This is an exploratory follow-up study of the clientele of the Psychiatric Crisis Unit, a short-term, crisis-oriented inpatient psychiatric ward. The main objective of the research was to test the following null hypothesis: there are no significant differences between those individuals who attempt to gain aftercare treatment as opposed to those individuals who do not following discharge from the Crisis Unit. A sample of fifty-one voluntary patients who consented to participate in the study was used in testing this hypothesis. Each subject completed the Minnesota Multiphasic Personality Inventory (M.M.P.I.) and a sociological questionnaire while in the Crisis Unit, and a follow-up questionnaire was administered via telephone or personal contact approximately one month after discharge. The follow-up information was used to determine whether the subject fell into the "aftercare” or “no-aftercare” group. Data collection lasted from July 1, 1970 to December 15, 1970. The data revealed that there were significant differences between the groups and, thus, the null hypothesis was rejected. The ten M.M.P.I. scales revealed no significant differences between the groups on the individual scales. However, when examined collectively, the aftercare group scored higher than the no-aftercare group on all scales except Self-Sufficiency (which is scored in the opposite direction, corroborating the tendency in the other scales). A discriminant function correctly classified seventy-three percent of the subjects. These results indicate that the aftercare subjects probably viewed themselves as “needing” more help. The significant predictor variables found included prior familial and personal experiences similar to those bringing the subject to the Unit, employment status, age, diagnostic designation, length of hospitalization, referral planning, and self-ratings on a mood scale which was administered upon discharge from the Crisis Unit. These variables were obtained with less effort than the psychological test data. It was found that the aftercare group (compared to the other group) was younger, had a higher rate of unemployment, and had a higher rate of familial and prior personal experiences. They were also diagnosed more frequently as psychotic, with depression ranking second, and rated themselves lower on the mood scale scores. However, the difference between the before and after mood scale scores revealed that these subjects felt they had “gained” more than the no-aftercare subjects. The no-aftercare group was diagnosed more frequently as depressed, with behavior/character disorders ranking second. They tended to rate themselves higher on the mood scale scores. However, the differences between the before and after mood scale scores revealed that they had not “progressed” as much as the aftercare subjects. Although not statistically significant, it was found that the aftercare subjects were hospitalized two days longer than the subjects of the no-aftercare group. More significant is the fact that the aftercare group had a higher rate of rehospitalization than the no-aftercare group. Data collected concerning the referral process revealed that aftercare subjects were more frequently referred for treatment than were subjects of the no-aftercare group. It was speculated that those subjects who perceived themselves and/or were perceived as being "sicker" would seek further help after discharge from the Crisis Unit. The findings also suggested that not all patients need or perceived themselves as needing further help.

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)

Since women dominate the health care system as consumers, it is important to understand how women want to be treated by medical staff, and the factors that contribute to satisfactory hospital experiences. The present research comprised two separate but integrated studies exploring these issues. The first study adopted an atheoretical approach. Qualitative and quantitative methods were used to examine the importance of hospital experiences in the lives of women, and the role of power within those experiences. Closed answer items about hospital experiences were completed by 124 women who had had a hospital stay of at least one night. In addition, ten of the women provided open-ended oral and written comments about their hospital experiences, which were used as the basis of the qualitative data. The majority of the women were satisfied with their hospital stay, but a small group recalled experiences of powerlessness associated with the non-medical aspects of their treatment, such as behaviours on the part of health professionals that influenced participants� sense of control as hospital inpatients. The qualitative data reflected similar issues to the quantitative data and provided �process� information by demonstrating how health professionals� behaviour could contribute to patients� feelings of powerlessness. The results suggested that hospital experiences were a salient part of these women�s lives. The richness of the qualitative data suggested that qualitative methodology would be a productive way to further study this area. The second study was an extension of the first via in-depth interviews with 19 women who perceived their hospital experiences as life-altering. The interview content and the analysis were based on a narrative approach that used the theoretical framework of McAdams� (1993) Life Story Model of Identity. Using McAdams� methodology enabled the researcher to evaluate how women constructed meaning from their hospital experiences, and the main issues they faced. The life story interview also proved a useful way to explore issues of loss and self-growth in the face of traumatic hospital experiences. Transcripts of descriptions of positive and negative experiences were analysed according to McAdams� themes of agency (sense of power and control) and communion (relationships with others), and sequences of redemption and contamination. Redemption sequences involve the storyline moving from a bad, affectively negative life scene, to a good, affectively positive life scene. In a contamination sequence, the narrator describes a change from a good, affectively positive life scene, to a subsequently bad, affectively negative life scene (McAdams & Bowman, 2001). Participants also rated their experiences according to Hermans� (Hermans & Oles, 1999) list of affects. There was strong agreement between McAdams� coding of agency and communion and Hermans� agentic and communal indices: the women�s hospital stories strongly emphasised the negative or opposite of McAdams� agentic theme �Self Mastery through Control�, which indicated powerlessness, and Hermans� affects, which involved low self-enhancement. It may be useful for future studies to conceptualise McAdams� themes as bipolar by incorporating currently coded themes and their reverse; in particular, by expanding ideas of agency to incorporate powerlessness, as this theme was pervasive in women�s hospital experiences. The rating of affects added to the findings as this showed a latent dimension of communion manifested as isolation. The common agency and communion themes were apparent in the two distinct but related aspects of hospitalisation that affect patients� sense of control: the medical condition and the manner in which patients are treated by medical staff. The findings of the main study built on the pilot study by showing how ideas of control and powerlessness can inform better practice. For example, respectful, dignified and fair treatment by health professionals played a part in determining redemption sequences; women also indicated this was how they wanted to be treated. Due to the vulnerability of the �sick role�, disrespectful or offhand treatment by health professionals had particularly distressing effects evident in contamination sequences, such as negative changes to sense of self and attitudes toward the health care system. In some cases, such treatment led to participants� avoiding subsequent interactions with doctors and to sustained feelings of helplessness. The present thesis demonstrates that doctors, nurses and other health professionals need to allow time to attend to the affective as well as the medical aspects of the encounter. Health professionals need a good bedside manner, compassion, and communication skills, as these characteristics play a part in maintaining female patients� sense of self and their faith in and satisfaction with the health care system.

In the past few years, many people with an Islamic background have settled in Australia. Within the health care context, this means that health care providers must modify the care provided to ensure it meets the needs of this culturally diverse population. Little nursing research has focused on understanding the perceptions and experiences of Muslim people within health care systems, particularly in Australia. This study provided an opportunity to explore, and document the experience of the hospitalisation for Islamic people and thereby advance the available information upon which important nursing care decisions that relate to this group can be more informatively made. This study aims to explore and interpret the lived experience of thirteen Muslim patients who had been hospitalised in an Australian hospital. The hermeneutic phenomenology of Heidegger (1967/1996), the philosophical hermeneutics of Gadamer (1989), and the ideas of van Manen (1990/1996) underpin this study. The meaning and understanding of the everyday experience of Muslim patient in a non-Islamic hospital is achieved through interpretation of the participants’ stories. Data were generated using unstructured audio-taped interviews from participants. The interviews were transcribed verbatim and analysed, then interpreted using phenomenological methods. The two themes to emerge from the participants’ experiences are: Being-thrown-into-an-un-everyday-world and living-Islam-in-the-un-everyday-world. The theme of Being-thrown-into-an-un-everyday-world arose from the sub-themes of the awareness of self and Being an outsider. The theme living-Islam-in-the-un-everyday-world was drawn from the three sub-themes of Being the same and different, hindrances to being Muslim, and adapting-to-the-un-everyday-world. The findings of this study provide an insight into the experience of Muslims being cared for in Australian hospitals. It is hoped that this interpretation will make a significant contribution to the care of Muslim patients by having health professionals consider how this group could be cared for in a culturally sensitive manner. It is not intended as a prescription for care but draws the reader to reflect on aspects of the Muslim faith and how this may impact on individuals experience when in hospital. The scope of this study and the dearth of available research in this area conclude that much more research needs to be undertaken. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1317115 / Thesis(Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

<p>Within the ambulance care in Uppsala County a vacuum splint is used to immobilize fractures on extremities. The research available on which method of immobilizing to prefer during pre-hospital treatment is limited.</p><p> </p><p>The purpose of this pilot study was to examine the perceptions of the ambulance personal in Uppsala County on the issue of usability of SAM-splint and vacuum splint when immobilizing extremities. The project was also aimed at researching if SAM-splint could be seen as an alternative or a complement to vacuum splint, and to get an apprehension on any evident differences in patients’ perceived pain when treated with the two different approaches.</p><p> </p><p>A descriptive comparative study was carried out. All patients, regardless of age and sex, with the need of immobilizing supposed fractures, were included.  Patients with suspected femur fracture, collum fracture, or where pre-hospital care was not possible or in question, was excluded. The collection of data was done using a questionnaire designed by the students responsible for the project. The ambulance personal completed the questionnaire after having concluded the treatment.</p><p> </p><p>The result showed that all patients with fractures to their extremities were immobilized. There were no evident differences in how the personal experienced the application of the two methods of immobilizing, but rather they were generally both perceived as easy to use. In Uppsala, where the paramedics had access to both SAM-splint and vacuum splint, the SAM-splint was the predominant choice.</p><p> </p><p>Based on this pilot study it can be established that the ambulance personal experienced the methods for immobilizing as easy in the event of fractures to the extremities. The SAM-splint is to be seen as a complement to the vacuum splint. Any difference in perceived patient rated pain connected to the different methods of immobilizing was not to deduce.</p> / <p>Inom ambulanssjukvården i Uppsala län används vakuumsplint för immobilisering av extremitetsfrakturer. Forskning och kunskap om vilken immobiliseringsmetod som är att föredra vid prehospital handläggning av extremitetsfrakturer är begränsad.</p><p><strong> </strong></p><p>Syftet med detta pilotprojekt var att i Uppsala län undersöka ambulanspersonalens uppfattning om användarvänligheten av vakuumsplint och SAM-splint vid immobilisering. Målet med projektet var även att ta reda på om SAM-splint kunde ses som alternativ eller komplement till vakuumsplintar samt om det fanns några uppenbara skillnader i patientskattad smärta mellan de olika immobiliseringsmetoderna.<strong> </strong></p><p><strong> </strong></p><p>En deskriptiv komparativ studie genomfördes där alla patienter oavsett ålder och kön i behov av immobilisering av misstänkta extremitetsfrakturer inkluderas. Patienter med misstänkt femurfraktur, collumfraktur eller där prehospital immobilisering ej varit möjlig eller aktuell exkluderades. Insamling av data har skett med hjälp av ett frågeformulär utformat av projektansvariga studenter. Frågeformuläret besvarades av vårdansvarig ambulanspersonal efter avslutat vårdtillfälle.</p><p> </p><p>Resultatet visade att samtliga patienter med extremitetsfrakturer immobiliserades. Det fanns ingen uppenbar skillnad gällande personalupplevd applicering mellan de olika immobiliseringsmetoderna utan generellt uppfattades de enkla att använda. I Uppsala där ambulanspersonalen hade tillgång till både SAM-splint och vakuumsplint valdes övervägande SAM-splint.</p><p><strong> </strong></p><p>Med detta pilotprojekt som grund kan sägas att ambulanspersonalen ansåg att immobiliseringsmetoderna var enkla att använda vid extremitetsfrakturer. SAM-splint kan ses som komplement till vakuumsplinten. Någon skillnad i patientskattad smärta mellan de båda immobiliseringsmetoderna framkom ej.</p>

Within the ambulance care in Uppsala County a vacuum splint is used to immobilize fractures on extremities. The research available on which method of immobilizing to prefer during pre-hospital treatment is limited.   The purpose of this pilot study was to examine the perceptions of the ambulance personal in Uppsala County on the issue of usability of SAM-splint and vacuum splint when immobilizing extremities. The project was also aimed at researching if SAM-splint could be seen as an alternative or a complement to vacuum splint, and to get an apprehension on any evident differences in patients’ perceived pain when treated with the two different approaches.   A descriptive comparative study was carried out. All patients, regardless of age and sex, with the need of immobilizing supposed fractures, were included.  Patients with suspected femur fracture, collum fracture, or where pre-hospital care was not possible or in question, was excluded. The collection of data was done using a questionnaire designed by the students responsible for the project. The ambulance personal completed the questionnaire after having concluded the treatment.   The result showed that all patients with fractures to their extremities were immobilized. There were no evident differences in how the personal experienced the application of the two methods of immobilizing, but rather they were generally both perceived as easy to use. In Uppsala, where the paramedics had access to both SAM-splint and vacuum splint, the SAM-splint was the predominant choice.   Based on this pilot study it can be established that the ambulance personal experienced the methods for immobilizing as easy in the event of fractures to the extremities. The SAM-splint is to be seen as a complement to the vacuum splint. Any difference in perceived patient rated pain connected to the different methods of immobilizing was not to deduce. / Inom ambulanssjukvården i Uppsala län används vakuumsplint för immobilisering av extremitetsfrakturer. Forskning och kunskap om vilken immobiliseringsmetod som är att föredra vid prehospital handläggning av extremitetsfrakturer är begränsad.   Syftet med detta pilotprojekt var att i Uppsala län undersöka ambulanspersonalens uppfattning om användarvänligheten av vakuumsplint och SAM-splint vid immobilisering. Målet med projektet var även att ta reda på om SAM-splint kunde ses som alternativ eller komplement till vakuumsplintar samt om det fanns några uppenbara skillnader i patientskattad smärta mellan de olika immobiliseringsmetoderna.   En deskriptiv komparativ studie genomfördes där alla patienter oavsett ålder och kön i behov av immobilisering av misstänkta extremitetsfrakturer inkluderas. Patienter med misstänkt femurfraktur, collumfraktur eller där prehospital immobilisering ej varit möjlig eller aktuell exkluderades. Insamling av data har skett med hjälp av ett frågeformulär utformat av projektansvariga studenter. Frågeformuläret besvarades av vårdansvarig ambulanspersonal efter avslutat vårdtillfälle.   Resultatet visade att samtliga patienter med extremitetsfrakturer immobiliserades. Det fanns ingen uppenbar skillnad gällande personalupplevd applicering mellan de olika immobiliseringsmetoderna utan generellt uppfattades de enkla att använda. I Uppsala där ambulanspersonalen hade tillgång till både SAM-splint och vakuumsplint valdes övervägande SAM-splint.   Med detta pilotprojekt som grund kan sägas att ambulanspersonalen ansåg att immobiliseringsmetoderna var enkla att använda vid extremitetsfrakturer. SAM-splint kan ses som komplement till vakuumsplinten. Någon skillnad i patientskattad smärta mellan de båda immobiliseringsmetoderna framkom ej.

Bakgrund: Personer över 80 år har ökat med nästan 22 % under åren 1992 – 2005. Under samma tid har vårdplatserna inom hela akutsjukvården nästan halverats. Detta har lett till ökat vårdbehov och större belastning på framför allt akutmottagningar, medicinkliniker, primärvården och kommunen. Tidigare studier har visat att inadekvata akutmedicinska inläggningar sker ofta runtom i Europa. Syfte: Syftet med studien var att studera inskrivning och utskrivning av patienter vid akutmedicinska avdelningar på ett sjukhus i Sverige. Metod: Studien genomfördes under 2007 på en akutmedicinsk klinik i Sydöstra Sverige. 411 akutmedicinska patientinläggningar bedömdes med Appropriateness Evaluation Protocol (AEP). Lika många hade möjlighet att besvara en enkätfråga, riktad till patienter, sjuksköterskor och läkare, om bedömning av utskrivningen. Resultat: Studien visar att 28,7% av patientinläggningarna inte uppfyllde AEP’s kriterier. De flesta patienter hade bröstsmärta som inskrivningsorsak oavsett adekvat eller inadekvat inläggning. Nära 30 % av patienterna, sjuksköterskorna och läkarna bedömde möjlig utskrivning ett dygn tidigare. Slutsats: Studien visar att inadekvata akutmedicinska inläggningar, enligt instrumentet AEP utgör en betydande del av beläggningen på en medicinklinik som är potentiellt påverkbar. Studien visar också att beläggningen kan påverkas genom tidigarelagd utskrivning enligt bedömningar av såväl patienter som sjuksköterskor och läkare. Resultatet talar för att en bättre kommunikation mellan patienter, sjuksköterskor och läkare skulle kunna optimera längden för akuta medicinska vårdtillfällen. / Background: Persons aged over 80 has increased by almost 22% during 1992-2005. In that time, bed occupancy throughout the emergency medical services has almost decreased to the half. This has led to increased care needs and greater burden, especially on emergency wards, medical clinics, primary care and community. Previous studies have shown that inadequate emergency medical admissions are frequently around Europe. Aim: The aim was to study admission and discharge of patients in acute medical wards at a hospital in Sweden. Method: The study was conducted in 2007 at an acute medical clinic in Southeast Sweden. 411 acute medical patient admissions were assessed with the Appropriateness Evaluation Protocol (AEP). Just as many were able to answer a survey question, directed to patients, nurses and doctors, on the assessment of discharge. Results: The study shows that 28.7% of patients' admissions did not meet AEP's criteria. Most patients had chest pain that enrollment cause any adequate or inadequate curing. Almost 30% of patients, nurses and doctors thought that discharge of the patient was possible one day earlier. Conclusion: The study shows that inadequate emergency medical admissions, with the instrument AEP, are an important part of the hospital bed occupancy of a medical clinic that is potentially impressionable. The study also shows that the hospital bed occupancy can be influenced by earlier discharge according to assessments by both patients, nurses and doctors.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

Psychiatric morbidity in the postpartum period has been a subject of research for years that has been plagued by much controversy. Most of the studies have come from Western countries. Studies that were done in Africa have concentrated on psychotic disorders in in-patients. A pilot study done by Cheetham et al (1981) at King Edward VIII Hospital found a high incidence of 'transient situational disturbances', which required further investigation. AIMS AND OBJECTIVES: 1. To document the spectrum of psychiatric morbidity in an out-patient population of postpartum Zulu women; 2. To define predictive factors which would identify women 'at risk'; 3. To assess the feasibility of 'Western' screening instruments; 4. To investigate whether 'postpartum blues' occurs in Zulu women. RESEARCH DESIGN A prospective, descriptive study was undertaken. Sample Selection: 177 postpartum Zulu women attending the ' Well-Baby' Clinic at King Edward VIII Hospital were randomly selected for inclusion in the study. Methodology: Three questionnaires: The General Health Questionnaire- 30, Pitt's Questionnaire of Anxiety and Depression and The Kennerley Blues Questionnaire were administered to the subjects. A Structured Clinical Interview DSM-III (SCID) was conducted in those women with symptoms. FINDINGS: 1. The majority of the sample were between the ages of 20 and 30 years, unmarried, with a Senior Primary education and a baby of 20 weeks. 2. 45.76% of the sample had a psychiatric diagnosis, with 18.07% having major depression. Other disorders included: adjustment disorders, schizophrenia and dysthymia. 3. Significant variables using Chi-square analysis were: inadequate antenatal care, a negative response from the partner and the absence of cultural rituals. No association was found with demographic and obstetric variables. 4. T-test analysis showed a correlation between the questionnaires and the SCID. 5. 37.3% had experienced 'postpartum blues'. CONCLUSIONS: 1. The spectrum of psychiatric morbidity is affective in nature and similar to other studies. 2. 'Postpartum blues' does occur in Zulu women. 3. Antenatal screening with 'Western' instruments could reduce psychiatric morbidity. 4. The nomenclature of puerperal disorders is inadequate and needs review. 5. More prospective, community-based research is needed, especially in rural Zulu women. / Thesis (M.Med.)-University of Natal, Durban, 1992.