Дисертації: "Aged Care Quality and Safety"

1

Daskein, Robyn. "Nursing Documentation and Quality of Care in Residential Aged Care in Queensland." Thesis, Griffith University, 2008. http://hdl.handle.net/10072/367277.

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Little is known about the relationship between registered nurses’ (RNs’) knowledge of nursing documentation, their attitudes towards this documentation, and how they perceive the importance of the forms used in the documentation process within residential aged care. The current study has several aims. This investigation sought to gain a measure of RNs’ knowledge of, and attitudes towards documentation, and assess their perception of the importance of forms used to document care. There were two phases of study. Study 1 utilised a cross-sectional, retrospective design with a large sample of RNs (n = 360) who completed Edelstein’s (1990) modified questionnaire to identify factors that influence nurses’ documentation in residential aged care in Queensland. A factor analysis was undertaken to extract influencing factors. The second study developed and tested a conceptual model of nursing practice and quality of care to determine relationships between the factors under investigation. This phase used a smaller sample of RNs (n = 46). Participating RNs were asked to provide personal characteristics (e.g. age, gender, first nursing qualification and studies in aged care) and to complete Edelstein’s (1990) modified questionnaire. A chart audit was conducted on residents’ records where the resident required interventions for challenging behaviour. Relatives of residents whose charts were audited also completed a survey to measure their perceived satisfaction with care of their family member. Finally, a model of the relationships between documentation and outcome measures was developed on the basis of prior literature and previous empirical studies. This model was labelled “The Nursing Practice and Quality of Care Model”. This model was then tested with a smaller sample of RNs, seeking to find out if it appropriately represented the relationships that exist between RN documentation and outcomes. Edelstein’s (1990) modified questionnaire was demonstrated to have acceptable reliability and validity. Results of Study 1 revealed that RNs working in aged care in Queensland have high levels of knowledge about documentation, and consider the forms they use to document care to be very important, but have mixed attitudes towards documentation. Several issues influenced the results for the knowledge and attitude scales. These included knowledge factors such as care-reporting guidelines, nurse time issues, legal issues and quality of reporting. Attitudes were influenced by charting, practice and policy issues. These findings provide important information on what variables affect RNs’ documentation. The RN participants in Study 2 were comparable to the national and state figures for RN aged care demographics (Hsu, Moyle, Creedy, & Venturato, 2005; Richardson & Martin, 2004). Overall, the findings of Edelstein’s (1990) modified questionnaire in Study 2 were consistent with Study 1, although different relationships were found between the knowledge and attitude factors. The chart audit revealed that although RNs did complete most items on the forms, no form was fully complete, and suggests that RNs are not generally fully compliant with nursing documentation requirements in residential aged care. Relatives of aged care residents were generally happy with the level of care for their family member, but felt that individual issues such as leisure and activity programs, meals, and dining services could be improved. Analysis of “The Nursing Practice and Quality of Care Model” involved structural equation modeling (SEM) to determine the relationship between experiences, knowledge and attitudes toward nursing documentation, compliance with writing nursing documentation and relatives’ satisfaction. Testing revealed that the model was generally a good fit; however, only some variables predicted to be included in the model were significant. Of greatest interest was the strong predictive relationship between care reporting guidelines and caring behaviour, which suggested that the more RNs knew about documentation, the better they were able to care for residents with challenging behaviour. Positive attitudes to policy issues by RNs, and high completion of charting review items also predicted better outcomes for residents. RNs who had studies in aged care showed a relationship with quality issues suggested that the more education RNs completed the more they knew about quality issues. However, there were some significant negative predictive relationships between variables such as quality issues and caring behaviour that were not anticipated. Overall results suggest that some RN documentation factors did significantly predict residents’ quality of care. This is an important step forward in finding ways to improve the care of residents in aged care facilities. Thesis (PhD Doctorate) Doctor of Philosophy (PhD) School of Nursing and Midwifery Griffith Health Full Text

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2

Hutchinson, Allen. "Exploring safety, quality and resilience in health care." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6574/.

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There still appears to be much to do to make the National Health Service in England a safer place for patients. Hospitals, in particular, are complex organisations in which staff and processes are under the twin simultaneous demands of an increasingly aged society and severe financial constraints. While much health care is well delivered, there remains a need to predict, and to explore, where and why problems occur. This thesis presents work which has refined methods and tools that can be used at health system and organisation levels to explore some key safety and quality issues in health care. The six publications presented and discussed here were published during a seven year period between 2006 and 2013. They explore three important issues relating to safer health care – safety culture and incident reporting, prospective hazard analysis, and the use of improved case note review methods to evaluate the safety and quality of care in hospitals. Two principal approaches to data access are presented in the publications. At the system and organisation level, information from large data sets was used to investigate the relationships between markers of safety and quality. At the health care provision level, data has been gathered about the work of health care professionals using mixed-methods approaches. The publications are discussed across two inter-related concepts – healthcare safety and healthcare resilience. While the study of safer healthcare has a long history the concept of healthcare resilience is still being developed. Resilience is concerned with the way in which organisations and people can adjust and maintain their functioning in the face of challenge or adversity. Although the presented publications themselves do not explicitly consider research into resilience, this theme is used to reflect on the study results and their potential value to health services.

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3

Veerkamp, Celeste Goff. "Gatekeepers to healthcare quality and patient safety| Veritas Credentials." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10158999.

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The current environment of healthcare requires organizations to look at each department and each employee from an economic vantage and to consider at all viable options for cost containment. An organization’s Medical Staff Office has traditionally taken responsibility for providing the credentials and privileging function for organizations. The amount of work and time as well as seasonal fluctuations in the number of applicants proves difficult for an organization from a staffing and budgetary standpoint. For many organizations, the ability to outsource its credentialing functions to a Credentials Verification Organization may prove a cost efficient option. Veritas Credentials seeks to remedy this difficulty for healthcare organizations by allowing the credential and privilege function to be outsourced. This business plan will show how Veritas Credentials intends to provide an array of services to ensure that healthcare organizations provide privileges to high quality providers which will ensure patient safety.

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4

Parand, Anam. "The role of acute care managers in quality of care and patient safety." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11677.

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Healthcare managers have a responsibility for the standard of their services and patient care delivered. Their work is thought to be essential in achieving and improving high quality care and patient safety. However, little is empirically known about their role in this. This thesis investigates acute care managerial work and impact in the context of quality of care and patient safety. It draws upon power and work-activity group theories and literature from other industries to guide investigation and elucidate findings. The introductory Chapters (Chapters 1-3) provide the background context of quality of care and patient safety, relevant management theory, and literature on the role of acute care managers in quality and safety. A systematic literature review in Chapter 4 illustrates a case for empirical research on this topic and suggests areas for further investigation. Chapters 5 and 6 report a case study investigation of the senior manager’s dimensions of involvement in a quality and safety improvement collaborative. These Chapters present self-reports of 17 Chief Executive Officers and 18 Medical Directors across 20 NHS hospitals on their actions and contributions to the UK Safer Patients Initiative (SPI). From this, a model of five principle dimensions of involvement emerged. Corroborating this model, Chapter 7 reports the staff perspective of their senior managements’ role in SPI, comprising interviews with 36 staff also involved in the SPI programme across the 20 hospitals. To explore the work of the acute care middle manager in quality and patient safety, 36 interviews with general managers, service and divisional managers across two NHS Trusts and two specialities reveal their relevant training/learning, demands, choices and constraints (Chapter 8). This informed two follow up surveys that further quantified the interview findings and explored theoretical power and role constructs. The first survey presents the views of 100 middle managers from 10 NHS Trusts on their quality and safety-related time, learning, activities, power and impact (Chapter 9). The second survey reports 60 clinical staff views on the same items, illustrating some divergence on critical constructs (Chapter 10). The thesis closes with a final Chapter (Chapter 11) comprising a summary of the key findings per Chapter and the overarching themes from the thesis. Methodological limitations/strengths, wider implications for managers and policy makers, and future research are considered. The Chapter ends with concluding remarks on the critical work performed by acute care managers across organisational levels for the daily preservation of quality and patient safety and its improvement.

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5

O'Reilly, Maria Therese. "Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/40314/1/Maria_O%27Reilly_Thesis.pdf.

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Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

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6

De, Bellis Anita Marie, and anita debellis@flinders edu au. "Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility." Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.

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This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care. Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care. Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'. The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision. The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice. There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation. If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.

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7

Grenade, Linda Elise. "Accreditation of residential aged care facilities: experiences of service providers." Thesis, Curtin University, 2003. http://hdl.handle.net/20.500.11937/1306.

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The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study.Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.

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8

Crawley, Leah R. "Gender differences in quality of life of residents living in aged care complexes /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09ARPS/09arpsc911.pdf.

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9

Glasson, Janet, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process." THESIS_CSHS_NFC_Glasson_J.xml, 2004. http://handle.uws.edu.au:8081/1959.7/481.

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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. Master of Health Science (Hons)

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10

Morrow, Martha Sue. "Quality and Safety of Intermittent Intravenous Infusions." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=casednp15283136058872.

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11

Lima, Beatrice de Barros. "Gestão do risco de queda em idosos: tecnologia da informação e comunicação para a disseminação da cultura de segurança do paciente." Universidade Federal Fluminense, 2016. https://app.uff.br/riuff/handle/1/5918.

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Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-09T19:02:10Z No. of bitstreams: 1 Beatrice de Barros Lima.pdf: 4437029 bytes, checksum: 617cb7a6bd81b32d6b8a4d04d656a2ab (MD5) Made available in DSpace on 2018-03-09T19:02:11Z (GMT). No. of bitstreams: 1 Beatrice de Barros Lima.pdf: 4437029 bytes, checksum: 617cb7a6bd81b32d6b8a4d04d656a2ab (MD5) Previous issue date: 2016-11 Mestrado Profissional em Enfermagem Assistencial A pesquisa trata da gestão do risco de queda como estratégia para segurança do paciente. Tem por objeto de estudo a gestão do risco quedas do paciente idoso hospitalizado em uma instituição certificada. O objetivo geral traçado é elaborar uma tecnologia da informação e comunicação a partir da perspectiva dos enfermeiros para gerenciar o risco de queda no contexto da segurança do paciente, e os objetivos específicos são: identificar os motivos das não conformidades relacionadas as evidenciadas no instrumento de auditoria e as possíveis estratégias facilitadoras nas perspectivas dos enfermeiros e discutir os resultados diante das recomendações do programa nacional de segurança do paciente na prevenção de queda por meio da auditoria interna. Utilizou-se como metodologia um estudo de natureza qualiquantitativa, de caráter descritivo e exploratório com abordagem no método de estudo de caso, cujo cenário foi um hospital privado, terciário na zona sul do Rio de Janeiro. Como referencial teórico, utilizaram-se estudos sobre segurança do paciente, gestão de riscos, acidentes por quedas e idoso. A coleta de dados foi realizada por meio de entrevista semiestrutura, no período de novembro de 2015 a junho de 2016, com 23 enfermeiros que exercem suas atividades nas referidas unidades: clínica, semi-intensiva e coronária. As respostas foram analisadas por meio de análise descritiva simples, emergindo quatro categorias temáticas: segurança do paciente, segurança do paciente com relação à meta 6, aspectos relacionados às não conformidades, perfil do cliente com maior risco de queda e relação com o envelhecimento. Resultado pesquisa: as respostas da auditoria interna com os motivos das não conformidades e estratégias para torna-las em conformidades, nos mostrou a necessidade de uma tecnologia de informação e comunicação no intuito de atender às ações de segurança do paciente com risco de queda. Com isto, almejo somar conhecimento científico à instituição que preconiza a qualidade do cuidado e da segurança nos processos assistenciais The research comes from the decline of risk management as a strategy for patient safety. Its object of study risk management of elderly patients hospitalized falls in a certified institution. The general objective set is to develop an information and communication technology from the perspective of nurses to manage the risk of falling in the context of patient safety and the specific objectives are to identify the reasons for non-conformities evidenced in the audit tool and possible strategies enabling the perspectives of nurses and discuss the results on the recommendations of the national patient safety program in fall prevention through internal audit. It was used as a study methodology of qualitative-quantitative, descriptive, exploratory approach to the case study method, whose setting was a private tertiary hospital in the south of Rio de Janeiro. As a theoretical framework, we used studies of patient safety, risk management, accidents from falls, elderly. Data collection was conducted through semi-structured interviews, from November 2015 to June 2016, with twenty-three nurses who pursue their activities in these units: clinical, semiintensiva and coronary. The responses were analyzed by simple descriptive analysis, emerging four thematic categories: patient safety, patient safety with respect to target 6, aspects of the non-conformities, and customer profile with higher risk of falling and related to aging. Preliminary results showed us identify the knowledge of nurses before the patient safety issue, patient safety with respect to target 6 and reporting the reasons and suggesting strategies for non-compliance audit tool interna.Com analysis of speeches revealed the need for information and communication technology in order to meet patient safety actions with risk of falling. With the result of this research, we aim to add scientific knowledge institution that advocates the quality of care and safety in care processes

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12

Grenade, Linda Elise. "Accreditation of residential aged care facilities : experiences of service providers /." Curtin University of Technology, School of Public Health, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15068.

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The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study. Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.

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13

Milliken, Danielle L. "Core Value Driven Care: Understanding the impact of core values on employee perception of Patient Safety, Employee Safety, and Quality of Care." Franklin University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=frank161046157154285.

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Lasiter, Rita Sue. "Older adults' perception of feeling safe in an intensive care unit." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/5583.

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Thesis (Ph.D.)--University of Missouri-Columbia, 2008. The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "December 2008" Includes bibliographical references.

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TOMMOSGÅRD, MICHELLE. "Indoor Environmental Quality Audit and Investigation of Ceiling Fans in an Aged Care Facility." Thesis, KTH, Energiteknik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-187915.

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This thesis project involved research into the thermal comfort of the occupants and staff at the Warrigal aged care facility at Warilla, NSW, Australia. An Indoor Environmental Quality (IEQ) Audit has been completed with a focus on parameters of luminance, noise levels, concentrations of CO2, NO2, formaldehyde and CO, and air velocity. An extensive investigation of the distribution of indoor air temperature and relative humidity has been performed. Small sensors called ‘iButtons’ were installed to record the relative humidity and air temperature every 15-minutes in many locations throughout the facility. It is important to note that the main occupants of Warilla aged care facility suffer from dementia, were bed-ridden elderly people or otherwise healthy older adults. It is thought that sensations of feeling comfortable in the indoor environment are perceived differently by elderly people and especially by dementia patients. This thesis work primarily focussed on the thermal comfort of adults with an emphasis on elderly and dementia patients. The results of the IEQ audit have been compared with recognised standards e.g. AHSRAE ADDENDA 62.1, ASHRAE 55, EN 15251, EN 12464, ISO 7730 and ISO/TS 14415. Furthermore, this thesis project involved the development of a CFD model to predict the airflow induced by ceiling fans in an indoor environment. Such ceiling fans were installed in the Warilla aged care facility as a result of a previous audit, and it was thought that these might have resulted in uncomfortable air temperatures in the bedrooms and dining rooms. Since the ceiling fans can assist in controlling the sensation of thermal comfort, these were investigated with a model built in ANSYS CFX. To validate the model, experimental measurements were compared with the results of the model, and an agreement was found to be around ±20-35% with the experimental results of measured air velocity of ceiling fans. The outcomes of the report are included in the end of this thesis. The IEQ audit found uncomfortable measures of temperature and humidity, mainly in the summer and spring seasons. In addition, the CFD modelling resulted in the performance of ceiling fans and the air velocities induced by it in relation to thermal comfort, which were outside of the thermal comfort criteria discussed in Chapter 3 (ASHRAE 55, 2013).

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Stokes, Julie Anne. "Introducing clinical pharmacy as a quality use of medicines intervention in residential aged care /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16923.pdf.

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Al-Awa, Bahjat. "Impact of hospital accreditation on patients' safety and quality indicators." Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209917.

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Ecole de Santé Publique Université Libre de Bruxelles Academic Year 2010-2011Al-Awa, BahjatImpact of Hospital Accreditation on Patients' Safety and Quality IndicatorsDissertation Summary I.\ Doctorat en Sciences info:eu-repo/semantics/nonPublished

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Bostick, Jane E. "The relationship of nursing personnel and nursing home care quality." MU has:, 2002. http://wwwlib.umi.com/cr/mo/fullcit?3052150.

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Pruksapong, Matana. "Development of a model for assessing the quality of an oral health program in long-term care facilities." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/1529.

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Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

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Tierney, Laura T. "Enhancing quality of life for aged care facility residents with dementia: The role of 'meaningful activities'." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/200216/1/Laura_Tierney_Thesis.pdf.

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This study explored quality of life and 'meaningful activity' for people living with dementia in residential aged care facilities, drawing on the experiences and perspectives of residents, their family members and care staff. The findings identified groups of residents who have fewer activity opportunities and less frequent participation in activities. A deeper understanding was developed of 'meaningful activity', the benefits of participating in these types of activities and the supports needed for residents to participate. The knowledge gained from this study will inform care practices and improve the daily lives of people living with dementia in residential aged care facilities.

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Long, Susannah. "Measuring and improving the safety and quality of care in older medical inpatients." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9089.

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Older people, often frail with multiple co-morbidities, constitute the largest proportion of hospital inpatient populations. Yet existing ways of measuring the quality and safety of care that they receive are not usually designed with the unique problems encountered by this vulnerable population in mind. The aims of the work presented in this thesis were to investigate what is known about the types, incidence and causes of safety and quality issues in older medical inpatients, to develop and test novel tools to measure the safety and quality of care that they receive and finally to design and test interventions to improve care. In Section 1 of the thesis (Chapters 1 and 2), an introduction of patient safety and quality in older people is presented, with an overview of current strategies for measurement and improvement, and the rationale for undertaking this research. Section 2 (Chapters 3 - 5) contains three exploratory studies in which different approaches (a systematic review of the literature and re-analysis of the major adverse event studies, a qualitative study involving staff who are involved in the care of older people, and an exploratory retrospective case record review) were used to produce an overall picture of safety and quality issues in older medical inpatients. This information was used to develop two novel case record review tools (the “Long tool” and “COMPACT”) to measure the quality and safety of care in older medical inpatients, using a combination of outcome and process measures. Section 3 (Chapters 6 and 7) describes the development and testing of these tools. Next, Section 4 (Chapters 8 and 9) of the thesis consists of two studies which were designed to provide the basis for further safety and quality improvement work in older medical inpatients. In Chapter 8, an investigation of the importance and trainability of safety skills (attributes of the safe practitioner) that may form the basis of a template for future patient safety curricula is described. In Chapter 9, a different improvement approach is described - the development and use of a multidisciplinary goal sheet on a medicine for the elderly ward, its effect on quality of care as measured by COMPACT, on staff perceptions of the incidence of adverse events, teamwork and communication, and on goal understanding. Finally, the discussion (Section 5, Chapter 10) reflects on the overall findings, strengths and weaknesses of the studies, and implications for clinical practice and future research.

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Seblega, Binyam. "EFFECTS OF HEALTH INFORMATION TECHNOLOGY ADOPTION ON QUALITY OF CARE AND PATIENT SAFETY IN US ACUTE CARE HOSPITALS." Doctoral diss., University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2957.

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The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitalsÂ performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis DonabedianÂ s structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT. Ph.D. Other Health and Public Affairs Public Affairs PhD

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Gardner, John Wallace. "Improving Hospital Quality and Patient Safety - An Examination of Organizational Culture and Information Systems." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1348805699.

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Söderberg, Johan. "Sources of preanalytical error in primary health care : implications for patient safety." Doctoral thesis, Umeå universitet, Klinisk kemi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-21256.

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Background Venous blood tests constitute an important part in the diagnosis and treatment of patients. However, test results are often viewed as objective values rather than the end result of a complex process. This has clinical importance since most errors arise before the sample reaches the laboratory. Such preanalytical errors affect patient safety and are often due to human mistakes in the collection and handling of the sample. The preanalytical performance of venous blood testing in primary health care, where the majority of the patients contact with care occurs, has not previously been reported. Aims To investigate venous blood sampling practices and the prevalence of haemolysed blood samples in primary health care. Methods A questionnaire investigated the collection and handling of venous blood samples in primary health care centres in two county councils and in two hospital clinical laboratories. Haemolysis index was used to evaluate the prevalence of haemolysed blood samples sent from primary health care centres, nursing homes and a hospital emergency department. Results and discussion The results indicate that recommended preanalytical procedures were not always followed in the surveyed primary health care centres. For example, only 54% reported to always use name and Swedish identification number, and 5% to use photo-ID, the two recommended means for patient identification. Only 12% reported to always label the test tubes prior to blood collection. This increases the possibility of sample mix-up. As few as 6% reported to always allow the patient to rest at least 15 minutes before blood collection, desirable for a correct test result. Only 31% reported to have filed an incident report regarding venous blood sampling, indicating underreporting of incidents in the preanalytical phase. Major differences in the prevalence of haemolysed blood samples were found. For example, samples collected in the primary health care centre with the highest prevalence of haemolysed samples were six times (95% CI 4.0 to 9.2) more often haemolysed compared to the centre with the lowest prevalence. The significant variation in haemolysed samples is likely to reflect varying preanalytical conditions. Conclusions This thesis indicates that the preanalytical procedure in primary health care is associated with an increased risk of errors with consequences for patient safety and care. Monitoring of haemolysis index could be a valuable tool for estimating preanalytical sample quality. Further studies and interventions aimed at the preanalytical phase in primary health care are clearly needed.

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Al, Nadabi Waleed K. A. "Towards a multidimensional approach to measure quality and safety of care in maternity units in Oman." Thesis, University of Bradford, 2019. http://hdl.handle.net/10454/18500.

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Improving the quality and safety of maternity services is an international top agenda item. This thesis describes the progress towards the development of a multidimensional approach to measure the quality and safety of care in ten maternity units in Oman based on three of the five dimensional Patient Safety Measurement and Monitoring Framework (PSMMF) which include measuring "past harm" and "anticipation and preparedness”. The three monitoring approaches used in this research are: (1) measuring the patient safety culture (2) measuring patient satisfaction (3) and monitoring caesarean section rates. The specific objectives of the research are to (1) measure patient safety culture level, (2) examine the association between nurse’s nationality and patient safety culture, (3) validate an Arabic language survey to measure maternal satisfaction about the childbearing experience, (4) measure patient satisfaction about the childbearing experience, and (5) to examine caesarean section rates across maternity units using statistical process control charts. This thesis started with four systematic reviews that focused on (1) the use of patient safety culture for monitoring maternity units (2) the available interventions to improve patient safety culture (3) Arabic surveys available for measuring maternal satisfaction and (4) the use of statistical process control charts for monitoring performance indicators. The overall conclusion from these reviews that these approaches are being increasingly used in maternity, found feasible and useful, and there are areas that need attention for future work. Five field studies were conducted to address the research aim and objectives. Patient safety culture was measured by a cross-sectional survey of all staff in the ten maternity units. It was found that safety culture in Oman is below the target level and that there is wide variation in the safety scores across hospitals and across different categories of staff. Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses in all domains except in respect of stress recognition and this difference need further investigation and needs to be considered by designers of interventions to enhance patient safety culture. Using two existing validated English surveys, an Arabic survey was developed, validated, and used to measure maternal satisfaction with childbirth services. It was found that the new survey has good psychometric properties and that in all the ten hospitals, mothers were satisfied with the care provided during child delivery but satisfaction score varied across hospitals and groups of participants. Caesarean section rate in the last 17 years was examined using statistical process control charts to understand the variation across the ten hospitals. It was found that caesarean section rate is above the rate recommended by the World Health Organisation. Special cause variations were detected that warrant further investigation. In conclusion, the field studies demonstrated that it is feasible to use the three approaches to monitor quality and safety in maternity units. However, further work is required to use these data to enhance the quality and safety of care. Additionally, future work is needed to cover the other three dimensions of the PSMMF. Ministry of Health in Oman,

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McGrath, Brendan Anthony. "Advances in multidisciplinary tracheostomy care and their impact on the safety and quality of care in the critically ill." Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/620231/.

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Tracheostomy is one of the first recorded surgical procedures and refers to an incision into the windpipe at the front of the neck, classically performed by surgeons to relieve airway obstruction. A tracheostomy tube can be inserted to maintain airway patency. The majority of tracheostomies are now performed the critically ill, typically whilst dependent on invasive respiratory support. Analysis of tracheostomy-related critical incidents helped to understand the frequency, nature and severity of problems that can occur at initial placement or during subsequent use. If problems occur, significant harm may rapidly develop, especially in the critically ill. Recurrent themes that contributed to avoidable mortality include poor emergency management and limitations in infrastructure, equipment provision, staff training and education. Many of the problems identified are amenable to prospective, multidisciplinary quality improvement strategies. This thesis describes my published work in this area. An underlying challenge to improving care lies in the fact that care requires input from many clinical disciplines. Complex patients need care in specialised settings that are not always adequately trained and supported in delivering safe tracheostomy care. My research has evaluated the impact of a co-ordinated multidisciplinary approach using bespoke resources, staff education, infrastructure changes and patient champions to direct healthcare improvements. I have critically appraised my bespoke resources and evaluated and justified the use of a variety of quality and safety metrics to define better care, both at patient-level and using institutional process measures, reflecting better coordination of care, contributing to significant cost savings. Further opportunities to build understanding of the nature of tracheostomy problems in ICU and the success of quality improvement initiatives will be discussed. Future aims are to not only improve care but also to perform a detailed economic analysis and capture knowledge on how to best implement necessary changes rapidly in today’s complex NHS.

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Maneejiraprakarn, Phattharamanat. "Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/404586/.

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Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety. Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014. Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found. Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.

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Swart, Reecë Pearl. "The relationship between nurses educational background and the safety and quality of patient care in surgical units in private hospitals in Gauteng / Reecë Pearl Swart." Thesis, North-West University, 2012. http://hdl.handle.net/10394/9215.

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Background: International literature seems to agree that nurses are the backbone of quality patient care and safety. Moreover, the appropriate training of nurses is vital to providing high quality and safe patient care. South Africa has a dual healthcare system and different categories of nurses. The perceptions of the safety and quality of care of the different categories of nurses are not known in the South African context. Objective: To determine the relationship between the educational background of nurses and their perceptions on the safety and quality of patient care in private surgical units in South Africa. Methods: This study followed a comparative descriptive design. Data was collected by means of a questionnaire as part of an international collaborative study, Nurse Forecasting in Europe (RN4CAST). Hierarchical linear modelling was used to examine the relationships among the variables in the 304 completed and returned questionnaires. Results: Overall, both registered- and enrolled nurses seemed satisfied with the safety and quality of care delivered in their units. Registered nurses (RNs) scored higher in the occurrence of incidents in surgical wards, whilst enrolled nurses (ENs) were of the opinion that current efforts to prevent errors are adequate. Conclusions: This study provides information that RN’s and EN’s have different perceptions in some areas on the quality and safety of patient care. A statistically significant difference was found between RN’s and EN’s perceptions on the prevention of errors in the unit, namely, losing patient information between shifts and patient incidents related to medication errors, pressure ulcers and falls with injury. Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

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Krevers, Barbro. "Patient and relative perspectives regarding quality in hospital care for older people : theory and methods /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med773s.pdf.

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

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

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Timothy, Badgery-Parker. "Measuring low-value care in New South Wales public hospitals." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20145.

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My aim in this thesis is to develop and apply measures of low-value care (where expected benefits do not outweigh the potential harm) based on hospital administrative data in New South Wales (NSW), Australia. Measurement is a prerequisite for understanding the drivers of and exploring remedies for low-value care. I developed low-value care measures for 27 procedures. In 2016-17, between 4487 and 8986 hospital episodes involved low-value care, accounting for 10% to 20% of all episodes involving these 27 procedures. However, my results almost certainly underestimate low-value care for these procedures. The proportion of low-value care varied considerably between hospitals. Multilevel modelling analysis confirmed that most variation is between hospitals; Local Health District and residential area have little association with low-value care. None of the (limited) hospital variables available were associated with low-value care. Further exploration of inter-hospital variation will require more detailed hospital data, including attitudes of individual clinicians within hospitals. Low-value care is also a patient safety issue. I used 16 hospital-acquired complications (HACs) to examine some immediate adverse consequences of low-value care. Across seven procedures where recommended care would not normally involve hospital admission, HAC rates ranged from 0.1% to 15.0% of the low-value episodes. To the best of my knowledge, these patients only entered hospital for the low-value procedure; therefore, the HACs can be attributed to the low-value care. This project occurred in partnership with the NSW Ministry of Health. Two other states commissioned analyses using their own data, and a peak private health insurance industry body commissioned an analysis using private health fund data. State health departments are using these methods to provide feedback to clinicians and hospital managers and may in future incorporate the indicators into funding and performance agreements.

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Chukmaitov, Askar S. "Variations in Quality Outcomes Among Hospitals in Different Types of Health Systems." VCU Scholars Compass, 2005. https://scholarscompass.vcu.edu/etd/1414.

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Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 risk-adjusted patient safety indicators (PSIs) as dependent variables. Random effects models were used in the analysis.It was found that the IQI and PSI models have different patterns. In the IQI models, CHS hospitals have lower AMI, CHF, Stroke, and Pneumonia mortality rates than hospitals in other system types. The PSI models did not indicate any systems' effects on adverse event rates. It was also found that system hospitals' compliance with the JCAHO performance area indicator for availability of patient specific information was associated with lower rates of CHF, Stroke, Pneumonia, and Infection due to medical care.The findings suggest that centralization of hospital structures may improve internal clinical processes by enhancing coordination of activities, communication between providers, timely adjustments of processes of care delivery and structures to external pressures. A lack of systems' effect on adverse events may be explained by a newness of the patient safety issues for hospitals and possible changes in reporting patterns of medical errors after the Institute of Medicine report of 1999. A system hospitals' compliance with the JCAHO performance area indicator may indicate improvements in information and clinical record systems.Hospital systems hold much potential for hospitals in improving patient quality of care and safety because they provide a laboratory for studying the health care process and sharing lessons across multiple institutions. Based on our findings, we recommend that future studies use a combination of IQIs and PSIs when examining institutional quality of care because both provide different and complementary information.

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Lee, Feng-Ping. "The relationship of comfort and spirituality to quality of life among long-term care facility residents in southern Taiwan /." Thesis, Connect to this title online; UW restricted, 2005. http://hdl.handle.net/1773/7328.

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Tukay, Remeliza Navarrete. "Diabetes Mellitus Type 2: A Quality Improvement and Patient Safety Initiative." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3213.

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The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using the instrument Patient Education: TEACH for Success Self-Assessment Questionnaire. The nurses' confidence and their perceived importance of the TEACH and MI skills application and skill assessment for promoting health behavior change were tested inferentially with a paired t test before and after nursing education implementation using the instrument Clinician Importance and Confidence Regarding Health Behavior Counseling Questionnaire. The primary care team developed their skills tailored to each patient's needs, considering the guiding principles and premises of the health belief model (HBM). Patients' self-care management knowledge, skills and confidence were improved. The project decreased the elevated HgbA1C of patients measured after the project initiative. The QI project leads to positive social change by decreasing the number of patients with uncontrolled diabetes among the veteran population. The patients and their providers can develop individualized plans of care for diabetes management by educating, redirecting, and evoking behavioral changes in the veteran patients by using a team approach.

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Vu, Ben H. "Investigating the Effectiveness of Cycloid Vibration Therapy on the Quality of Life, Mobility and Nutrition of Aged Care Residents." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/407568.

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In Australia, 3.8 million people are aged 65 or over; this age group is projected to grow to 8.7 million by 2056, making up 22 per cent of Australians (1). This rapid ‘ageing’ of the population is thanks to current advancements in medical technology and public health schemes (2). Although individuals can now expect to live into their sixties and beyond, ageing is associated with an accumulation of generalised impairments to health (3-5). Therefore, managing healthy ageing in older adults to improve their quality of life, mobility and nutrition is an important social and economic challenge in Australia. Physical activity has been well established as a key factor to support an individual’s biopsychosocial health and is essential to prevent age-related impairments (6-8). However, several established barriers (e.g., physical limitations, competing priorities and access barriers) prevent older adults from undertaking physical activity (9-12). Vibration therapy has been reported to mechanically stimulate muscle spindles, initiating muscle contractions like physical activity, without the need for wide-ranging movements (13, 14). A systematic review was conducted to understand the effectiveness of vibration therapy on the quality of life, mobility and nutrition of older adults. The review highlighted a total of five studies examining these variables. These randomised controlled trials revealed that participants undertaking vibration therapy had improved knee joint mobility (15, 16), general functional mobility (15, 17, 18), gait and walking ability (17, 18) and balance ability (15, 18, 19). Some of these studies also reported significant improvement in certain aspects of quality of life (15, 17). However, nutrition was not a key variable assessed in any of the studies. Along with these findings, seated cycloid vibration therapy was considered the most viable form of vibration therapy for older adults with impaired mobility due to its postulated ease of use, portability and safety compared to standing whole-body vibration. However, the study focusing on seated cycloid vibration therapy was of low quality, suggesting further research for this therapy. A pilot intervention study was conducted on the effectiveness of cycloid vibration therapy on the quality of life, mobility and nutrition of aged care residents to cover the gaps evaluated by the systematic review. In the pilot intervention study, 14 eligible aged care facility residents aged 65 and over who met the inclusion criteria were allocated into either the cycloid vibration therapy (intervention) group or the control group based on exclusion criteria. Initially, those in the intervention group were to participate in the intervention for 12 weeks, with outcome measurements being conducted at baseline, week four, week eight and week 12. However, due to restrictions placed on aged-care facilities due to COVID-19 at week four of the intervention, the cycloid vibration therapy treatment was only provided for four weeks. Additionally, outcome measures were conducted at baseline and six months postintervention when COVID-19 restrictions were relaxed. Consequently, outcome measures were not performed at the end of week 4, 8 and 12. However, this allowed for any long-term effects to be measured using the 6-Dimensional Quality of Life Assessment, Physiotherapy Mobility Assessment and Mini Nutritional Assessment. No significant differences at six months post-intervention were observed in the quality of life, mobility or nutrition of participants undertaking the cycloid vibration therapy treatment compared to baseline. Despite these findings, participants evaluated the intervention as relaxing and comfortable and desired the intervention to have been at the aged care facility during the COVID-19 pandemic. A qualitative study was also conducted to assess the experiences of these participants during the COVID-19 pandemic concerning their quality of life, mobility and nutrition. Semi-structured, one-on-one interviews addressed resident life during the fullscale COVID-19 aged-care restrictions imposed by the Queensland Government. Participant experiences comprised three major themes: (1) reduced face-to-face contact with close ones, (2) disruption to daily routines and activities and (3) aged care staff affecting resident wellbeing. These major themes were observed to affect the quality of life, mobility and nutrition of older adults in several ways. Thus, they were considered potential confounding factors to the previous intervention study. Overall, these studies validate the need for further research into the effectiveness of cycloid vibration therapy on the quality of life, mobility and nutrition in aged care residents. Unavoidable limitations of the study, that is, the break in the intervention period and the effect of COVID-19, make the findings of this research project inconclusive. However, participant evaluations revealed that they enjoyed the cycloid vibration therapy program and desired to redo the intervention. With participants expressing disruption to services and staff availability, providing the residents with cycloid vibration therapy may have proved invaluable to their quality of life, mobility and nutrition. Recommendations based on the limitations of this study may help design a large-scale intervention study regarding the effectiveness of cycloid vibration therapy on the quality of life, mobility and nutrition of aged care residents. Thesis (Masters) Master of Medical Research (MMedRes) School of Pharmacy & Med Sci Griffith Health Full Text

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

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

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Woods, Bernadette M. "Assessment of staff attitudes to patient safety." Thesis, View thesis, 2004. http://handle.uws.edu.au:8081/1959.7/46693.

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Safe, high-quality health care requires an open, transparent, and just culture where people are willing and have the opportunity to discuss errors and system problems and to do something about them. There is paucity of research in relation to safety issues in health care. Objective: To identify the components of a safe culture and measure staff’s attitudes to those components in an area health service. Method: A mixed mode method comprising qualitative and quantitative measures was used. A 60-item survey comprising a likert response scale and measuring safety attitudes and values was administrated to 3,200 staff in an Area Health Service (AHS) in Western Sydney. Focus groups were conducted with various professional groups to provide greater depth to salient issues identified in the survey. Results: The response rate was 26%. Teamwork, communication, leadership, and performance shaping factors were identified as components of a safe working health service and that staff were committed to safety. The results show that there is a positive safety and teamwork culture. However, the results about organisational culture were not positive. Results also showed that there is a high level of stress factors that influence safety in the organisation. There were a number of attitudes and patterns that warranted improvement and further investigation. However several areas of discontent among staff in terms of leadership and communication were acknowledged. In regard to attitudes suggesting invulnerability to the effects of stress and fatigue, the majority of respondents acknowledged this belief. These findings are more favourable than those earlier studies using the Operating Room Management Attitudes Questionnaire (ORMAQ), although these were conducted in other countries and the respondents were surgeons, anaesthetists, and Intensive Care Unit staff. A number of factors have emerged both from the questionnaire survey and the follow up focus groups that should be considered. The awareness of the need to encourage teamwork, communication, leadership prevailed. Conclusion: Health care organisations can benefit from the valuable information and an understanding of staff’s attitudes to patient safety. It confirms the findings of other studies that attitudes to leadership, teamwork and performance shaping factors such as fatigue and stress have an impact on an organisation’s capacity to develop a culture of safety. Health care organisations need to acquire this kind of information, and build on it if they are considering developing and implementing patient safety programs.

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Van, Wyk Annemarie. "The relationship between burnout and the safety and quality of patient care in private critical care units in Gauteng province / Annemarie van Wyk." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4951.

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INTRODUCTION AND AIM: Research recognises the clear links between nurses’ experience of professional burnout and the quality of the work environment. To that end it is extremely important for nurse managers to create an organisational climate that promotes the emotional stability of nurses. This could help to improve global patient safety by reducing the frequency of adverse events. Many of the factors commonly associated with burnout, also causes unsafe patient care, and poor quality of care. Effectively managing patient safety must be a priority in units where nurses face high pressure. Staff in critical care units (CCUs) spends a tremendous amount of time with people, including the patient, family members, physicians, and other members of the multidisciplinary team that might lead to emotional and physical exhaustion and burnout. The aim of this study was to investigate the relationship between nurse burnout and the safety and quality of patient care in private critical care units in Gauteng. RESEARCH DESIGN AND METHOD: A quantitative correlational design was selected to address the research question at hand. A previously developed checklist was used to describe the demographic characteristics of the critical care units that participated in the study (n=31). A total of 298 critical care nurses participated in the study (n=298). Burnout among registered nurses working in these units was explored by means of the Maslach Burnout Inventory Scale (MBI). The registered nurses’ perceptions of the safety and quality of patient care in their units were explored by means of the RN4CAST questionnaire. Data was analysed using descriptive and inferential statistics. FINDINGS: The mean scores for emotional exhaustion measured 2.69, for depersonalisation 1.55 and for personal accomplishment 4.43. From the mean scores of each of the sub–scales of the MBI it was evident that registered nurses working in private critical care units in Gauteng province did not experience burnout. The relationship between burnout and the safety and quality of patient care was investigated by means of a Spearman rank correlation coefficient. The results indicated that emotional exhaustion demonstrated a negative relationship with the quality of nursing care in the unit (r = –0.275; p=0.00), and patient safety in the unit (r = –0.245; p=0.00). Depersonalisation demostrated a negative relationship with the quality of care in the nursing unit (r = –0.249; p=0.00 and patient safety in the unit (r = –0.205; p=0.00). Personal accomplishment demonstrated a weak positive relationship with the quality of nursing care in the unit (r = 0.197; p=0.003) and a moderate positive relationship with patient safety in the unit (r = 0.204; p=0.00). The results demonstrated a relationship between burnout and the safety and quality of patient care in private critical care units in Gauteng. Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

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Robbins, Julie. "Speaking Up is Hard to Do:What Can Management Do to Help When Patient Safety is on the Line?" The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400.

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Pappne, Demecs Ilona. "The use of creative activities in dementia in residential aged care facilities in Australia : a cross-sectional study." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/82146/1/Ilona_Pappne%20Demecs_Thesis.pdf.

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This thesis provides the first inquiry into the use of creative activities in dementia care in residential aged care facilities in Australia. The study used descriptive method design, incorporating a mix of quantitative and qualitative approaches to explore the incidence and the characteristics of these activities from the carers' perspective. Information about the use of creative activities and the appreciation of these activities by residents and carers is essential to the provision of dementia care and treatment to improve the quality of life of people with dementia.

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Stratton, Karen Marie. "The relationship between pediatric nurse staffing and quality of care in the hospital setting /." Connect to full text via ProQuest. IP filtered, 2005.

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Thesis (Ph.D. in Nursing) -- University of Colorado, 2005. Typescript. Includes bibliographical references (leaves 198-212). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

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Vartak, Smruti Chandrakant. "Association between organizational factors and quality of care: an examination of hospital performance indicators." Diss., University of Iowa, 2010. https://ir.uiowa.edu/etd/2784.

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The recent reports by Institute of Medicine, `To Err is Human' and `Crossing Quality Chasm', revealed a large prevalence of medical errors and substandard care in US hospitals. Since then there has been a substantial increase in the efforts to measure and improve quality of care. The objective of this study was to compare the quality of care across hospitals using available performance indicators and examine the association between organizational factors and hospital performance. The main focus of this study was on important structural attributes of hospitals, namely - teaching status, location and market competition. The Nationwide Inpatient Sample for years 2003 and 2005, and the State Inpatient Database for years 2004 to 2006 were used for analyses. Two types of hospital performance indicators were examined to compare quality of care - Patient safety indicators developed by Agency for Healthcare Research and Quality, and process of care indicators developed by Centers for Medicare and Medicaid services. Multivariable regression analyses were performed using generalized estimating equations and random effects regression models. Several organizational factors as well as patient characteristics were included in the multivariable models as control variables. Overall, the results from this study showed an inconsistent relationship between teaching status, location of hospitals or market competition and quality of care in hospitals. In addition, the results demonstrated that isolating potential effects of hospital structure on outcomes requires controlling for the variation in patient characteristics, such as age and comorbidities, which increase patients' risk for incurring patient safety events. The findings from this study provide useful insight into the areas where the patient safety and quality initiatives should be focused. Moreover, the results identified the organizational factors that are relevant to certain types of hospitals and which should be considered before evaluating quality of care and enacting any policies about publicly reporting of performance or payment initiatives that are relevant to these hospitals.

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Bland, Rosemary. "Senior citizens, good practice and quality of life in residential care homes." Thesis, University of Stirling, 2006. http://hdl.handle.net/1893/70.

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This thesis is an examination of the definition and implementation of ‘good practice’ in residential care for senior citizens. The central contention is that ‘good practice’ is a term that has been variously defined. Different groups define it in different ways, and their definitions have changed over time. This reflexive qualitative study explores ‘good practice’ in local authority, voluntary and private residential care homes in Scotland from the perspective of policy, practice and the experience of senior citizens who live in them. The study is based on analysis of policy documents, historical studies, and reanalysed interview and survey data from two earlier studies conducted by the author and colleagues. The thesis shows that the notion of ‘good practice’ that emerges in policy and practice documents is a confused and often conflicting set of ideas. Historically, the earliest were driven by concerns over cost. In more modern times, statements about ‘good practice’ have had a more benevolent intent but are frequently flawed by paternalistic and ageist assumptions. It is shown that staff in residential homes typically adopt a different set of attitudes: their preoccupation is with safety and the avoidance of risk. Although benevolent in intention, these interpretations of ‘good practice’ are also at variance with what residents themselves actually want. Two particular models or styles of care are examined in detail. One of these is the use of ‘keyworkers’, often implemented in ways that fail to realise its potential. The other is the ‘hotel’ model of care. The potential of this model as an alternative to the statutory model is explored. The thesis concludes that it is a model that can realise the goal of enabling residents to exercise independence, choice and privacy while meeting their needs in residential care.

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Yeung, Chi-ho Jackson, and 楊志豪. "The effectiveness and safety of exogenous melatonin in improving the sleep quality among health care professionals: a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46943912.

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Lenrick, Raymond. "A potential for further enhancing obstetrical safety : Patient harm measurement with the global trigger tool in the south-east health-care region of Sweden." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-19073.

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A decade of heightened awareness concerning safety issues in healthcare since the Institute of Medicine’s awakening call has resulted in a string of counteroffensive measures. The pace of improvement has been slow and not altogether clear. Rates of patient harm are in general now measured by voluntary reporting and indicator measurements. The use of triggers or clues in random nurse-based reviews to enable identification of patient harm is a more effective method for measuring the overall rate of harm in a health care organisation. Measured actual overall rates of patient harm, their variations and patterns during delivery in the south-east health-care region of Sweden are not previously known. Measurement is important to patient safety improvement, as a foundation for accountability, effort selection and keeping track of results. The patient’s voice must also be much clearer in quality and safety improvement efforts in healthcare. The Institute of Healthcare Improvements Global Trigger Tool for measuring adverse events was used to review 1137 deliveries during 2011 in the seven departments (10% of all cases). Mother and new-born were both evaluated. Thirty eight patient harm events per 1000 patient days were identified, correlating to 13% of admissions. Presupposed rates among staff were double this value. Current patient safety indicators are half this value. One third of patient harm events at birth affected the new-born. Twenty different categories of harm were found. This study shows significantly higher rates of patient harm than previously reported. The nurse reviewers defined the method as valuable and a useful method for measuring harm at delivery. Limitations at this stage are no observed changes in health care delivery or clinical outcomes and that value assessment is based entirely on the judgement of the data-abstractors.

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Blignaut, Alwiena Johanna. "The relationship between the qualifications of professional nurses and their perception of patient safety and quality of care in medical and surgical units in South Africa / Alwiena Johanna Blignaut." Thesis, North-West University, 2012. http://hdl.handle.net/10394/7711.

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Background: Several international studies have been published on the importance of exploring and describing the perceptions of professional nurses to improve patient safety and quality of care. There is also a growing body of literature that has established the associations of qualifications on patient safety and quality of care. However, no comparable research has been conducted in South Africa, and little is known about the influence of personal characteristics, such as qualifications of the professional nurse, on his/her perception of patient safety and quality of care. Objective: To investigate the perceptions of professional nurses regarding patient safety and quality of care as well as the relationship between the qualifications of professional nurses and these perceptions in medical and surgical units in public and private hospitals in South Africa. Design: Cross-sectional survey of nurses. Setting and participants: 1187 professional nurses (161 Baccalaureate degree and 956 diploma-prepared) working in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in South Africa completed the survey. Measurements: Perceptions of patient safety, quality of care and occurrence of adverse events, qualifications, age, job satisfaction, emotional exhaustion, experience, personal accomplishment and depersonalization. Results: 54.1% (n = 87) of Baccalaureate professional nurses and 51.2% (n = 490) diploma nurses feel as if their mistakes are held against them. 37.9% (n = 61) of Baccalaureate professional nurses and 42.4% (n = 404) diploma nurses perceive important information to be lost during shift changes. 39.1% (n = 63) of Baccalaureate professional nurses and 38.6% (n = 369) diploma nurses feel that things “fall between the cracks” when transferring patients from one unit to another. 43.5% (n = 70) of Baccalaureate professional nurses and 48.7% (n = 465) diploma nurses feel that their hospital‟s managements are not approachable. Almost half of professional nurses (49% [n = 79] Baccalaureate and 44.4% [n = 418] diploma) do not have confidence in hospital management to resolve reported problems regarding patient care. 26.6% (n = 26.8) of Baccalaureate professional nurses and 25.5% (n = 237) of diploma professional nurses perceive the quality of care in their hospitals to have deteriorated. Both Baccalaureate and diploma professional nurses reported adverse events to occur a few times a year or less. Verbal abuse towards nurses is reported to occur once a month or less. Qualifications revealed no correlation with perceptions of patient safety and quality of care, though emotional exhaustion and depersonalization showed a small to medium negative correlation and personal accomplishment a small to medium positive correlation with these perceptions. Conclusions: Supportive leadership and development of an environment in which professional nurses can freely report adverse events and hindering factors with regard to quality of care might benefit patients in terms of safety and better quality care. Thesis(M.Cur.)--North-West University, Potchefstroom Campus, 2012.

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Greenberger, Hilary Beth. "Influences on Health Related Quality of Life in Community Dwelling Adults Aged 60 Years and Over." VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1638.

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Hellström, Anne, and Lisa Sjöström. "I den bästa av världar… är kvalitet lika för alla? : intervjuer med politiker och enhetschefer inom äldreomsorgen." Thesis, Stockholm University, Department of Social Work, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7014.

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The purpose of this study was to examine and describe how politicians and directors of care define and experience quality in aged care facilities. Further on we wanted to compare on which fundamental principles the participants base their opinion about quality and how they work with quality. To reach our aim we conducted five interviews with politicians and directors of care. The results show that it is hard to determine quality in an unambiguous and objective way. Quality in aged care appears to be about relations and encounters amongst people. The participants in our study agree that experiences are subjective and depending on individual expectations.There are fundamental principles shared by both politicians and directors of care regarding safety and respect of human integrity. Directors of care point out the difficulties in having multiple perspectives to consider, residents and their relatives have other expectations on what services should be provided than the directors of care understand to be their assignment from the local government. It appears to be a gap between political goals and reality. The future will bring changes, regarding both needs and expectations. The participants see a challenge in developing aged care and meeting new generations of elderly.

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Martin, Jissa. "Investigating the effectiveness of a structured low-impact activity program on mobility, nutrition and quality of life in aged care residents: A Pragmatic, Non-Randomised Controlled Pilot Trial." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/406057.

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Background: Australia’s growing ageing population presents several challenges for the government, economy and health and aged care sectors to cater to their increasing needs. Age-associated changes in mobility, which can lead to impaired nutrition status and lower quality of life (QoL) for older adults, also contributes to this burden. Physical activity is recommended to manage the age-associated changes in older adults. The aim of the current study was to evaluate the feasibility of conducting a pragmatic study to assess the effects of an established, structured activity program on QoL, mobility and nutrition in aged care residents. Methods: A pragmatic, non-randomised, controlled pilot trial was conducted with a mixed methods analysis design. A total of 24 participants were included in the study with 12 participants each in the structured activity group and control group. Participants in the activity group consisted of residents who were active participants of the established program, while the control group were residents who did not participate in any structured activity program. The primary outcome was a predefined criterion assessing trial feasibility. Secondary outcomes included changes in QoL, mobility and nutrition between and within the groups over time. Assessment of Quality of Life-6 Dimensions (AQoL-6D), Mini Nutritional Assessment (MNA) and Physiotherapy Mobility Assessment (PMA) tools were employed to assess QoL, nutrition and mobility, respectively, at baseline and follow-up (i.e., after six months). Interviews were conducted at the end of the study to obtain feedback on the structured activity program from staff and participants. Five participants (three from activity group and two from control group) and three staff were interviewed. Thematic analysis was used with the emerging themes in the interviews developed into major categories. Results: The average age of participants was slightly higher in the control group (83.67 years) than in the structured activity group (79.33 years). Most participants in the study were female (66.67%). The feasibility criterion of a minimum 80 per cent recruitment rate was met. Retention and completion fell slightly short of this 80 per cent criteria. However, the feasibility of proceeding to a full trial can be considered by employing strategies to increase retention and completion. No statistically significant differences (p > 0.05) were found between the activity and control group for AQoL-6D total score, MNA and PMA score at baseline or follow-up. Emerging themes identified from the interview data include reluctance to participate in group activities for the control group participants, satisfaction with the program and experience of effects with participation for activity group participants as well as promoting choice and dignity and social interactions for the staff. Conclusion: Key criteria for progression of the trial to a larger multi-centre study was met with conditions. Recruitment of a larger sample size with power to detect changes in the outcome measures is important, as under-powered studies limit the ability to conclude the effects of the activity program on the outcome measures. Thesis (Masters) Master of Medical Research (MMedRes) School of Pharmacy & Med Sci Griffith Health Full Text

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Sequeira, Shwetha Sophia. "Evaluation the quality of sexually transmitted infection care: a comparison of five clinical settings at an urban safety net hospital." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21252.

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Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings. OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis. METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts. RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling. CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses. 2031-01-01

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