Tesis: "Nursing Quality control"

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Cruickshank, Mary T., of Western Sydney Hawkesbury University, and Faculty of Management. "Developing a quality culture within a school of nursing in higher education." THESIS_FMAN_XXX_Cruickshank_M.xml, 2000. http://handle.uws.edu.au:8081/1959.7/604.

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During the past decade, nurses in the clinical setting have began making a paradigm shift from Quality Assurance to Total Quality Management, or as it is commonly referred to within health care facililties, Continuous Quality Improvement.In contrast, scant attention has been paid to quality management practices in nursing in the higher education sector. This study provides an applied example of where it investigates quality management practices in the context of organisational culture and human resource management with the aim of developing a quality culture model for a school of nursing in higher education.The research study that was conducted produced several major findings from the views of nurse academics who participated in it. Several issues associated with nurse academics' opinions of quality management practices utilised in schools of nursing have been unravelled.The fundamental issue is that procedures and policies formulated for nurses in the hospital setting do not serve the needs of nursing education.The most crucial factor to be considered in policy developments and future research is that it needs to be contextualised in the culture of nursing in higher education.It has become imperative that a transparent quality culture reflects contemporary nursing in Australia and the proposed model in this thesis provides nurses with an opportunity to shape a quality system for the nursing profession. Doctor of Philosophy (PhD)

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Werely, Volene Joy. "An audit of discharged patient files at hospitals specialising in the management of tuberculosis." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6502.

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Thesis (MCur)--University of Stellenbosch, 2011. ENGLISH ABSTRACT: Background: In her clinical practice as nursing manager the researcher was concerned about incomplete and inaccurate documentation of patients diagnosed with tuberculosis (TB) which were compromising the management of these patients. The primary care nurses endorsed these concerns. Goals and Objective: The goal of this study was to audit nursing documentation according to the phases of the nursing process and the discharge planning of patients diagnosed with TB discharged from TB hospitals in the Western Cape. The objectives for the study were to determine whether the patients were adequately assessed and diagnosed, whether nursing care plans were formulated based on the assessment and whether they were implemented and evaluated according to the nursing process - including the discharged planning. Ethics approval was obtained from the Committee of Human Research Science at Stellenbosch University and permission was also obtained from the respective institutions. Methodology: A descriptive design with a quantitative approach was applied for the purpose of this study. The total population for the study was N=1768. A systematic random sample of 12% from each hospital was drawn: n=214, hospital A (n=142) and hospital B (n=72). Criteria included:  all adult patients older than 18 years  patients who were discharged between 01 January 2007 and 31st December 2007  all discharged patients from the two hospitals specializing in patients diagnosed with TB. Instrumentation: An audit instrument based on the objectives of the study was approved as the data collection tool. Guided by the proposed study a 10% (n=21) of the number of discharged patient files were drawn for the purpose of a pilot study. Reliability and validity was ensured through the use of experts in the field of nursing, research methodology and statistics. A pilot study was also conducted to support the reliability and validity of the study. Data collection: The researcher collected the data personally with the support of five trained field workers who only assisted at hospital B and was reluctant to assist at the second hospital. Data analysis: Data was analysed with the support of a statistician and expressed in frequencies and tables. Results: All phases of the nursing process showed a low compliance. Results showed that only n=90(42%) of the registered professional nurses checked and signed the initial assessment, furthermore only n=53(34%) showed that a recording was made of all referral documentation to the patient’s follow-up clinic. Recommendations: Recommendations based on the scientific evidence obtained from the study include the implementation of a quality assurance programme namely standardisation, auditing, case management of patients, education and training, rewarding of staff and further research. Conclusion: In conclusion guided by the research question “Are the audited discharged patient files at hospitals specialising in the management of patients with TB in the WCDoH compliant?” The researcher concludes that the discharged patient files are not compliant. AFRIKAANSE OPSOMMING: Agtergrond: In haar kliniese praktyk as verpleegbestuurder is die navorser besorgd oor die onvolledige en onakkurate dokumentasie van pasiënte wat met tuberkulose (TB) gediagnoseer is en wat dus die versorging van hierdie pasiënte in gevaar stel. Hierdie besorgdhede is deur die primêre sorg verpleegsters bevestig. Doel en Doelwitte: Die doel van die studie is om die verpleegdokumente te ouditeer volgens die fases van die vepleegproses, asook die ontslagbeplanning van die pasiënte gediagnoseer met TB van die hospitale in die Wes-Kaap. Die doelwitte is om te bepaal of die pasiënte korrek geassesseer en gediagnoseer is en of verpleegsorgplanne opgestel is, wat gebaseer is op die assessering en versorgingsplanne wat geïmplementeer en geëvalueer is volgens die verpleegproses, insluitende die ontslagbeplanning. Etiese goedgekeuring is toegestaan deur die Komitee vir Menslike Navorsingswetenskap van die Universiteit van Stellenbosch en toestemming is ook ontvang van die onderskeie instansies. Metodologie: ’n Beskrywende ontwerp met ’n kwantitatiewe benadering is toegepas vir die doel van die studie. Die totale bevolking vir die studie is N=1786. ’n Sistematiese ewekansige geselekteerde steekproef van 12% van elke hospitaal is geneem: n=214, hospitaal A (n=142) en hospitaal B (n=72). Die kriteria sluit in:  alle volwasse pasiënte ouer as 18 jaar  pasiënte wat gedurende die periode 01 Januarie 2007 tot 31 Desember 2007 ontslaan is  alle ontslag pasiënte van die twee hospitale wat spesialiseer in pasiënte wat gediagnoseer is met TB. Instrumentasie: ‘n Ouditinstrument gebaseer op die doelwitte is goedgekeur as die dataversamelingsinstrument. Na aanleiding van die voorgestelde studie is 10% (n=21) van die aantal ontslag pasiëntlêers getrek vir die doel van die loodsondersoek. Betroubaarheid en geldigheid is verseker deur gebruik te maak van deskundiges in die verplegingsveld, die navorsingsmetodologie en statistiek. Die loodsondersoek is ook uitgevoer om die betroubaarhied en geldigheid van die studie te rugsteun. Dataversameling: Die navorser het die data persoonlik gekollekteer met die bystand van vyf opgeleide veldwerkers wat slegs hulp verleen het by hospital B en wat teësinnig was om hulp te verleen by die tweede hospitaal. Data-analise: Data is geanaliseer met die hulp van ’n statistikus en is uitgedruk in frekwensies en tabelle. Resultate: Alle fases van die verpleegproses het nie voldoen aan die vereistes nie. Resultate dui daarop dat slegs n=90 (42%) van die geregistreerde professionele verpleegsters die aanvanklike assessering nagegaan en onderteken het, vervolgens het slegs n=53 (34%) getoon dat ’n opname gemaak was van alle verwysde dokumentasie van die pasiënt se opvolgbesoek aan die kliniek. Aanbevelings: Aanbevelings is gebaseer op die wetenskaplike bewys wat verkry is van die studie vir die implementering van ’n gehalte versekeringsprogram, naamlik standardisering, ouditering, gevallebestuur van pasiente, opvoeding en opleiding, erkenning aan die personeel, en voortgesette navorsing. Samevatting: Ter afsluiting gelei deur die navorsering’s vraag nl. “Is die geouditeerde verpleegdokumente in hospitale wat spesialiseer in die bestuur van pasiente gediagnoseer met TB in die Weskaap se Department van Gesondheid bygehou?” Die navorser bevestig dat die verpleegdokumente nie bygehou was nie.

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Mengzhen, Xu, and Shen Qinyu. "The effect of Tai Chi exercise on quality of life and glucose control among patients with type 2 diabetes : - A descriptive literature review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-30251.

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Haro, Tyah Jo. "Enhanced Glycemic Recovery After Cardiac Surgery: A Quality Improvement Project." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/338757.

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Hyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.

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Barlow, Hilary Joan. "An evaluation of neonatal nursing care in selected hospitals in the Western Cape." Thesis, Stellenbosch : University of Stellenbosch, 2003. http://hdl.handle.net/10019.1/16253.

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Thesis (MCUR)--University of Stellenbosch, 2003. ENGLISH ABSTRACT: South Africa has a proud history of a high standard of health care delivery in State funded hospitals. This implies that high standards of education and care in both medical and nursing training have been achieved. The care of sick and premature newborn infants by nurses is a speciality that has evolved worldwide over the last forty years as a result of various technological developments. In order to ensure the standard of care delivered, protocols of care should be available for nurses to refer to and to measure their work against. There were no protocols of care available in the two Neonatal Units (NICUs) used in this study. Using a non-experimental, exploratory descriptive design, the researcher set about measuring the quality of nursing care in the NICUs. Standards (structure, process and outcome) were written by the researcher, and validated. The results showed that the standards were not met at an acceptable level in various areas. One of the areas of great concern was the lack of effective hand washing. Outcome standards which reflect the consequences of care indicated serious shortages of staff in some cases and insufficient staff training. Recommendations are that a Quality Assurance Program should be introduced with training and education of the nurses working in the NICUs and the introduction of evidencebased practice. Future research should aim at showing the way to improve the service delivered. AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n trotse geskiedenis van ‘n hoë standard van gesondheidsorgdienslewering in Staatsbefondsde hospitale. Dit impliseer dat hoë standaarde in mediese en verpleegopleiding bereik is. Die versorging van siek en premature pasgebore babas deur verpleegkundiges is ‘n spesialiteit wat oor die afgelope veertig jaar wêreldwyd ontwikkel het as gevolg van verskeie tegnologiese ontwikkelings. Ten einde te verseker dat ‘n hoë standard van sorg gelewer word, moet protokolle beskikbaar wees vir verpleegkundiges om te gebruik en hulle werkverrigting teen te meet. Daar was geen protokolle beskikbaar in die twee neonatale eenhede wat in hierdie studie gebruik is nie. ‘n Nie-eksperimentele, verkennende, beskrywende ontwerp is deur die navorser gebruik om die gehalte van verpleegsorg in die neonatale eenhede te evalueer. Standaarde (struktuur, proses en uitkoms) is deur die navorser opgestel en gevalideer. Die resultate toon aan dat die standaarde in verskeie areas nie aanvaarbaar nagekom word nie. ‘n Kommerwekkende bevinding was die afwesigheid van effektiewe was van hande. Uitkomsstandaarde wat die resultaat van sorg weerspieël, het aangedui dat daar ernstige tekorte aan personeel in sommige gevalle bestaan het asook onvoldoende opleiding van personeel. Aanbevelings is dat ‘n Gehalteversekeringsprogram ingestel behoort te word en met die opleiding van verpleegkundiges werksaam in die neonatale eenhede en evidence-based practice aangespreek moet word. Toekomstige navorsing behoort aan te dui hoe om die diens wat gelewer word, te verbeter.

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Hellqvist, Sofia. "Quality management in the healthcare sector and the perception of an enabling formalization." Thesis, Stockholms universitet, Operations Management, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-192429.

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Organizational performance in the healthcare field is of great interest for many stakeholders. Efficient use of resources and delivery of high quality of care should be relevant to any taxpayer hoping to live healthily and grow old in Sweden. Simultaneously, the working conditions for the employees need to be sustainable if the impending lack of 170 000 workers in the healthcare sector by the year of 2030 is to be mitigated (Statistiska centralbyrån, 2012). The scope of this study is to examine how the quality management systems applied to ensure and improve the aforementioned objectives are perceived by the individual employees. Specifically, practitioners in the nursing professions are enquired about the design principles of enabling control as described by Adler and Borys (1996). The study has utilized a quantitative methodology and an online survey to collect personal perceptions and experiences from 400 individuals in the nursing professions on this topic. Major findings are that the majority of the respondents state that they perceive three out of four of the design principles of an enabling system to be present in the quality management system at their workplace. In addition, there is a strong association between the perception of the enabling characteristics flexibility and repair and general job satisfaction. Further studies with larger samples would increase the statistical power of these correlations. In addition, a large proportion of the respondents perceive that the quality management processes is negatively affected by financial constraints. Only a minority of the respondents perceive the workload constituted by tasks connected to quality management as reasonable.

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Johansson, Marita, and Cathrin Jonasson. "En varm patient : Sjuksköterskans omvårdnad och förebyggande av hypotermi i samband med dagkirurgisk operation." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-15141.

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Nästan alla patienter blev hypoterma före, under och efter operation. För att undvika detta vidtog sjuksköterskan olika omvårdnadsåtgärder för att minska risken för oönskad hypotermi. Det var viktigt för vårdpersonal att få kunskap om vilka omvårdnadsåtgärder som är optimala för att minska komplikationer, samt få förståelse för hur hypotermi påverkar patienten under hela vårdförloppet. Kunskapen behövs för att lindra lidandet och öka tryggheten i samband med operation. Syftet var att söka evidens för bästa beprövade omvårdnadsåtgärd för att förebygga hypotermi hos patienter samt beskriva hypotermins påverkan på patienter under dagoperativt vårdförlopp. En litteraturstudie genomfördes där kvantitativa och kvalitativa artiklar analyserades med hjälp av innehållsanalys enligt Fribergs modell (Friberg 2012). Resultatet visade att det var viktigt att börja värma patienten före operation och att starta med en högre begynnelsetemperatur. Vid steriltvättning rekommenderades varm desinfektion. Även vid artroskopier var det en fördel att använda uppvärmd vätska. Vid korta ingrepp fungerade både värmekällan Hot dog (elektriskt täcke/madrass) och Bair Hugger (varmluftstäcke). Bair Hugger var i dagsläget den enskilt mest effektiva metoden för att snabbt höja temperaturen, mest miljömässiga samt ekonomiskt hållbara metoden vid längre operationer, givet att den var inställd på hög värme (43°C). Dock räckte det inte med en metod för att få en normaltempererad patient, utan flera olika metoder behövde kombineras samtidigt. En riktlinje för sjuksköterskor var att fortsätta med hög temperatur på värmekällan även då patientens kroppstemperatur hade uppnått normal temperatur. Först när patienten började svettas var det lämpligt att sänka temperaturen. Det var viktigt att mäta temperaturen för att fånga upp alla som var hypoterma, då inte alla patienter uppvisade symtom såsom shivering. Öka vårdpersonalens medvetenhet om vikten av att värma patienter på operation och använda alla metoder som finns tillgängliga för att minska hypotermi och öka välbefinnandet.

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Huff, Nicole S. "Social support, God locus of health control, and quality of life among African American breast cancer survivors." Thesis, Central Michigan University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3567665.

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As African American (AA) breast cancer survivors live longer with the disease, much attention should be directed to quality of life and factors influencing it. An understanding of survivors' belief that God controls their health and their social support needs is necessary as an effort to develop health care services and programs that are culturally sensitive. This study was the first to explore the association between an individual's belief that God controls their health, social support and quality of life among AA breast cancer survivors. The purpose of this study was to examine the relationship between social support, God Locus of Health Control (GLHC) and quality of life (QoL) among the survivors residing in Illinois. This study's alternative hypotheses predicted after controlling for age, location of residence, marital status, and time since diagnosis, social support and GLHC, combined and individually, would positively correlate to QoL for AA breast cancer survivors. The study used a descriptive, correlational and quantitative design by testing the variables using hierarchical multiple regression and Pearson correlation. A convenience sample of 92 AA women was recruited from a community hospital, a Federally Qualified Health Centers, a beauty shop, two support groups, a member association that advocates for health care disparities, and local newspapers. Quantitative measures included Social Support Questionnaire (Northouse, 1988), GLHC scale (Wallston et al., 1999), Quality of Life Index - Cancer Version III (QLI - CV III) (Ferrans, 1990), and Demographic Characteristics form created by researcher. Results concluded QoL was not affected by social support and GLHC, combined, and GLHC, individually. However, social support was a predictor of QoL. Statistically significant relationships were found between social support, QoL and its domains: a) health and functioning subscale, b) social and economic subscale, c) psychological/spiritual subscale and d) family subscale. Statistically significant relationships were not found between GLHC and QoL and its domains. The mean score for social support and GLHC scales were low compared to prior study results. The QLI - CV III mean score was moderately high compared to other study results. Additional findings concluded women residing in the suburb had statistically significant higher mean QoL than those living in the rural or urban areas of Illinois. Also, married women in this sample had a higher mean QoL than unmarried women. Although AA breast cancer survivors' QoL was not increased by their belief that God controlled their health and the mean social support score was low, the study results provided valuable information for future research and the development of social support programs that are culturally sensitive.

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Baugh, Nancy. "The Relationship of Physical Activity, Eating Behaviors, and Hunger Control to Weight Loss and Quality of Life in Gastric Banding Patients." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/229.

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Gastric banding as a weight loss surgery has increased in popularity in the United States since its approval by the Food and Drug Administration in 2001. Successful weight loss after weight loss surgery is most frequently defined as greater than 50 percent of excess weight loss (EWL). Systematic reviews show that the band is widely effective in achieving successful weight loss in most patients, however individual studies show more inconsistent outcomes. Although previous research supports gastric bypass surgery as having a positive effect on quality of life after gastric bypass, there is very little data to support this relationship in gastric banding patients. Weight loss outcomes after gastric banding surgery at Virginia Commonwealth Health System were less than 50 per cent EWL at one and two years. A retrospective, descriptive study sought to answer the following questions: 1) What is the relationship between physical activity, eating behaviors and hunger control on weight loss and quality of life after gastric banding surgery and 2) Does successful weight loss at one year predict successful weight loss at two years. The International Physical Activity Questionnaire Sort Form (IPAQ) was used to assess participation in physical activity. The Medical Outcomes Study Short Form (SF-36) was used to determine quality of life. Weight loss outcomes were 34.6 per cent at one year and 39.7 per cent at two years, which was less than the established success rate of greater than 50 per cent EWL, However, most patients lost some weight and demonstrated a significant improvement in most domains of health related quality of life. Participation in physical activity increased fro preoperatively to year one but decreased in year two. Although participation in physical activities overall decreased from year one to year two, there was a significant relationship between participation in greater than 150 minutes per week of moderate or vigorous physical activity and adequate weight loss (p =0.025) and participation in health enhancing physical activities and adequate weight loss (p < 0.05). There was no statistically significant relationship noted between any of these eating behaviors and the percentage of excess weight loss at one or two years. There was a significant relationship between degree of hunger reported by patients and successful weight loss at one year (p < 0.05). There is sufficient statistical evidence of a positive linear relationship between two- year weight loss and one- year weight loss (p < 0.05). That is, one-year weight loss is a significant predictor for two- year weight loss. Based on the results of this study, it is recommended that gastric banding patients participate in at least 150 minutes per week of moderate to vigorous physical activity. Additionally, clinicians should consider development of adjustment protocols that achieve early reduction of hunger in the banding patient.

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Oliveira, Aline Silveira Cardoso. "Qualidade da espinheira-santa comercializada no mercado formal na cidade de Pelotas." Universidade Federal de Pelotas, 2006. http://repositorio.ufpel.edu.br:8080/handle/prefix/3831.

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Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-04-13T18:31:46Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Silveira_Cardoso_Oliveira.pdf: 2264789 bytes, checksum: 935fe6affb42c7bd8ef6d0e2d3a89651 (MD5) Made available in DSpace on 2018-04-13T19:59:09Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Aline_Silveira_Cardoso_Oliveira.pdf: 2264789 bytes, checksum: 935fe6affb42c7bd8ef6d0e2d3a89651 (MD5) Previous issue date: 2006-09-12 Sem bolsa A prática da fitoterapia segura não se verifica apenas por meio da análise do produto final, mas também, na obtenção da espécie vegetal, desde sua identificação, cultivo, colheita, beneficiamento, armazenamento e comercialização. A ausência de qualidade, a adulteração e a utilização incorreta podem interferir na eficácia e até mesmo na segurança do uso do produto. Uma das espécies amplamente utilizada tanto na medicina popular quanto no sistema oficial de saúde é a Maytenus ilicifolia Mart ex Reissek (espinheira-santa) para o tratamento de dispepsias. O objetivo deste trabalho foi avaliar os parâmetros de qualidade das amostras secas de espinheira-santa disponíveis nos locais de comercialização formal na cidade de Pelotas. Este estudo tem delineamento classificado como descritivo experimental e analítico. Foram coletadas 11 amostras de plantas medicinais popularmente conhecidas como cancorosa e/ou espinheira-santa, vendidas no comércio formal (farmácias, drogarias e supermercados) e uma amostra padrão coletada no Instituto Federal Sul-rio-grandense, Campus Pelotas - Visconde da Graça. Foram avaliadas características organolépticas e físico-químicas, além dos rótulos dos produtos. Todas as amostras foram reprovadas em pelo menos dois parâmetros analisados, indicando que é necessário ampliar a fiscalização visando garantir a segurança ao consumidor. The practice of safe phytotherapy does not occur only through the analysis of the final product, but also in obtaining the plant species, from its identification, growing, harvest, processing, storage, and commercialization. The lack of quality, adulteration, and the misuse may interfere with the efficacy and even in the safe use of the product. One of the widely used species is Maytenus ilicifolia Mart ex Reissek (espinheira-santa), which is a common practice both in popular medicine and official health system for treatment of dispepsy. The objective of this work was evaluate the parameters of quality of dry samples of „espinheira-santa‟ available in formal local marketing in the municipality of Pelotas. The design of this study is descriptive, experimental and analytical. Eleven samples of medicinal plants popularly known as „cancorosa‟ and/or „espinheira-santa‟ were collected from formal marketing (pharmacies, drugstores and super markets), and a standard sample was collected from Instituto Federal Sul Riograndense, Campus Pelotas – Visconde da Graça. Physico-chemical and organoleptic characteristics were evaluated, as well as the labels of the products. All samples were not approved at least in two parameters analyzed, indicating that is necessary to expand surveillance to ensure consumer safety.

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Mugerwa, Pumla Princess. "The relationship between clinical learning environmental factors and clinical competence of newly qualified registered nurses in public hospitals." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/19266.

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There is increasing concern that newly qualified registered nurses (RNs) find it difficult to make a smooth transition from completing their four-year nursing training to taking up their posts as first time RNs. In a constantly changing healthcare system, these newly qualified RNs are expected to work independently and be competent in applying the decision making and problem-solving skills gained during their training. While certain aspects of clinical incompetence may be ascribed to individual factors, the importance of the clinical learning environment and its influence on the development of clinical competence cannot be ignored. Nurses need support and guidance to effect a successful transition from being novice to competent nurse and the environment is regarded as important in developing technical competencies. The research study followed a positivistic, quantitative paradigm, where the hypothesized relationship between clinical learning environmental factors and clinical competence of newly qualified RNs were explored. Data was collected from the experienced RNs in the hospitals by means of a structured pre-existing questionnaire, namely the Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and inferential statistics were used to analyse data. The analysed data was used to describe the findings. Recommendations were made based on the findings. Results suggested that the development of clinical competence is dependent on both the individual and context. Positive relations were reported between clinical learning environmental factors and clinical competencies.

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Martins, Luís Miguel da Silva. "Formação da Equipa de Enfermagem do Bloco Operatório no reprocessamento de Dispositivos Médicos (DM) Reutilizáveis." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2014. http://hdl.handle.net/10400.26/7627.

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Relatório de Estágio de Mestrado em Enfermagem Perioperatória O presente relatório incluí-se no plano de estudos do I Mestrado em Enfermagem Perioperatória, da Escola Superior de Saúde do Instituto Politécnico de Setúbal, realizado com o intuito da obtenção do grau de Mestre em Enfermagem e documento ilustrativo do desenvolvimento de competências no âmbito de enfermeiro perioperatório, competências essas que se procuraram desenvolver durante o estágio realizado no serviço do Bloco Operatório (BO) de um Hospital Privado (Hospital X) na margem sul do Rio Tejo. Neste contexto, foi desenvolvido um Projeto de intervenção, denominado de “Formação da Equipa de Enfermagem do Bloco Operatório no reprocessamento de Dispositivos Médicos (DM)” reutilizáveis, com o objetivo de melhorar a qualidade e a segurança dos cuidados de enfermagem prestados à pessoa submetida a cirurgia no Bloco Operatório do Hospital X. As áreas que se pretenderam abordar remetem-nos para o controlo de infeção e esterilização, nomeadamente os conhecimentos que a equipa de enfermagem do BO em estudo poderá deter, em termos de reprocessamento dos DM reutilizáveis que utilizam diariamente na sua prática profissional. As razões que levaram a esta escolha, prendem-se com o facto de serem áreas onde comummente surgem dúvidas durante a prática diária da equipa de enfermagem e por serem também, áreas pouco exploradas a nível académico e profissional. Através das metodologias descritiva e analítica, foram efetuadas análises reflexivas e críticas do percurso realizado, bem como uma exposição das competências de enfermagem abrangidas e de como as mesmas foram atingidas. Abstract: This report is included in the study plan of the I Master in Perioperative Nursing, of Escola Superior de Saúde do Instituto Politécnico de Setúbal, conducted with the aim of obtaining a Master degree in Nursing and an illustrative document of the skills there where developed in the context of a master degree and in perioperative nursing, during the internship in the Operating Room of a Private Hospital (Hospital X) located on the south bank of Rio Tejo. In this context, we developed an intervention project called “Formation for the Operating Room Nurses in Reprocessing of Reusable Medical Devices” to try achieve the goal of improving the quality and safety of nursing care, provided to the person undergoing surgery in the Operating Room at Hospital X. The areas that are intended to achieve lead us to the infection control and sterilization process, including the knowledge that the operating room nursing team may hold, in terms of methods of reprocessing reusable medical devices, used in the professional daily practice. The reasons for this choice are related to the fact that these are commonly areas where doubts arise, during the daily nursing team practice and also these are areas whit low exploration in academic and professional terms. Through descriptive and analytical methodologies, reflective and critical analyses where made as well an exposure of the skills covered and how they where reached.

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Laches, Lisa A. "The Relationships Among Pain, Dyspnea, Constipation and Quality of Life in Lung Cancer Patients Enrolled in a Hospice Program." Scholar Commons, 2007. http://scholarcommons.usf.edu/etd/3926.

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There is evidence of a relationship between pain and associated symptoms, specifically constipation and dyspnea, and quality of life. Literature supports that endstage lung cancer patients suffer more symptoms than those with other types of cancers, and the course of treatment is primarily palliative, as many of these diagnosed patients cannot be cured. The purpose of this secondary analysis of data was to evaluate the relationships between pain and other common symptoms in end stage lung cancer patients in hospice care, and the relationships among pain, dyspnea, constipation and quality of life. The study sample included fifty lung cancer patients admitted to a hospice program, reporting pain. A series of Pearson’s correlations were used to analyze relationships between the variables pain intensity, pain distress, dyspnea intensity, dyspnea distress, constipation intensity and the relationships of these variables with quality of life. The results showed positive significant correlations between pain intensity and pain distress (r = .44, p = .002), dyspnea intensity and dyspnea distress (r = .47, p = .001), and constipation intensity and quality of life (r = -.57, p = .013). Pain and the relief of pain have been studied extensively in cancer patients, yet little research has been done in the way of side effects of opioid use, specifically constipation. This study reinforces to vi nursing the importance of a thorough assessment upon admission to hospice, and at each subsequent nursing visit, which includes a bowel habit history, current medications in use, potential risk for developing constipation and management of constipation once it is present. Hospice patients with lung cancer are reporting a decrease in quality of life secondary to constipation. Prevention or rapid alleviation of this symptom will provide comfort and allow the patient to focus on important end of life tasks.

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Bimray, Portia Benita. "Die bepaling van standaarde vir 'n omvattende opvolgdiens aan onkologiepasiente op die Wes-Kaapse platteland." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51693.

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Thesis (MCur)--Stellenbosch University, 2000. ENGLISH ABSTRACT: Against the background of the approach to make the follow up care to oncology patients more accessible and with the emphasis on quality care, it was indicated that this service needs to be evaluated. A study based on a combination of qualitative and quantitative methods (also called triangulation) was conducted to formulate structure, process and outcome standards for a comprehensive follow up care for the oncology patients and to evaluate this service according these standards. The most important results are: • The quality of care relating to the structure standards was optimal regarding the organization of the patient's visits, follow up treatment and referrals. A suboptimal standard was found regarding the general management system. • In the process standards focusing on the physical and psychosocial needs of the patient, a suboptimal standard was found regarding all aspects. Nursing practice leading to subobtimal care of patients is a major cause for concern. • With the outcome standards reflecting in patient satisfaction, positive as well as negative opinions and perceptions were found. Recommendations include: • Upgrading of management systems • Empowerment of the nurses with knowledge and scientific competencies • Attention to the opinions and perceptions of the patients to completely involve the patient in the service and treatment process. Keywords: Oncology follow up service I formulation of structure, process and outcome standards. AFRIKAANSE OPSOMMING: Teen die agtergrond van die benadering om opvolgdienste meer toegangklik te maak vir onkologiese pasiënte, met die beklemtoning van gehaltesorg, is dit aangedui dat hierdie diens geëvalueer moes word. 'n Studie gebaseer op 'n kombinasie van kwalitatiewe en kwantitatiewe metodes (genoem triangulasie) is uitgevoer om struktuur, proses en uitkomsstandaarde vir 'n omvattende opvolgdiens aan onkologiepasiënte te formuleer en die diens aan die hand daarvan te evalueer. Die belangrikste resultate is: • Die gehalte van sorg wat verband hou met die struktuurstandaarde was net optimaal ten opsigte van die organisasie van die pasiënt se besoeke, opvolgbehandeling en verwysings. 'n Suboptimale standaard is gevind ten opsigte van die algemene bestuurstelsel. • In die prosesstandaarde wat fokus op die fisiese en psigososiale behoeftes van die pasiënt, is 'n suboptimale standaard in alle aspekte gevind. Verpleegpraktyk wat lei tot suboptimale sorg van pasiënte is 'n groot bron van kommer. • Met die uitkomsstandaarde wat reflekteer in pasiënttevredenheid is positiewe maar ook negatiewe opinies en persepsies gevind. Aanbevelings sluit in: • Verbetering van bestuurstelsels • Bemagtiging van die verpleegkundige met kennis en wetenskaplike vaardighede • Aandag aan pasiënte se opinies en persepsies ten einde die pasiënt ten volle te betrek by die hele diens en behandelingsproses. Sleutelwoorde : Onkologiese opvolgdiens / formulering van struktuurproses en uitkomsstandaarde.

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Myhre, Teri Ann, and University of Lethbridge Faculty of Arts and Science. "Medication safety practices : a patient's perspective." Thesis, Lethbridge, Alta. : University of Lethbridge, School of Health Sciences, 2007, 2007. http://hdl.handle.net/10133/626.

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Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. The purpose of the study is to explore patients’ perceptions, attitudes and beliefs about the safety practices utilized by nurses when administering medications. Specifically, the study addresses patients’ perceptions of nurse behaviours regarding safe medicine administration, patient behaviours, patients’ perceptions and nurse behaviours regarding pain medicine, patients’ perceptions of nursing care, and patients’ perceptions of their participation/accountability in care. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care. x, 125 leaves ; 29 cm

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Silva, Amanda Aparecida. "Avaliação da qualidade de vida relacionada à saúde: percepção sobre as condições de trabalho e de vida entre profissionais de enfermagem, de hospital universitário no município de São Paulo." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/6/6134/tde-19032009-155546/.

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Introdução - O ambiente psicossocial do trabalho em enfermagem influencia diretamente a qualidade de vida dos trabalhadores desta área. Diferenças entre as categorias profissionais nesta profissão podem se traduzir em diferenças na percepção de saúde e de condições de trabalho. Objetivo - Avaliar as associações entre condições de trabalho e qualidade de vida relacionada à saúde (QVRS) de enfermeiros, técnicos e auxiliares de enfermagem. Métodos Foram coletados dados em um hospital universitário no município de São Paulo, de uma população de 696 enfermeiros, técnicos e auxiliares de enfermagem, população predominantemente feminina (87,8%) e que trabalhava em turnos diurno e noturno. Os dados coletados a partir de questionário correspondiam a informações sobre aspectos sóciodemográficos, condições de trabalho e de vida, hábitos de vida e sintomas de saúde referidos desta população. Foram também utilizados os questionários: Questionário Genérico de Avaliação de Qualidade de Vida (SF-36), Escala de Estresse no Trabalho e Desequilíbrio Esforço-Recompensa (ERI). Foram ajustados modelos de regressão logística ordinal de chances proporcionais para cada dimensão do SF-36. Resultados Aproximadamente 22% da população foi classificada como trabalhando em condições de alto desgaste e 8% em desequilíbrio desfavorável entre esforços e recompensa no trabalho. Vitalidade, dor e saúde mental foram as dimensões do SF-36 com pior avaliação. Os modelos de regressão múltipla 5 demonstraram: alto comprometimento associado a todas as dimensões do SF-36, e ERI desfavorável associado a todas as dimensões relacionadas à saúde mental. Alto desgaste no trabalho, ERI desfavorável, alto comprometimento e ser enfermeira associaram-se de maneira independente aos resultados desfavoráveis da dimensão de aspectos emocionais. Conclusões As dimensões relacionadas à saúde mental foram as que mais sofreram influência dos fatores psicossociais do trabalho. ERI desfavorável e alto comprometimento mostraram-se mais significativos à saúde desta população comparados com altas demandas e baixo controle. Os resultados indicam que a análise conjunta dos modelos de desequilíbrio esforço-recompensa e demandacontrole contribui para a discussão sobre os papéis profissionais, condições de trabalho e QVRS de profissionais de enfermagem. Introduction- The psychosocial work environment influences the quality of life of nursing professionals. Differences among job titles may lead to distinct perceptions of working conditions and health status. Aim-To evaluate working and living conditions and quality of life associated with health (HRQL) among nursing professionals. Methods- Six hundred ninety six nursing professionals, registered nurses and nurse assistants, predominantly females (87.8%), working day or night shifts, participated in a study carried out in an university hospital of São Paulo, Brazil. Data collection took place during 2004-2005 and included a comprehensive questionnaire including sociodemographic characteristics, life styles, working and living conditions, and health outcomes. HRQL was evaluated using the short form questionnaire of quality of life (SF-36). Working conditions included the job stress scale, effort-reward imbalance (ERI), and other environmental and occupational stressors. Ordinal logistic regression of proportional ratios was used to evaluate each of SF-36 dimensions. Results- Imbalance of the effort-reward ratio and high work strain were mentioned by 7.8% and 22.1% of the participants, respectively. Vitality, pain and (poor) mental health were the SF-36 worse perceived outcomes. The multiple regression models showed: over commitment associated with all SF-36 dimensions, and unfavorable ERI associated with mental health dimensions. High 7 job strain, unfavorable ERI, over commitment, and being a registered nurse were independently associated with negative emotional outcomes. Conclusions- The dimensions associated with mental health were significantly influenced by psychosocial factors at work. Unfavorable ERI and over commitment were more significantly associated with health compared to high demands and low control. These results show the importance to jointly evaluate ERI and demand- control models to discuss professional roles, working conditions and HRQL of nursing professionals.

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Lindberg, Maria. "Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward Issue : Patient-Professional Interactions, Experiences, Attitudes and Responsibility." Doctoral thesis, Uppsala universitet, Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-168319.

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The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

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Alvarado, Fredrik. "Pålitliga kvalitetsmått? : en fallstudie i upplevelser av arbete med avvikelser i en personalgrupp inom äldreomsorgen." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för socialvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-8325.

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Välfärdsomsorg som i Sverige bedrivs enligt hälso- och sjukvårdslagen samt socialtjänstlagen är enligt lag skyldig att bedriva en systematisk kvalitetsutveckling. I denna kvalitetsutveckling inkluderas att arbeta med identifiering av brister samt risker för brister. Detta sker genom att personal i omsorgsverksamheter systematiskt ska rapportera avvikelser varpå ett avvikelsearbete påbörjas. Avvikelsearbetet leder till åtgärder i verksamheter och är därmed ett relativt omedelbart kvalitetsutvecklande. Samtidigt fyller avvikelsearbetet en funktion på en mer aggregerad nivå då det i statistiska sammanställningar kan ge fingervisning om hur verksamheter bedrivs samt att brister, och eventuella behov, tydliggörs. Statistiskt underlag samt tydliggjorda brister och behov kan i sin tur användas för att underbygga beslut som berör verksamheterna, både beslut inom verksamheter men också politiska beslut som sätter ramar och förutsättningar för organisationer och verksamheter. Således kan avvikelsearbete mynna ut i ett av de flera kvalitetsmått vilka i vårt samhälle idag är avgörande för att kunna utvärdera att offentligt bekostad välfärd dels är effektiv men också av god kvalité. Det finns idag en utbredd kritik av den samhälleliga styrmodell som kallas New Public Management. Kritiken riktar bland annat in sig på de stora krav av uppföljning och utvärdering som är både resurskrävande och riskfyllda i den mening att utvärdering och mätning av kvalité kan innehålla skevheter och föra med sig missvisande resultat. Kritik förs också fram mot att det administrativa arbetet tar över tid och resurser från kärnverksamheten, i den här studien äldreomsorg. Föreliggande studie syftar till att undersöka hur personal inom äldreomsorgens särskilda boende upplever deras avvikelsearbete utifrån begreppet organisationskultur. Det är av relevans att höra hur den personal som arbetar med avvikelsearbete upplever sitt arbete med kvalitetsutveckling. Avvikelsearbete som arbetsuppgift medför nämligen möjliga utmaningar: personal inom äldreomsorg är en av de personalgrupper i samhället som är mest belastad arbetsmiljömässigt, avvikelsearbete kan vara laddat med en känsla av utpekande av syndabockar, det finns incitament för organisationer att visa upp en yta av att kvalitetsarbete pågår. Studien har genomförts som en fallstudie med kvalitativ ansats där sju semistrukturerade intervjuer med vårdbiträden samt undersköterskor från en och samma arbetsgrupp har gjorts under våren 2018. Resultatet går i linje med tidigare forskning som lyfter fram olika aspekter som relevanta för ett framgångsrikt avvikelsearbete: kommunikation och dialog med kollegor och chef, uppmuntran från chef, tydlig struktur för hur avvikelsearbetet bedrivs. Resultatet visar också på aspekter som kan lyftas fram som brister i avvikelsearbetet: hur personal kompenserar för att hinna med sitt arbete, att avvikelser gällande vissa brister inte alltid rapporteras. För att tolka och analysera studiens resultat används socialpsykologen Edgar Scheins arbete om organisationskultur samt företagsekonomen Mats Alvessons arbete om mekanismer inom organisationer. Welfare Care that in Sweden is given according to laws regulating health care and social services is obligated to secure systematic quality improvement. Risk management through deviation reports is a part of this quality improvement which can affect the welfare care rather immediate. Deviation reports can also be used in statistical overviews where both risks and needs within the given care can be accentuated. As a consequence, information about risk, needs and statistical overviews can also be used for decision-making in both care organisations and in policy decisions that sets the framework for the welfare care given. Hence, deviation reports can be used as one of several quality indicators that today is fundamental in the evaluation of the quality of publicly financed welfare care. Criticism of New Public Management as a control model in welfare address the heavy demands of evaluation, auditing and monitoring which implicates risks of skewness and misguiding results. Criticism also points out that the administrative work that follows with NPM takes time and resources from the welfare cares main focus which in this paper is care for the elderly. This paper aims to examine how staff within elderly care homes experience their work with deviation reports regarding the concept of organizational culture. It is of relevance to examine this since these staff are the ones producing the evidence on which decisions are based. Also, statistics shows that staff within elder care is highly over represented in regard to risk in the work environment. Deviation reporting is also filled with challenges like avoiding the sensation of pointing out a scapegoat or someone to blame. There are also incentives for organisations to keep a facade that their operations are fully functional. This study has been completed as a case study through a qualitative approach where seven semi-structured interviews with assistant nurses and nurses aides from a single work group has been made during spring 2018. The result is in line with earlier research that points out different aspects that are of relevance for successful work with deviation reports. The results also point out aspects that can be regarded as flaws within the work of deviation reports. To interpret and analyse the result of this study two main perspectives has been used; social psychologist Edgar Scheins work on organizational culture and professor of business administration Mats Alvessonswork on mechanisms within organizations.

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Nunes, Maria João. "Otimização de Práticas na Prestação de Cuidados à Pessoa em Isolamento de Contacto." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10687.

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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico Cirúrgica No âmbito do 3º Mestrado Enfermagem Médico-Cirúrgica (MEMC) da Escola Superior de Saúde do Instituto Politécnico de Setúbal (ESS/IPS), o presente relatório pretende apresentar a reflexão sobre a aquisição e o desenvolvimento de competências comuns e específicas as quais definem o Enfermeiro Especialista em Enfermagem Médico-Cirúrgica (designadamente em Enfermagem em Pessoa em Situação Crítica e em Enfermagem em Pessoa em Situação Crónica e Paliativa), assim como, as competências de Mestre. Foi aplicada a metodologia de projeto, tendo desenvolvido no decorrer dos estágios o Projeto de Intervenção em Serviço (PIS) e o Projeto de Aprendizagem Clínica (PAC). O PIS decorreu num Serviço de Cirurgia Geral (SCG). Verificada a necessidade de intervenção no âmbito da otimização de práticas na prestação de cuidados à pessoa em situação de isolamento de contacto, após a realização do diagnóstico de situação, planeámos e executámos o Projeto de Intervenção em Serviço neste âmbito. A IACS constitui um problema de saúde devido à elevada morbilidade e mortalidade sendo fundamental a adoção de precauções básicas as quais garantem a segurança dos profissionais e da pessoa (Pina et al, 2010). Visando a divulgação de boas práticas propusemo-nos a desenvolver e a realizar formação e treino da equipa de enfermagem e da equipa de assistentes operacionais neste âmbito. Para a aquisição e desenvolvimento das competências específicas do enfermeiro especialista realizámos o PAC, tendo-nos centrado no desenvolvimento dos domínios nas áreas do controlo de infeção, emergência e catástrofe e cuidar da pessoa a vivenciar processos complexos. Concretamente realizamos uma ação de sensibilização aos familiares das pessoas internadas no serviço, relativa à importância da higienização das mãos aquando da visita; participação num exercício de simulacro de situação de inundação numa unidade de cuidados intermédios e consequente poster de divulgação; realização de poster acerca do tema hipodermóclise, com o qual obtivemos o 2º lugar num encontro de enfermagem. O PAC decorreu num SCG. Abstract: Under the 3rd Master of Medical-Surgical Nursing (MEMC) of the Superior Health School of Institute Polytechnic of Setubal (ESS/IPS), this report constitutes a reflection about the Master and specific skills acquisition and development process for Medical-Surgical Specialist Nurses (particularly in Critical Care and Chronic and Palliative care. As methodology it was used Project Methodology and during the deplacements, the Intervention Project in Service (PIS) and the Clinical Learning Project (CAP) were developed. The PIS took place in a General Surgery Service (SCG). Facing the need for intervention in providing care to the person in isolation, we planned an Intervention Project. The IACS constitutes a health problem due to its high morbidity and mortality. Therefore, it is fundamental to adopt basic precautions that guarantee the safety, not only of the workers, but also of the person herself (Pina et al, 2010). Aiming the dissemination of good practice, we decided to develop training for the nursing staff and healthcare assistants. Aiming the acquisition and development of specific skills of the specialist nurse we proceeded with the cap, focused in areas such as infection control, emergency and catastrophe and care for the person experiencing complex processes. Specifically we carry out an action to raise relatives awareness of the importance of hand hygiene; participation in a flood drill in an intermediate care unit, with respective elaboration of a poster; creation of a poster about hypodermoclysis , that earned the 2nd prize in a meeting of nursing. The PAC took place in SCG.

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Silva, Leandra Terezinha Roncolato da. "Avaliação da qualidade da assistência à saúde quanto às medidas de prevenção e controle de pneumonia associada à ventilação mecânica." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-16112010-101217/.

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Os serviços de saúde vêm desenvolvendo programas e ações visando a qualificação de seus processos de trabalho com intuito de reduzir, eliminar e prevenir deficiências da qualidade e que também atendam às necessidades e expectativas dos usuários. Diferentes estratégias de avaliação das práticas em saúde têm sido adotadas, permitindo a identificação das condições em que as práticas assistenciais são executadas. As infecções hospitalares constituem risco significativo à saúde dos usuários e, dentre estas, a pneumonia (PNM) assume particular importância, dada a prevalência e mortalidade a ela associadas, especialmente quando acomete pacientes graves internados em unidades de terapia intensiva (UTI). Para avaliação dos processos de trabalho, a literatura recomenda a utilização de indicadores que avaliem não só a estrutura, como também o processo e o resultado. Assim, este estudo objetivou avaliar a qualidade da assistência à saúde prestada em uma UTI, quanto ao uso das medidas de prevenção e controle de PNM em pacientes de alto risco submetidos à ventilação mecânica. Trata-se de um estudo descritivo exploratório, com abordagem quantitativa, realizado na UTI adulto de um hospital público de ensino de grande porte e nível terciário. Os sujeitos da pesquisa foram os pacientes internados na unidade sob assistência ventilatória invasiva com rebaixamento de consciência e/ou nutrição por sondas digestivas. Os dados foram coletados diariamente nos três turnos de trabalho utilizando o Indicador de Avaliação da Adesão às Medidas de Prevenção e Controle de Pneumonia em Pacientes de Alto Risco (IRPR) que monitora a aplicação de medidas de controle e prevenção de pneumonia hospitalar, a saber: decúbito elevado (entre 30 e 45º), fisioterapia respiratória, utilização de soluções estéreis nos equipamentos de terapia respiratória e adesão à rotina de troca dos inaladores estabelecida na instituição. Participaram do estudo, 38 pacientes, sendo 26 (68,42%) do sexo masculino e 12 (31,58%) do sexo feminino, com idades entre 19 e 82 anos e tempo de internação na UTI de 1 a 28 dias. Destes pacientes, 19 receberam alta, 3 (7,89%) permaneceram internados e 16 (42,10%) evoluíram para óbito. Foram realizadas 839 observações, relacionadas às medidas de prevenção e controle de PAVM conforme indicador IRPR. A conformidade geral a todas as medidas de prevenção e controle de PAVM correspondeu a 26,94%. A manutenção da cabeceira elevada e o atendimento de fisioterapia foram as medidas que mais influenciaram negativamente na obtenção dessa conformidade geral. Observou-se nos prontuários médicos que 13 (34,21%) pacientes desenvolveram PNM durante a internação. Foram calculados os índices de conformidade e não conformidade geral e de cada medida específica de prevenção e controle de PAVM para estes pacientes, com resultados semelhantes. Conclui-se que a conformidade alcançada nesta investigação não foi satisfatória (26,94%), embora algumas medidas isoladas que compõem o indicador IRPR tenha alcançado índices próximos a 100%. Este estudo possibilitou identificar a não adesão a determinadas práticas, embora instituídas na instituição investigada. Espera-se que a divulgação dos resultados propicie a adoção de novas estratégias educativas para equipe de saúde, visando desenvolver ações de melhoria contínua para práticas assistenciais. The health services have been developing programs and actions aiming at the qualification their process of work with intent to reduce, to eliminate and to prevent deficiencies of the quality and that also meet the needs and expectations of users. Different strategies of evaluation of the practices in health have been adopted, allowing the identification of the conditions under which care practices are executed. The hospital infections constitute significant risk the health of the users and among these, the pneumonia (PNM) assumes private importance, given the prevalence and mortality it associated, especially when to assault patient serious interned in units of intensive therapy (UTI). For evaluation of the work processes, the literature recommends the use of pointers that not only evaluate the structure, as well as the process and the result. Thus, this study it objectified to evaluate the quality of the assistance to the health given in a UTI, how much to the use of the measures of prevention and control of PNM in patients of high risk submitted to the ventilation mechanics. This is a descriptive exploratory study, with quantitative boarding, carried through in the adult UTI of a public hospital of education of great transport and tertiary level. The study subjects were patients interned in the unit under invasive ventilators support with degradation of conscience and/or nutrition for digestive sounding leads. The data had been collected daily in the three turns of work using the Pointer of Evaluation of the Adhesion to the Measures of Prevention and Control of Pneumonia in at righ risk (IRPR) that monitors the application of measures of control and prevention of hospital pneumonia, namely: high decubitus (between 30 and 45º), respiratory therapy, use of barren solutions in the equipment of respiratory therapy and adhesion to the routine of exchange of inhalers established in the institution. Participated in the study, 38 patients, being 26 (68.42%) of masculine sex and 12 (31.58%) of the feminine sex, with ages between 19 and 82 years and time of internment in the UTI of 1- 28 days. From these patients, 19 they had 19 received high, 3 (7.89%) had remained interned and 16 (42.10%) had evolved for death. 839 comments, related to the measures of prevention and control of PAVM as indicating IRPR had been carried through. General conformity to all the measures of prevention and control of PAVM corresponded 26.94%. The maintenance of the high headboard and the attendance of therapy had been the measures that had more influenced negative in the attainment of this general conformity. It was observed in the medical handbooks that 13 (34.21%) patient ones had developed PNM during the internment. The indices of conformity and not general conformity and each specific measure of prevention and control of PAVM for these patients had been calculated, with similar results. One even so concludes that the conformity reached in this inquiry was not satisfactory (26.94%), some isolated measures that compose pointer IRPR have reached next indices the 100%. This study identified not adherence to certain practices, through established in the institution studied. It is hoped that the dissemination of results conducive to the adoption of new educational strategies for health staff in order to develop actions for continuous improvement to health care practices.

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Silva, Lúcia Marta Giunta da [UNIFESP]. "Avaliação da estrutura e processo assistencial de enfermagem na prevenção e controle da infecção de sítio cirúrgico em pacientes submetidas à cirurgia oncológica de mama." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/9017.

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Made available in DSpace on 2015-07-22T20:49:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28 Introdução: Altas taxas de infecção podem refletir a qualidade de um serviço de saúde. Considerando-se que as taxas de infecção de sítio cirúrgico (ISC) encontradas em estudos prévios no local do presente estudo variaram de 14,1% a 22%, questionou-se se a estrutura e o processo assistencial de enfermagem estariam influenciando estas taxas. Uma vez obtida esta resposta, outra indagação relacionou-se à capacidade de um programa educativo de gerar a construção de propostas ou projetos de mudanças por parte dos seus participantes, a partir e uma dinâmica que prime pela interatividade. Objetivo: Avaliar a estrutura e processo assistencial de enfermagem e um programa educativo para os enfermeiros, com o uso de estratégias educacionais interativas, para a prevenção e controle de ISC. Método: Estudo de intervenção, aprovado pelo Comitê de Ética em Pesquisa da UNIFESP sob o número 1486/07, desenvolvido em duas etapas. A primeira consistiu de um estudo observacional e de análise documental, realizado por meio de auditorias de estrutura e processo, na Unidade de Ginecologia e Setor de Oncomastologia do Hospital São Paulo (HSP), entre agosto de 2007 e março de 2008. Esta fase do estudo foi descrita no primeiro artigo que compõe o corpo desta tese. A segunda, de abordagem quali-quantitativa, foi realizada no período de outubro de 2008 a setembro de 2009 e compreende a estruturação, desenvolvimento e avaliação do projeto educacional em ambiente virtual voltado para as enfermeiras dos setores acima mencionados, para controle de ISC, baseado no Modelo Skopos e organizado a partir dos recursos do ambiente Moodle. O conjunto de dados desta etapa foi descrito nos três artigos subsequentes que compõem a tese. Resultados: A avaliação da estrutura e processo assistencial de enfermagem evidenciou que os documentos normativos estavam em consonância com o preconizado na literatura, porém, a estrutura física e os processos assistenciais dos locais pesquisados apresentavam limitações importantes com impacto negativo para o desenvolvimento dos processos assistenciais adequados à prevenção de ISC. No que se refere à estruturação e utilização de um ambiente virtual de aprendizagem na educação continuada em enfermagem, o Moodle mostrou-se valioso para estruturação de um programa educativo de enfermagem, que buscou distanciar-se do modelo de comunicação unilateral e hierárquico. A avaliação do alcance dos objetivos e da adequação dos conteúdos propostos pelo referido programa, por parte das quatro enfermeiras que participaram do processo, mostrou que as mesmas têm clareza dos benefícios e dos principais fatores limitantes atrelados aos programas educativos. E, ainda, embora novas estratégias pedagógicas, particularmente interativas, sejam bem-vindas, as profissionais preferiram os encontros presenciais para verbalização e organização das reflexões. Finalmente, a aplicação das ferramentas HFMEA® e diagrama de Ishikawa possibilitou a análise de quatro processos assistenciais de enfermagem e seus modos de falha: 1) Agendar cirurgia via Setor de Oncomastologia; 2) Fluxo de Admissão e Alta de Paciente Cirúrgico na Unidade de Internação de Ginecologia; 3) Realização de Procedimentos Cirúrgicos Ambulatoriais; 4) Retorno Ambulatorial de Pacientes Cirúrgicos. Possibilitou, ainda, a elaboração de ações de melhoria que foram iniciadas a partir das discussões realizadas no programa. Conclusões: Os resultados do estudo evidenciaram a necessidade de revisão do processo assistencial de enfermagem e adequação da estrutura, a fim de que os padrões de prevenção e controle da ISC fossem atendidos. Em relação ao programa educativo, a experiência de uso de tecnologia educacional na instituição em questão mostrou-se factível e propiciou a reflexão conjunta sobre a situação-problema vivenciada, bem como a proposta de ações para sua solução. Porém, como todo processo inovador, há uma trajetória a ser construída para que os enfermeiros habituados ao estilo expositivo, presencial e focado em objetos previamente determinados, sejam capazes de se beneficiarem de estratégias interativas, colaborativas e baseadas em projetos. Introduction: High rates of infection can reflect low health service quality. The fact that previous studies performed at the same location of the present study found surgical site infection rates (SSI) ranging from 14.1% to 22% raised questions about the possibility of the nursing care structure and process to affect those rates. After obtaining this first answer, another question emerged, concerning the capacity of an inservice training program be able to encourage the participants, by means of an interactive dynamics, to develop proposals or projects from making changes. Objectives: To evaluate nursing care structure and process in preventing and managing SSI; and evaluate an inservice training program for nurses involved in the context of the identified problems, using interactive educational strategies aiming at the prevention and control of this complication. Method: This intervention study was approved by the UNIFESP Research Ethics Committee under register 1486/07, and was developed in two stages. The first stage consisted of and observation and analysis study, performed by means of inspections of the structure and process at the Gynecology Oncomastology Units at Hospital São Paulo (HSP), between August 2007 and March 2008. This stage was described in the first article that composes this dissertation. The second stage used a quali-quantitative approach and was performed from October 2008 to September 2009. It consisted of the structure, development, and evaluation of the educational project in a virtual environment for the Training Program at Work for nurses of the referred hospital units, in SSI control, based on the Skopos Model, and organized based on the resources of the Moodle environment. The data regarding this stage was described in the three subsequent articles that comprise the dissertation. Results: The evaluation of the nursing care structure and process showed that the normative document were in agreement with the literature; however, the physical structure and the nursing care processes of the studied locations presented important limitations, which had a negative impact on the development of adequate health care processes to prevent SSI. In terms of the structure and use of a virtual learning environment in continuing nursing education, Moodle showed to be valuable in structuring a nursing training program, which sought to stand apart from a unilateral and hierarchical communication model. The evaluation of goal achievement and content adequacy of the referred program was performed by four nurses who participated in the process. The nurses found that the program presents clear benefits and the main limiting factors associated with inservice training. In addition, although new educational strategies, particularly if interactive, are welcome, the professionals preferred in-person meetings. Finally, using the HFMEA® and the Ishikawa diagram permitted to analyze four nursing care processes and their forms of failure: 1) scheduling a surgery through the Oncomastology Unit; 2) Surgery Patient Admission and Discharge Flow at the Gynecology Hospitalization Unit; 3) Performing Outpatient Surgical Procedures; 4) Outpatient Return Appointments for Surgery Patients. In addition, it was possible to make a list of improvement actions that were initiated based on the discussions held during the training program. Conclusions: The study results evidenced the need to review the nursing care process and to make the structure adequate with a view to meet the standards for SSI prevention and control. As for the inservice training program, the experience of using educational technology at the referred institution was feasible and provided the chance for group analyses about the problematic situation, as well as the proposal of actions for its solution. However, just as any innovative process, there is a pathway to be constructed so that nurses, who are used to training programs that are expositive, performed on-site and focused on previously determined objectives become capable of benefiting from interactive, collaborative, and project-based strategies. TEDE

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Martin, Cécile. "Concurrence, prix et qualité de la prise en charge en EHPAD en France : Analyses micro-économétriques." Phd thesis, Université Paris Dauphine - Paris IX, 2014. http://tel.archives-ouvertes.fr/tel-01021277.

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En France, les prix des EHPAD sont élevés au regard d'une qualité qui semble insuffisante. Des projets de réformes sont en discussion, mais les pouvoirs publics sont face à un dilemme : toute recherche de réduction des coûts risque de dégrader la qualité plus qu'elle ne l'est déjà et toute amélioration de la qualité serait probablement inflationniste.L'objectif de cette thèse est d'étudier si ce dilemme peut être résolu, en analysant en particulier le rôle de la concurrence, réelle et par comparaison, qui pourrait être introduite dans ce secteur. Par une approche micro-économétrique, nous organisons notre analyse autour de trois questions de recherche : (i) que peut-on attendre des réformes proposées de la tarification et de l'augmentation de la capacité des établissements ? (ii) comment le développement du secteur privé lucratif pourrait permettre de réduire les prix et d'améliorer la qualité ? (iii) existe-t-il des contraintes environnementales responsables de la faible qualité des EHPAD? Nous observons, d'une part, que les projets de réforme permettraient de réduire l'inefficacité et donc éventuellement les prix des EHPAD, mais au détriment de leur qualité. D'autre part, nous constatons que l'essor des EHPAD lucratifs s'accompagne d'une augmentation des tarifs et d'une dégradation de la qualité de la prise en charge, qui pourraient être modérées par une structure de marché plus concurrentielle. Enfin, les EHPAD sont confrontés à des difficultés locales de fidélisation du personnel soignant qui affectent leur qualité et qui ne semblent pas pouvoir être résolues par un ajustement des salaires. Ces résultats peuvent servir de repères à la mise en place d'une politique publique adaptée.

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"Quality assurance in perioperative nursing practice." Thesis, 2015. http://hdl.handle.net/10210/14395.

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Kearns, Irene Josephine. "A value clarification on quality within a nursing service." Thesis, 2012. http://hdl.handle.net/10210/4379.

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M.Cur. The nursing service manager is responsible and accountable for ensuring quality health care in a nursing service. The principle of liability requires a formal quality improvement programme in the nursing service according to which a specific level of quality nursing can be maintained. It is therefore clearly evident that a quality improvement programme, objectively maintain and evaluate the quality of a service. Opportunities for improvement are identified, and a mechanism is provided for taking remedial steps to bring about and maintain improvement, The abovementioned is of utmost importance and implies a constant commitment to health care service of a high quality. The overall objective of this study is to formulate and describe guidelines for a quality improvement programme for the nursing service of a referral hospital in the Gauteng Province. This study is an explorative, descriptive, qualitative and contextual research aiming to investigate the perceptions of quality in nursing/midwifery which will facilitate the exploration and description of a value clarification on quality, by the chief professional nurses, senior professional nurses, administrative personnel and patients within the nursing service of the referral hospital in the Gauteng Province. Focus group interviews, naive sketches and interviews as methods of data gathering was conducted. A simple random sampling method was used. A total number of three focus group interviews were conducted: one with seven chief professional nurses, one with fourteen senior professional nurses and one with twelve administrative personnel using tape recordings with the written consent of the participants. Naive sketches were obtained from the same groups. An expert psychiatric nurse, with a master's degree in the field and whose daily activities involved interviewing of the psychiatric nursing students and psychiatric patients, conducted the focus group interviews. The researcher conducted thirty individual patient interviews. Trustworthiness in this research was done according to Guba's model (!!! Krefting, 1991:214-222). Data analysis was done according to Tesch's (1990, in Creswell, 1994:155) protocol. An external coder with expertise in the field of coding in qualitative data was utilised to analyse and categorize the data. The researcher and the independent coder had consensus discussions for the formulation of the main categories and sub categories. Consensus discussions were also conducted with the study leader. The results were quantified based on the number of respondents whose perception on quality had reference to the same categories. The structured coding was based on the principles of quality: structure, process and outcome. A description of the conceptual framework was developed from the data analysis and a literature study. This framework with its content and criteria serves as scientific and theoretical basis of the quality improvement programme and are based on the values/value clarification on quality of the different roleplayers in the nursing service. Fifteen belief statements/values were described from the value clarification. The guidelines for the quality improvement programme of the nursing service in the referral hospital were described, based on the eight steps of the quality assurance model of Laing and Nish (Booyens, 1998: 576). A description of values is the first step and from these values on quality in the nursing service, the formulation of management standards was deduced in conjunction with the conceptual framework and the nursing/midwifery practice standards of the Nursing Department of RAU. Lastly the evaluation, limitations, recommendations and conclusion of the study were done.

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Rampfumedzi, Dorothy Pelewe. "Quality control of obstetric nursing records in a selected regional hospital." Diss., 2006. http://hdl.handle.net/10500/2442.

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Armstrong, Susan Jennifer. "A quality audit system for nursing colleges in Gauteng." Thesis, 2011. http://hdl.handle.net/10210/3560.

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D.Cur. During the last decade there has been a surge of interest in quality issues in education. This is largely due to spiralling costs of education and political demands for accountability in public institutions. In South Africa, higher education institutions are now required by law (Higher Education Act No. 101 of 1997 and the South African Qualifications Act No. 58 of 1995) to introduce quality management in an attempt to assure quality ofboth the programmes and the education providers. The Nursing Colleges in Gauteng provide nursing education to nearly 2000 nurses and, as such, make the major contribution to providing for the quality of the health care services. The colleges therefore have a double reason for introducing quality improvement measures, which start with a system for monitoring the quality of the colleges. In this study a quality audit system has been developed to address this need. There is no comprehensive internal audit system, which allows for quantitative measurement and acts as an empowerment strategy for institutional quality improvement in the nursing colleges in South Africa. The following research questions are relevant: • what should an auditing system for nursing colleges comprise? • what are the indicators of quality in a nursing college? • is the auditing system trustworthy? The overall aim of the study was to develop an audit system for the nursing colleges in Gauteng. This aim was supported by the following objectives: Phase one: to conduct a value clarification of quality within the nursing colleges in Gauteng, as perceived by the internal and external customers. Phase two: to explore and describe a conceptual framework for a quality audit system for nursing colleges in Gauteng. Phase three: a. to develop a quality audit system for the nursing colleges in Gauteng b. To pilot the audit system in one nursing college in Gauteng. A qualitative, exploratory, descriptive and contextual design was conducted within the nursing colleges of Gauteng in order to develop a contextual framework and a quality audit system for the nursing colleges. The content validity was tested by means of quantitative methods. The audit system that was developed included a tool for auditing the quality of nursing colleges as a means to identifY conformance to standards, criteria and indicators and to improve the quality of the structure, processes and results ofthe organization. The standards were developed on the basis of a value clarification of internal and external customers. Clusters ofindicators were developed for each of the standards. The value of this study is that a comprehensive audit system has been developed which empowers the staffand students ofthe college to improve the quality ofthe college. The same system can be used for purposes of accreditation, as an accountability mechanism and for institutional recognition.

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Onianwa, Patricia Obiajulu. "An appraisal of continuous quality improvement (CQI) mechanisms and development of quality care indicators amongst clinical nurses in selected teaching hospitals in South-West (SW) Nigeria." Thesis, 2009. http://hdl.handle.net/10413/8173.

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Aim: This study appraised the CQI mechanisms and processes in the clinical nursing divisions of five selected teaching hospitals located in South-West Nigeria and developed quality care indicators to measure and monitor quality of care amongst clinical based nurses in these teaching hospitals. Background: Studies have been done on evaluation of quality care to determine what good care is; whether the care nurses give is proper and effective, and whether the care provided is good quality. Several authors have asserted that evaluating the quality of nursing care is an essential part of professional accountability. Literature also suggests that in providing high quality care, it is important that nurses develop appropriate evaluative measurement tools to ensure professional aspect of nursing. Conversely, it is a concern that in the clinical nursing division of some teaching hospitals in SW Nigeria, CQI mechanisms/processes (such as a structured auditing, monitoring and measuring quality of nursing care, established systems of continuing professional learning/ In-service Education Unit) were not more evident, particularly when these teaching hospitals were supposed to be seen as models for providing quality care services. It was not certain what CQI activities were present in similar hospitals, and if such activities were present, there was uncertainty as to how these activities were performed. In addition, the type of instrument/tools available for nursing care measurement was uncertain. There is a paucity of published evidence relating to the quality of nursing care measurement in the teaching hospitals in SW Nigeria. Gaps identified in the study would form the basis for future training and education of nurses involved in care-giving to promote quality care. Findings from the study provided evidenced-based scientific rationale for practice in relation to quality nursing care measurement in the health care institutions, thus adding to the body of knowledge of quality improvement. The methodology employed in the study is an action research; with a mixed method-Sequential explanatory incorporated. Quantitative data was collected and analysed, followed by the collection and analyses of qualitative data. The study was done in five cycles which included a survey that elicited responses from the participants on general knowledge and perceptions about CQI. Cycle two included generating promising solutions and an action plan. In cycle three, established quality-care indicators were analysed, developed and thereafter, the newly adapted instrument for nursing care measurement was tested for applicability to settings. Participants reflected on the testing of the new tool in the fourth cycle and lastly, implementation/testing outcomes were evaluated in the fifth cycle. Conclusion: Established quality-care indicators were adapted in each of the five hospital settings for quality nursing care measurement. The newly adapted quality care indicators were tested for applicability on two acute-care wards in three of the five participating hospitals. The results of the study could be used in Nigeria and elsewhere as a means to protect the rights of the patient; by measuring and monitoring the quality of nursing care. Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

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Lai-Liang, Lee, and 李來涼. "Influencing Factors Affecting The Efficacy Of Implementing The Nursing Quality Control Circle." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/48786838614405664144.

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碩士 義守大學 管理科學研究所 89 Abstract The utmost concerns of any hospital administrator faced nowaday is how to lower the operational cost whereas the quality of medical care can be simultaneously maintained. For this reason, in order to be competitive in medical services, most hospitals begin to adopt and to implement a variety of quality management tactics for the purpose of maintaining their competitiveness and long-term survival in the medical profession. These tactics include quality control circle, procedural remodelization, total quality management, and ISO….etc. The aims of the present research are to assess the efficacy of nursing quality control circle(NQCC) and to delineate the factors influencing NQCC. The basis for this research is based upon the question and answer approach. The subjects who participated in this study encompassed the nursing staffs in three types of hospital (medical centers, district hopositals and local hospitals )in which NQCC are currently being conducted. The survey was conducted during the period from November, 2000 through April, 2001. A total of 464 questionnaires had been sent out. After eliminating the inappropriate returning questionnaires, a 86.6% (401 of 464) of respondent rate was obtained. The two key purposes of this questionnaire survey can be outlined: (1) to analyze the data regarding the nursing personnel and the hospital itself for the activities involving NQCC, and (2) to delineate the effects of three variables (individual, group and organization) on the performing efficacy of NQCC. The four preset goals of NQCC are: (A) Nursing quality assurance (NQA); (B) cost-effectiveness(CE); (C) Risk management (RM), (D)Staff need（SN）. Firstly, we found that “action orientation”, the fourth element of the “organization” factor, influenced NQA, CE and SN greatly (p  0.01). Conversely, “mission and goal orientation” affected RM significantly. Secondly, “group factor ” was found to affect NQCC significantly. The most obvious influencing factor in this category is “team leaders attitude and ability”, the fourth element of group factor (p  0.01) which greatly affect NQA and SN, respectively. Conversely, “specific goal” can affect CE and RM, respectively. Thirdly, “individual factor” generally affects all phases of NQCC. Among these, “personal commitment”, the first element of “individual factor”, can influence NQA, CE, RM and SN greatly (p  0.01). Keywords：nursing , quality control circle, efficacy of implementing.

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Cook, Peter 1947. "Investigation into value difference within the professional culture of nursing." 1995. http://web4.library.adelaide.edu.au/theses/09EDM/09edmc771.pdf.

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Chung, Min-Huey, and 鍾明惠. "Implementation and Operation of Pressure Injury Database and Compound Query in Nursing Quality Control." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/x9eh8t.

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碩士 國立臺灣大學 事業經營碩士在職學位學程 107 By managing adverse events in medical care, administrator can detect errors, analyze nature and causes of adverse events, and establish mechanisms to prevent them. However, most adverse event information management systems do not provide event prediction function, and most adverse event related research uses a small sample. Therefore, the present research develops an adverse event cloud database and management information system to provide clinical personnel for the management and prevention of adverse events. The specific methods and objectives include: (1) Designing and establishing an adverse event database with MySQL, including drugs events, falls events, tubing events, pressure injury and needle stick injury; (2) Building an application web service with PHP for user to manage data, search events, and generate statistical charts of adverse events; (3) Providing users explore important factors of damage of adverse events with decision tree model function in the web page. In this study, the random forest model was used to predict the severity of hospital pressure injuries, and the correct rate was 54.5~64.4%. The most important factors affecting the degree of pressure injury in the adverse events were the occurred units. The others include the site of occurrence, repeated friction at the apophysis, the use of assistive devices, long-term fixed posture, and Barden Scale score. In addition to facilitating medical personnel to report on adverse events in the hospital, this system also provides decision tree model results. These can be reference for clinical and have important contributions to the prevention and management of adverse events, and finally to enhance patient safety.

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Banamwana, Gilbert. "Exploring the perceptions of quality nursing care among nurses working in two district hospitals in Rwanda." Thesis, 2011. http://hdl.handle.net/10413/11057.

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It has been reported for over the last decade that the quality of nursing care provided towards patients has decreased tremendously. The literature shows the impact of poor quality nursing to patients and assumes the influence of nurses’ perceptions of quality nursing care on its delivery. However, studies about such perceptions are still few in Rwanda. Aim: The purpose of this study was to explore the perceptions of quality nursing care among nurses working in two district hospitals in Rwanda. Methodology: A non-experimental exploratory descriptive design which was quantitative in nature was used. A self-report questionnaire comprised items related to socio-demographic characteristics of participants, perceptions of quality nursing care, nurses’ role in continuous quality improvement and factors affecting the delivery of quality nursing care. The sample was obtained through a purposive non-probability sampling of the nurses (n=150) who were available during data collection from 16 to 28 October 2011, with a return rate of 110 (73%) of completed questionnaires. Results: The findings from demographic data indicated that many of nurses were young, with 48.2% falling into the 20 to 30 year old bracket and the majority of the participants (83.3%) were enrolled nurses. Many of the participants were new to the nursing profession, with 47.2% falling into the 6 months-5 years working experience bracket. This study suggests that nurses had an appropriate perception of quality nursing care, as evidenced by the mean score of 4.183 (SD: .5741), related to nurses’ understanding of quality nursing care with mean score of 4.137 (SD: .5763) for the perceptions of the delivery of quality nursing care. The role played by nurses in continuous quality improvement was evident, but it was constrained by the factors related their nursing practice environment, including: shortage of nurses, lack of time, heavier workloads, and few opportunities for advancement. Conclusion: In summary, this study provided insights into nurses’ perceptions of quality nursing care, and their current ongoing endeavours to provide quality improvement in spite of challenges in their workforce environment. This study has described the challenges which interfere with the delivery of quality nursing care that need to be addressed so that patients may benefit from evidence-based care. Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

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Van, der Westhuizen Lucille Bertha. "The quality of nursing unit management in training hospitals in Namibia." Thesis, 2012. http://hdl.handle.net/10210/7095.

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M.Cur. The study on the quality of nursing unit management was done in the four training hospitals approved for registered nurses' training in Namibia. There are no written standards on the quality of unit management in the hospitals. The objectives of the study were to formulate standards on quality nursing unit management and to evaluate compliance of clinical units with these standards A quantitative, contextual, descriptive and evaluative research design was followed. The study was done in two phases. In phase one, standards were formulated by means of a literature study by the researcher and validated through consensus discussion groups with nurse managers representing the different management levels and clinical disciplines. Purposive sampling was used and 25 participants rated the draft standards for relevance, representativeness, completeness and clarity. A rating instrument for this purpose was attached to the draft standards in the form of a questionnaire, and posted to participants, before the consensus discussion groups. Reliability and validity of the instrument and related items were ensured through the development of a conceptual framework and the consensus discussion groups. The pilot study indicated that a rating scale of 'Compliance', Partial Compliance, 'Non-Compliance' and 'Not Applicable' are more appropriated. Phase two represents the quality survey for the compliance with standards. The sample for the quality survey included 60 units from all four hospitals, representative of all clinical disciplines. Data was collected by means of interviews, observation and document analysis, using an evaluation instrument. Two surveyors, the researcher and a colleague, both lecturers from the Department of Nursing, University of Namibia, were involved in the data collection process. Double evaluations were done in 19 clinical units, representing 31,7% of the total clinical units (n=60), and the researcher alone evaluated 41 units, representing 68,3%. A high inter-rater reliability between the ratings of the surveyors was proven. The ethical principles of informed consent and anonymity have been adhered to throughout the study. Data was analysed through statistical analysis and are presented as descriptive statistics and comparative statistics. The findings revealed that, although unit nurse managers emphasise unit organisation, the quality of nursing unit management in the training hospitals in Namibia is poor. The findings also revealed that a need exists to empower nurse managers through in-service education on strategic planning as well as quality management in general. The recommendations from this study are to make written standards available, to empower nurse managers in quality management, to validate standards for quality nursing unit management nationally in the Namibian hospitals and for further research.

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Miles, Irene Moira. "Resocialization of nurses from functional to scientific nursing." Thesis, 2014. http://hdl.handle.net/10210/12010.

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Booi, Mutshavhani Charlotte. "Quality management systems used by nursing education institution in Gauteng Province." Thesis, 2008. http://hdl.handle.net/10500/2606.

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Quality assurance forms an integral part of education and training programme delivery. The purpose of this research was to determine whether the quality management systems (QMS) used by nursing education institutions in Gauteng are aligned to the SAQA criteria and guidelines for education and training providers. A quantitative, descriptive and exploratory design was followed using a self-administered questionnaire as data gathering instrument. A total of 32 respondents from three selected nursing education institutions completed the questionnaire. The data were analysed by using the Statistical Package for Social Sciences (SPSS) program. The findings revealed that the nursing education institutions only partially comply with SAQA’s core criteria for quality management systems. Recommendations to improve the current QMS were made. Health Studies M.A. (Health Studies)

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Labuschagne, Linette. "Gehalteverpleging van meganies-geventileerde pasiënte." Thesis, 2014. http://hdl.handle.net/10210/10779.

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M.Cur. The intensive care nurse practising respiratory nursing care, is responsible for giving high quality nursing care. Due to the rising cost of health care more pressure is placed on the nurse to provide a high quality nursing care (Sanazaro, 1986:27) Bruwer (1986:220-245) states that there is a need for an orderly, methodical qua l Ity assurance approach on all nursing levels in South Africa, based on a South African model, as well as the development of nursing standards for public and private hospitals. Mechanical ventilation forms an important part of the nursing of the adult critically ill patient in the intensive care unit. To ensure that the patient benefits from mechanical ventilation and does not suffer from complications due to mechanical ventilation, standards must be developed to ensure the giving of a high quality of nursing care. Without these standards it is impossible to determine the quality of their nursing care given. The quality can furthermore,only be questioned and not be determined scientifically. Standards for providing high quality nursing care to mechanically ventilated patients do not exist in South Africa. The quality of the nursing care that these patients receive is therefore questioned.

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Pope, Eloise. "The experience of registered nurses nursing in the general adult intensive care unit." Thesis, 2014. http://hdl.handle.net/10210/12011.

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M.Cur. (Intensive Care Nursing) The problem of intensive care nurses leaving the profession due to non-conducive working environments and uncompetitive conditions of employment is becoming more alarming and is therefore as relevant as ever. The researcher is concerned about the quality of nurse-awareness nurses create in order to practice quality nurse care. Confusion among nurses about their professional rights and responsibilities adds fuel to the fire. The management of health care services is at times not sensitive to the needs of nurses, and nurses are not always recognized for their inherent professional worth. In the adult intensive care unit at which the researcher practices as unit manager she perceived her colleagues to be experiencing some sort of emotional and spiritual discomfort in going about their daily activities. As the researcher felt responsible for the well-being of the staff in the unit she decided to investigate the phenomenon via a formal research study. The objectives of the study were two-fold: Firstly to explore and describe the registered nurse's experience of nursing in the intensive care unit and then to use the information obtained to describe guidelines for the compilation of a support programme for the nurses nursing in the unit The research questions that were generated are: How do registered nurses in the intensive care unit experience nursing there and how can the information be utilized to describe guidelines to support these nurses? The researcher used an exploratory, descriptive, contextual and phenomenological qualitative design to answer these research questions. Phenomenological interviews were conducted with five interviewees who had been possessively selected.

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Els, Roelien. "An exploration of the perceptions of nurses of their roles and responsibilities in realisation of the quality improvement initiative "Back to Basics" nursing care." Diss., 2017. http://hdl.handle.net/10500/24860.

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Patient outcomes are influenced by the quality of care that the workforce renders. The registered nurse, as designated process-owner of the “Back to basics” quality improvement (QI) initiative, plays a vital role, being responsible for providing compassionate patient-centred care to alleviate suffering and restore health. The aim of the study was to gain an in-depth understanding of how nurses perceive their roles, responsibilities and challenges in delivering basic nursing care, linked to the organisational “Back to basics” QI initiative. A qualitative study with an explorative descriptive contextual design was utilised. Registered nurses with a direct patient care involvement in the general nursing discipline of a private hospital group participated in focus-group interviews. Data were analysed using Creswell’s data-analysis cycle. Findings were that patient care coordination involves an assessment-delegation-supervision triad. However, meeting stakeholder expectations, management and administrative responsibilities, remove the registered nurse from direct patient care. Time constraints affect physical bedside availability to model the exemplary knowledge, skills and attitudes underlying quality basic nursing care delivery. Reduced opportunities to model quality basic nursing care at the bedside affect patients’ care expectations, resulting in complaints related to basic nursing care omissions. Participants felt that they needed more clarification on the “Back to basics” QI initiative, and more in-service training. The many broad-ranging recommendations include in-service training that empowers registered nurses with the competencies to deal with role and task balance in the face of the diverse and complex demands of the modern healthcare arena. Health Studies M.A. (Health Studies)

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"The clinical competencies of the shift leader in the ICU setting." Thesis, 2010. http://hdl.handle.net/10210/3244.

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M.Cur. The purpose of this study was to describe the clinical competencies of the shift leader in the ICU setting in order to determine if there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative, descriptive design was used and cluster sampling implemented. A survey, utilizing questionnaires, was used to gather data from three clusters, comprising 11 hospitals from a single private healthcare group. 251 questionnaires were distributed and 98 were returned, indicating a response rate of 39%. Validity and reliability were ensured. Results indicated that respondents classified the majority of competencies as essential competencies. None were classified as critical competencies and only four were classified as specific competencies. Shift leaders were viewed as competent by all respondents in all three clusters. Results were used to describe a typology of the competencies of the shift leader in the ICU setting.

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39

Rosetti, Maureen C. O'Keeffe. "The impact of ownership type on the cost and quality of nursing home care in the United States." Thesis, 1995. http://hdl.handle.net/1957/34932.

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The overall objective of this research was to analyze the effect of ownership status on 1) quality of care delivered, 2) the cost of nursing homes in the United States and 3) wages to Registered Nurses. The model developed here uses a two stage least squares technique to correct for observed endogeneity problems. Results show that a model which includes ownership classification interactively with all independent variables, performs better than a model which simply uses dummies to proxy for ownership status. Nonprofit homes were found to have higher direct patient care expenditures than profit homes. Non-profits were also found to have a more specialized nursing force. Both of these results suggest that non-profits may actually provide a higher quality of care than for profit enterprises. No support was found for the hypothesis that nonprofits have more philanthropic wage policies. Graduation date: 1996

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Eilers, Helea Sophia. "Standaarde vir 'n verplegingskollege." Thesis, 2014. http://hdl.handle.net/10210/12018.

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M.Cur. College management is liable for quality management ofthe college to facilitate quality education. Nursing collegeshave the autonomous responsibility for planning, organising, implementing and controlling nursing education in order to ensure the achievement of programme objectives set by the South African Nursing Council. The college is further accountable to the community for the training of nurses to meet their health needs. Through the implementation of quality improvement strategies, which begin with the description of standards, the college manager accepts responsibility for facilitating quality nursing education through quality management. The purpose of the study was to describe standards for a nursing college, which can be used as a management instrument to facilitate quality education, as well as effective functioning of a nursing college. The aim of the study is justified by means of a descriptive, explorative, contextual research design. Standards for a nursing college were developed and validated by utilising a structured two-phase research method. For the development of standards, the Delphi method, round one, was used to identify subjects for standards, after which a preliminary conceptual framework was compiled. A comprehensive literature control was then undertaken to refine the preliminary conceptual framework. A final conceptual framework was formulated which served as a basis for the description of standards. The final validation of standards occurred in the quantifying phase by means of consensus discussions between experts during round two of the Delphi method. The main subjects for which standards were described, include philosophy, mission, strategic planning, personnel management, general management, research role of the tutor, community involvement, academy, students and quality improvement programme. Structural standards, which can be utilized as a management instrument, were described and represented in the form of an accreditation instrument. The purpose of this instrument is for management to use it for self-evaluation, while the standards are implemented and tested in the nursing colleges.

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Muller, Marie Elizabeth. "Verpleegdiensstandaarde vir privaathospitale." Thesis, 2014. http://hdl.handle.net/10210/10645.

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D.Cur. With the current expanding privatisation of health services in South Africa, the establishing of quality assurance mechanisms is not only essential but is becoming a prerequisite for further privatisation. Privatisation of health care services, together with economical problems, are causing the role fulfilment and accountability structure of the nurse administrator to become much more complex and greater demands are continually made. A profile of the nurse administrator in private hospitals in South Africa, was compiled by means of an explorative descriptive study. This was done to ascertain their preparedness for the formalisation of quality assurance in nursing. The conclusion which was ultimately reached conceded that the nurse administrator in South African private hospitals, is not adequately prepared for her managerial responsibilities. She is, however, according to the registered qualifications, adequately qualified;.. to exercise effective quality control and assurance in the various nursing disciplines. Consequently national nursing service standards for private hospitals were formulated. These standards were validated bya representative group of national experts. The validation process consisted of a two-stage research technique. The statistical validity was calculated by means of a content validity index for each standard. Fourteen (N=275) of these standards (5%) were rejected by the whole group and 25 (9%) require reformulation. The respondents from the private sector rejected three more standards. Standards form the basis of the quality assurance process. These standards should equip the nurse administrator with valuable guidelines to promote a high standard of nursing service management in private hospitals. It is recommended that these standards should serve as optimum standards for nurse administrators in private hospitals.

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Mavanyisi, Rynnet Doris. "The effect of quality assurance nurse managers on the provision of patient care at selected public hospitals in the Limpopo Province." Diss., 2014. http://hdl.handle.net/10500/18842.

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Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. Health Studies

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Pryse, Yvette M. "Using Evidence Based Practice: The Relationship Between Work Environment, Nursing Leadership and Nurses at the Bedside." Thesis, 2013. http://hdl.handle.net/1805/3220.

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Indiana University-Purdue University Indianapolis (IUPUI) Evidence based practice (EBP) is essential to the practice of nursing for purposes of promoting optimal patient outcomes. Research suggests that the implementation of EBP by staff nurses is problematic and influenced by beliefs, nursing leadership and the work environment. The purpose of this descriptive study was to examine variables that describe the relationship among beliefs about EBP, the work environment and nursing leadership on the EBP implementation activities of the staff nurse. The variables of interest were 1) individual staff nurse characteristics, 2) beliefs about EBP, 3) the EBP work environment and 4) nursing leadership for EBP. A descriptive, quantitative method was used. A sample of 422 Registered Nurses from two urban hospitals (one Magnet and one non-Magnet) completed an online 58 item survey that included questions related to individual belief’s about EBP, the EBP work environment and nursing leadership for EBP as well as EBP implementation activities. Education, tenure and Magnet status were not significantly related to EBP implementation activities in either the univariate or multivariate analysis. EBP beliefs had a significantly positive relationship with EBP implementation activities in both the univariate and multivariate analyses. Work environment and nursing leadership support for EBP had significant positive relationships with self-reported implementation activities in only the univariate analysis. The most surprising finding was that there were no differences between Magnet and non-Magnet work environments for EBP implementation scores, yet the Magnet hospitals reported higher means on the EBP Beliefs Scale than the non-Magnet hospital. The results of this have implications for identifying and testing strategies to influence EBP implementation activities through development of nursing leadership skills for EBP and creating a more EBP friendly work environment.

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Reimer, Nila B. "Things that matter to residents in nursing homes and the nursing care implications." Thesis, 2014. http://hdl.handle.net/1805/6054.

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Indiana University-Purdue University Indianapolis (IUPUI) A move toward care of residents in nursing homes where they are respected and heard is finally emerging. Common strategies used in nursing homes to improve quality of care for residents are integration of person-centered care and assessing care using satisfaction surveys. Although approaches of integrating person-centered care and satisfaction surveys have been valuable in improving nursing home quality, strategies of care that include things that matter from residents’ perspectives while living in nursing homes need investigation. The purpose of this qualitative descriptive study was to describe things that residents age 65 and older state matter to them while living in the long-term care sections of nursing homes. A qualitative mode of inquiry using purposeful sampling led to a natural unfolding of data that revealed things that mattered to residents. Content analysis was used to reduce the data in a manner that kept the data close to the context yet moved the data toward new ideas about including things that mattered to residents in nursing care. The findings revealed residents’ positive and negative experiences and addressed the question: How can nurses manage residents’ positive and negative aspects of care in nursing homes? This study substantiated the importance of developing nursing care strategies derived from residents’ descriptions of care. Finding ways to promote nurses’ investment in attitudes about a person-centered care philosophy is essential for successful person-centered care implementation. Enhancing nurses’ knowledge, skills, and attitudes with an investment in person centeredness will be more likely to put nurses in a position to role-model care that is person-centered from residents’ perspectives.

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45

"Associations of Depression, Sleep, and Acculturation on Glycemic Control in Korean Americans with Type 2 Diabetes Mellitus." Doctoral diss., 2017. http://hdl.handle.net/2286/R.I.44147.

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abstract: Type 2 diabetes mellitus (T2DM) is a chronic disease affecting more than ten percent of the U.S. adults. Approximately 50 percent of people with diabetes fail to achieve glycemic targets of A1C levels below seven percent. Poor glycemic control disproportionately affects minority populations such as Korean Americans (KAs). Successful diabetes self-management requires a comprehensive approach that takes into account depression, sleep, and acculturation to achieve good glycemic control. Therefore, the purposes of this study were to: 1) describe the levels of glycemic control, depressive symptoms, sleep quality and duration, and acculturation; 2) examine an association of depressive symptoms with glycemic control; 3) identify mediational roles of sleep quality and sleep duration of less than 6 hours between depressive symptoms and glycemic control; and 4) explore a moderation role of acculturation between depressive symptoms and glycemic control in KAs with T2DM. This is a cross-sectional, descriptive correlational study. A total of 119 first generation KAs with T2DM were recruited from Korean communities in Arizona. A1C levels, the Center for Epidemiological Studies Depression Scale, the Pittsburgh Sleep Quality Index, the Suinn-Lew Asian Self-Identity Acculturation scale, the International Physical Activity Questionnaire, and the Berlin Questionnaire were measured. Descriptive statistics, multiple regression analyses, path analyses, and the Sobel tests were conducted for data analyses of this study. Poor glycemic control (A1C ≥ 7 %), high depressive symptoms (CES-D ≥ 16), poor sleep quality (PSQI > 5), and short sleep duration (< 6 hours) were prevalent among KAs with T2DM. The mean score of acculturation (2.18) indicated low acculturation to Western culture. Depressive symptoms were revealed as a significant independent predictor of glycemic control. Physical activity was negatively associated with glycemic control, while cultural identity was positively related to glycemic control. Sleep quality and sleep duration of less than 6 hours did not mediate the relationship between depressive symptoms and glycemic control. Acculturation did not moderate the association between depressive symptoms and glycemic control. Diabetes self-management interventions of a comprehensive approach that considers depressive symptoms, sleep problems, and cultural differences in minority populations with T2DM are needed. Dissertation/Thesis Doctoral Dissertation Nursing and Healthcare Innovation 2017

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Schoonwinkel, Petronella Beulah. "'n Program om gehalte-werklewe van psigiatriese verpleegkundiges te bevorder." Thesis, 2014. http://hdl.handle.net/10210/9197.

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"Standaarde vir die volwasse pasiënt op druk-gekontroleerde ventilasie in kritiekesorgeenhede." Thesis, 2012. http://hdl.handle.net/10210/5607.

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M.Cur. Nursing practitioners working in the critical care unit are responsible for quality nursing care of the patient on pressure-controlled ventilation. Pressure-controlled ventilation is a high-risk interaction, with potential life-threatening complications, for example barotrauma.There are, however, in the South-African context no standards for pressure-controlled ventilation with which quality nursing of the patient on pressure-controlled ventilation can be evaluated. The following question is then asked in this study: Which standards should be formulated for the adult patient on pressure-controlled ventilation incritical care units? The goal of this study is then to formulate standards for the adult patient on pressure-controlled ventilation in critical care units. An explorative, descriptive and modified standard-generating research design is followed in this study. The research methodology as suggested by Muller (1998a:606-609; 1998b:636-637) for standard development during the quality improvement process is used in this study. Standard formulation consists out of three phases, namely a development phase, a quantifying-/ validation phase and a testing phase. During the development phase of this study, a literature study is conducted after which concept standards for the adult patient on pressure-controlled ventilation in critical care units are formulated. During the validation phase of this study, the concept standards are validated by means of a consensus debate session with clinical domain experts. Seventeen standards in total were formulated. Standard one to fifteen are structure standards. These standards address the ethico-legal, philosophical and management framework according to which the nurse practitioner functions during the nursing of the adult patient on pressure controlled ventilation in critical care units. It also includes the fascilitating context, as well as facilities, equipment, stock and medication, procedures and protocols and aspect of personnel development necessary to nurse the patient on pressure-controlled ventilation. Lastly in this group of standards the knowledge and skills which the critical care nurse requires for nursing the patient on pressurecontrolled ventilation are described. Standard sixteen is the process standard for nursing the patient on pressure-controlled ventilation.This standard is described as one comprehensive standard to facilitate easy use in practice and to address the nursing process holistically. Standard seventeen can be described as the outcome standard for the nursing of the adult patient on pressure-controlled ventilation and describes the expected aspects of quality improvement.

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Baumann, Paula Kerler. "The Relationship between Individual and Organizational Characteristics and Nurse Innovation Behavior." Thesis, 2011. http://hdl.handle.net/1805/2603.

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Indiana University-Purdue University Indianapolis (IUPUI) Nurses are a key component of the health care system and have the ability to provide innovative solutions to improve quality and safety for patients, while improving workplace conditions, and increasing recruitment and retention of nurses. Encouraging innovation behaviors among nurses is essential to improving health care. Innovation behaviors are defined as behavior from an employee toward developing new products, developing new markets, or improving business routines in their employing organization. The purpose of this descriptive study was to explore the relationships among individual and organizational characteristics and employee innovation behavior among nurses. The proposed model, The Framework for Study of Innovation Behaviors among Nurses, was developed based on the work by Kuratko, Hornsby, and Montagno and is specific to nursing innovation behaviors.

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"Novel Statistical Models for Complex Data Structures." Doctoral diss., 2012. http://hdl.handle.net/2286/R.I.15200.

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abstract: Rapid advance in sensor and information technology has resulted in both spatially and temporally data-rich environment, which creates a pressing need for us to develop novel statistical methods and the associated computational tools to extract intelligent knowledge and informative patterns from these massive datasets. The statistical challenges for addressing these massive datasets lay in their complex structures, such as high-dimensionality, hierarchy, multi-modality, heterogeneity and data uncertainty. Besides the statistical challenges, the associated computational approaches are also considered essential in achieving efficiency, effectiveness, as well as the numerical stability in practice. On the other hand, some recent developments in statistics and machine learning, such as sparse learning, transfer learning, and some traditional methodologies which still hold potential, such as multi-level models, all shed lights on addressing these complex datasets in a statistically powerful and computationally efficient way. In this dissertation, we identify four kinds of general complex datasets, including "high-dimensional datasets", "hierarchically-structured datasets", "multimodality datasets" and "data uncertainties", which are ubiquitous in many domains, such as biology, medicine, neuroscience, health care delivery, manufacturing, etc. We depict the development of novel statistical models to analyze complex datasets which fall under these four categories, and we show how these models can be applied to some real-world applications, such as Alzheimer's disease research, nursing care process, and manufacturing. Dissertation/Thesis Ph.D. Industrial Engineering 2012

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Uys, Cornelle. "Quality management : barriers and enablers in a curative primary health care service." Diss., 2004. http://hdl.handle.net/10500/1908.

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Curative primary health care nurses are the first level of contact with health personnel the patient has when entering the district-driven health system of South Africa. It is imperative that these nurses are competent, or patients may suffer. Several factors exist as barriers to competent curative care. Donabedian's structure-process-outcome framework has been used in the study of these factors. Literature were selected from international and national studies of nursing to discover barriers and enablers in general nursing care but also specifically in curative primary health care. The curative primary health care nurses in the Southern Cape/Karoo region were used as a sample for the study. Data gained from questionnaires were organised to present the findings: Barriers to a curative PHC service seem to be multifactorial, with scarce resources causing great stress for the workforce. This have a negative impact on relationships between employer and employee, CPHCNs and their patients, the type of managing that take place, and the quality of the examination and treatment of patients. Slow changes frustrates workers, causing more stress and poor attitudes, feelings of not being valued, and not being motivated (internally and externally). Enablers examined showed that although the workforce may be discontented and overworked, they still try to deliver their best, with few medical mistakes. Patients still have a lot of respect for their healthcare deliverers, but this trend may not continue for much longer. Patients are already returning more often to clinics, causing even more stress for staff. Health Studies M.A. (Health Studies)

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