groups (Odds Ratio=1.26; CI=0.94, 1.70; P=0.29).
In a follow up mixed-methods study, we sought to understand why VisualDx did not make a difference. All CRCT provider participants were surveyed about their experience in the trial. VisualDx users (intervention arm) were interviewed about their experience using the CET. Ease of access and usefulness for patient communication facilitated successful use while irrelevant search results and use of other sources were barriers. Although PCPs reported benefits, they did not perceive the CET as useful often enough to motivate using it frequently or exclusively, thereby reducing the likelihood of it making a difference in the problem resolution and return appointment outcomes.
There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx. PCPs did not perceive VisualDx as “useful” often enough for to use it frequently, or exclusively, thereby reducing the likelihood of this CET making a difference in patient-level outcomes.
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Brickley, Bryce. "Supporting Patient-Centred Care by General Practitioners." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/410952.
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Patient-centred care (PCC) is an essential aspect of high-quality health care. Broadly, PCC is defined as care that is respectful and responsive to the needs and wishes of patients. The concept of PCC is embedded within primary health care policy throughout the world because of its potential to reduce the burden of disease and illness. The widespread policy-based advocacy towards PCC has resulted in many primary care organisations endorsing PCC and clinical teams enacting PCC. General practitioners (GPs), also referred to as family physicians, are positioned at the front-line of the primary health care system and are typically the first port of call for patients seeking health care services. There are several challenges for GPs to enact PCC holistically, such as lack of skills and knowledge regarding PCC, a lack of agreement in the literature of what constitutes GP-delivered PCC, and a lack of tools to support GPs with PCC. Supporting GPs to enact PCC is essential to achieve better patient outcomes from GP-delivered chronic disease management, preventative care and holistic care. The overarching aim of this PhD program was to build upon the understanding of GPdelivered PCC and research ways to support GPs to enact PCC. The sequential, multiphased design allowed the researcher to identify and subsequently address key gaps requiring further exploration. The aims within this doctoral research program were to synthesise literature relating to PCC delivered by GPs; explore patients’ and GPs’ perceptions and experiences of PCC; develop and evaluate a new model of PCC; develop and evaluate a tool kit to support GPs with PCC; and explore the perceptions and experiences of PCC within general practice teams during the COVID-19 pandemic. These aims were addressed in four phases of research. The research was within the pragmatic paradigm, qualitatively driven, and guided by assumptions from constructivist and interpretivist epistemological beliefs. In phase one, an integrative systematic literature review was conducted to identify studies that that related to GP-delivered PCC. Four main themes of GP-delivered PCC were identified, and these informed a new theoretical model with four components: 1) understanding the whole person, 2) finding common ground, 3) experiencing time, and 4) aiming for positive outcomes. The review identified several gaps in the literature, including a lack of qualitative studies involving both GPs and patients, which guided the subsequent research in conjunction with the updated theoretical model of GP-delivered PCC. In phase two, qualitative focus group interviews were conducted with patient advocates and GPs to explore perceptions and exp riences of PCC. Five themes emerged: 1) understanding of PCC is varied and personal, 2) valuing humanistic care, 3) considering the system and collaborating in care, 4) optimising the general practice environment and 5) needing support for PCC that is embedded into training. Findings suggested that more work was needed to create novel interventions with capacity to expose GPs to feedback from patients, promote GP self-reflection on PCC and support GPs to assess the patient-centeredness of the practice environment. Next, the model of GP-delivered PCC developed in phase one was qualitatively tested in the same focus groups. The data was synthesised to produce an updated model of PCC consisting of six inter-related elements, called Putting Patients First: A Map for Patient-Centred Care. Qualitative testing among GPs and patient advocates supported the credibility of the model and enhanced its applicability to ‘real world’ practice. In phase three, co-creation and action research informed the development of an innovative tool kit to support holistic PCC among general practice teams. This tool kit consolidates the new knowledge on PCC generated within this PhD and can be used in practice to support the understanding and delivery of PCC by general practice teams. The worldwide pandemic occurred during the research program and changed the anticipated direction of the final study to the delivery of PCC under pandemic conditions. One-on-one semi-structured interviews with practice representatives from five Australian general practice clinics who had been recognised for their pursuit of quality care. Key findings were that the pandemic altered the perceptions and experiences of PCC within general practice teams and created new barriers to enacting PCC. However, general practice teams who have previously been recognised for their ability to deliver high quality care, have maintained their focus on PCC. Strong leadership, patient-focused practice culture, new technology and infrastructure enabled PCC. This innovative PhD research contributes novel and important findings to support GPs with PCC. Collectively, the studies within the PhD informed a multifaceted understanding of GP-delivered PCC and described novel strategies to enact PCC. The concept of PCC has persevered despite the influence of the COVID-19 pandemic on the health system, and PCC should continue to be a focal point for research, policy, and practice. The understanding of PCC is varied among patients, GPs and between patients and GPs. Strategies to enhance PCC should emphasise the translation of complex PCC research, and harness the tools produced within this PhD to generate a uniform understanding of PCC between patients and general practice teams. The tools developed within the PhD can also provide a foundation for future research striving to enhance the levels of PCC in general practice; and inform policymakers and general practice organisations seeking to promote and sustain PCC. This work ensures that all patients and general practice teams have access to tools that can inform PCC.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Health Sci & Soc Wrk
Griffith Health
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Pacholski, Denise C. "Patient Feedback Regarding Telehealth." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1594983499602595.
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Fryer, Ashley-Kay. "Improving Health Care Delivery: Patient Care Integration and Manager Commitment." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493267.
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This dissertation investigates how patient-perceived integrated care and manager commitment influence the improvement and integration of health care delivery. Using survey instruments, across three studies I examine potential mechanisms for improving health care delivery: patient perceptions of integrated care, a physician organization care management program, and manager commitment to a quality improvement program.
In Chapter Two, I examine how patient-perceived integrated care relates to utilization of health services. I assess relationships between provider performance on 11 domains of patient-reported integrated care and rates of emergency department (ED) visits, hospital admissions, and outpatient visits. I find better performance on two of the surveyed dimensions of integrated care are significantly associated with lower ED visit rates: information flow to other providers in doctor’s office and responsiveness independent of visits. Better performance on three dimensions of integrated care is associated with lower outpatient visit rates: information flow to specialist, post-visit information flow to the patient, and continuous familiarity with patient over time. No dimension of integration is associated with hospital admission rates.
In Chapter Three, I use the same patient sample to evaluate the achievement of integrated care by a care management program (CMP) from the perspective of older patients with multiple chronic conditions. Survey results suggest that patient perceptions of integrated care vary substantially among survey items and domains. CMP enrollment is significantly associated with greater patient perceptions of care integration in two domains: connecting patients to home services and being responsive independent of visits, domains that were targeted for improvement by the CMP. Enrollment in the CMP is not significantly associated with other domains of integration.
In Chapter Four, I assess whether and how senior and middle manager commitment to a falls reduction quality improvement (QI) program is associated with the successful implementation of the program. Survey results suggest managers’ affective commitment to the program is positively associated with program implementation success across all manager levels surveyed (senior managers, middle managers, and assistant middle managers). Stronger frontline worker support for the falls QI program partially mediates the relationship between manager affective commitment and falls program implementation success for middle managers and assistant middle managers, but not for senior managers. Manager affective commitment to the falls program mediates the relationship between organizational support for the falls program and program implementation success across all manager levels.
Together, these studies advance our understanding of how patient-perceived integrated care, care management programs, and manager commitment to a quality improvement program influence the integration and improvement of health care delivery. Findings demonstrate how patient reports of integration can be useful guides to improving health systems. Dissertation results also provide empirical evidence of a relationship between manager commitment—at both the middle and senior manager levels—and successful QI program implementation. In addition, these studies provide practical implications for physicians and hospital managers seeking ways to improve the quality and integration of health care delivery.Health Policy
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Ahmed, Fareen. "The impact of patient-physician race concordance on patient centered care." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1523082.
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Patient centered care considers patients' values, personal preferences, cultural traditions and lifestyles when it comes to implementing care and treatments. This study looks at the effect of patient-physician race concordance on patient centered care and focuses on which ethnic backgrounds are more impacted by this concept. When patients feel they can relate to their care providers, they tend to report higher satisfaction rates when it comes to their treatments. Results of this study can be applied to future research revolving around patient centeredness and can be used to determine how to enhance patient centered care for all patients.
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Oswald, Sharon. "A retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27289.
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This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.
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Shiri, Clarris. "Patient education : the effect on patient behaviour." Thesis, Rhodes University, 2006. http://eprints.ru.ac.za/1348/.
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Avlijas, Tanja. "A Concept Analysis of the Patient Experience in Acute Care." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39715.
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Background: Patient experience has become an essential quality indicator in healthcare.
Purpose: The purpose of this thesis was to conduct a concept analysis of the patient experience.
Methods: Walker and Avant’s methodology served as the framework for this concept analysis.
Data were retrieved from seven databases and one search engine. The literature search used keywords related to "patient experience" and included articles published at any time up until March 2018. A total of 257 articles and organizational websites were included in the analysis after meeting the inclusion criteria.
Results: Twenty attributes were found to define the patient experience: communication, respect for patients, information/education, patient-centered care, comfort/pain, discharge from hospital, hospital environment, professionalism/trust, clinical care/staff competency, access to care, global ratings, medication, transitions/continuity, emotional dimension, outcomes, hospital processes, safety/security, interdisciplinary team, social dimension, and patient dependent features.
Conclusion: The results of this study will guide and clarify the critical concepts towards an explicit definition of the patient experience.
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Leichtfuss, Ute. "A descriptive study on doctors' practices regarding different aspects of stroke rehabilitation in private acute-care hospitals situated in the Western Cape metropole." Thesis, Stellenbosch : Stellenbosch University, 2009. http://hdl.handle.net/10019.1/4784.
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Thesis (MPhil)--Stellenbosch University, 2009.A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University
ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector.
AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.
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RinaldiFuller, Julie. "Patient to nurse ratios and safety outcomes for patients." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/JRinaldiFuller2008.pdf.
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Fröjd, Camilla. "Cancer patients' satisfaction with doctors' care : consequences and contributing conditions /." Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [ditributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8267.
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Mandizvidza, Vimbai. "Quality of current ischaemic stroke care practices in the Cape Metro Health District, South Africa." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27457.
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The aim of this study was to assess the acute and post-acute services for ischaemic stroke patients in the Cape Metro Health District in relation to the South African ischaemic stroke guideline. Part A: Protocol - The protocol outlines the purpose of the study and highlights the importance of conducting this study by analysing the literature on stroke care in both high and low and middle-income countries. The literature also highlights the gaps in stroke care in South Africa which justify the need for this study. The protocol also outlines the methods of data collection and analysis as well as the ethical considerations. Part B: Literature Review - This expands on the literature on the different components of both acute and post-acute stroke care in both high and low and middle-income countries. It also elaborates on stroke in South Africa and why it is important to conduct this study. Part C: South African Medical Journal manuscript - The manuscript summarises the whole study and includes the literature on stroke care, justification of the study and how the data was collected and analysed. The manuscript also includes the results obtained and sections on the discussion and conclusions.
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Söderholm, Werkö Sophie. "Patient Patients? : Achieving Patient Empowerment through active participation, increased knowledge and organisation." Doctoral thesis, Stockholms universitet, Företagsekonomiska institutionen, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7261.
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This study examines patient empowerment in two local diabetes branch organisations in Sweden. In particular, the study focuses on the organisations’ membership, participation and influence on external actors. The overall aim of this thesis is to explore patient empowerment in order to discern what influence patient organisations and individual members can have and how they use it. This study is based on both quantitative and qualitative empirical data. Interviews with active members from two local diabetes organisations were conducted and a survey was carried out to identify the members’ thoughts and feelings about their membership, motivations, participation and influence, as well as to examine their local organisation, its work and influence. The findings form an overall picture of how members experience their organisation, memberships and empowerment. Characteristics of the two local patient branch organisations were identified and the leaders were found to be intensely dedicated people. The interviews, survey and participant observations revealed the members’ opinions about their organisation, their reasons for joining, their involvement, participation and influence, as well as their understanding of the local organisation and the Swedish Diabetic Association (SDA) and their possibility to empower them. Without organisations, members felt that they could not have a significant influence on external actors and events.
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Beattie, Michelle. "Measuring the patient experience of hospital quality of care." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/23410.
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The primary motivation of this PhD by publication has been the apparent disconnect between the metrics of hospital quality of care at national and board level and patients’ experiences. Exploration of the gap led to the realisation of two key points. Firstly, the concept of healthcare quality continually evolves. Secondly, the NHS Scotland Measurement Framework does not include a measure of patient experience at the microsystem level (e.g. hospital ward). This is needed to counterbalance easier to obtain metrics of quality (e.g. waiting times). Resource tends to follow measurement. Papers 1 and 2 were exploratory, investigating theoretical and practical aspects of measuring quality of hospital care at the clinical microsystem level. With the associated Chapters, they highlighted both the necessity and the possibility of measuring the patient experience at the micro level of the healthcare system. They also drew attention to the inadequacy of “satisfaction” as a metric, leading to closer examination of “experience” as the decisive metric. This required the development of a systematic review protocol (Paper Three), then a systematic review (Paper Four). The review (Paper Four) examined the utility (validity, reliability, cost efficiency, acceptability and educational impact) of questionnaires to measure the patient experience of hospital quality of care, with a newly devised matrix tool. Findings highlighted a gap for an instrument with high utility for use at the clinical microsystem level of healthcare. Paper Five presents the development and preliminary psychometric testing of such an instrument; the Care Experience Feedback Improvement Tool (CEFIT). The thesis provides, as well as the matrix tool and CEFIT, theoretical and methodological contributions in the field of healthcare quality. It contributes to an aspiration that the patient’s voice can be heard and acknowledged, in order to direct improvements in the quality of hospital care.
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Jeavons, David Anthony. "The failing diabetic patient in primary care." Thesis, Durham University, 2006. http://etheses.dur.ac.uk/2593/.
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Diabetes is a progressive disorder. The majority of people with Type 2 diabetes are likely to require more intensive treatment regimes over time and a substantial proportion have sub-optimal glycaemic control as measured by glycated haemoglobin (HbA1c). For these people a change to insulin is a possible option. However, this requires a major step for most people and their clinicians. The aim of this research was to ascertain the size of the problem, to obtain the views and perceptions about diabetes management of people with Type 2 diabetes and their carers' (including diabetic nurses and general practitioners), to establish a consensus based management regime, and to ascertain the possible impact on diabetes specific quality of life of the commencement of insulin. This thesis used four methodologies. An existing primary care database was analysed to assess the scale of the problem of the poorly controlled Type 2 diabetic population in primary care. Qualitative research using focus groups was used to explore the beliefs of patients and clinicians towards diabetes and in particular the commencement of insulin in those failing on oral treatment. A mixed consensus group was used to describe a care pathway for these patients. Finally, in a cohort of people with Type 2 diabetes failing on oral therapy, a disease specific questionnaire was used to ascertain quality of life issues around the initiation of insulin. Main findings:1) Over half of people with Type 2 diabetes were in poor glycaemic control, defined as an HbAlc ˃8%. 2) People with Type 2 diabetes viewed diabetes as a "mild disease", using their experience and the social effects of living with their diabetes to monitor progress. They saw insulin as a last resort to be delayed as long as possible.3) Clinicians felt the majority of diabetes care could and should be provided in the community with an active management approach. Non-compliance with treatment was seen as an issue. Insulin was viewed positively while, at the same time, seen as being actively resisted by patients. The increase in resource and workload around insulin initiation was a major concern. 4) Much uncertainty remained regarding the management of the failing diabetic patient. The value of early insulin treatment was questioned for the asymptomatic patient. Shared decision-making was advocated but problems around risk/benefit information and lack of resources in both primary and secondary care were highlighted. 5) Insulin treatment in a cohort of people with Type 2 diabetes in poor glycaemic control on oral hypoglycaemic agents resulted in a modest but significant improvement in glycaemic control in routine care. Insulin initiation did not result in a change in quality of life. Patients' satisfaction with their tablet treatment was high but increased significantly on starting insulin therapy. However, these conclusions were limited by low study numbers from poor study recruitment. Conclusions Improving the care of people with poorly controlled Type 2 diabetes who are on maximal oral treatment is not straightforward and represents large resource and workload issues. Patient and clinician beliefs affect management and are not always currently sought and addressed. The benefits of early, more aggressive treatment with insulin need to be better quantified and information better presented to allow patient participation in decision making: glycaemic control is not the only factor that needs to be considered. A large gap in resources to achieve this was identified. The effect of insulin treatment on quality of life unfortunately has not been adequately answered in this research due to low participant numbers.
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Davies, Alice. "Patient and staff experiences of coercive care." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/59329/.
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It is generally accepted that the use of compulsory powers in the treatment of mental health difficulties may be required to prevent harm to self or others. Exploring the experiences of patients and staff in relation to the use of coercive measures can offer a meaningful insight into how clinical settings might best meet the needs of their clients. Chapter 1 consists of a systematic review of the literature exploring inpatient experiences of coercion by asking 'what are patients' emotional experiences of psychiatric inpatient care?' and 'what can be done to help minimise the negative impact of patients' experiences of coercion?' Negative experiences were found to impact upon prognosis, engagement and later attitudes to accessing care; core emotions experienced included fear, anger and sadness. Suggestions for ways of minimising the negative impact of coercion have been discussed in depth. Chapter two presents an empirical study conducted in an Assertive Outreach Team (AOT) which explored staff experiences of working with Community Treatment Orders (CTOs). Eight multidisciplinary team members participated in interviews. Following the use of Interpretative Phenomenological Analysis, three superordinate themes emerged from the data. The findings emphasise the individual way in which clients were perceived to respond to the implementation of the CTO and explore the tension that staff experience between the use of engagement and coercion. Clinical implications were discussed as well as suggestions for further research. The final paper offers a reflective account of the research process. It is structured around the three superordinate themes which emerged from the empirical data and considers the way in which the researcher’s own experiences were closely related to issues arising from the research. Methodological limitations and ethical issues are discussed as well as an exploration of the way that personal style has influenced the process and facilitated future self-development.
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Debbage, Samantha D. "Do integrated care pathways improve patient outcomes?" Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/14949/.
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The purpose of the study was to determine if the use of an Integrated Care Pathway (ICP) was associated with more positive outcomes than traditional methods of care. The effectiveness of the ICP had not previously been tested (in relation to traditional methods of care) to determine if it made any difference, at a patient, staff or system (healthcare organisation) level. In February 2001 (as part of the NHS modernisation agenda) the gynaecology services within one UK city were re-organised and two separate units were merged into one new larger unit. Prior to the reorganisation, the two units offered similar treatments and were managed collectively; however, one site had developed and implemented ICPs and the other site had continued to use traditional methods of care delivery. ICPs are multidisciplinary plans for organising and delivering patient care. The plan of care is outlined in a sequential manner including all interventions with expected patient outcomes. The literature suggests that ICPs result in improved patient outcomes and lower hospital costs by decreasing length of stay and improving observations i.e. detecting signs of infection in a timelier manner. ICPs are recognised to facilitate the multidisciplinary partnerships in planning of patient care. However the literature was primarily anecdotal or non generalisable, and therefore additional local research was deemed essential. To ensure the research problem could be answered, three specific research questions were developed for testing: (1) What effect does an /~ / ICP have on the outcomes of gynaecological patients attending for major abdominal surgery? (2) What factors, including the use of an ICP contribute to the variance in length of stay for gynaecological patients? (3) What are the opinions of the staff who have used the ICP, of the ICP itself? Relevant directional hypothesis were derived from each research question. A quasi-experimental design was used to answer the first research question. Subjects were attached to one of two groups, a treatment group, which used the ICP, and a comparison group, which continued to deliver care based on traditional methods. Descriptive correlation was used to answer research question two and for the third research question descriptive exploration was used. Variables of interest from a patient, staff and system (health care organisational) level were collected to determine the effectiveness of the ICP compared with traditional methods. One of the difficulties faced with ICP research is the number of variables that can potentially influence patient care. Holzemer's model (1994, based on the work of Donabedian, 1966) was used to conceptualise the variables (and therefore the data collection instruments) into the category of structure, process or outcome at either a patient, provider or systems (health care organisation) level. This in turn helped to theorise the linkage between the variables within this study, identifying conceptual and functional relationships. The abdominal surgery ICP supported improvements in cost and efficiency through a reduction in length of stay (treatment site = 5.29 days, comparison site = 6.16 days) and a positive return to patients' perception of health. However, there was a reduction in patient satisfaction with nursing care with the introduction of the ICP and this needs further study. Involving patients in future developments and evaluations could promote long-term patient satisfaction.
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Wahl, Grendi Heidi. "Measuring Patient Experience in Hospital Maternity Care." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-281290.
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This thesis concerns Patient Experience (PX), in hospital maternity care in Sweden. The focus lies in the development of a measure to describe the current state of PX. The thesis uses a semi-sequential mixed-methods study design; exploration of the patient journey, through qualitative methods, informs the adaptation of an existing maternity care experience survey instrument. The resulting survey instrument is tried in a pilot study and renders a composite measure of PX. Part of the analysis is dedicated to understanding the e!ect of information and communication in PX; Exploratory Factor Analysis is used to test the model and attempt an answer. The results show that it is possible to describe PX using the proposed survey instrument. The composite measure preserves di!erences in perceptions better than an arithmetic average of two discrete VAS-1 type measurements, and is more appropriate when measuring attitudes, and opinions using Likert-type measures. A three component solution describes 65.44% of the total sample variance. Determining to what degree PX is influenced by information and communication remains di"cult to quantify, but these initial results indicate that the manner of the attending sta! during aftercare and the respondent’s mastery of information during discharge are important dimensions of patients’ total PX (ANOVA R .695, R Square .483). The model’s three components are almost entirely built from items that address interpersonal skills and information assimilation. These correspond to two of the three Service Quality Dimensions, namely Interaction Quality and Outcome Quality. Most important of the three is the component “Chemistry in aftercare”. The predictive strength of the model shows merit under the context of the study and could advise further e!orts to develop measurements for PX in maternity care in a Swedish hospital setting. Lastly, this study contextualises Service Design in hospital maternity healthcare; the study therefore o!ers ample opportunity for innovation.Arbetet handlar om Patientupplevelse (PU), i förlossningsvården i Sverige. Fokus ligger på utvecklingen av ett mätvärde att beskriva den nuvarande patientupplevelsen. Arbetet använder kvalitativa och kvantitativa metoder (mixed-methods), i en semi-sekventiell design; utforskning av patientresan ligger till grund för anpassningen av ett existerande mätinstrument. Det nya mätinstrumentet testas i en pilotstudie och ger ett kompositmätvärde av PU. En del av analysen ägnas åt att förstå vilken e!ekt information och kommunikation har på PU; Explorativ faktoranalys används för ändamålet. Resultaten visar att det är möjligt att beskriva PU genom det föreslagna mätinstrumentet. Det resulterande kompositvärdet är bättre på att beskriva skillnader i uppfattning än ett medelvärde av två diskreta variabler av VAS-1 typen, och är också lämpligare när attityder och åsikter mäts med hjälp av Likert-skalor. En trekomponentslösning beskriver 65.44% av den totala stickprovsvariansen. Att avgöra hur mycket PU påverkas av information och kommunikation förblir svårt att kvantifiera, men dessa inledande resultat visar att patientbemötande under eftervårdstiden och patientens förmåga att bemästra information under utskrivningen är viktiga dimensioner av patienters totala PU (ANOVA R .695, R Square .483). Modellens tre komponenter är nästan uteslutande uppbyggda av variabler som fångar upp personliga relationer och assimilering av information. Dessa motsvarar två av de tre dimensionerna i Servicekvalitetsmodellen, nämligen Interaktionskvalitet och Utfallskvalitet. Viktigaste komponenten är Personlig kemi under eftervården. Modellens förutsägningsstyrka visar förtjänst under studiens kontext och kunde informera framtida ansträngningar att utveckla mätvärden för förlossningsvården inom svensk sjukhusmiljö. Till sist kan nämnas att studien kontextualiserar Service Design inom förlossningsvården; studien erbjuder därför omfattande möjligheter för innovation.
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Swickard, Scott W. "Patient Safety Events During Critical Care Transport." Case Western Reserve University School of Graduate Studies / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671.
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