Tesi: "Medical personnel and patient"

1

Wentzell, Natasha. "Improving the measurement of patient safety : development of a new patient safety climate survey /". Halifax, N.S. : Saint Mary's University, 2008.

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2

Nimmo, Graham R. "Materialities of clinical handover in intensive care : challenges of enactment and education". Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/21540.

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The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

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3

Wong, Lai-cheung. "A study of hospice care : [factors affecting] communication between the health care professionals and the patients /". [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13409475.

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4

Holman, Grady Talley Thomas Robert Evans. "Patient handling restrictions & conditions". Auburn, Ala., 2007. http://repo.lib.auburn.edu/2007%20Fall%20Dissertations/Holman_Grady_7.pdf.

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5

Ding, Chunyan. "Medical negligence law in transitional China a patient in need of a cure /". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43913696.

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6

Rutledge, Thomas. "Psychological response styles and cardiovascular health : confound or independent risk factor?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0002/NQ34622.pdf.

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7

Poznanski, Carol A. "An analysis of nursing personnel staffing patterns and patient falls on two medical units /". Staten Island, N.Y. : [s.n.], 1987. http://library.wagner.edu/theses/nursing/1987/thesis_nur_1987_pozna_analy.pdf.

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8

Aagard, Erik A. "A pre-design study of patient and medical professional atitudes and reactions towards the colors of medical scrubs". Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1218038251.

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9

Fu, An-Chen Brooks John M. "The influence of local area physician supply on the dispersion of care among Medicare patients with a consistent diagnosis". [Iowa City, Iowa] : University of Iowa, 2009. http://ir.uiowa.edu/etd/360.

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10

Ding, Chunyan, e 丁春艳. "Medical negligence law in transitional China: a patient in need of a cure". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43913696.

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11

Svenaeus, Fredrik. "The hermeneutics of medicine and the phenomenology of health : steps towards a philosophy of medical practice /". Linköping : Tema, Univ, 1999. http://www.bibl.liu.se/liupubl/disp/disp99/arts187s.htm.

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12

Beaulieu, Anne. "The truth of the trace : constructing the power of the medical image". Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=26637.

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This thesis traces the developments of imaging technologies used for medical diagnosis. Giddens' sociological theory of modernity serves as a basis for the consideration of the bureaucratisation of medicine and the use of the patient file as source of information about health. The importance of 'inscriptions', in relation to scientific knowledge and power, is analysed through Bruno Latour's theory. Donna Haraway's call to rethink objectivity, not as a quality of universal knowledge, but as a given point of view, also influence the approach of this discussion of diagnostic practices.
The author demonstrates the need for abstract concepts of patient and disease to achieve modern medicine. The links between theoretical notions (anatomical pathology, in particular) and diagnostic practices, as well as the concept of objectivity underlying the use of technology to gather information about health are examined. The effects of the biostatistical method used to evaluate health are also discussed. Finally, the importance of context in the experience of illness is noted.

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13

Lauria, Ivone Do Carmo. "Contribution à une méthodologie de l'étude des représentations sociales: une approche des relations structurelles et interpersonnelles en milieu hospitalier". Doctoral thesis, Universite Libre de Bruxelles, 1997. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/212102.

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14

Wong, Lai-cheung, e 黃麗彰. "A study of hospice care: [factors affecting] communication between the health care professionals and thepatients". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1992. http://hub.hku.hk/bib/B31977182.

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15

Oswald, Sharon. "A retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission". Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27289.

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This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.

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16

Breslin, Jonathan M. Gedge Elisabeth Boetzkes. "A care-based model of the physician-patient relationship /". *McMaster only, 2003.

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17

Park, Louisa. "The influence of effective communication between patients and health professionals on patients' perceptions of quality of care, health outcomes, and treatment compliance /". [St. Lucia, Qld.], 2006. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19741.pdf.

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18

Abdul, Rouf P. V. "Exploring patient and health professional use, views and attitudes towards complementary and alternative medicines during pregnancy". Thesis, University of Aberdeen, 2015. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=228640.

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The aim of this doctoral research was to explore CAM use in pregnancy from the perspectives of pregnant women and health professionals. The research was conducted in four phases: a systematic review of the published literature from 2008-2012; cross sectional surveys of two cohorts of women during the first and last trimester; and a cross sectional survey of health professionals (midwives, obstetricians, anaesthetists) at Aberdeen Maternity Hospital. The systematic review reported a significant proportion of women used CAM during pregnancy with prevalence rates ranging from 5.8% to 74.2%. The study of health professionals identified that more than 30% of respondents have prescribed, referred or advised the use of CAM to pregnant women. The main associated factor for CAM use was, 'personal use of CAM', with an odds ratio of 8.26 (95% CI 3.09–22.05; P < 0.001). Two thirds of women (63%) reported using CAM, excluding vitamins and minerals, during early pregnancy. The independent predictors of CAM use identified were: use by family and friends (OR 4.1, 95% CI 2.3–7.3, p < 0.001); ethnicity (non-white British) (OR 3.4, 95% CI 1.8–6.8, p < 0.001); and use prior to pregnancy (OR 2.4, 95% CI 1.2–4.8, p = 0.014). Two thirds of women (61.4%) reported using CAM, excluding vitamins and minerals, during the third trimester. The independent associated factors for CAM medicine use identified were: CAM use before pregnancy (odds ratio [OR] 4.36, 95% confidence interval [CI] 2.39–7.95, P<0.001); a university education (OR 2.41, 95% CI 1.46–4.0, P<0.001), and CAM use by family or friends (OR 2.36, 95% CI 1.61–3.47,P<0.001). The lack of an evidence based approach together with the reliance on the advice of family and friends is of concern given the lack of robust data of efficacy and safety. To date, four peer reviewed papers from this doctoral research have been published.

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19

Allen, Sheldon. "The feasibility of implementing brief motivational interviewing in the context of tuberculosis treatment in South Africa". Thesis, Stellenbosch : University of Stellenbosch, 2006. http://hdl.handle.net/10019.1/4867.

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Digitized using a Konica Minolta 211 PCL Scanner. 300dpi (OCR).
Thesis (MA (Psychology))--University of Stellenbosch, 2006.
AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die uitvoerbaarheid van die implementering van 'n benadering genaamd Kort Motiverende Onderhoud (KMO) in die konteks van die behandeling van tuberkulose (TB) in Suid-Afrika. TB is 'n ernstige bedreiging vir wereldwye gesondheid en is nog nie onder beheer gebring nie, ten spyte van die feit dat dit geneesbaar is. Sedert die beskikbaarheid van effektiewe medisyne-middels, is die oorsaak vir die voortdurende verspreiding van die siekte gesien as 'n probleem van gebrekkige deurvoerbaarheid van die behandeling. Hierdie eng begrip van die epidemie is deur die psigologiese en sosiale wetenskappe, asook andere, verbreed. Daar is baie debatering oor en om die onderwerp van deurvoerbaarheid en die internasionale TB beheer beleid, bekend as Direkte Observerings-Behandeling, Kortkursus (DOBK). Sekere deskundiges argumenteer dat DOBK 'n onvoldoende respons is tot die uitdaging van die verbetering van deurvoerbaarheid en die kontrolering van TB. Dit skyn asof die meelewende aspekte van die TB behandeling nagelaat word in die TB beleide en protokol en sommige beweer dat hierdie faktor sowel as gebrekkige aandag aan ander sistemiese faktore verantwoordelik is vir swak programuitvoering. Suid-Afrika is 'n voorbeeld hiervan, waar die kommunikasie tussen verpleegsters en TB pasiente beskryf word as outoriter, verpleegstergesentreerd en taakgeorienteerd. 'n Pasientgesentreerde benadering (PGB) is 'n wyse waarop die pasientversorger kommunikasie en die bevredigingsvlak van die pasient bevorder word en sommige promoveer dit as a wyse om die behandelingsdeurvoerbaarheid en genesingsuitkomste te verbeter. Die uitdaging is egter dat die konsep van 'pasientgesentreerdheid' op verskeidenheid van wyses geinterpreteer en geimplimenteer kan word. KMO is 'n PGB tot kommunikasie wat bestem is om 'n gees van samewerking te bevorder en om mense se gemengde gevoelens oor gedragsverandering by te le. KMO as 'n aanpassing van Motiverende Onderhoudvoering, is 'n spyskaart van konkrete vaardighede of middels wat gesondheidsvoorsieners in onderhoude rakende geneeskundige gedragsverandering kan gebruik. KMO is gebaseer op teoriee oor gedragsverandering en word gebruik in 'n wye verskeidenheid van genesingsbehandeling, insluitende deurvoerbaarheidsbehandeling. Alhoewel dit selde in minder ontwikkelende lande toegepas is en nog nooit in TB, is KMO suksesvol toegepas in ander besige kontekste vir gesondheidsvoorsiening. Die ontwerp van die huidige studie oor die lewensvatbaarheid van KMO in die konteks van TB behandeling in Suid-Afrika het ontstaan uit die ontwerp van 'n groter studie wat ander intervensies vir 'n PGB ingesluit het. Die doelstellinge van die huidige studie was om die konteks te beskrywe en wat gebeur het gedurende die intervensietydperk en om die uitvoerbaarheid van KMO te verduidelik.
ENGLISH ABSTRACT: This thesis explores the feasibility of implementing an approach called Brief Motivational Interviewing (BMI) in the context of tuberculosis (TB) treatment in South Africa. TB is a serious threat to global health and has not been controlled despite the fact that it is curable. Ever since effective drugs became available, continued spread of the disease has been understood as a problem of poor adherence to treatment. This narrow understanding of the epidemic has been broadened by psychological and social science perspectives among others. There has been much debate around the topic of adherence and the international TB control policy known as Directly Observed Treatment, Short-course (DOTS), as some suggest that it is an incomplete response to the challenge of improving adherence and controlling TB. The caring aspects of TB treatment seem to be neglected in TB policies and protocols, and some argue that this and the lack of attention to other systemic factors are responsible for poor programme performance. South Africa is an example of this, where the communication between nurses and TB patients has been described as authoritarian, nursecentred and task-oriented. A patient-centred approach (PCA) is a way of improving patient-provider communication and patient satisfaction, and some promote it as a way of improving treatment adherence and health outcomes. The challenge, however, is that the concept of 'patient-centredness' can be interpreted and implemented in a variety of ways. BMI is a PCA to communication that is designed to promote a spirit of collaboration and resolve people's mixed feelings about behaviour change. An adaptation of Motivational Interviewing, BMI is a menu of concrete skills or tools that health providers can use in consultations about health behaviour change. BMI is based on theories about behaviour change and has been used to address a wide variety of health behaviours, including treatment adherence. Although seldom applied in less developed country settings and never before applied in TB, BMI has been successfully applied in other busy health care settings. The design of the present study of the feasibility of BMI in the context of TB treatment in South Africa evolved within the design of a larger study that included other interventions designed for a PeA. The present study aims were to describe the context and what happened during the intervention period and to describe BMI's feasibility. Using elements of participatory action research, BMI communication training was developed and implemented with TB staff based in four urban primary health care facilities. A grounded theory approach was used to describe the dynamics of the implementation process and generate a theory about what made BMI more or less feasible in this context. A multidisciplinary team contributed to the study design. Data were gathered largely through participant observation, focus groups and key informant interviews and generated volumes of diverse materials including field notes, training materials, video and audio-taped interactions. The data were analysed using the inductive approach to grounded theory analysis promoted by Glaser (1992) and relied on theoretical sampling and constant comparative analysis. The quality and trustworthiness of the data were ensured through an emphasis on researcher reflexivity and triangulation of the perspectives of different materials, participants and health facilities. The study was implemented as a pilot BMI training process at one facility in Port Elizabeth (Eastern Cape Province) followed by expanded training targeting TB staff of three facilities in Cape Town (Western Cape Province). Data analysis resulted in a categorised description of the research settings, the interactions and relationships among patients, providers, managers and researchers, the training interventions and the way participants responded to it during each phase of the process. Although seemingly similar at the outset, analysis began to show that dynamics of implementation at each facility were complex and multidimensional. The categories that were generated during each cycle of implementation were used to shape the categories selected for the next. Examining the categories across the four health facilities yielded a grounded theory with seven core categories regarding the role of: (1) the personal qualities of the TB staff involved, (2) the way staff moved in and out of the TB service, (3) the leadership, hierarchy and staff dynamics in the health facilities, (4) the pressurised working conditions of TB staff, (5) the poverty of patients, (6) mismatches between the TB programme's protocols and BMI, and (7) the capacity of staff to innovate and improve care. These findings are discussed in terms of the way they respond to the study's research questions and the way the grounded theory categories relate to each other. Their significance is understood from a social constructivist perspective as bound within the context of the study. The findings are also compared to the theoretical perspectives included in the study design and new literature on the diffusion of innovations in service organisations. Recommendations are made for future context-focused research and adherence related intervention development. If interventions like BMI are to be implemented successfully in contexts such as those included in this thesis, policy-makers and managers need to consider the ways in which working conditions, policies and protocols and patient poverty may be counter-productive, and focus on the innovative potential of health staff and teams for delivering patient-centred care.

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20

Callahan, Timothy C. "Challenging medicine's humiliations : the need to re-educate the practitioners /". Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/7738.

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21

Kaufman, David R. "Representation and utilization of information during the clinical interview in medicine". Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=59603.

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This study evaluated the ability of subjects at 3 levels of expertise, expert physicians, residents and medical students, in the acquisition, representation, and utilization of patient information in the context of solving a complex medical problem. Each subject interviewed a volunteer medical outpatient and was subsequently requested to provide a differential diagnosis. The doctor-patient dialogue was analyzed using cognitive methods of discourse analysis. These methods were used to characterize differences in the content and nature of the history-taking process and in the development of problem representations. The study characterized differences at two levels of representation, observations and findings. Observations are the minimal semantic units of the doctor patient discourse. Findings are higher order units that derive meaning in specific medical contexts.
Differences were found between groups of subjects in the accuracy of diagnoses and in the qualitative nature of representations. These differences were manifested most clearly in terms of a series of efficiency measures designed to characterize the ability of subjects to generate findings. In general, the expert physicians were more selective in the elicitation and processing of critical and relevant findings. An attempt is made to characterize these differences in terms of the strategies used to acquire and represent patient information.

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22

Slade, Catherine Putnam. "Does patient-centered care affect racial disparities in health?" Diss., Atlanta, Ga. : Georgia Institute of Technology, 2008. http://hdl.handle.net/1853/22569.

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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.
Committee Chair: Robert J. Eger III, Ph.D.; Committee Member: Christopher M. Weible, Ph.D.; Committee Member: Gregory B. Lewis, Ph.D.; Committee Member: Monica M. Gaughan, Ph.D.; Committee Member: Valerie A. Hepburn, Ph.D.

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23

Tierney, Shirley J. "Nursing Unit Staffing: An Innovative Model Incorporating Patient Acuity and Patient Turnover: A Dissertation". eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsn_diss/18.

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Changes in reimbursement make it imperative for nurse managers to develop tools and methods to assist them to stay within budget. Disparity between planned staffing and required staffing often requires supplemental staffing and overtime. In addition, many states are now mandating staffing committees to demonstrate effective staff planning. This retrospective quantitative study developed an empirical method for building nursing unit staffing plans through the incorporation of patient acuity and patient turnover as adjustments towards planning nursing workload. The theoretical framework used to guide this study was structural contingency theory (SCT). Patient turnover was measured by Unit Activity Index (UAI). Patient acuity was measured using case mix index (CMI). Nursing workload was measured as hours per patient day (HPPD). The adjustment to HPPD was made through the derivation of a weight factor based on UAI and CMI. The study consisted of fourteen medical, surgical, and mixed medical-surgical units within a large academic healthcare center. Data from 3 fiscal years were used. This study found that there were significant, but generally weak correlations between UAI and CMI and HPPD. The method of deriving a weight factor for adjusting HPPD was not as important as the decision-making relative to when to adjust planned HPPD. In addition, the measure of unit activity index was simplified which will assist researchers to more easily calculate patient turnover. As a result of this study, nurse managers and will be better able to adjust and predict HPPD in cases where benchmarking has been problematic. Data-driven adjustments to HPPD based on UAI and CMI will assist the nurse manager to plan and budget resources more effectively.

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24

Thobias, Anna. "Exploration of factors associated with poor adherence among patients receiving antiretroviral therapy at Katutura State Hospital Communicable Disease Clinic in Khomas region, Namibia /". Online access, 2008. http://etd.uwc.ac.za/usrfiles/modules/etd/docs/etd_gen8Srv25Nme4_2455_1273775841.pdf.

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25

Webb, Janet Marie. "Information about primary care physicians considered most useful by managed health care consumers". CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1370.

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26

Tornero, Mary Carolyn. "Improving patient satisfaction with a major healthcare organization". CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1406.

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27

Samba, Sheku. "Obstetric Fistula| The Experiences of Patients and Medical Personnel in Sierra Leone". Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10636481.

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Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.

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28

Griffiths, Debra. "Agreeing on a way forward management of patient refusal of treatment decisions in Victorian hospitals /". full-text, 2008. http://eprints.vu.edu.au/2036/1/griffiths_debra_thesis.pdf.

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The purpose of this study is to investigate and develop a substantive theory, of the processes adopted by nurses and medical practitioners when patients with serious illness refuse medical treatment. The study seeks to identify the main constraints confronting nurses and medical practitioners and to explain the key factors that moderate the processes of dealing with refusal decisions. Using a grounded theory method, a sample of 18 nurses and 6 medical practitioners from two public hospitals in Melbourne were interviewed. In addition, observations and documentary evidence were utilised. The basic social psychological problem shared by nurses and medical practitioners is conceptualized as Competing Perspectives: Encountering Refusal of Treatment, which reflects the diverse perceptions and beliefs that confront participants when patients decide to forgo therapy. In utilizing the grounded theory method of analysis, it is recognised that participants deal with this problem through a basic social psychological process conceptualized as Endeavouring to Understand Refusal: Agreeing on a Way Forward. This core variable represents the manner in which participants, to varying extents, deal with the situations they face and it incorporates the various influences which moderate their activities. Endeavouring to Understand Refusal: Agreeing on a Way Forward comprises a series of three transitions. The first involves a struggle for participants to come to terms with, or even recognize that patients are rejecting treatment. The second transition illustrates the varied responses of participants as they interact with patients, relatives and each other, in order to clarify and validate decisions made during episodes of care. The third transition reflects the degree to which patients and family members are incorporated into treatment decisions, and highlights a shift in emphasis, from a focus on the disease state, to the patient as a person with individualistic thoughts and wishes. The remaining social processes evident in the study consist of four categories. The first, Seeking Clarification, embodies exploration undertaken by participants and their recognition that treatment is actually being refused. The second category, Responding to Patients and Families, demonstrates the level of expertise of participants communicating, and their ability to encourage reciprocity in the professional-patient relationship. The third category, Advocating, highlights the extent and manner in which patient and family wishes are promoted to members of the treating team. The fourth category, Influencing, reveals the ability of participants to utilize a degree of authority or power in order to shape particular outcomes. The findings also indicate that over arching the core variable and categories are various contextual determinants that moderate the way nurses and medical practitioners deal with patient refusal of treatment. These determinants are categorized into three main influences: The Context of Work, describes the of the environment and organisational factors pertinent to public hospitals; Beliefs and Behaviours, illustrates the perceptions of, and values held, by four key groups involved in decisions, namely, nurses, medical practitioners, patients, and family members; and Legal and Ethical Frameworks, examines the existing principles that support or guide professional practice in situations where patients with serious illness refuse medical treatment.

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Smith, Barbara. "A constructive view of the non-compliant patient: Understanding barriers to compliance and proposed solutions". CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1654.

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The health care industry is currently experiencing many changes. Managed care is altering the way health care is delivered through advances in technology and new approaches in financing. As part of this transition, importance will be placed on patients becoming better consumers and participants in determining their health care service needs. The focus of this study is on the non-compliant patient and the many factors that revolve around this topic.

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Lee, Susan Fiona. "Controlling involvement to promote confidence in pallative care decisions a grounded theory from the patient's perspective /". Connect to thesis, 2006. http://portal.ecu.edu.au/adt-public/adt-ECU2006.0021.html.

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31

Hamilton, Sarah. "Negotiating roles and making claims as a patient in the psychiatric consultation : a frame analysis". Thesis, University of Sussex, 2014. http://sro.sussex.ac.uk/id/eprint/48726/.

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Abstract (sommario):

My thesis develops an understanding of patient role and identity performances in psychiatric consultations. Recent increased attention to shared-decision making and patient-centred care in psychiatry is in large part influenced by changing ideas about the doctor-patient relationship, challenging power discrepancies and reconsidering notions of ‘expert' and ‘lay' contributions. Previous work surrounding this field has mostly focused on psychiatrists' talk, asking ‘how can psychiatrists improve shared-decision making skills?' While important, I argue that this focus is at odds with the principles behind shared-decision making by failing to consider patients' own performances in their talk with psychiatrists. I re-analyse recorded interactions in 92 psychiatric consultations with patients prescribed anti-psychotic medication. Drawing on the work of Goffman, I identify frames which are negotiated throughout the consultations and explore how these shape the roles and ‘footing' adopted by patients. I demonstrate techniques used by patients to maintain a balance between making credible and influential claims and maintaining an acceptable patient role. Finally I consider the impact of family members attending these consultations. I explore how they collaborate and compete with patients in making claims, and the impact of their presence on patients' own performances. The thesis makes the case for considering patients as active participants in constructing the interaction in psychiatric consultations and the need to understand the work being undertaken by patients to construct their place in the immediate discourse and in their wider social connections. It moves towards developing this understanding by providing a detailed review of various techniques seen in this data set. In using a frame analysis it also provides a relatively new perspective on considering discourse and demonstrates how this kind of approach can be useful when analysing institutional talk.

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32

Griffiths, Debra. "Agreeing on a way forward: management of patient refusal of treatment decisions in Victorian hospitals". Thesis, full-text, 2008. https://vuir.vu.edu.au/2036/.

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The purpose of this study is to investigate and develop a substantive theory, of the processes adopted by nurses and medical practitioners when patients with serious illness refuse medical treatment. The study seeks to identify the main constraints confronting nurses and medical practitioners and to explain the key factors that moderate the processes of dealing with refusal decisions. Using a grounded theory method, a sample of 18 nurses and 6 medical practitioners from two public hospitals in Melbourne were interviewed. In addition, observations and documentary evidence were utilised. The basic social psychological problem shared by nurses and medical practitioners is conceptualized as Competing Perspectives: Encountering Refusal of Treatment, which reflects the diverse perceptions and beliefs that confront participants when patients decide to forgo therapy. In utilizing the grounded theory method of analysis, it is recognised that participants deal with this problem through a basic social psychological process conceptualized as Endeavouring to Understand Refusal: Agreeing on a Way Forward. This core variable represents the manner in which participants, to varying extents, deal with the situations they face and it incorporates the various influences which moderate their activities. Endeavouring to Understand Refusal: Agreeing on a Way Forward comprises a series of three transitions. The first involves a struggle for participants to come to terms with, or even recognize that patients are rejecting treatment. The second transition illustrates the varied responses of participants as they interact with patients, relatives and each other, in order to clarify and validate decisions made during episodes of care. The third transition reflects the degree to which patients and family members are incorporated into treatment decisions, and highlights a shift in emphasis, from a focus on the disease state, to the patient as a person with individualistic thoughts and wishes. The remaining social processes evident in the study consist of four categories. The first, Seeking Clarification, embodies exploration undertaken by participants and their recognition that treatment is actually being refused. The second category, Responding to Patients and Families, demonstrates the level of expertise of participants communicating, and their ability to encourage reciprocity in the professional-patient relationship. The third category, Advocating, highlights the extent and manner in which patient and family wishes are promoted to members of the treating team. The fourth category, Influencing, reveals the ability of participants to utilize a degree of authority or power in order to shape particular outcomes. The findings also indicate that over arching the core variable and categories are various contextual determinants that moderate the way nurses and medical practitioners deal with patient refusal of treatment. These determinants are categorized into three main influences: The Context of Work, describes the of the environment and organisational factors pertinent to public hospitals; Beliefs and Behaviours, illustrates the perceptions of, and values held, by four key groups involved in decisions, namely, nurses, medical practitioners, patients, and family members; and Legal and Ethical Frameworks, examines the existing principles that support or guide professional practice in situations where patients with serious illness refuse medical treatment.

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Devreux, Isabelle. "Relationship between staff satisfaction, productivity and patient satisfaction: a study in physical rehabilitation services". Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209609.

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Abstract (sommario):

La satisfaction du patient et du personnel sont considérés comme des indicateurs importants afin de mesurer la qualité dans le secteur hospitalier.

Dans les services de revalidation, les rencontres thérapeutes-patients présentent une valeur significative par le temps consacré, l'approche thérapeutique mais également la relation qui découle du processus de soin.

L'objectif de la recherche fut d'évaluer la satisfaction du personnel travaillant dans les services de revalidation physique (thérapeutes et techniciens ou assistants) et les différents variables démographiques ou liés à l'environnement du travail ainsi que la satisfaction des patients traités dans ces services.

Une analyse transversale par questionnaire a permis de mesurer la satisfaction au travail et les éléments de productivité dans les services de revalidation. Simultanément, une enquête concernant la satisfaction des patients a été réalisée dans ces mêmes départements. La recherche fut effectuée au sein de dix centres hospitaliers au moyen d'un questionnaire d'enquête commun basé sur le modèle " Effort- Reward Imbalance" ou “déséquilibre efforts-récompenses” et des informations complémentaires sur les conditions de travail ont étés collectées au moyen de questionnaires spécifiques. L’étude met en évidence des variables démographiques tells l'âge, la nationalité, le niveau d'éducation, ainsi que la charge travail et les types de cas traités comme facteurs significatifs influençant le stress au travail.

Les résultats confirment une corrélation positive entre le stress au travail par le déséquilibre Efforts-Récompenses et la performance quantitative (productivité) des thérapeutes en revalidation. Il est basé sur la satisfaction des thérapeutes en fonction des heures de travail, du nombre moyen de patients par jours ainsi que des mesures de productivité élevées du département. En ce qui concerne les récompenses perçues comme positives, le soutien du médecin et du superviseur apparaissent comme facteurs de motivation importants. Il a été également déterminé que les thérapeutes appréciaient la participation et l’expression de son opinion dans la gestion thérapeutique du patient. Bien qu’une corrélation entre la satisfaction des patients et le degré de stress au travail des thérapeutes n’ait pas été démontrée, ces deux mesures varient de manière significative en fonction des types d’hôpitaux et du degré de « Over-commitment » des thérapeutes dans leur travail.

Les déterminants essentiels de la satisfaction des patients en revalidation apparaissent toutefois liés à l’intervention du thérapeute tel que sa capacité à rassurer le patient ou la qualité de l’information liée au plan de traitement et doivent être considérés dans l’approche thérapeutique en revalidation.

Les résultats de l’étude ont permis de concevoir un modèle systémique de satisfaction et de stress au travail résumant les éléments liés de manière significative au déséquilibre des efforts et récompenses dans les services de revalidation physique et qui pourrait inspirer les directeurs ou gestionnaires hospitaliers a promouvoir une atmosphère de travail positive.

Patient and staff satisfaction are considered as important indicators to monitor quality in healthcare. In rehabilitation services the patient and therapist encounters are of significant value by the amount of time, the therapeutic approach but also the personal relations in the care process. The aim of the research was to evaluate the staff job satisfaction in physical rehabilitation services and the related variables as well as its correlations to patients’ satisfaction.

A cross sectional survey approach in the rehabilitation services has measured the job satisfaction and the related elements of productivity. Simultaneously a survey of the patients’ satisfaction was performed. As the research in the physical rehabilitation services was conducted in ten different health care facilities of the Jeddah region, a common assessment tool was utilized based on the Effort Reward Imbalance (ERI) model and complementary information were collected using specifically developed survey questionnaires. Socio-demographic variables such as age, nationality, work specialty, educational levels, as well as the caseload and workload appeared also as significantly influencing job satisfaction.

The findings confirmed a positive correlation between the Effort Reward Imbalance and the quantitative performance (productivity) of the rehabilitation staffs. It is supported by the level of job satisfaction of the therapists which is related to the number of patients per day, caseload, hours of work and high productivity measures. From the aspects of positive rewards, the role of the supervisor and doctors appear as important motivators. It was also found that therapists valued the fact of being given the opportunity to participate and discuss opinions in the patient management and quality improvement.

While no evidence confirmed a positive correlation between patients’ satisfaction about the rehabilitation treatments and the staff job satisfaction, both measured patients’ and staff satisfaction varied significantly according to the hospital type and the degree of Over-commitment.

Essential determinants of patients’ satisfaction appeared however related to the therapists' input, such as the ability to reassure or the quality of information given in the treatment plan and have to be taken into account when delivering the patients’ care.

All the results allowed the design of a systemic model of staff job satisfaction resuming the significant related elements of effort and reward in the rehabilitation services and could be utilized to inspire the hospital leaders, managers and executive directors to promote a healthy work life environment based on a valued human resources approach.

Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Nestel, Debra. "Communication skills for medical students, doctors and dentists : a programme evaluation /". Thesis, Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19657468.

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Postaci, Senan. "An Advanced Personal Health Record Platform For Patient Empowerment". Master's thesis, METU, 2012. http://etd.lib.metu.edu.tr/upload/12614583/index.pdf.

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Abstract (sommario):

In recent years, many Personal Health Record (PHR) systems have been developed to retrieve patients&rsquo
Electonic Health Records (EHRs) from external sources. However, current PHRs can provide access to only a small number of EHR systems, since there are many dierent interfaces, data formats and medical terminologies among dierent systems. When this is the case, all these diversity yields high integration costs. Development of such systems is dicult and expensive because of the reasons such as accessing to evidence based medical information, utilization of social networks to share information, incorporation of available medical knowledge models, etc. Due to the technical diversity of external information systems, a developer of a PHR system faces a dicult integration process when he wants to integrate a new source or service. Integration of medical devices is also important and necessary in a PHR system. However, most of the medical device vendors use proprietary formats and protocols for communicating their devices with external systems
again, causing high integration eorts and costs. In this thesis, these problems and challenges are addressed by providing an on-line personal iv healthcare management platform, i.e. eSaglikKaydim which is built on top of a highly modular architecture and provides services based on worldwide standards. In this way, eSaglikKaydim platform can be integrated with any external health information service and medical device so that it maximizes the data variety retrieved from all kinds of external health data sources. The work presented in this thesis is part of the OSAmI project supported by European ITEA and funded by the TU¨
BI

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36

Lenz, Lynn. "Disruptive behaviors in healthcare : implications for patients /". Connect to online version, 2009. http://minds.wisconsin.edu/handle/1793/45112.

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Byrd, Rebekah J. "Culturally competent medical care of LGBTQ patients". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/911.

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38

Hardy, Jennifer Lynette. "Healthcare providers communication mechanisms using a case management model of care implications for information systems development, implementation & evaluation /". Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060731.120940/index.html.

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39

Brookbank, Kathleen. "HIV : impact on community health nursing personnel". Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/834518.

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40

Liddle, Keir. "The impact of leadership on the delivery of high quality patient centred care in allied health professional practice". Thesis, University of Stirling, 2018. http://hdl.handle.net/1893/28081.

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Abstract (sommario):

The Healthcare Quality Strategy for NHS Scotland, relates its overall vision of healthcare quality to six dimensions of care as: Safe, Efficient, Effective, Equitable, Timely and Patient Centred. Patient Centred Care also underpins many subsequent policies such as the management of Long Term Conditions (Scottish Government, 2008) and the Chief Medical Officers Realistic Medicine report (Barlow, et al., 2015) Leadership styles and associated policies and procedures are often assumed to inhibit or encourage the delivery of quality Patient Centred Care and the NHS invests millions of pounds per year in Leadership training. At a clinical team and management level there are behaviours and initiatives that can arguably have positive and negative impacts on the ability of individual practitioners to provide quality Patient Centred Care. However there have been no attempts to empirically test the association between (good) Leadership and quality Patient Centred Care. Without any evidence of such a relationship, NHS investment of substantial resources may be misguided. Additionally, much of the focus of research in both Leadership and Patient Centred Care has focused on medical practitioners and nurses. There is little research that focuses on the impact of allied health professionals' (a term describing 12 differing health care professional groups representing over 130,000 clinicians throughout the United Kingdom) practice on the quality of person centred care and how this is affected by Leadership structures and styles. This study aimed to explore whether there is a direct or indirect link between (transformational) Leadership and achieving the delivery of high quality Patient Centred Care (PCC) in allied health professional (AHP) practice. Aim The aim of this thesis was to explore whether it was possible to empirically demonstrate a relationship between Leadership (good or bad) and Patient Centred Care, and to do this in relation to Allied Health Professional practice. Research questions I. Is there a relationship between Transformational Leadership and Patient Centred Care in AHP practice? II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? III. Do local contexts influence the ability of leaders to support Patient Centred Care? Study one Study one was designed to answer research question one: exploring the relationship between transformational Leadership and Patient Centred Care using survey design. Two groups of Allied Health Professionals were selected to take part in the study: Podiatrists and Dieticians. Clinical team leaders from across 12 Podiatry teams and 12 Dietetic teams completed a survey composed of measures of transformational Leadership and self-monitoring. Clinicians from these teams were also be asked to complete questionnaires on their perception of their clinical leaders’ transformational Leadership skills. This allowed comparison of self-assessed Leadership and team assessed Leadership. Clinicians were also asked to collect patient experience measures from 30 of their patients. Study Two Study Two was designed to answer research questions 2 and 3: how do AHPs conceptualise Leadership and how do they view the link between Leadership and their ability to deliver Patient Centred Care; and how might local context impact on professional Leadership and therefore its potential to enable or inhibit Patient Centred Care. In depth interviews were conducted with clinicians and clinical team leaders to explore the barriers and facilitators to effective Leadership, teamwork and the provision of quality care. Interviews were conducted with 21 Podiatrists and 12 Dieticians and analysed using a framework analysis approach. Results I. Is there a relationship between Patient Centred Care and transformational Leadership in AHP practice? The theory that there is a link between transformational Leadership and Patient Centred Care was confirmed. A significant relationship was discovered for the dietetics group linking Transformational Leadership with patient centred quality of care measures. There was also a relationship in the podiatry group that was suggestive of a relationship. II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? AHP’s in both groups had broadly similar conceptualisations of Leadership and both groups played down the role of Leadership in the delivery of Patient Centred Care. A far more salient factor in achieving the delivery of high quality Patient Centred Care for the AHP’s interviewed was professional autonomy. III. Do local contexts influence the ability of leaders to support Patient Centred Care? A number of contextual issues related to both Patient Centred Care and Leadership were identified from the qualitative analysis. These were centred on systemic factors, relating to management and bureaucracy, and individual factors, such as relationships within teams. In Podiatry a major shift in the context of care was ongoing during the study, namely a greater emphasis on encouraging patients to self-care. This affected the relationships between patients and Podiatrists, and Podiatrists and managers, in a way that Podiatrists felt it negatively impacted on their ability to provide quality Patient Centred Care. Conclusion A weak relationship was observed between Transformational Leadership styles and the delivery of Patient Centred Care in two Allied Health Professional groups. Professional autonomy was identified as being more likely to facilitate delivery of person centred care. Organisational issues and intervening policy directives can impact on the delivery of Patient Centred Care, regardless of Leadership. Recommendations Further work exploring the link between Leadership and Patient Centred Care is required. The concept of professional autonomy should be fostered within Leadership programs to enhance delivery of Patient Centred Care. The impact of individual policies, such as moves towards more self-care, on quality criteria need to be more fully considered. Whilst such policies may make care more efficient, there may be negative consequences for other quality care criteria, such as Patient Centred Care.

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Slade, Catherine Putnam. "Does Patient-Centered Care affect Racial Disparities in Health?" Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/pmap_diss/24.

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Abstract (sommario):

This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

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Sinclair, Andrew. "The primary health care experiences of gay men in Australia". Connect to this title online, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20060713.084655/.

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Terkildsen, Sheryl Ramona. "End of life nursing education consortium grant implementation project". CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2324.

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This project addressed the continuing education needs of nursing staff and other health care professionals for delivering competent and compassionate palliative or end of life care. The scope of the project included, writing a grant application, training and certification by the end of life Nursing Education Consortium and implementing an education program for staff at the Loma Linda Veterans Affairs medical center.

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Alvarez, George Francisco Centre of Health Informatics UNSW. "Interruptive communication patterns in the intensive care unit ward round". Awarded by:University of New South Wales. Centre of Health Informatics, 2006. http://handle.unsw.edu.au/1959.4/23430.

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Abstract (sommario):

Medical error and patient safety have become important issues. It is clear that medical error is more influenced by systemic factors rather than human characteristics. Communication patterns, in particular interruptive communication, maybe one of the systemic factors that contribute to the burden of medical error. Objective: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit during ward rounds. Methods: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 hours, using the Communication Observation Method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. Results: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95%CI 33.9-40.1] of total communication event time (5hr: 53min). T.T.I. accounted for 5.3% of total communication event time (56min). Conclusion: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.

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Long, Janel Elaine Lehman. "Facilitating Positive Relationships between Patients and Foreign Born Providers in South Central Pennsylvania". Thesis, University of North Texas, 2016. https://digital.library.unt.edu/ark:/67531/metadc849700/.

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Foreign-born providers make up over a quarter of the physician workforce nationally. Patients in south central Pennsylvania are primarily white with limited interaction with foreigners which can produce barriers to communication and trust. This study proposes practical steps for building positive relationships between patients and their foreign-born providers. Ethnographic methods were used to interview and survey patients and providers about the relationships between foreign-born providers and patients, primarily in the Summit Health system. The results of the study provide a framework of how trust is built between patients and providers in general, suggest additional actions for foreign-born providers, and propose ways patients can do their part to achieve a positive relationship with their provider. While much of the literature on cultural competence is in the context of patients who are from minority ethnicities, this study adds to the body of research by also considering the providers as part of minority groups.

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Bergqvist, Marija, e Malin Bernce. "Risker som kan uppkomma i samband medomvårdnadsdelegering från sjuksköterska till övrig omvårdnadspersonal. : En litteraturstudie". Thesis, Malmö universitet, Malmö högskola, Institutionen för vårdvetenskap (VV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-43229.

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Bakgrund: Delegering från sjuksköterska till övrig omvårdnadspersonal utgör en stor del av det dagliga arbetet och är en komplex uppgift som potentiellt kan komma att utgöra en patientsäkerhetsrisk. Tidigare studier visar att sjuksköterskor upplever delegering som en belastande del av sitt arbete, utmaningarna ligger främst i att säkerställa god vård när mycket av omvårdnaden måste delegeras. Sjuksköterskor beskriver vidare att de hade önskat mer utbildning i delegering under sin grundutbildning. De ser det som en utmaning att “kontrollera” andras arbete, och känner sig inte bekväma i den arbetsledande rollen. Syfte: Att genom en litteraturstudie sammanställa och återge uppfattningar och erfarenheter som beskrivs kring risker som kan uppkomma i samband med delegering av omvårdnadsuppgifter från sjuksköterska till övrig omvårdnadspersonal. Metod: Allmän litteraturstudie baserad på tio studier med kvalitativ ansats genomfördes efter databassökning i PubMed och CINAHL. Granskningen genomfördes med Statens beredning för medicinsk och social utvärderings (SBU) Mall för kvalitetsgranskning av studier med kvalitativ forskningsmetodik (2014). Studierna analyserades med Fribergs analyssteg, samtliga studier föll under huvudkategorin patientsäker delegering och data med liknande innehåll delades in i två underkategorier. Resultat: Resultatanalysen identifierade en huvudkategori följt av två underkategorier; samverkan och kommunikation som vidare delades in i sju rubriker. Konklusion: Delegeringsprocessen är komplex och förutsätter god kommunikation och samverkan för att undvika risker för patientsäkerheten. Vidare måste sjuksköterskan ha god förståelse för vilka omvårdnadsuppgifter som är lämpliga att delegera, samt ta ansvar för uppföljning och säkerställande i syfte att värna patientsäkerheten.
Background: Delegation from a nurse to other nursing staff constitutes a large part of the daily work and is a complexed task that could potentially constitute a patient safety risk. Previous studies show that nurses experience delegation as a burdensome part of their work, the challenges lie mainly in ensuring good care when much of the nursing must be delegated. Nurses further describe that they would have liked more training in delegation during their undergraduate education. They see it as a challenge to have to “control” the work of others, and do not feel comfortable in the managerial role. Aim:To compile and reproduce perceptions and experiences that are described about the risks that may arise in connection with the delegation of nursing tasks from a nurse to other nursing staff through a literature study. Method: General literature study based onten studies with a qualitative approach was conducted after database search in PubMed and CINAHL. Review was conducted with the Swedish Agency of Medical and Social Evaluation (SBU) template for quality review of studies with qualitative research methodology (2014). The studies were analysed with Friberg’s analysis steps, all studies fell under the main category patient-safe delegation and data with similar content were the divided into two subcategories. Results: The results analysis identified a main category followed by two subcategories; collaboration and communication which was further divided into seven headings. Conclusion: The delegation process is complex and requires good communication and teamwork to avoid risks to patient safety. Furthermore, the nurse must have a good understanding of which nursing tasks are suitable to delegate and take responsibility for follow-up and ensuring in order to safeguard patient safety.

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Kangas, Elina, e Berfin Ucar. "Stråldos till personal vid hantering av diagnostiska radiofarmaka vid förberedelse och undersökning av patient". Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för naturvetenskap och biomedicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-36251.

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Fowler, Rebecca. "Grand Canyons: Authoritative Knowledge and Patient-Provider Connection". Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc799543/.

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Abstract (sommario):

In 2011, African Americans in Tarrant County, Texas experienced an infant mortality rate of 14.3 per 1,000 live births. The leading cause of infant mortality in Tarrant County is prematurity and maternal nutritional status. Both maternal under-nutrition and over-nutrition are known risk factors for premature birth. Improving maternal nutrition, by reducing rates of gestational diabetes and preeclampsia, and by increasing consumption of essential prenatal vitamins and nutrients, is a road to decreasing preterm birth in African Americans. This qualitative study, based on both anthropology and public health theory, of the nutrition behavior of a group of African American expectant mothers and the experience of their health care providers and co-facilitators had a goal to provide a foundation for future development of nutrition behavior research and education for this specific population. The main finding of this study was the substantial gap of lived experience and education between the patients and their providers and co-facilitators, which hinders delivery of care and the patients’ acquiescence to nutrition recommendations. The discrepancies between the authoritative knowledge of the providers and the bodily knowledge of expectant mothers were responsible for the ineffectiveness of nutrition recommendations.

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Fillion, Jennifer Mary. "Metaphor Use in Interpersonal Communication of Body Perception in the Context of Breast Cancer". PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/1014.

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Abstract (sommario):

Female breast cancer patients are often confused, frustrated, and devastated by changes occurring in their bodies and the treatment process. Many women express frustration and concern with the inability to know what the next phases of their life will bring. Previous research also states that many women struggle to communicate with others about treatment as well as side effects. This research examined how woman are use metaphors to describe their experience with breast cancer, specifically throughout the treatment period related to body image struggles. I qualitatively conducted interviews with women who were either currently in treatment or just finishing. My interview questions related to their uncertainties, as well as the changes occurring to their bodies. After conducting the interviews I transcribed the conversations and coded for specific metaphors. The results were consistent with previous research, in that that the interviewees used at least four major metaphors to describe what they are going through. The four most prominent metaphors were (1) journey, (2) game, (3) struggle/fight, (4) grasping. The findings could benefit patients, nurses, physicians as well as family and friends to reduce stress and help with coping. The findings may also help female patients struggling with identity issues due to lumpectomies or mastectomies. Understanding how patients comprehend the disease can ultimately help others to understand and hopefully reduce some of the concerns of all those involved in such situations.

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Fure, Elin, e Signe Nilsson. "Att beskriva livskvalitet hos personer med palliativ vård". Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-31254.

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Abstract (sommario):

Bakgrund: Då bot inte längre är möjlig påbörjas palliativ vård, vilket handlar om att skapa förutsättningar så att personen med palliativ vård och dennes anhöriga upplever högsta möjliga livskvalitet. Att träffa döende personer och ge dessa omvårdnad är en ofrånkomlig del av sjuksköterskeyrket. Beskrivningar av livskvalitet från personer med palliativ vård är därför en viktig kunskapskälla för sjuksköterskor. Syfte: Syftet med föreliggande studie var att beskriva hur personer med palliativ vård upplever livskvalitet. Metod: En beskrivande litteraturstudie som baserats på 13 vetenskapliga artiklar. Alla inkluderade artiklar hade kvalitativ ansats och söktes fram i databasen PubMed. Huvudresultat: Personer med palliativ vård beskrev att deras tankesätt förändrades efter sjukdomsdebuten. Detta upplevdes som en strategi för att hantera sjukdomen och öka känslan av livskvalitet. Något som ytterligare bidrog positivt till livskvaliteten var att upprätthålla relationer med släkt och vänner samt att få vara omgiven av sin familj. Den främsta orsaken till minskad livskvalitet beskrevs vara när symtom framträdde och när sjukdomen upplevdes styra personens liv. Slutsats: Att drabbas av obotlig sjukdom och få palliativ vård påverkade upplevelsen av livskvalitet. Den kunde både öka och minska under sjukdomsförloppet och att ha en sjuksköterska med helhetssyn på personen med palliativ vård var av stor vikt för bibehållen livskvalitet.
Background: When cure is no longer possible, palliative care begins. Palliative care is about creating conditions so that the person with palliative care and his or her relatives experience the highest possible quality of life. To meet people who are dying and care for them is an inevitable part of the nursing profession. Descriptions of quality of life by persons with palliative care is therefore an important source of knowledge for nurses. Aim: The aim of this study was to describe how persons with palliative care experience quality of life. Method: A descriptive literature review based on 13 scientific articles. All the included articles had a qualitative approach and were found through the PubMed database. Main results: Persons with palliative care described that their mindset changed after the onset of the disease. This was seen as a strategy for managing the disease and to increase the quality of life. Something that further increased the quality of life was to maintain relationships with friends and relatives and to be surrounded by family. The main reason for decreased quality of life was describes as when symptoms appeared and when the disease was experienced to control the persons life. Conclusion: To suffer from an incurable disease and receive palliative care affected the quality of life. The experience of quality of life could both increase and decrease during the course of the disease and having a nurse with a holistic approach towards the person with palliative care was essential to maintain quality of life.

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Tesi sul tema "Medical personnel and patient"

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