Rozprawy doktorskie na temat „Health practitioners”

Many industries, including healthcare, are trying to take advantage of voice assistant systems by incorporating their technology into the industries’ environment. However, not many companies or researchers have successfully integrated this technology into the daily practice of healthcare practitioners. Doctors, nurses and other healthcare practitioners spend much of their interaction time with patients clicking on the Electronic Medical Record (EMR) screen trying to access and update data. An important contribution of this research is to analyze this healthcare need for this technology in the healthcare practitioner’s workflow. This research developed an Alexa chatbot skill, “Doctor’s Assistant,” as a generic application to help healthcare practitioners access and update EMR data via speech, while reducing data entry time and providing better patient care. The evaluation of this application illustrates that the “Doctor’s Assistant” skill is both effective and accurate.

As a practitioner involved in the planning and development of educational activities in the field of public health, I have worked within many pedagogical traditions and program parameters. Through this work, I have experienced both subtle and radical shifts in the range of skills, knowledge and relationships required to collaboratively plan and evaluate educational work. In this professional and community-based landscape, competing and often overlapping models of education and evaluation have led to much conceptual confusion and ambiguity around narrowly defined notions of best practice, evidence and knowledge legitimacy. Drawing from Dorothy Smith’s (1999) standpoint theory from which my inquiry was developed as a result of my participation with colleagues in the field, I explore how three professional practice networks of learning and development practitioners speak of the skills, knowledge, relationships and worker identities in a changing field. This research seeks to explicate the kinds of informal and largely unarticulated knowledge that is produced through the changing contexts of work. This research maps the changing conditions of educational work through my own case stories of educational practice and uses these as a springboard for discussion among three diverse professional practice networks. The Story/Dialogue Method (S/D-M) developed by Labonte and Feather (1996), is a constructivist methodological approach that, in this application, structures group dialogue into reflective insights and theories about how educational work occurs in varied settings among different professional and community-based groups. A strong reliance on interpersonal skills was articulated by all three networks to build trust, assess individual and organisational learning needs, to build partnerships and to motivate learners. Skills were often described vaguely and summarised as a series of situational specific attributes. A valuing of reflexive, working knowledge as opposed to professional or discipline-based expertise was raised as an important aspect of partnership building and in negotiating program parameters. The need to build individual and organisational relationships through formal and informal encounters was cited as a series of legitimate yet often ‘behind the scenes’ professional practices. Aligning with the notion of worker identity described by Chappell, Rhodes, Solomon, Tennant and Yates (2003) as process, practitioners spoke of their identities as constructed and temporary, negotiated through newly emerging roles and changing relationships with peers and learners. This study suggests that evidence-based practice is a contested term drawing its meanings from multiple theoretical and pedagogical traditions including that of intuition. Perhaps unsurprisingly then, evidence guiding educational approaches is viewed as a pragmatic and eclectic mix of tools stored to be adapted for use in new ways. Additionally, this study concludes that all participants (including myself) regard educational practice as a collaborative and continually negotiated endeavour.

This thesis comprises a review of studies on the diffusion of recommended guidelines on preventive practices and three papers evaluating the preventive practice patterns of general practitioners in Torino, Italy.
The first paper presents estimates of preventive practices and perceived effectiveness of preventive interventions. Patterns of practice were found to be consistently similar to those in other studies.
The second and third papers explore an array of determinants for ten primary and secondary preventive interventions.
An analysis of determinants indicates that complex patterns of behaviours are rather condition-specific, while the application of techniques is influenced to a varying extent by organizational and attitudinal factors.

The debates related to the representation of the mentally ill in the media have been wide ranging over the last 20 years. Emergent representations have often been stigmatizing, claiming that the mentally ill are violent and dangerous. This study used an emergent methodological design to explore what the current representations of the mentally ill were and identify a case study from the available representations. It then examined the influence that the case study had on the thoughts and practice of experienced mental health practitioners. The study involved 8 practitioners and identified thoughts influenced by reading the case study and an academic article. Practitioner’s thoughts were captured over 3 separate interviews and by practitioners providing written reflections. At the last interview, practitioners were asked to provide comments as to what the experience of taking part in the study had meant to them. Generic themes related to risk, blame and professionalism all emerged. The study also found that practitioners were able to reflect on the influence that the material had on them, finding that only after discussing the reflections in the interviews that they became aware of some of their defensive thoughts and actions. The outcome of the study is that the media continue to present a negative representation of the mentally ill and mental health care, and that practitioner’s thoughts and actions are influenced by the media representation.

Effective interprofessional collaboration between nurse practitioners and physicians is imperative to meet the health care needs of all Americans. This project measures attitudes of nurse practitioners to determine the barriers to effective interprofessional collaboration with their physician colleagues. It was hypothesized that there is a positive relationship between nurse practitioner attitudes and interprofessional collaboration and a positive relationship between years in practice and interprofessional collaboration. Sixty-three nurse practitioners participated by completing the Collaborative Practice Scale and Jefferson Scale of Attitudes toward Physician and Nurse Collaboration. The Core Competencies for Interprofessional Collaborative Practice served as the framework for this project. Findings of this project revealed nurse practitioners are overall accountable for their patient care and report high levels of interprofessional collaboration. These results are a foundation for future inquiry in providing and evaluating programs to enhance interprofessional collaboration.

The United Arab Emirates does not currently possess an adequate number of well trained Family Practitioners and only a small proportion of the medical work force are employed in Primary Care. Continuing medical education is important in Family Medicine and, to date, there has been no study in this subject carried out in the United Arab Emirates. It was decided to evaluate and assess the current situation within Family Medicine and the amount of continuing medical education received by medical practitioners in Abu-Dhabi. Accordingly, 3 studies were carried out to provide this information. Initially, a perspective, descriptive study was carried out, involving all Primary Care Practitioners. There was an 80% response, yielding 86 completed questionnaires. The study revealed a perceived low prestige for Family Medicine among Family Practitioners, over half of whom (58%), felt that they did not have the confidence of the public. Only 3% of Family Practitioners were Emirati Nationals. 23% had received training in Family Medicine but only 3% had formal qualifications. It is unlikely that the Government will spend large sums of money on the training of expatriate doctors through a residency programme but there should be a practical alternative. There is a clear need to increase the numbers of Emirati National doctors. It was seen as important to determine how medical students and Interns graduating from the United Arab Emirates University, made their career choices. A second, cross-sectional, descriptive study, was set up. A questionnaire was administered to all final year students in the Faculty of Medicine and Interns in the University hospital. There was an 80% return yielding 48 questionnaire for analysis. The leading reason for selecting a speciality was personal interest 85% and half of the respondents were of the opinion that there was no organised career structure in Family Medicine in the United Arab Emirates. 52% did not wish to enter Family Medicine although 85% appreciated the importance of this speciality. There was also a general feeling that Family Medicine was poorly organised within the Emirates (90%). Continuing medical education is a systematic attempt to facilitate change in doctors' practice. Differences observed over time in patients' health and in doctors' performance and their knowledge and skills, are the types of change that have been the focus of research in continuing medical education. Medical education is successful when it results in improved outcomes for patients, but there may not be much connection between traditional didactic instruction and improvement in clinical practice. Evidence suggests that continuing medical education activities that are learner focused, take place in small groups and adhere to the principles of adult learning, are beneficial to practising physicians and their patients. It was decided to carry out a study designed to ensure the effect of a practiced based, small group, continuing medical education programme on the knowledge and clinical practice of primary health care doctors in the management of hypertension. A randomised, controlled trial was carried out in four Primary Health Care Centres in Abu-Dhabi, two of which were designated as the intervention centres and the other two, the control centres. The first part of the study was the establishment of the intervention, which was a small-group, practice-based, continuing medical education programme (6 hours) in the care of hypertensive patients, relevant to primary care practice. The second part was a study of the effectiveness of the programme, obtained by an evaluation of knowledge and practice, three months before and three months after the intervention. There was no change in the knowledge of care of hypertensive patients between the control and intervention groups but there was evidence that the continuing education programme had changed some aspects of the clinical practice and the performance of primary health care doctors, in the management of hypertension. The results suggested that this form of medical education could be effective.

The formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at:  exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality.  eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and  developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy  Theory articulating the strategy  Aim of the strategy  Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.

While ethical codes have been established for practitioners, there is a possibility that dual loyalty affects occupational medical practitioners’ (OMPs) decisions in determining fitness status of employees. Literature indicates dual loyalty of OMPs leads to ethical dilemmas. The study’s main objective is to determine if dual loyalty participates in OMPs’ decisions and influences OMPs to breach medical ethics required in their profession, resulting in employees unfairly losing their jobs. The study interrogates literature review on dual loyalty and adopts a multi-layered approach focussing on the Constitution; relevant Acts and guidelines; case law and ethical principles. Case studies from the Medical Inspector’s archives are interrogated to determine the influence dual loyalty has on OMPs’ decision-making. Case law indicates that conflict of interest is the source of dual loyalty. Occupational medical practitioners have fiduciary duties and need to serve the best interests of the employees. From case studies discussed, the study shows that OMPs are affected by dual loyalty and tend to disregard medical ethics. They may be conflicted when making decisions concerning employees’ fitness to work, especially when individualised assessments are not conducted. A guideline addressing ethical obligations and human rights should be drafted for OMPs, guiding them on dealing with dual loyalty. Employers will need awareness training in various institutions so that OMPs are supported and encouraged to have sound medical ethics. This will promote best practice in doctor-patient relationships, avoiding dual loyalty dilemmas.
Mini Dissertation (MPhil)--University of Pretoria, 2019.
Public Law
MPhil
Unrestricted

Patients in rural areas in the United States do not have adequate health care facilities for illnesses and injuries not serious enough for emergency care, but telemedicine could have a positive impact both economically and medically to control rapidly rising health care costs, which is a significant percentage of the gross national product. The purpose of this case study was to explore the barriers physicians encountered in telemedicine implementation. Participants included 4 physicians who took part in face-to-face interviews in a clinical setting in Ohio to explore strategies used in implementing telemedicine. The results of these interviews, coupled with observations and document reviews, were analyzed. Complex adaptive systems theory was used to conceptualize the existing association between individual behavioral patterns and the social system in which the patterns take place. Significant themes showed (a) how physicians utilize the technology and (b) how the application allows physicians to build relationships with patients. The characterization strategies aimed to mitigate barriers in adopting telemedicine technology in rural markets were consistent with the study findings and the literature review. The results of this research study might contribute to positive social change through economic and health benefits to rural inhabitants by reducing the distance barrier to physicians' offices and increasing timely and effective patient diagnosis in the selected location.

Magister Pharmaceuticae - MPharm
The global movement towards enhancing inter-professional collaboration in patient care is in light of the increasing potency of drugs and complexity of drug regimens, particularly in the chronically ill where poly-pharmacy is rife, collaborative patient management by general practitioners and community pharmacists, in particular, has the potential to enhance patient therapeutic outcomes in primary healthcare. Literature from other parts of the world has enumerated the advantages of collaboration. South Africa with its unusual quadruple burden of disease and human resource deficient public healthcare system would benefit from collaboration between general practitioners and community pharmacists through expanded roles for community pharmacists to enable them to make more meaningful contributions to primary healthcare regimens. Particularly with the introduction of the National Health Insurance (NHI) programme. This dissertation aims to assess from general practitioners‟ perspectives: the current level and stage of collaboration (using the collaborative working relationship (CWR) model proposed by McDonough and Doucette, 2001) between general practitioners and community pharmacists in patient care, if general practitioners‟ perceptions of the professional roles of community pharmacists in patients‟ care can influence desired collaboration (prospects of enhanced future collaboration) and how do general practitioners envision enhanced future collaboration between them and community pharmacists in patient care, possible barriers to the envisioned collaboration between the two practitioners, and how general practitioners‟ demographic characteristics influence inter-professional collaboration with community pharmacists. Sixty randomly selected consenting general practitioners in private practice participated in a cross-sectional, face- to-face questionnaire study. The questionnaire contained a range of statements with Likert scale response options. Data was initially entered into Epi Info (version 3.5.1., 2008) and then exported to IBM SPSS Statistical software for analysis (version19, 2010). Medians were used to summarize descriptive data and Spearman‟s correlation coefficient, Mann-Whitney U Test and Kruskal-Wallis Test was used for bivariate analysis. Ethical approval was granted by the Senate Research and International Relations Committee, University of the Western Cape (Ethical Clearance Number: 10/4/29). The results indicated low-levels of current collaboration at stage 0 of the CWR model between general practitioners and community pharmacists. A statistically significant correlation was observed between general practitioners‟ perceptions of the professional roles of community pharmacists and desired collaboration (prospects of enhanced future collaboration), [p=0.0005]. Good prospects of enhanced future collaboration between general practitioners and community pharmacists were observed. General practitioners identified barriers to collaboration to include: the lack of remuneration for collaboration, absence of a government mandate or policy supporting collaboration, inability of general practitioners to share patients‟ information with community pharmacists and questionable professional ethics exhibited by community pharmacists particularly over financial gains. Most general practitioners agreed that joint continuing professional education organized by pharmaceutical companies or other groups will increase interaction and enhance collaboration. Enhanced Inter-professional collaboration between general practitioners and community pharmacists‟ can be possible in the future but hindrances need to be eliminated for this to be achieved. Future research can be aimed at exploring the perspectives‟ of community pharmacists to inter-professional collaboration in South Africa and interventions that will enhance collaboration.

Legislative changes in line with changing societal perspectives have resulted in increased service pressure on primary health practitioners to take further responsibility for the assessment and treatment of co-morbid psychiatric disorders in individuals with intellectual disability (ID) and for secondary and tertiary level services to reduce waitlists. The unique attributes of the ID population and a core lack of training for health professionals in the ID field has resulted in a large number of practitioners feeling under-trained and under-resourced to carry out this role effectively, to the potential detriment of the ID population. The challenges health practitioners experience when diagnosing co-morbid mental health disorders in individuals with ID and how they overcome these challenges was explored in this study. Participants were health practitioners of varying professions, including Psychiatrists, Clinical Psychologists and General Practitioners. Health practitioners completed an online survey and/or partook in a focus group or individual interview. The method used in this research was thematic analysis. The study found that health practitioners use holistic and contextual approaches to carry out assessments of individuals with ID, utilise ID specific tools, and liaise with experienced, specialised health practitioners as ways of dealing with the complexity of diagnosing co-morbid mental health difficulties in individuals with ID. In addition, it is recommended that more training in the ID area is provided for health practitioners, particularly for GPs in light of recent policy changes with emphasis of assessment and treatment occurring at the primary health level and for best practice guidelines to be developed. A further research project is suggested, exploring specific challenges facing GPs in this area of practice.

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

The thesis explores how practitioners in Mental Health nursing can be empowered and how this empowerment impacts on the care provided for clients The study begins by exploring the origins of the research, where the initial idea came from and how it builds on and develops previous work. (Nichols 1991, 1993) Questions raised in the introductory chapter about the worth and value of practitioners and their self motivation led to an exploration of the traditional scientific research approach. The detrimental effects of excluding subjects/participants from the research process was discussed. This included an exploration of how the outcomes of a research study can be better applied and have greater influence once they become part of the articulated experiences of practitioners. The main part of the thesis describes the work of a collaborate inquiry group made up of 12 practitioners working in Mental Health Nursing. The group worked together for 12 months identifying their own ideas for developing practice in order to provide a platform to enable empowering concepts to emerge. Data collection and analysis centred on the use of the dialectic as a question and answer approach to generate new knowledge. Tape recordings of group meetings and . one-to-one interviews enabled data to be recorded and analysed. Recorded conversation was systematically analysed using a framework devised by Stenhouse (1980). This framework enabled original recordings(as archives) to be condensed into meaningful statements about the impact of empowered practitioners. Chapters are organised in order to assist the presentation of data. The thesis shows the impact the dynamic of a collaborative inquiry has on practitioners and their experiences of empowerment, how practitioners used their empowerment to improve client care and the kinds of limitations that impinge on empowered practise. The authenticity of the thesis rests on the way that practitioners validated their own experiences and the concepts that emerged about empowered practise. This validation process was enhanced by seeking the views of practitioners, not involved with the research, about the process and outcomes of the collaborative inquiry. The thesis is drawn together by considering how the outcomes of this research could be further utilised and how by transforming prepositional statements into questions the dynamic of the dialectic assists with the further development of knowledge.

Ten to fifteen per cent of women from affluent countries, utilising private health care services are diagnosed with Postnatal Depression (PND) annually. Despite the high prevalence and the negative consequences for mother, child and partner, PND remains largely undiagnosed. Thus, this study explored health practitioners' experience of and attitude towards screening for postnatal depression to explore the barriers to screening as well as potential mechanisms to improve the rate of detection.

The evidence of the cardiovascular benefits of yoga is promising, but is limited by a lack of examination of mechanisms and specificity of effects compared to other interventions. To address these weaknesses, the present cross-sectional study comprehensively examined psychological and physiological contributors to cardiovascular health in regular yoga practitioners compared to regular runners and to sedentary individuals. Blood pressure (BP), heart rate (HR), and high frequency power (HF), a measure of heart rate variability, were measured at rest, and changes in BP and HR were measured in response to two laboratory stressors: an isometric handgrip task and a mental arithmetic task. Potential mediators of group differences on these outcome variables were measured including psychological factors, lifestyle factors, respiration rate, waist circumference, and aerobic fitness. In the present study, yoga practitioners and runners, relative to sedentary individuals, had significantly lower resting HR, higher HF, fewer depressive and anxious symptoms, lower hostility, less incidence of cigarette smoking, and superior aerobic fitness levels. Yoga practitioners had a higher rate of vegetarianism compared to runners and sedentary individuals. Yoga practitioners who reported regularly practicing a breathing technique called Ujjayi had a significantly lower respiration rate compared to runners and sedentary individuals. The lower resting HR in yoga practitioners compared to sedentary individuals was partially mediated by aerobic fitness, and the relatively higher HF power was partially mediated by both aerobic fitness and respiration. Implications and suggestions for future research are discussed.

Background: Multimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony’s general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners’ opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications. Methods/design: This is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients’ records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews. Discussion: To be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians’ decision making process regarding treatment.

Thesis (MA)--University of Stellenbosch, 2003.
ENGLISH ABSTRACT: Background: South African companies need to contend with numerous transformation and development issues since the country's re-entry into the international marketplace. One component that is receiving increasing attention is the wellbeing of employees in the drive to remain competitive within the global economy. This study argues that mental illness is a component of employee wellbeing that has been ignored, even though these conditions are highly prevalent and costly to businesses. The lack of recognition, research and information about mental illness in the workplace raises questions about the knowledge and orientation of human resource (HR) practitioners. This study therefore aimed to investigate and describe the mental health literacy and attitudes ofHR practitioners in South Africa. Methodology: This study had a descriptive purpose and employed a sample survey research design to distribute a mail questionnaire to a randomly selected sample of human resource practitioners registered with the South African Board for Personnel Practice (SABPP). The measuring instrument comprised mental health literacy and attitudes scales that have been extensively researched and reported to have sound psychometric properties. Three vignettes portraying mental disorders selected for their relevance to the business world (i.e., depression, panic disorder and alcohol abuse) were used as aids to achieving the research aim. A standard statistical package (SPSS 10.0) was utilised to determine descriptive and inferential statistics with an accepted 5% level of significance. Results: A response rate of 31% was achieved yielding an equal distribution of responses across the study vignettes. HR practitioners who acted as respondents to this study were found to be illiterate regarding mental illness and to hold subtle negative attitudes towards the mentally ill. Less than 10% could recognise mental illness as opposed to the majority who regarded the behaviour in the vignettes as normal responses. Whereas just over a third could correctly name the diagnosis described in the vignettes, only 7% were able to identify panic disorder. Most respondents believed that psychosocial stress factors caused mental illness, while only 29% where of the opinion that biological factors had a role in the aetiology of mental illness. Respondents favoured psychological and lifestyle treatment strategies and opposed medical treatments, irrespective of the type of mental illness presented with. Although as a group respondents showed mainly positive attitudes towards the mentally ill, evidence was found that the commonly held myths of danger/violence and the irresponsible/ childlike nature of the mentally ill were adhered to. Conclusions: The HR field should take cognisance of the reality of mental illness. Urgent steps need to be taken to adequately equip HR practitioners and students with both evidencebased knowledge and a positive orientation to enable the effective management of these conditions in the workplace. Attention should be given to addressing common mistruths and misconceptions, and to creating an awareness of the significant role that the HR practitioner can play in timeously recognising and appropriately dealing with employee mental health problems so that companies can benefit by the optimal utilisation of human resources.
AFRIKAANSE OPSOMMING: Agtergrond: Suid-Afrikaanse maatskappye het te doen met verskeie transformasie- en ontwikkelings aangeleenthede sedert die land se terugkeer na die internasionale mark. Die welstand van werkers is 'n aspek wat toenemend aandag verkry met hierdie strewe om mededingend te bly in die globale ekonomie. Hierdie studie argumenteer dat geestessiekte as 'n komponent van werkerwelstand geïgnoreer word, alhoewel dit algemeen voorkom en besighede heelwat geld kos. Die beperkte herkenning, navorsing en inligting oor geestessiekte in die werkplek lei tot vrae omtrent die kennis en inslag van Menslike Hulpbron- (MR) praktisyns. Derhalwe, ondersoek en beskryf hierdie studie die kennis en houding jeens geestesgesondheid van MH-praktisyns in Suid-Afrika. Metodologie: Hierdie studie se doel is beskrywend van aard en maak gebruik van 'n steekproef opname navorsingsontwerp. 'n Vraelys is gepos aan 'n ewekansig gesellekteerde steekproef van MH-praktisyns wat geregistreer is by die Suid-Afrikaanse Raad vir Personeelpraktyk. Die meetinstrument bestaan uit geestesgesondheid kennis- en houdingskale wat ekstensief nagevors is en wat beskryf is om goeie psigometriese eienskappe te besit. Drie gevaUestudies van geestessteurings relevant tot die besigheidswêreld (depressie, panieksteuring en alkoholmisbruik) is gebruik as hulpmiddels om die navorsingsdoeiwit te bereik. Standaard statistiese sagteware (SPSS 10.0) is gebruik om beskrywende en afleidende statistiek te bepaal met 'n aangenome 5% vlak van betekenisvolheid. Bevindings: Altesaam 31% van vraelyste is beantwoord en dit was eweredig verdeel tussen die verskillende gevallestudies. MH-praktisyns wat deelgeneem het aan hierdie studie het swak kennis omtrent geestessiekte en subtiele negatiewe houdings ten opsigte van persone met geestesiekte getoon. Minder as 10% kon geestessiekte identifiseer teenoor die meerderheid wat die gedrag in die gevallestudies as normaal beskou het. Net oor 'n derde kon die diagnose korrek benoem en slegs 7% kon panieksteuring korrek identifiseer. Meeste van die respondente het geglo dat psigososiale stresfaktore geestessiekte veroorsaak, terwyl net 29% van mening was dat biologiese faktore 'n rol speel in die etiologie van geestessiekte. Respondente het psigologiese en lewensstyl behandelingsmodaliteite verkies bo mediese behandeling en dit was onafhanklik van die tipe geestessteuring wat voorgekom het. Alhoewel die respondente as 'n groep hoofsaaklik 'n positiewe houding getoon het ten opsigte van persone met geestessiekte, was daar bewyse dat algemene mites ondersteun is en dat persone met geestessiekte beskou is as gevaarlik/aggressief en as onverantwoordeliklkinderlik. Gevolgtrekkings: Die MH veld moet die realiteit van geestessiekte aanvaar. Dringende stappe moet geneem word om MH-praktisyns en studente te voorsien van uitkomsgebaseerde kennis en 'n positiewe houding sodat effektiewe hantering van hierdie toestande kan plaasvind in die werkplek. Algemene onwaarhede en miskonsepsies moet aangespreek word en die bewustheid van die betekenisvolle rol van die MH-praktisyn moet benadruk word. Geestesgesondheidsprobleme van die werker moet betyds herken word en toepaslik gehanteer word sodat maatskappye voordeel kan trek uit die optimale gebruik van menslike hulpbronne.

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

National policies (DoH, 2008; 2011) propose a clear role for GPs in responding to the increase in childhood obesity, despite a limited evidence base which would secure such an emphasis. Previous research has indicated multiple barriers to the engagement of GPs in this clinical activity due to the sensitivities of the subject, low levels of role competence and confidence and limited access to specialist services. Using interpretive phenomenological analysis, this study explored how GPs made sense of their experiences of identifying and managing childhood obesity in order to provide a unique insight into these professional behaviours. Retrospective semi-structured interviews were carried out with ten GPs,who had been in practice for over 25 years. Four themes emerged. The first ‘understanding the family’ demonstrated how the GPs utilised their knowledge of the family’s health beliefs, motivations, skills, and wider socio economic factors to compile a unique understanding of the family which framed their responses to the obese child. The second ‘flexibility and responsiveness’ explored how this complex knowledge of the family was used to negotiate and address the different physical and emotional needs of the child. The third theme ‘professional and individual dilemmas’ explored areas of professional uncertainty, the identification of perceived legitimate role boundaries and the personal belief systems of the GPs regarding childhood obesity. The final theme ‘organisational challenges’ highlighted how time pressures, competing priorities, and structural constraints challenged their abilities to provide effective responses. An extended explanatory insight is provided by exploring the GPs’ dominant epistemological framework which resulted in the identification of 4 role types, using Laws et al., (2009) theoretical framework. The role types are considered in relation to the GPs’ professional identities and their contextual responses to the child and family. The research concludes with practical recommendations for service improvement at the practitioner, commissioner and national policy level.

The British Government, since 1997, have placed a strong emphasis on public health and the reduction of health inequalities. Alongside this, they have progressed a major reform of the NHS which aims to 'shift the balance of power' to the frontline. Primary care is an increasingly important aspect of the Government's new agenda, which aims to improve health for everyone, and for the worst off in particular. This thesis identifies general practice, and the core practitioners that work within it, as key potential contributors to a public health agenda. But 'public health' is a conceptually contested terrain, and as a concept, can be understood and interpreted in a myriad of ways. The impact of this lack of shared understanding is explored both for policy making and implementation, and for the development of public health practice in primary care. This research brings together public health and primary care literatures in order to illuminate the historical and organisational contexts within which current developments are taking place. It critically analyses the public health discourse of New Labour policy documents in order to explore the ways in which 'public health' is understood and talked about within recent government policy, and the government's expectations of primary care practitioners, in terms of their public health roles. Finally, the research draws on case study material from one (pre-2002) health authority area in England to examine practitioners' understandings of public health, and their perceptions of their public health roles. Using Wenger's (1998a) social theory of learning as a framework, it looks at the organisational and wider contexts in which practitioners work, and explores how varied and unclear understandings of public health, both in policy and practice, might be affecting practitioners' engagement with public health. The study highlights the dangers of vagueness surrounding the term public health, and finds a tendency both in policy and practice to regard it as a set of activities, rather than as an approach to work. Its malleability means that it can be interpreted both in a politically acceptable way, and in a way that fits within existing practice. Thus, as a concept, it loses its radical edge and is no longer something that challenges or guides policy and practice. The research finds that the ways in which practitioners interpret public health can contribute to their non-engagement in the public health agenda. This is not helped by conflicts within policy which threaten the development of stronger public health roles within general practices. The thesis concludes by recommending the development of shared understandings of public health, particularly as a valuedriven approach to work, rather than as a set of activities.

Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2007.
Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 5831. Adviser: Ruth V. Russell. Title from dissertation home page (viewed May 9, 2008).

In many states, outdated rules and regulations restrict nurse practitioners (NPs) from practicing to their full potential, often limiting patients’ access to primary care. Modernizing NP state scope of practice laws and allowing patients greater access to NPs services is a priority. Unlike other professions, nurse practitioners have been unable to consistently influence legislative changes to health policy. This study examined the political efficacy and participation of nurse practitioners in the United States today (N=632). A descriptive cross sectional design, in conjunction with a political efficacy framework, evaluated nurse practitioners’ participation in political activities and their internal and external political efficacy. Increased internal political efficacy was significantly (p < 0.001) associated with NPs who were older, had specific health policy education, and have been mentored in health policy. Our findings show that NPs vote at consistently higher rates (94%) than the general population and almost 50% report contacting legislators via mail/email/phone. As a group however, NPs report limited participation in other political activities, especially grassroots efforts. These findings hold significant implications for the profession as we strive to make policy changes across the country. It is important that educators assess our current methods of educating NPs about politics and health policy. Professional organizations and policy makers must reexamine outreach and strategies to inspire greater grassroots engagement of NPs.

Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and Resources and NP-Physician Relations were comparable (M = 3.00, SD = 0.86; M = 2.98; SD = 0.73). NPs scored lowest on Professional Visibility (M = 2.74, SD = 0.76) and NP-Administration Relations (M = 2.63, SD = 0.79). Recommendations included optimization of NPs as advance practice nurses, establishing adequate administrative and clinical support, provision for interprofessional team development and function, distribution of standardized information about the NP role across and within institutions, and further exploration of NPs' experiences related to work hours and agency culture. Positive social change was supported as the NP practice model was extended throughout the current health care system, contributing to the shifting health care narrative/culture (from illness-focused care to wellness-focused care), and demonstrating full appreciation of patient/client-centeredness.

Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.

This study sought to explore the perceptions of mental health care practitioners’ perceptions on mental illness within the isiXhosa cultural context. A qualitative exploratory descriptive and contextual design was used for the study. A non-probability purposive sampling method was used to select eight participants from Komani Hospital in Queenstown. Data was collected through semi-structured interviews. The services of an Independent Interviewer were used to avoid any bias as interviews took place where the researcher is employed. All interviews were transcribed verbatim and the data collected was analyzed according to Tesch’s eight steps of data analysis as described in Cresswell (1994:155). The researcher utilized services of an Independent Coder who verified the identified major themes. Four major themes emerged from the analysis of the interview: Mental health care practitioner’s perceptions of mental illness, perception of the causes of mental illness within the isiXhosa cultural context, mental health care practitioners’ views in the management and treatment of mental illness and suggestions put forward to improve the services to mental health care users. The major findings of this study were the lack of knowledge of culture of mental health care users. It is recommended that it would be proper if there could be co-operation between mental health care practitioners and traditional healers by working together as a team.

Aim. This study aimed to explore factors influencing health practitioners’ work performance. This knowledge will facilitate development of appropriate support and education for health practitioners in delivering quality healthcare. Design and participants. A mixed method exploratory descriptive study using cross-sectional methodology was used to gather relevant data and obtain an overview from 60 health workers and 40 health managers in health facilities operated by the Ministry of Health (MOH) in Jazan region, Saudi Arabia. Survey questionnaire followed by selected unstructured interviews to gather data were used. Descriptive statistics, particularly the percentage and weighted mean (Wm) were used. Findings: Results showed that a typical health practitioner in Jazan, KSA has a mean age of 31.17 (health workers) and 28 (health managers). Majority are female (68.33% health workers; 85% health managers) and from other Asian countries. Most have Diploma in Nursing/Midwifery (46.67% health workers; 55% health managers) as educational qualification. Many of them are charge nurses (41.67%). The average number of years they have worked is 6.92 years for the health worker and 12.63 years for the health managers. The health workers showed agreement on the utilization of performance appraisal in their unit (Wm=3.66); however, they were uncertain on their appraisal regarding remuneration, benefits, and recognition (Wm=3.30) as well as uncertain on staffing and work schedules (Wm=3.01) and staff development (Wm=2.39). Factors affecting their work performance were generally intermediate in nature (Wm=2.39), but shortage of staff specifically was a major factor (Wm=3.27). They perceived the strategies to improve and maintain excellent performance as moderately needed (Wm=2.23). Health managers were often involved in management tasks (Wm=2.89) and they assessed their skills as “Good” (Wm=3.63). Conclusion. Many of the health practitioners in Jazan are predominantly younger, female expatriates. They encounter issues in their job and in management that may affect their work performance. Addressing these issues is necessary to assist their development and support work performance. The strategic plan developed from these results will support the education and training of these health practitioners and will be implemented and evaluated.

Eating disorders are mostly prevalent in young females, with rates of disordered eating up to five times higher than diagnosable cases. There is evidence to suggest females from a South Asian background have higher rates of eating disorder symptomatology than their White counterparts. Culture plays a role in susceptibility to eating disorders, and factors such as parental control, stigma and ethnic stereotyping by health professionals can be additional barriers to seeking and receiving appropriate help. This thesis was concerned with the clinical decision-making processes of UK mental health practitioners and whether the ethnicity of clients affected this. Three vignettes were devised, one including clinical features indicative of a restrictive eating pattern, one of a binge eating pattern and one with depression and anxiety symptoms. Each vignette was presented with a picture of either a young Asian female or a White female. One hundred and fifty six participants, all clinical staff in IAPT services, filled in an online survey comprising of one vignette and a questionnaire exploring factors involved in clinical decision-making and potential barriers to engagement. Mental health practitioners were less likely to rate the vignette as showing symptoms of anorexia nervosa when the picture presented was that of an Asian female as opposed to a White female, and more likely to rate the Asian version with bulimia nervosa. There were no significant differences between ethnic groups in terms of treatment recommendations. Social and cultural factors were identified as areas of concern in the White vignette version, an unexpected finding. These findings indicate there may be ethnic bias present in decision-making regarding eating disorders and disordered eating patterns. It is recommended training in both identifying eating disorder symptomatology and cultural competency is emphasised more in training courses and beyond. Further research into decision-making by mental health providers is also needed.

Background Since its introduction in the 1980s, reports show an increase in the placement of gastrostomies in children, particularly in those with disabilities, due to its many benefits. To date, little has been reported on the practices, perceptions and experiences of the health care practitioners when engaging in the management of children with gastrostomies. Research aims This study aims to provide insight into the practices as well as the perceptions and experiences of the health care practitioners working with gastrostomies in a paediatric setting. Method A qualitative interpretative design was used. Eighteen healthcare practitioners, who form part of the multidisciplinary team working with paediatric gastrostomies, from one of the two prominent tertiary institutions in Cape Town, South Africa were recruited for this study. Semi structured interviews were conducted after which data analysis took place. Results Four themes emerged from the data collected; experience of better patient health evolving post gastrostomy despite complications, health care practitioners’ perceived change to a family’s quality of life, the gastrostomy process: just as you think it’s going right then something goes wrong; and experiencing multidisciplinary team work, and its influences on the management of patients with gastrostomies. Conclusion The health care practitioners reflected on their practices, perceptions and experiences of gastrostomy management as being a process. During the different stages of the process, they engaged with the advantages and disadvantages the gastrostomy has on the health of a child; the positive and negative influences on the quality of life for families and identified the importance of but also the lacking in the provision of education and ongoing support for caregivers. An effective multidisciplinary team is a requirement for the management of the gastrostomy; inadequacies within the team contributed to undesirable service delivery and poor health outcomes for the child. This study highlights the importance of and the need for the implementation of best practice guidelines for gastrostomy decision-making, placement and management in the paediatric setting.

Background: Primary care practitioners are at the forefront of the health service and therefore have an opportunity to promote oral health, manage certain oral conditions, or refer appropriately to the closest dental service. In under-resourced areas, patients are more likely to present initially to a primary health care nurse or doctor, with oral or dental needs. Studies abroad have revealed that general practitioners do not always examine the oral cavity, enquire about oral health, or manage oral disease particularly well and have expressed an interest to learn more about oral health. A literature search for similar South African studies did not yield results. This study aims to describe current oral health care practice provided by primary care practitioners in Cape Town and to assess whether this level of service might benefit from interventions to improve the quality of care. Methods: The Nominal Group technique (NGT) was used to identify and achieve consensus among 8 community health centre primary care practitioners regarding the main challenges to providing oral health care and offer suggestions for strengthening oral health care. This assisted the development of a questionnaire, which was then distributed to practitioners at five Community Health Centres in the Cape Town Metropole. The questionnaire aimed to assess the knowledge, attitudes and current practices of practitioners in the area of oral health. Results: The NGT yielded valuable information to inform the questionnaire; two main topics were discussed which helped inform two sections of the 9-part questionnaire. A total of 53 doctors and clinical nurse practitioners completed the questionnaire. Only 17% of participants reported routinely examining the oral cavity, others examined it on request of the patient or suspicion of an abnormality. A minority (13.2%) stated that they routinely promote oral health in the consultation and reported limiting factors to include: insufficient time during consultations, forgetting to include oral health promotion, a limited knowledge of oral disease, and limited access to Oral Health Services. Suggestions for strengthening the oral health care included training clinicians in oral health, motivating clinicians to provide better oral health care, improving patient education on the importance of oral health care, and improving the integration of Primary Care services with Oral Health services. Limitations of this study include a small sample size, studying only urban community health centres in Cape Town, the absence of input from oral health experts, the absence of input from patients and missing data. Conclusion: It is apparent from this study that oral health is inadequately managed, for a number of reasons; including time constraints, limited knowledge of treating clinicians, and limited available oral health services. Possible interventions to improve this clinical area can be posed to relevant authorities and may include examining undergraduate curricula (medicine and nursing) to assess the content and quality of oral health education, provide in-house training to CHC staff by local dentists and oral hygienists, provide information sessions for staff at CHC about the local Oral Health Service available in their areas, and offering education to patients in the waiting room on the topic of good oral health.

Thesis advisor: Christopher Maxwell
Though much research has been done on the subject of substituting nurse practitioners for physicians as health care providers, both analytic methods and results have been inconsistent. Various studies have shown nurse practitioners to provide equivalent or improved care especially in primary care settings. However, no consensus has been reached on whether or not and under what conditions this substitution is economically efficient. Because of variation in productivity and substitution rates, the economic viability of nurse practitioners must be assessed on a department specific basis, taking into account differences in nurse practitioners’ job descriptions.One specific area this economic efficiency could be assessed in is in the diagnosis of ear infections. A study conducted through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey showed that 15% of pediatric visits included a diagnosis of middle ear infection (Freid, 1998). If employed properly, nurse practitioners could be used to achieve significant cost savings in this area.This thesis is intended to address the economic efficiency of nurse practitioners as compared to physicians in diagnosing ear infections. First nurse practitioner quality in this specific area will be assessed by comparing nurse practitioner diagnosis error rates to physician error rates based on surveys asking both types of providers to provide diagnoses based on tympanic membrane images collected through previous telemedicine visits. Next the economic practicality of employing nurse practitioners in this field will be assessed in terms of the relative costs of these errors, measured as the cost of unnecessary prescriptions in the case of overdiagnosis and the cost of an unnecessary follow-up visit in the case of underdiagnosis
Thesis (BA) — Boston College, 2012
Submitted to: Boston College. College of Arts and Sciences
Discipline: College Honors Program
Discipline: Economics Honors Program
Discipline: Economics

With the continued growth in the numbers of nurse practitioners and certified nurse-midwives, more and more women will receive prenatal care from advanced practice nurses. The purpose of this research was to assess the routine screening practices of advance practice nurses providing prenatal care and to compare those practices with current guidelines. The study focused on five areas of prenatal screening: bacterial vaginosis, group B streptococcus, gestational diabetes, maternal serum markers, and fetal movement monitoring. The interaction model of client health behavior by Cheryl Cox, specifically professional-technical competencies, part of the client-professional element of the model, provided the theoretical framework for this study. The sample was obtained :from two major nursing organizations involved in prenatal care: the National Association of Nurse Practitioners in Women's Health and the American College of Nurse-Midwives. A random sample of250 members from each organization was sent a postcard explaining the study and directing them to the online survey. In four out of five screening areas, there was no significant difference in the screening practices of NPs and CNMs. Bacterial vaginosis was the only screening with a significant difference. There was inconsistency with what the advanced practice nurses state they do and current guidelines with respect to screening for group B streptococcus and maternal serum markers.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The Department of Health estimates that 80 percent of South Africans consult traditional healers before consulting modern medicine. The aim of this study is to investigate the extent of the use of traditional medicine in local communities in the Limpopo Province, and add value to a draft policy that was introduced by the Minister of Health. (South Africa, Department of Health 2007a) Traditional healers are regarded as an important national health resource. They share the same cultural beliefs and values as their patients. They are respected in their communities. In South Africa, traditional healers have no formal recognition as health care professionals. Despite the advantages of modern medicine, there is a dramatic evolution in traditional medicine developing and developed countries. In recognition of the value that traditional medicine has added to people’s health needs, government organisations have realised the gap and needed to embark on public participation to bring to light the solution, by implementing a relevant policy (Matomela 2004). According to research done by Pefile (2005), positive outcomes that resulted from the use of traditional medicine include a more holistic treatment, a wider choice of health care that suits people’s needs, and scientific advancement, this paves a way forward for a policy to be put into place for the legal recognition of traditional medicine. New legislations have been brought about in regulating traditional medicine and practitioners. This paper provides a synopsis of government initiatives to close the gap and address the concerns of integrating traditional and modern medicine. The thesis addresses the challenges involved in incorporating the two disciplines for the best possible impact of local communities in accessing their rights as vested in the constitution. The study is a qualitative study where relevant practicing traditional healers, users, Western doctors, nurses, managers and government policy makers were interviewed regarding the draft policy on traditional medicine. This was to obtain information on the challenges, gaps and possible solutions regarding the integration of African traditional medicine into the health care system of Southern Africa. Findings show the following: a majority of traditional healers do not agree to scientific trialling and testing on the herbs that they prescribe, and Western doctors feel that traditional healers should only treat patients spiritually unless they have a scientifically tested scope and limitations on their field. The study also found that traditional healers want to be registered and integrated into the health care system, but do not agree to have regulated price fixing. Other conclusions included that the communities seek traditional help for cultural reasons and more benevolent purposes, but are changing their focus towards seeking medical help from clinics where it is provided for them. However, people within the communities are still confused whether to seek traditional or western medicine and therefore seek both. It was found that medications are not readily available in district clinics and hospital waiting times force people into seeking traditional help. Nurses, doctors and caregivers acknowledge that traditional healers are hampering the health care of patients by delaying hospital treatment of patients hence progressing illnesses. However, they also state that traditional healers help people spiritually and mentally. Therefore policy makers have found solutions to educate healers and create regulatory boards to limit and create a scope of practice for traditional healers. Recommendations and solutions for the relevant policy are as follows: It is recommended that traditional health practitioners should only be allowed to practice and train over the age of 21. They must be prohibited from certain procedures, for example: drawing blood, treating cancers, and treating AIDS/HIV. They should only be allowed to practice midwifery if they have had training. They should be prohibited from administering injections and supervised drugs, unless trained at a tertiary level traditional healers can be used as home caregivers, spiritual healers, and traditional advice counselling entities in the communities. Traditional healers must be prevented from referring to themselves as a ‘doctor’ or ‘professor’. This misleads people into believing that they are allopathic doctors. ‘Traditional health practitioners’ must realise that they are holistic healers, and must be addressed as such. A strong recommendation is to rename ‘traditional health practitioners’ as ‘spiritual practitioners’. With regards to regulations, it must be imperative that every practicing traditional health practitioner be registered annually with the relevant board. A good suggestion is for traditional health practitioners (THP) to attend formal training courses, under an experienced herbalist, and it should be documented on paper. A written record of the location of practice, and specialty must also be documented. There must be policies on health and safety, hygiene and sterility that need to be in place. It is suggested that training on patient confidentially must be taught and implemented. A code of conduct and a standard of professional ethics must also be implemented. Health and safety regulations pertaining to the profession and the citizens must be listed. Efforts towards dispelling myths and making people aware, thereby filtering out the positive side of the traditional medicine (e.g. medical benefits with some herbs), and rooting out the ‘quack’ practices (e.g. the use of amulets around a patient’s body to cure diseases) should be practiced. Pertaining to co-operative relationships between modern medical doctors and traditional practitioners, it is recommended that the use of exchange workshops between the two professionals needs to be developed. Also scientific information and technology must be available to traditional healers. A continued professional development (CPD) programme should be a mandatory requirement, as for all other health care professionals. It seems the development of traditional hospitals, in which a scope of practice is defined, can be used as a recovery ward and a spiritual guidance centre. The above recommendations will encourage a healthier, safer and transparent health care system in South Africa, where all disciplines of medicine co-exist in one National Health Care System.
AFRIKAANSE OPSOMMING: Nadat navorsing deur die Departement van Gesondheid gedoen is, is daar gevind dat 80 persent van Suid-Afrikaners tradisionele genesers besoek. Die doel van hierdie navorsing is om ondersoek te doen na die gebruik van tradisionele medisyne deur landelike gemeenskappe in die Limpopo Provinsie, en om ook ‘n bydrae te lewer tot die konsepbeleid wat deur die Minister van Gesondheid bekendgestel is (South Africa, Department of Health 2007a). Tradisionele genesers kan beskou word as ‘n belangrike hulpbron in die nasionale gesondheidsdiens. Hulle deel in kulturele gelowe en waardes van hulle pasiente en word ook gerespekteer in hulle gemeenskappe. Suid-Afrika egter, gee geen erkenning aan tradisionele genesers of die feit dat hulle in die gesondheidsdiens is nie. Ondanks die feit van moderne geneesmiddels, is daar ‘n dramatiese evolusie wat besig is om plaas te vind in die Westerse Wêreld. Die erkenning en waarde van tradisionele medisyne wat bydra tot mense se gesondheidkwaliteit, het daartoe gelei dat Staatsorganisasies begin insien het dat daar ‘n gaping is en dat publieke peilings gedoen word om ‘n oplossing te vind en ‘n beleidsdokument saam te stel wat tradisionele genesers insluit (Matomela 2004). Die ondersoek wat Pefile (2005) gedoen het, het positiewe resultate getoon by die gebruik van tradisionele medisyne wat ‘n holistiese behandeling in ‘n wyer verskeidendheid van medisyne insluit by gebruikers. Ook die wetenskaplike vooruitgang van tradisionele medisyne het daartoe bygedra dat ‘n beleidsdokument in plek gesit word vir die wettige erkenning daarvan. Nuwe wetgewing is in werking gestel om beheer uit te oefen oor tradisionele genesers en tradisionele medisyne. Hierdie dokument verskaf ‘n sinopsis van die Staat se inisiatiewe om die gaping tussen moderne medisyne en tradisionele medisyne aan te spreek en ook om landelike gemeenskappe toe te laat om hulle reg uit te oefen soos wat in die Grondwet vervat is. Die studie is kwalitatief waar relevante praktiserende tradisionele genesers, verbruikers, Westerse dokters, verpleegkundiges, bestuurders en staatsdiensbeleidvormers ondervra is oor ‘n konsep beleidsdokument oor tradisionele medisyne. Dit was gedoen om informasie rakende die uitdaging , gapings en 'n moontlike oplossing te vind vir die integrasie van Afrika se tradisionele medisyne in die gesondheidsorgsisteem van Suidelike Afrika. Belangrike bevindings sluit die volgende in: die meerdeerheid tradisionele genesers stem nie saam dat wetenskaplike toetse gedoen word op kruie wat hulle voorskryf nie; tradisionele genesers will geregisteer en geïntegreer word in die gesondheidsorgsisteem maar stem nie saam oor prysregulering en prysvasstelling nie; Westerse dokters is van mening dat tradisionele genesers net pasiënte geestelik moet kan behandel tensy hulle ‘n wetenskaplik getoetse doel en beperkings in hulle veld het; Westerse dokters glo dat tradisionele genesers dwarsboom die gesondheidsorgsisteem deurdat hulle behandeling vetraag; die gemeenskap soek tradisionele hulp op vir kulturele redes en ander welwillendheidsredes maar gaan soek mediese hulp by klinieke waar dit aan hulle verskaf word; mense van gemeenskappe is verward en raadpleeg beide tradisionele genesers en Westerse dokters vir hulp; sommige medisyne is nie altyd by klinieke beskikbaar nie en mense sien nie kans om in lang rye te wag by hospitale nie en dit noop dat hulle tradisionele medisyne gebruik; verpleegkundiges en gesondheidswerkers erken dat tradisionele genesers mense vertraag om gesondheidsorg en behandeling by hospitale te kry, maar verstaan ook dat tradisionele genesers aan mense geestelike hulp verleen; en besleidskrywers moet oplossings vind om tradisionele genesers op te voed en om komitees te stig wat tradisionele genesers se ruimte van praktisering in toom te hou. Die volgende word as voorstelle tot aanpassing van die genoemde beleidsdokument geïdentifiseer:- Tradisionele genesers mag alleenlik praktiseer en opleiding verskaf na die ouderdom van 21 jaar. Hulle moet verbied word om sekere prosedures, byvoorbeeld die trek van bloed; behandeling van HIV/VIGS; om voor te gee dat hulle mediese praktisyns is; om vroedvroue te wees slegs indien gekwalifiseer daartoe; om inspuitings toe te dien en medisyne uit te reik slegs indien hulle tersiëre opleiding gehad het. Tradisionele genesers se dienste kan gebruik word as gemeenskapsgesondheid hulpwerkers, geestelike genesers, en kan tradisionele advies en begeleiding aan die gemeenskap lewer. Tradisionele genesers moet belet word om die titels “Dokter” en “Professor" te gebruik. Tradisionele genesers moet daarop let dat hulle holistiese genesers is en moet daarvolgens aangespreek word. Hulle moenie pasiënte mislei deur voor te gee dat hulle allopatiese geneeshere is nie. “Tradisionele genesers” moet hernoem word na “geestelike genesers”. Tradisionele genesers moet by ‘n erkende organisasie geregistreer word en moet so-ook jaarliks registrasie hernu. Formele onderrig wat deur ‘n ervare kruiegeneser aangebeid word moet bygewoon en gedokumenteer word. ‘n Geskrewe rekord van die ligging van die praktyk en betrokke spesialisering moet bygehou word. Beleidsvoorskrifte wat verband hou met gesondheid en veiligheid, hygiene en sterilisasie moet in die tradisionele gesondheidgeneserspraktyk geïmplementeer word. Opleiding in pasiëntkonfidensialiteit moet aangeleer en toegepas word. Samewerking en werkswinkels tussen moderne mediese dokters en tradisionele gesondheidgenesers moet geïmplementeer en ontwikkel word. Mediese wetenskapsinligting en tegnologie moet aan tradisionele genesers bekendgemaak word. Voorts moet ‘n voortgesette professionele ontwikkelingsprogram (POP) aan alle gesondheidswerkers voorgeskryf word. Dit blyk wenslik te wees om tradisionele hospitale tot stand te bring waar die bestek van praktyk gedefinieer word. Sulke hospitale kan dien as plekke waar pasiënte aansterk en geestelike onderskraging geniet. ‘n Etiese kode en standaard vir professionele etiek moet geskep word vir tradisionele genesers. Gesondheids- en sekureitsregulasies moet van toepassing wees en geïmplementeer word. Pasiënte moet ingelig word oor die wegdoen van mites en fabels. Daardeur kan die positiewe sy van tradisionele medisyne (byvoorbeeld mediese voordele van kruie), en uitroei van “kwakke” (byvoorbeeld dra van gelukbringers om die lywe), verdryf word. Dit sal die aanmoediging van ‘n gesonder, sekuriteitbewuste en deursigtige gesondheidsorg sisteem bewerkstellig in Suid-Afrika waar alle dissiplines van medisyne saam bestaan in die Nasionale Gesondheidsorgsisteem.

This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson’s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.

Depression negatively impacts the American economy, and there is a shortage of physicians to provide treatment. Nurse practitioners are viable alternatives to provide high-quality treatment of depression. The project's purpose was to describe nurse practitioners' attitudes toward nonpharmacological interventions to treat clinical depression. Attitude theory provided the theoretical framework. The American Psychiatric Association's guidelines for treating major depression provided the conceptual framework. The project used a quantitative nonexperimental descriptive survey research design. A purposeful sample of 63 nurse practitioners was obtained from members of the American Association of Nurse Practitioners. Data were collected through an online survey that included questions about participant demographics, attitudes about depression treatment modalities, and experience with individual and group psychotherapy in the treatment of depression. Frequencies and percentages were calculated for demographic information and information related to the use of individual and group therapy. Means and standard deviations were calculated for each of the Likert scale items. The findings showed that participants had more knowledge about medications used to treat depression and individual therapy than they did about group therapy. Findings showed that the participants believed that medication combined with individual therapy was the most effective treatment for individuals diagnosed with depression. Barriers to using group therapy were identified. These findings provided information to nurse practitioners about preferred treatment modalities for depression and the barriers to using group therapy to treat depression.

The federal program of deinstitutionalizing psychiatric facilities has resulted in a well documented, ever-increasing mentally ill population in the nation's prisons and jails. Historically, the criminal justice system has maintained a laissez-faire attitude toward the mentally ill, and only became involved with the mentally ill when a crime had been committed. As such, the President's Mental Health and Criminal Justice Consensus Project was developed to explore ways that the two systems could work together to address the growing problem of the mentally ill offender. However, challenges arise because the criminal justice system has typically been viewed as a loosely coupled, fragmented system that is unwilling or unable to address the social issue of the mentally ill offender. The concept of coupling between agencies has serious ramifications for the ability of agencies to successfully collaborate. Theoretical foundations for collaboration between mental health and criminal justice agencies lie partly in labeling theory and the drive to avoid the negative stigmatization of the mentally ill by the formal criminal justice system. A second theoretical foundation is found in developmental theories, which seek to explain the development of organizational knowledge and skills, in handling mentally ill offenders, through interaction between the mental health and criminal justice systems. In this study, it is asserted that agencies that are appropriately coupled and have experience with collaboration will perceive greater benefits from the collaborative exchange. Furthermore, this leads to the main hypothesis of the current study that agency coupling and collaborative experience will increase the perception of benefits of collaboration and support of collaborative efforts that deal with mentally ill offenders. To assess the main hypothesis of the current study, a modified Dillman methodology was utilized. The research population consisted of a complete enumeration of the 20 Florida State's Attorneys Offices, the 66 County Sheriffs, the 54 Probation Office Managers, and the 313 municipal law enforcement agencies for a total study population of 453 possible respondents, of which 49% responded. Overall, the findings of the current study illustrate a willingness of agencies to couple with outside agencies to address the phenomenon of the mentally ill offender. The results provide theoretical support for the need to reduce the negative stigma of a mentally ill individual being additionally labeled a criminal offender. The results additionally bolster the belief that the knowledge and skills to do this can best be accomplished through interaction with outside agencies.
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Health and Public Affairs
Public Affairs: Ph.D.