Thesis (Ph.D)--Biomedical Engineering, Georgia Institute of Technology, 2009. / Committee Chair: Vidakovic, Brani; Committee Member: Griffin, Paul; Committee Member: Kemp, Charlie; Committee Member: Sprigle, Stephen; Committee Member: Villivalam, Arun. Part of the SMARTech Electronic Thesis and Dissertation Collection.

Background: The role of foster carer is a complex and emotionally demanding one. This is particularly true in the presence of difficult behaviour which can, at times, leave the foster carer feeling overwhelmed and increases the risk of placement breaking down. It is therefore important to find ways to support foster carers. The present study sought to explore the lived experience of foster carers caring for children who presented with difficult to manage behaviour, with consideration given to their attachment characteristics. Aim: The primary aim of this study was to generate a grounded theory of foster carers’ experience of caring for a child who presents with difficult to manage behaviour, in order to inform supports. Method: The study adopted a qualitatively driven mixed methods design (QUAL+quan). Grounded theory (Glaser & Strauss, 1967) was used as the primary component. Eight female foster carers, with either past or present experience of caring for a child who they felt presented them with difficult to manage behaviour, were interviewed. Interviews were recorded and transcribed. Adult attachment data was gathered to elaborate and enhance the interpretation of the foster carers’ narratives. Foster carer’s attachment characteristics were measured using The Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994), and the presence of behavioural difficulties were confirmed using the Assessment Checklist for Children (ACC: Tarren-Sweeney, 2007). Results: A core category emerged from the grounded theory analysis (‘Making Sense’) in addition to five main categories (‘Personal Impact’, ‘What Helps’, ‘What Makes it Difficult’, ‘Responding’ and ‘The Relationship’). The overarching theme to emerge from the research was the influence foster carer’s level of reflection and understanding of the behaviour (their mentalizing capacity) had on their experience of the child’s difficult behaviour, which appeared to relate to their attachment characteristics in addition to a number of internal and external factors. Consideration is given to the psychological process that emerged from the categories generated from the foster carers’ narratives, and the consequent proposed ground theory. Conclusions: The findings confirm the complexity of the foster caring role, and suggest the positive impact foster carer’s reflective stance can have on their experience of difficult behaviour in the child they care for. Research strengths and limitations are discussed, in addition to clinical practice and research implications.

<p> Employee satisfaction and engagement have a direct impact on customer satisfaction. Dissatisfaction and disengagement lead to an increased intent to leave a job, poor patient outcomes, and decreased productivity. The retention and recruitment of qualified staff becomes an urgent priority to ensure safe and prudent patient care. The purpose of the qualitative research study was to better understand the beliefs, attitudes, perceptions, and reasons for emergency department registered nurses (ED RN) satisfaction and engagement in the workplace focusing on Herzberg&rsquo;s, Vroom&rsquo;s, Yetton&rsquo;s, Maslow&rsquo;s, Benner&rsquo;s, and Kahn&rsquo;s motivation and engagement theoretical frameworks. The qualitative case research study focused on satisfaction and engagement elements using structured interviews of 21 ED nurses from three hospitals of varying sizes and capabilities and included three generational cohorts of Baby Boomer, Generation X, and Millennial RN. Interview analysis showed distinct similarities and differences in nurse satisfaction and work engagement with a consistency in job engagement with no distinct differences among generations. Distinct findings included persistent lack of staff resources, poor communication from leaders, and compassion fatigue among staff. Findings reflected strong interpersonal relationships, teamwork, autonomy, and a strong sense of accomplishment among nurses. Findings indicate that satisfied nurses have improved outcomes, produce happier customers, and feel a sense of accomplishment in the job performed. The positive social impact of this study is in providing guidance on retaining ED RN to provide adequate staffing levels for safe, quality healthcare.</p><p>

<p> Ambulatory care comprises a major and increasingly important part of the U.S. and other countries&rsquo; health care sectors. Every year in the U.S., about 80% of the population seeks care at a doctor&rsquo;s office, amounting to one billion visits. These visits divide almost equally between primary care and specialty clinic organizations. Diagnostic work is part of most ambulatory care, and central to over 40% of patient visits that originate due to a new problem or a flare-up of an ongoing chronic problem. Yet, the risks associated with diagnostic failures have not garnered much attention from health care leaders and policy makers until a recent National Academy of Medicine (NAM 2015) report synthesized research data with the statement that &ldquo;most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.&rdquo; This dissertation first reviews organizational theories and measurement challenges relevant to diagnostic safety and quality in the context of ambulatory care, and then presents three papers analyzing specific organizational factors hypothesized to enable or thwart an accurate and timely diagnosis. The first paper targets delayed diagnosis from missed evidence-based monitoring in high-risk conditions (e.g., cancer) within five specialty clinics in an urban publicly funded health system. The second paper analyzes staff-reported office problems that could lead to diagnostic error (e.g., not having test results when needed) in over 900 primary and specialty clinics across the nation. The third paper examines the associations between two types of time pressure (i.e., encounter-level and practice-level), organizational factors, and patient effects including perceptions of missed diagnostic opportunities. The three primary conclusions from this work are 1) organizational vulnerabilities for missed monitoring common to the different clinics included challenges with data systems, communications handoffs, population-level tracking, and patient activities, leading to the development of &lsquo;design seeds&rsquo; for context-flexible solutions to improve diagnostic quality; 2) two organizational factors&mdash;stage of health information technology (HIT) deployment and patient safety culture are associated with diagnostic-related office problems, and 3) encounter and practice-level time stressors in primary care clinics are associated with perceptions of greater adverse effects on diagnosis and treatment, and worse patients&rsquo; experiences of chronic care from the clinic team, respectively, as well as associated with several organizational factors including HIT, patient-centered culture, relational coordination for interdependent teamwork, and leadership facilitation of changes to address frontline practice challenges. Taken together, the dissertation papers also demonstrate the applicability of the NAM Improving Diagnosis Conceptual Framework for research on ambulatory care organizations. </p><p>

Thesis (M.A. (Political and International Studies))--Rhodes University, 2006. / A thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts.

The general aim of the present thesis was to develop a theory on caring and uncaring encounters within nursing and health care from the patient's perspective. Results of an analysis of two phenomenological studies (paper I), as well as research findings from five other phenomenological studies (papers II-VI), were used to develop the theory. Caring and uncaring can be conceptualized on a continuum symbolizing five basic modes of being with another, which, for example, involves a neutral mode of being with another, where the individual is perceived as neither caring nor uncanng. There are two major metaphors in the theory, that of the bridge, symbolizing the openness in communication and the connectedness experienced by the recipient of care in an encounter perceived as caring. The other metaphor is the wall, which symbolizes negative or no communication, detachment and lack of a caring connection, experienced by the recipient in an encounter perceived as uncaring. In the theory the importance of professional caring within nursing and health care is proposed, essentially involving competence, caring, and connection. The above-mentioned 'bridge' is developed through mutual trust and the development of a connection between the professional and the recipient. This connection is a combination of professional intimacy and a comfortable distance of respect and compassion -- professional distance. On the other hand, uncaring involves perceived indifference and incompetence, creating distrust, disconnection and the above-mentioned 'wall' of negative or no communication. The recipient of professional caring is influenced positively. Theconsequences, which are an increased sense of well-being and health, can be summarized as empowerment. Uncaring, however, has the negative consequences of decreased sense of well-being and health, which can be summarized as discouragement. Empowerment and discouragement in this context are defined as subjective experiences of the recipients of care. The importance of seeing the recipient in his or her inner and outer contexts is emphasized in the theory. The inner context involves perceived needs, expectations, previous experiences and sense of self, which in the perspective of the recipient of nursing can be summarized as both a sense of vulnerability and the need for professional caring. The perceived hospital environment comprises the recipient's outer context. It is concluded that nurses and other health professionals can, by theirprofessional caring or lack of it, be powerful sources of empowerment ordiscouragement to those whom they are pledged to serve. / <p>Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.</p><p>The following papers included in the Ph.D. Thesis are removed due to copyright restrictions.</p><p>Paper I: Halldirsdottir, S. l 991. Five basic modes of being with another. In Gaut, D.A., &amp; Leininger, M.M., (eds) <em>Caring: The compassionate healer</em>. NationalLeague for Nursing, New York, 37-49.</p><p>Paper II: Halldirsdottir, S. &amp; Hamrin, E. 1997. Caring and uncaring encounters'vvithin nursing and health care: From the cancer patient's perspective. <em>Cancer Nursing</em> April, 20(2):120-128.</p><p>Paper III: Halldirsdottir, S. &amp; Hamrin, E. 1996b. Experiencing existentialchanges: The lived experience ofhaving cancer. <em>Cancer Nursing</em>, 19(1), 29-36.</p><p>Paper IV: Halldirsdottir, S. &amp; Karlsd6ttir, S.I. 1996a. Empowerment ordiscouragement: Women's experience of caring and uncaring encounters during childbirth. <em>Health Care for Women lnternational</em>, 17( 4).</p><p>Paper V: Halldirsdottir, S. &amp; Karlsdottir, S.I. i 996b. Journeying through labourand delivery: Perceptions of women who have given birth. <em>Midwifery</em> 12(2).</p><p>Paper VI: Halldirsdottir, S. 1996a. The lived experience of health: Aphenomenological case study. (on the day of the defence date the status of this article was <em>Submitted</em>. <strong>Published later:</strong> Halldorsdottir, S. 2000. Feeling empowered: A phenomenological case study of the lived experience of health.  In B. Fridlund and C. Hildingh (eds),  <em>Qualitative methods in the service of health </em>(pp. 82-96).  Lund: Studentlitteratur.</p>

[pt] Historicamente os estudos e pesquisas dos movimentos migratórios são orientados por valores patriarcais, sendo a migração tratada quase sempre como uma questão masculina, invisibilizando a presença feminina nesse processo. Essa omissão das mulheres migrantes nos estudos migratórios reforça insistentemente a trajetória de mobilidade masculina como sendo a norma. Assim, em virtude de tal omissão histórica da migração feminina, a proposta é estudar, a partir da intersecção entre o gênero, processo migratório e fronteira, a migração feminina para o setor de cuidados, que consiste no trabalho realizado no âmbito doméstico de cuidados com a limpeza do ambiente doméstico e principalmente o cuidado de pessoas (crianças, idosos, pessoas com deficiência, etc.), e que tem estado ocultada nas análises tradicionais dos estudos migratórios. Dentro dessa problemática, o presente trabalho tem como proposta fazer uma análise crítica das implicações da invisibilidade de gênero para a (des)proteção internacional dos direitos humanos de trabalhadoras paraguaias, que migram e/ou transitam irregularmente para atuar na área de cuidados na fronteira de Foz do Iguaçu. Este lugar de vulnerabilidade reforça a invisibilidade na ótica estatal da proteção, em que se consideram os sujeitos incluídos na norma e merecedores da proteção estatal e dos direitos humanos: nacionais, cidadão, migrante regular/documentado, etc. Para responder a esse questionamento: onde estão essas mulheres migrantes na fronteira?, utilizouse da metodologia feminista que permite analisar a partir de questionamento desse silenciamento das mulheres migrantes, as assimetrias constituídas pelas relações de gênero no processo de mobilidade das trabalhadoras paraguaias na fronteira, tendo em vista as particularidades intrínsecas no projeto migratório feminino e no trabalho do setor de cuidados. A presente pesquisa foi desenvolvida mediante abordagem qualitativa e técnicas metodológicas, como a análise indutiva de normas e de política social, com base em fontes secundárias: a partir levantamento de dados estatísticos existentes em informativos institucionais, originários do Observatório de Migrações (Obmigra), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Instituto de Pesquisa Aplicada (IPEA), com o intuito de fazer o levantamento do perfil da mulher migrante na fronteira. / [en] Historically, studies and research on migratory movements are guided by patriarchal values, with migration being treated almost always as a male issue, making the female presence invisible in this process. This omission of migrant women in migration studies insistently reinforces the trajectory of male mobility as the norm. Thus, due to this historical omission of female migration, the proposal is to study, from the intersection between gender, migratory process and border, female migration to the care sector, which consists of the work carried out in the domestic sphere of care with cleaning the domestic environment and especially the care of people (children, the elderly, people with disabilities, etc.), and which has been hidden in traditional analyzes of migration studies. Within this problem, the present work proposes to make a critical analysis of the implications of gender invisibility for the international (un)protection of the human rights of Paraguayan workers, who migrate and/or transit irregularly to work in the area of care at the border of Foz do Iguaçu. This place of vulnerability reinforces invisibility from the state perspective of protection, which considers the subjects included in the norm and deserving of state protection and human rights: nationals, citizens, regular/documented migrants, etc. To answer this question, where are these migrant women on the border, we used the feminist methodology that allows analyzing, from the questioning of this silencing of migrant women, the asymmetries constituted by gender relations in the process of mobility of Paraguayan workers on the border, in view of the intrinsic particularities in the female migratory project and in the work of the care sector. This research was developed using a qualitative approach and methodological techniques, such as the inductive analysis of norms and social policy, based on secondary sources: from the survey of existing statistical data in institutional newsletters, originating from the Migration Observatory (Obmigra), Instituto Brasileiro de Geografia e Estatística (IBGE) and the Institute of Applied Research (IPEA) in order to survey the profile of migrant women at the border.

This research investigates and develops a new approach to the management of service quality with the emphasis on patient and staff satisfaction in the healthcare sector. The challenge of measuring the quality of service in healthcare requires us to view the problem from multiple perspectives. At the philosophical level, the true nature of quality is still debated; at the psychological level, an accurate conceptual representation is problematic; whilst at the physical level, an accurate measurement of the concept still remains elusive to practitioners and academics. This research focuses on the problem of quality measurement in the healthcare sector. The contributions of this research are fourfold: Firstly, it argues that from the technological point of view the research to date into quality of service in healthcare has not considered methods of real-time measurement and monitoring. This research identifies the key elements that are necessary for developing a real-time quality monitoring system for the healthcare environment.Secondly, a unique index is proposed for the monitoring and improvement of healthcare performance using information-theoretic entropy formalism. The index is formulated based on five key performance indicators and was tested as a Healthcare Quality Index (HQI) based on three key quality indicators of dignity, confidence and communication in an Accident and Emergency department. Thirdly, using an M/G/1 queuing model and its underlying Little’s Law, the concept of Effective Satisfaction in healthcare has been proposed. The concept is based on a Staff-Patient Satisfaction Relation Model (S-PSRM) developed using a patient satisfaction model and an empirically tested model developed for measuring staff satisfaction with workload (service time). The argument is presented that a synergy between patient satisfaction and staff satisfaction is the key to sustainable improvement in healthcare quality. The final contribution is the proposal of a Discrete Event Simulation (DES) modelling platform as a descriptive model that captures the random and stochastic nature of healthcare service provision process to prove the applicability of the proposed quality measurement models.

Organisational learning is conceptualised within healthcare policy as an acontextual entity to be implemented across services through a prescribed governance framework. Studies of organisational learning often exclude context in this way. The central questions of this thesis concern how and why context is relevant and important in relation to organisational learning. In order to address these issues, context and organisational learning were conceptualised as mutually constitutive activity and knowing-in-practice respectively. Taking a cultural-historical activity theoretical approach, learning is understood to be an intrinsic part of activity. These issues were explored empirically through qualitative case study in three purposively sampled Scottish primary care teams. Initial findings suggested collective learning occurred through participation in everyday activity. Team accounts of apparently the same routine object of work revealed distinctive patterns of activity. Each team seemed to be doing the same thing differently. Exploration of mediating means present in each teamâ s activity accounted for these differences: although similar on the surface, the attribution of meaning to each was contested and shaped through the cultural, historical and inherently contextual activity which they mediated within each activity system. Further analysis demonstrated members of each primary care team co-configured these objects with members of other interlinked activity systems. Different things were actually being done in similarly different ways. This showed how inherently contextual activities shaped the content of collective learning and offered an explanation of why context is relevant and important in collective learning. These findings suggest efforts to transfer knowledge as a discrete, manageable entity between situations are unlikely to succeed due to the filtering and translating effect of inherently contextual activity. From this perspective, organisational learning and related concepts such as â implementationâ and â best practiceâ become problematic. Healthcare policy concerning collective learning, within which such approaches are central, may benefit from reconsideration.

No description available.