In the hospital environment is observed profound and constant change, with the growing and accelerated technological innovation that makes available to health professionals and users, various types of technologies, where there are the educational technologies, management technologies and assistive technologies. The technologies are part of the nursing inserting in health in the workplace, especially in hospitals. This scenario is constituted by various kinds of technologies which constantly change so as to require professional development suitability for dealing with them accurately and efficiently. In this technological age sometimes the conception of the term technology also has been used in an emphatic, incisive and decisive manner, but mistaken, it has been seen only as a product or equipment. technology concepts are different, and from a scientific knowledge, systematized, organized, applied and practical - which requires human presence and is concretized in the act of caring, to a transformative and emancipatory conception of the subject. The cuidativo-educational technologies are covered in this research as a set of knowledge / scientific knowledge, that support the operation of the process of caring for and educating each other directly and indirectly in the nurse practice, from everyday experience and research within a critical perspective, reflective, creative, transformative and multidimensional between humans and the environment in which they operate. This study aimed to analyze the insertion of cuidativo-educational technologies in the practice of nurses working in a university hospital. This is a field research with a qualitative approach, descriptive and exploratory, developed with 21 nurses of a university hospital in Rio Grande do Sul. The data were collected through non-participant observation and semi-structured interview period March to December 2015. the analysis and interpretation of data occurred through Content analysis. the ethical aspects were respected under Resolution 466/2012. Emerged as a result the design of the nurses on the concept that these attributed to the terms: technologies, care technology, educational and cuidativo-educational. He was perceived hegemony of reductionist design the machine, tool, artifact in the speeches of the participants, however, some nurses considered as technological ability, knowledge of the professional. The cuidativo-type education was seen as the intertwining of care-educate and educate care, where one can not (co) exist without the other. In the context of hospital work, brochures, manuals, brochures, websites, among others, detached cuidativo-educational possibility, then, with the interrelationship people-person, person-tool or person-universe. As a contribution, the Cuidativo-educational technologies allow to develop or strengthen the autonomy of the subjects involved in the health-disease, with the foundation, the empowerment of the human being in their living conditions in its multidimensionality. / Em âmbito hospitalar observa-se profundas e constantes mudanças, com a crescente e acelerada inovação tecnológica, que disponibiliza aos profissionais da saúde e usuários, os mais diversos tipos de tecnologias, onde destacam-se as tecnologias educacionais, tecnologias gerenciais e tecnologias assistenciais. As tecnologias fazem parte da enfermagem inserindo-se no contexto de trabalho em saúde, principalmente em hospitais. Este cenário é constituído por diversos tipos de tecnologias, as quais se modificam constantemente, de modo a exigir dos profissionais o desenvolvimento de aptidão para lidar com as mesmas de forma precisa e eficaz. Nesta era tecnológica por vezes a concepção do termo tecnologia ainda tem sido utilizado de forma enfática, incisiva e determinante, porém equivocada, pois tem sido vista somente como um produto ou equipamento. Os conceitos de tecnologia são vários, sendo desde um conhecimento científico, sistematizado, organizado, aplicado e prático - o que requer a presença humana e se concretiza no ato de cuidar, até uma concepção transformadora e emancipatória dos sujeitos. As tecnologias cuidativo-educacionais são tratadas nesta pesquisa como um conjunto de saberes/conhecimentos científicos, que sustentam a operacionalização do processo de cuidar e educar do outro de modo direto e indireto na práxis do enfermeiro, a partir da experiência cotidiana e da pesquisa dentro de uma perspectiva crítica, reflexiva, criadora, transformadora e multidimensional entre os seres humanos e o meio em que se inserem. Objetivou-se analisar a inserção das tecnologias cuidativo-educacionais na práxis dos Enfermeiros que atuam em um Hospital Universitário. Trata-se de uma pesquisa de campo, com abordagem qualitativa, do tipo descritivo e exploratório, desenvolvida com 21 enfermeiras de um Hospital Universitário do Rio Grande do Sul. A coleta de dados ocorreu por meio de observação não participante e entrevista semiestruturada no período de março a dezembro de 2015. A análise e interpretação dos dados ocorreu por meio da Análise de Conteúdo. Foram respeitados os aspectos éticos conforme a Resolução 466/2012. Emergiram como resultados a concepção das enfermeiras acerca do conceito que estas atribuíram aos termos: tecnologias, tecnologia de cuidado, educacionais e cuidativo-educacionais. Percebeu-se a hegemonia da concepção reducionista a máquina, ferramenta, artefato nos discursos das participantes, contudo, algumas enfermeiras consideraram como possibilidade tecnológica, o conhecimento do profissional. A tipologia cuidativo-educacional foi vista como o entrelaçamento do cuidar-educar e educar-cuidar, onde uma não pode (co)existir sem a outra. No contexto do trabalho hospitalar, os folders, manuais, cartilhas, web site, entre outros, desprenderam possibilidade cuidativo-educativa, logo, havendo a inter-relação pessoa-pessoa , pessoa-ferramenta ou pessoa-universo. Como contribuição, as Tecnologias Cuidativo-educacionais permitem o desenvolver ou fortalecer da autonomia dos sujeitos envolvidos no processo saúde-doença, tendo como fundamento, o empoderamento do ser humano sob sua condição de vida na sua multidimensionalidade.

Masters in Public Administration - MPA / South Africa

The aim of this study was to investigate the attachment styles of children between the ages of six and twelve years of age who were admitted as inpatients in a children’s ward of a psychiatric hospital. Attachment theory (Bowlby, 1997, 1998) proposes that children develop certain attachment styles towards their primary caregivers from birth through to three years of age, after which the styles remain relatively constant as can be seen through attachment behaviours later on in life. These attachment styles can be secure, insecure-ambivalent / anxious or insecure-avoidant (Ainsworth, Blehar, Waters&Wall, 1978). Green and Goldwyn (2002) also refer to a fourth category that was established through later research on attachment, named disorganised attachment. Psychiatric hospitalisation of a child implies the assumption of psychopathology and through institutionalisation, he or she is literally separated from the primary caregivers and inevitably placed in unfamiliar surroundings with strangers, making it an ideal setting to investigate attachment features. The researcher worked from the supposition that the mere fact of hospitalisation and implied pathology would thus point to insecure attachment styles in these children. A qualitative research design was implemented to gather information regarding the children’s attachment styles. Two projective techniques were used, namely the Children’s Apperception Test and the Picture Test of Separation and Individuation. Analysis of the information consisted of a first- and second-order process of thematic content analysis. The results yielded thirteen categories of experience. An extensive description of each category was provided, and the categories were then related to theory. The results obtained support previous research findings that found that institutionalised children tend to show more insecure attachment styles. The results from this study also indicated that these insecure attachment styles tend to be predominantly insecure-avoidant or insecure-disorganised. / Dissertation (MA(Psychology))--University of Pretoria, 2007. / Psychology / unrestricted

Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)) A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.

Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)). A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.

The primary motivation of this PhD by publication has been the apparent disconnect between the metrics of hospital quality of care at national and board level and patients’ experiences. Exploration of the gap led to the realisation of two key points. Firstly, the concept of healthcare quality continually evolves. Secondly, the NHS Scotland Measurement Framework does not include a measure of patient experience at the microsystem level (e.g. hospital ward). This is needed to counterbalance easier to obtain metrics of quality (e.g. waiting times). Resource tends to follow measurement. Papers 1 and 2 were exploratory, investigating theoretical and practical aspects of measuring quality of hospital care at the clinical microsystem level. With the associated Chapters, they highlighted both the necessity and the possibility of measuring the patient experience at the micro level of the healthcare system. They also drew attention to the inadequacy of “satisfaction” as a metric, leading to closer examination of “experience” as the decisive metric. This required the development of a systematic review protocol (Paper Three), then a systematic review (Paper Four). The review (Paper Four) examined the utility (validity, reliability, cost efficiency, acceptability and educational impact) of questionnaires to measure the patient experience of hospital quality of care, with a newly devised matrix tool. Findings highlighted a gap for an instrument with high utility for use at the clinical microsystem level of healthcare. Paper Five presents the development and preliminary psychometric testing of such an instrument; the Care Experience Feedback Improvement Tool (CEFIT). The thesis provides, as well as the matrix tool and CEFIT, theoretical and methodological contributions in the field of healthcare quality. It contributes to an aspiration that the patient’s voice can be heard and acknowledged, in order to direct improvements in the quality of hospital care.

The purpose of this study was to investigate whether elderly clients in an acute care setting perceived themselves as being treated with dignity and respect, and whether clients with a higher socioeconomic status are more likely than clients with a lower socioeconomic status to be treated with dignity and respect. Sixty-two elderly clients who had been in hospital at least five days, were alert and oriented during their hospitalization, and could speak English were selected for the study. Using a convenience sampling technique, the clients were selected from medical and surgical units of two major teaching hospitals. They were interviewed within three days after discharge to respond to items on a questionnaire selected from the Medicus Quality Assurance Tool. The results of the study show that elderly clients may not perceive that they are consistently treated with dignity and respect. Older clients (75+ years) are less likely than younger older clients (65-74) to be treated with dignity and respect, and elderly clients with a lower socioeconomic status and women, are less likely to be treated with dignity and respect. / Applied Science, Faculty of / Nursing, School of / Graduate

This study investigated the relationship between cognitive development and children’s understanding of the hospital nurse’s role. A group of 35 hospitalized children with chronic conditions and without neurological deficits, aged 4 to 10 years, were given three tasks (i.e., the Nurse’s Role Task, the Balance Beam Task, and the Task of Intrapersonal Understanding), scored for developmental level using Case’s (1992) neo-Piagetian theory of cognitive development as a framework. A full sample of 4—year—olds was not pursued due to the distracting hospital environment which, in combination with the shorter attention span of the 4-year-olds, rendered the interviews extremely difficult to complete. Descriptive results indicated a moderately advanced understanding of the hospital nurse’s role by 8— and lO—year—olds, being on the order of one—third of a substage (i.e., approximately 8 months ahead in development), whereas 4— and 6—year—olds showed an age— appropriate level of understanding of the hospital nurse’s role. Analysis of Variance indicated a statistically significant effect for age on all three tasks (p < .01). Six levels of social—cognitive development in understanding the hospital nurse’s role were found, which were, in successive order: (1) Roles of the nurse as scripted actions (i.e., 4-year-old level), (2) Roles of the nurse as motivated action sequences (i.e., 6—year—old level), (3) Roles of the nurse as planned action sequences (i.e., 8— year—old level), (4) Roles of the nurse as generalized dispositions toward action (i.e., 10—year-old level), (5) Roles of the nurse as demonstrating logically planned decisions towards action (i.e., 12-year—old level), and (6) Roles of the nurse as demonstrating logically planned action sequences (i.e., 14—year—old level). Furthermore, results indicate that a few 6- and 8-year-olds and the majority of l0—year—olds could give an accurate description of the duties of the hospital nurse, that is, 1) nurses are there to help children, 2) nurses have a responsibility for the well-being of their patients, 3) nurses want to improve the physical and emotional health of their patients, 4) nurses also see their own shortcomings in their care for children and have good intentions, and 5) nurses are human and have their own feelings, thoughts, doubts, and ideas. Suggestions for future research have been provided in order to further improve communication between health care professionals and hospitalized children with chronic conditions. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals. Opioid use disorder (OUD)-related hospitalizations are increasing, and incurring significant costs; care delivered in this setting is likely sub-optimal. This study examined hospital-based services for OUD using a conceptual framework based on an interdisciplinary review of policy, organizational behavior, systems science, economics, and health services delivery scholarship. The study's primary research question was: How do supply-side attributes influence hospital OAT delivery, health outcomes, and health services utilization for persons hospitalized with OUD? Supply-side attributes refer to the contextual elements inside and outside of a hospital that may be associated with hospital OAT delivery performance, such as social structures (e.g., hospital standards of care, societal values) and resources and technologies (e.g., hospital staffing, federal treatment policies). A mixed methods study described, explored, and identified how patients with OUD are cared for in the hospital and the barriers and facilitators to delivering OAT during hospitalization. The sequential mixed methods approach (i.e., qualitative followed by quantitative analyses) included analysis of 17 key informant interviews with addiction medicine physicians from 16 non-federal U.S. hospitals, 25 hospital guidance documents from 10 non-federal U.S. hospitals, and administrative data from 12,407 OUD-related hospital admissions from the Veterans Health Administration (VHA) health system. The findings from the study's three aims and 16 research sub-questions were integrated to reach seven conclusions: 1) OAT is underused in the hospital; 2) OAT delivery varies within and across hospitals; 3) OAT is used ineffectively; 4) non-OAT modalities are inappropriately used during and after hospitalization; 5) supply-side attributes inside and outside the hospital facilitate and impede hospital OAT delivery; 6) demand-side attributes facilitate and impede hospital OAT delivery; and 7) the hospital is an important service delivery mechanism in the OUD care continuum. The study's findings could be extrapolated to improve policy and practice by implementing education and health service delivery interventions through regulatory and allocative policy mechanisms focused on physicians, medical trainees, and hospital and health system administrators. Understanding how OAT delivery may be improved within the acute care delivery system is an important element to support efforts to curb the ongoing drug poisoning crisis.

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