Patient monitoring is a complex task, particularly during childbirth, where assessment of the baby's condition is inferred from the continuous electronic recording of the baby's heart rate pattern and maternal uterine contractions (CTG). Computerised decision support has long been advocated, as difficulties in the interpretation of the CTG have led to failure to intervene and unnecessary intervention. The problem is large, for obstetric litigation now accounts for 80% of the UK National Health Service litigation bill. The Plymouth Perinatal Research Group has developed a computerised decision support system for patient monitoring during childbirth and the UK Medical Research Council has agreed to fund a multicentre randomised trial. The work of this thesis was an investigation of the labour ward care system to inform the human-centred design of the decision support system for patient monitoring in childbirth, prior to the clinical trial. It was recognised that many decision support systems have failed to gain clinical acceptance, as conventional design models were inadequate. Lack of attention to the organisational context of the care system and the process of the direct patient care led to the design of inflexible 'expert' systems, which constrained working practices. A pilot ethnographic study of an existing decision support system, used for the analysis of umbilical cord blood samples, was undertaken to clarify the research approach required for the main study. It was found that barriers to effective use within the wider work system included inadequate implementation and lack of organisational support. A case study approach produced a more comprehensive account of the context and process of the use of the computer system. The main study combined qualitative with quantitative techniques to investigate the system of care in childbirth, both outside and within the delivery room, to provide a unique, holistic perspective. The organisational context of the labour ward was investigated by direct observation of clinicians over the course of their work for 220 hours. Observations were documented and transcribed to computer text files. Patterns of actions and events were coded using ATLAS(ti) data analysis software. The codes were counted and tabulated to model the main features of this labour ward care system, which was expressed in the form of a rich picture diagram. These findings were confirmed by a limited study of five other UK labour wards. The core qualitative categories, derived from the observation data, found a complex and problematic relationship between communication, decision making and accountability. Decisions were often made outside the delivery room and were subject to misinterpretation and bias. The organisational hierarchy made it difficult for junior staff to question clinical management decisions. A system of tacit practice, external demands upon clinicians and transient allocation of junior midwives to labour ward militated against teamwork. This increased the vulnerability of the care of mothers to error. The process of direct patient care, within the individual delivery room, of 20 mothers in labour was captured in a novel audio-video observation study. The 111 hours of first stage labour and 12 hours of second stage labour were recorded and digitised to computer files. Recurrent actions and patterns of behaviour were coded both quantitatively and qualitatively using ATLAS(ti) data analysis software. Midwives left the room on average every 15 minutes to be absent for 27% of the first stage of labour. Record keeping occurred on average every 10 minutes and accounted for 19% of midwives' time. Midwives had little time to talk with mothers and only sat down at the bedside for 15% of the time. Psychosocial support was not given priority. Parents were generally excluded from communication between clinicians yet 108 clinicians took part in the care of the 20 women. Pressures from medicolegal directives and task-orientated imperatives overshadowed meaningful interaction with parents and caused spurious care priorities. This work has revealed the need for a critical reassessment of the type of support that is required for monitoring situations in all areas of medicine. A range of functions, such as shared information displays and models, have been suggested to augment roles and relationships between clinicians and parents to support patient-centred care. The present work has revealed that a combination of computer-based technology and changes to working practice can support the parents, their individual carers and their various roles. In this way the system of care can be more aligned to the objective of a safe and emotionally satisfying birth experience for parents and staff. A further programme of research is required to follow-up the existing studies, develop these new forms of interaction between technology and clinicians, and evaluate their effectiveness. The research methods employed in the present work will provide a more comprehensive evaluation of the decision support system in the forthcoming multicentre trial. The methods of investigation have also been shown to be of relevance to patient safety research, service delivery and training.

<p> Sightseers Ophthalmology Services is a mobile medical business that provides concierge vision and ophthalmic services to individuals in Newport Beach and Huntington Beach. The implementation of the Affordable Care Act (ACA) has provided millions of previously uninsured patients with medical coverage, which is causing increased demand for primary and specialty care services, in addition to higher premiums for those who have historically maintained an insured status. A result of the ACA is overcrowding; patients are having more difficulty getting access to care, and are experiencing long wait times in clinic when they actually <i>do</i> get an appointment. Concierge medicine is becoming more popular as many patients are finding that increased costs and inconvenient access to care are not worth their time and money. Newport Beach and Huntington Beach are home to a population who may prefer concierge eye services, and be able to meet the expense of them, if needed. Sightseers is an affordable way to have access to same-day or next-day appointments; and, moreover, we come directly to the patient. Whether the patient has difficulty with transportation, a conflicting work schedule, or if he or she simply does not want to travel to and wait in a busy ophthalmology clinic, Sightseers&rsquo; business plan proves that convenient and high quality services can benefit both the patient and the provider.</p>

<p> 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&rsquo;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. </p><p> 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.</p>

M.B.A. / Please refer to full text to view abstract

<p> The American healthcare system is being overwhelmed with chronic illnesses. These illnesses account for a significant amount of total healthcare expenditures. Medicare/Medicaid and Managed Care Organizations (MCO&rsquo;s) are seeking innovative treatment at cost savings. Disease Management (DM) is an intervention intended to reduce healthcare expenditures and advance the quality of life for persons with chronic conditions by preventing or reducing the effects of the disease through integrated care. Companion Pet Therapy 4 U is proposing Complementary and Alternative Medicine (CAM) which is a fluctuating set of diagnostic and therapeutic modalities that are considered to be unconventional. This approach utilizes a combination of Alternative Therapy (AT) and Disease Management (DM) home care services to elderly chronically ill homebound patients. A companion dog/ trainer and a care coordinator/nurse will visit homebound patients, review patient care plans, and educate patients on DM. Companion Pet Therapy 4 U will reduce healthcare expenditures, produce cost savings by empowering chronically ill homebound elderly patients to become pro-active in the treatment process.</p>

<p> Today&rsquo;s healthcare system is undergoing numerous changes. As a result of the increased number of insured people throughout the nations under the Affordable Care Act (ACA), primary care physicians do not have the time to provide quality care for patients. This business plan proposes to open up a concierge medical practice in Newport Beach with the mission to provide quality care to patients. The aim of the practice is to limit the number of patient loads to have time to dedicate to the care of patients while focusing on education and prevention.</p>

It has been indicated through research and by personal testimony that although some barriers for inclusion for those with special needs have been broken down since the enactment of the Americans with Disabilities Act of 1990, one of the most significant barriers still remains - negative and often subtle attitudes. Positive attitudes toward individuals with special needs have been shown to facilitate inclusion while negative attitudes hinder inclusion. Since the ADA law exempted churches from the mandates for inclusion, many have found participating in churches a significant challenge. The purpose of this study was to explore the attitude measurement score of senior pastors as it relates to awareness of special needs populations, types of special education ministries in the churches, previous life experiences with persons with developmental disabilities, and the pastor's training through formal and informal courses of instruction related to developmental disabilities. The research explored potential factors which shape pastoral attitudes and result in either barriers or facilitators to intentional special needs ministries. Data was collected through an online survey format and the results were used in a statistical analysis to facilitate the answering of the research questions. The sample population for the research included the 1296 senior pastors of Southern Baptist churches in South Carolina who have published church and/or personal email addresses in the South Carolina Baptist Annual Report 2008. Through statistical analysis of the survey results, precedent literature review concepts concerning the value oflife experiences with individuals with developmental disabilities can have a positive impact on positive attitudes. The pastors overall had positive attitudes toward individuals with developmental disabilities, but most significantly in the realm of the behavioral domain. Strong statistically significant correlations could not be drawn between having a positive attitude toward individuals with special needs and special needs ministry among the pastor's surveys. There were definite trends which support the important roles of experience and education being made available to pastors in order to potentially bring positive changes concerning inclusion in local churches. Keywords: attitude measurement, special needs ministry, pastoral attitudes, individuals with developmental disabilities, church special education ministry

<p> The purpose of this business plan is to explore the possibility of a community-based adult daycare center in the city of Norwalk, California. The city of Norwalk is experiencing a steady growth of aging seniors (65 years of age and over) in need of a community-based coordinated care program that can assist caregivers with respite time and provide the continuum of care for their aging loved ones. Market research on the aging population of Norwalk indicates that there is currently 10,602 elder adults 65 and over living in the city of Norwalk, with about 1,590 of them at risk of being institutionalized. In addition, the market research also shows that only two licensed adult daycares exist in the city of Norwalk and serve about 2 percent of the aging population that are at risk of being institutionalized. Therefore, We Care Adult Daycare has the potential to enter the adult daycare market and establish a community-based adult daycare in the city of Norwalk. We Care Adult Daycare will operate as a for-profit limited liability company owned by three investors. According to We Care Adult Daycare&rsquo;s business plan, the breakeven analysis shows that the company will be profitable after the first year of operation. Estimated sales are projected to grow at a 2.5 percent monthly rate and at the end of three years, will present a company revenue of about $440,006. We Care Adult Daycare will be able to provide a community-based adult daycare center in the city of Norwalk.</p>

Background: Palliative care focuses on improving quality of life for patients and their families by providing relief from the stress, pain, and other symptoms of a serious disease or injury. Trauma care has a heavy focus on improving resuscitation efforts, which has left little room in the literature for studies on utilization of palliative care in this population. Objective: The purpose of this DNP project was to better understand the use of palliative care for trauma patients at a Level 1 trauma center in southern Arizona to inform a future quality improvement (QI) project. Project Design: A survey was completed to determine 1) how palliative care is utilized for trauma patients at this institution; 2) what barriers exist for the use of palliative care in this population; 3) what is the culture of the trauma team regarding palliative care; and 4) whether there are differences in palliative care use between physicians and advanced practice providers (APPs) on the trauma service. Participants and Setting: Eleven trauma APPs and attending physicians at a Level 1 trauma center in southern Arizona. Measurements: APPs and physicians were surveyed using a survey tool created by the author to answer the project questions. This survey assessed barriers to the use of palliative care, situations and patient characteristics prompting palliative consults, previous education in palliative care, comfort with difficult topics and symptoms, and suggestions for improving palliative care use at this facility. Results: As a team, there was agreement between APPs and attending physicians that lack of timely availability of palliative care staff was a barrier to initiating consults, in addition resistance from families regarding palliative care. Both groups were also likely to consult palliative care for assistance with transitions of care and when there is family conflict in decision making. Both groups felt that increased availability of palliative staff to cover nights and weekends, as well as provider education on palliative concepts would improve utilization of palliative care. Conclusion: Future QI projects should focus on provider-identified interventions to improve palliative care use, such as continuing education on palliative care and increased availability of palliative care staff.

A research report submitted in partial fulfillment of the degree of MSc (Med) in Bioethics and Health Law, Steve Biko for Bioethics, University of Witwatersrand, May 2015 / In response to an increasing number of litigations relating to nursing care errors, negligence or acts and omissions that arise mostly due to unprofessional or unethical behaviour by nurse practitioners, compounded by the growing awareness of patient’s rights, nurse practitioners as such need an intervention by the regulatory body, the South African Nursing Council (SANC). The argument presented in this report is regarding the obligatory role of SANC to uphold professional and ethical practice for nurses in terms of the curriculum, the scope of practice, the code of ethics, continuing professional development and by offering an appropriate workplace ethical climate. The basis of the argument is philosophical perspectives, legislation and moral theories related to ethical practice. The moral theories applied to this study are deontology, utilitarianism, virtue ethics and Ubuntu as an African moral theory, whereas legislation relates to rules and regulations related to nursing practice. The overall significance of the study is to enhance nursing care with specific focus on upholding ethical principles from the SANC position, that will positively impact on the improvement of health care by nurses with reference to the Nursing Act No. 33 of 2005, The Bill of Rights (Constitution of South Africa), The Universal Declaration of Human Rights, the Patient’s Rights Charter, the International Council of Nurses (ICN) , the South African Nursing Council Code of ethics and the National Health Act 61 of 2003.