This qualitative descriptive research study was conducted to understand nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. Examination of the literature revealed research on the importance of ambulatory care nurses, their bond with the communities they serve, and the need for ambulatory settings for underserved communities. The review also explored the fierce strike of the COVID-19 pandemic on these communities and the social justice implications of serving low-income and low-resource patients. No literature was found on this specific dissertation topic: ambulatory nurses’ experiences working in underprivileged communities during the COVID-19 pandemic. The sample used for this study consisted of 25 registered nurses who worked in ambulatory settings during the inception of the COVID-19 pandemic. In particular, the time period spanned February 2020 through the end of June 2020. The communities consisted of poorly resourced neighborhoods. The narrative description and accounts of nurses interviewed for this study will facilitate an understanding of nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. The researcher used a qualitative methodology, qualitative descriptive, to frame the stories. Qualitative content analysis methods, specifically thematic analysis, were used to understand the nurses’ reflections and experiences. Roy’s Adaptation Model (RAM) was the theoretical framework to guide the open-ended interview questions. The researcher developed questions based on the four modes of RAM: the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode. Thematic analysis was used to identify themes from the interview transcripts. A thematic analysis strategy is an approach used to identify and analyze patterns of meaning from interview data (Braun & Clarke, 2006). A thorough overview was made of all the data, including initial notes. The notes were obtained by reading and rereading the transcripts and highlighting interesting phrases or statements called meaningful units. These units were then compiled into sub-themes, and ultimately themes were comprised after highlighting parts of the transcripts that generated similar content. Themes were developed by identifying patterns among meaningful units and data relevant to each theme. Themes were then reviewed to ensure they accurately represented the data after highlighting, constant review, and compounding them in meaningful units that identified and generated the final set of themes. The researcher developed and kept reflexive journal notes, which were reviewed constantly throughout the study to maintain best-practice qualitative methodology (Ortlipp, 2008). The thematic analysis revealed multiple themes. The themes discovered were crying, protector vs. moral distress, resilience vs. compassion fatigue, family vs. bereavement, and self-concept vs. self-care. An overarching theme of struggle was also manifested within this research.

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M.A. (Heath Studies)

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M. A. (Heath Studies)

A fila de espera nas unidades de pronto-atendimento pediátrico é um problema constante em diversos hospitais do Brasil. A introdução de novas tecnologias pode contribuir para a gestão dessa fila. No entanto, inexistem pesquisas de aplicativos que abordem esse problema. Neste estudo foram desenvolvidas duas atividades principais e relacionadas, mas independentes. A primeira foi o desenvolvimento de um aplicativo multiplataforma para dispositivos móveis, visando à diminuição da fila de espera no pronto-atendimento pediátrico de um grande hospital de Curitiba. A adoção de um modelo de sistema de pré-reserva ou check-in permitiu que o aplicativo indicasse os horários de menor frequência para utilização do pronto atendimento, sem descaracterizá-lo como pronto atendimento. Em outras palavras, o sistema busca melhorar o funcionamento do pronto atendimento sem torná-lo um sistema de agendamento de consultas eletivas. O aplicativo possui três principais funcionalidades: apresentação do número de crianças aguardando atendimento, apresentação do tempo estimado de espera para uma consulta e o sistema de checkin para a fila de espera. Durante o período de 90 dias de avaliação do protótipo foram realizados 2.835 downloads e instalações em dispositivos móveis com 35.811 acessos registrados. A segunda atividade foi a análise dos resultados e efeitos da utilização do sistema de check-in na fila de espera do pronto-atendimento pediátrico. O aplicativo propõe um horário mais adequado para o usuário ir ao hospital, minimizando o risco de ocorrência de eventos adversos. Foram obtidas e analisadas 129 observações completas de pacientes que utilizaram a função de check-in. O levantamento de dados relacionou a quantidade de pacientes aguardando na fila de espera por três perspectivas de tempo, considerando o tempo real de espera no momento do check-in do usuário no aplicativo, em comparação, ao tempo de espera deste usuário com o horário de agendamento gerado pelo aplicativo, assim como ao tempo de espera de sua entrada/chegada real ao hospital. Para verificação do resultado das comparações dos tempos foi adotado o método estatístico de análises temporais. Nas 129 observações de pacientes que utilizaram o check-in, os resultados demonstraram que em média os pacientes aguardaram atendimento por 19,24 minutos em comparação ao resultado do tempo médio 127,8 minutos de espera na fila dos pacientes que não utilizaram o aplicativo em seus atendimentos. O método proposto de check-in apresentou índices de melhora na redução do tempo de espera dos pais que utilizaram o aplicativo em comparação aos demais pais, indicando que ele pode ser usado para contribuir na gestão da fila de espera do pronto atendimento pediátrico. / Waiting queues in pediatric emergency unit are a constant problem in many hospitals in Brazil. The introduction of new technologies can contribute to the management of the queues. However, research about mobile applications to that address this problem was not identified. The present study developed two main activities that are related but independent. The first was the development of a cross-platform mobile application aimed at reducing the waiting queue in the pediatric emergency room of a major hospital in Curitiba. Using a pre-booking/check-in model, the application indicates time slots when the flux of patients is low in the emergency room. The model sought to achieve a balance between demand of treatment and hosting capacity that would help manage overcrowding and maintain the responsiveness in the service. The mobile application has three main features: to show the number of children that are waiting for care, to present the estimated waiting time for an appointment and a check-in system for the queue. During the 90-day evaluation of the prototype, 2,835 downloads and installations on mobile devices were carried out with 35,811 registered accesses. The second activity was the analysis of the effects of the check-in system use in the pediatric emergency department queue. The application proposes a time slot with fewer patients in the queue for the user, minimizing the risk of adverse events. 129 complete observations of patients who used the check-in function were obtained. The data related to three types of patients’ waiting times in queue were analyzed: the real waiting time in the room considering the check time in the application, the waiting time considering the scheduled time generated by the application, and the waiting time considering the actual arrival time at the hospital. To analyze the results, the three types of waiting times were compared using the statistical method of analysis time. In the 129 observations of patients who used the check-in, the analysis showed that on average, patients waited for care 19.24 minutes compared to the average time 127.8 minutes of waiting in the queue for patients who do not used the application. The proposed method of check-in reduced the waiting time for parents who used the application in comparison to other parents, indicating that it could be used to contribute to the management of the overcrowding in pediatric emergency unit.