Nurses are an integral part of the health care system and their job encompasses a wide range of responsibilities including the promotion of health, prevention of illness and care for physically, mentally ill and disabled people. Nurses have a mandate to be responsible and accountable to the public they serve. For these reasons, it is crucial that nurses possess attitudes that allow them to provide optimal care in a supportive manner for patients. Despite the fact that considerable research on the experiences of nurses caring for the mentally ill in general hospitals has been done globally, none has been conducted in the Eastern Cape, South Africa. Additionally, no studies could be obtained from anywhere in the world on the experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations. Studies indicated that nurses have different experiences when caring for mental health care users. It was therefore considered necessary to find out how non-psychiatric trained nurses perceive the caring of mental health care users during the 72 hour observations. The research design used to explore and describe their experiences was qualitative, descriptive, explorative, phenomenological and contextual in character. Semi-structured interviews were conducted with eight (8) participants who were purposively selected. This was done after necessary permission from the Department of Health and informed consent from the research participants. Steps were taken throughout the course of the study to ensure trustworthiness. Data were analysed using Tesch’s methods and the services of an independent coder were used. The results indicate that there are different experiences with regard to the caring for mental health care users during the 72 hour observations. The major themes identified are: feelings experienced by these nurses, lack of knowledge, challenges and strategies used for coping with a violent user, need for support from security staff and lack of policies. v Guidelines as a supportive action are suggested. From the results of the study recommendations are made in the areas of nursing education, nursing practice and nursing research. It is concluded that for non-psychiatric trained nurses to provide optimal care to mental health care users, the nurses need knowledge and skills in order to facilitate the promotion, maintenance and restoration of mental health of these patients as an integral part of health.

Improving hospital efficiency is a critical concern for health care managers and policy makers. Hospital technical efficiency is measured as the ratio of what quantity and quality of care is produced to what could be produced given the level of resources available to the hospital (its budget). What a hospital should produce given the resources at its disposal is called the “production frontier”. In order to improve hospital performance, health policy makers need knowledge and information about how well the hospitals they fund are utilizing the resources they receive. Data Envelopment Analysis, a non-parametric technique, is applied to administrative data on hospitals in Canada to produce the “technical frontier” and get insight into the variation of technical efficiency of acute hospitals at the Pan-Canadian level (except for the province of Quebec, which does not report its data on hospitals in a way that would make them comparable to the rest of Canada). DEA is preferred to the alternative method of stochastic frontier for the following reasons: DEA does not require to impose a specification on the production function of hospitals (for which theory is clearly lacking), and it allows the analyst to estimate a multi-output frontier (a stochastic frontier would have to weight arbitrarily the value of quantity versus that of quality of care in hospitals, whereas the DEA approach generates these weights from the data). Efficiency scores are serially de-correlated using a bootstrap technique and then entered as the dependent variable in regressions to identify the main factors of efficiency or inefficiency. Specifically, this thesis aims to: 1) estimate the level of technical efficiency of acute inpatient care in 35 teaching hospitals, 54 large hospitals and 90 medium-size hospitals respectively in Canada and identify the potential factors that have influence on technical efficiency; 2) uncover and measure the existence of possible spatial spillovers of hospital efficiency in Canada and examine its potential determinants while taking into account the interaction between hospitals by means of spatial regression; and 3) examine the technical and scale efficiency of the 229 small and rural hospitals across Canada (outside Quebec), as well as estimate the impact of institutional and contextual variables on hospital technical and scale efficiency respectively. The major findings are: 1) hospital output (combination of number and quality of stays; quality being measured as the inverse of in-hospital mortality) in Canada could be increased by 24 percent with the same resources by eliminating inefficiency. Highly efficient teaching hospitals benefit from producing care under favourable environments. Higher efficiency could be achieved by increasing cooperation within the health system and making more post- acute care beds available to both large and medium hospitals; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care (elasticity of 0.3): Canadian hospitals are clearly complements to each other and work in networks much more than in competition. The hospital size (the number of beds), the percent of transfers between acute hospitals, and the percent of patient transfers to home care are the main drivers of efficiency among acute hospitals in Canada while controlling of the dependence between hospitals; and 3) Among small hospitals, the average output orientation technical efficiency on all types of services is 54% at the current input-output mix. To improve their technical efficiency, small hospitals should provide with more home care facilities to discharge their patients to (so-called Alternative Level of Care patients) and strengthen their cooperation with larger, urban hospitals. Small hospitals are scale inefficient, specifically, rural hospitals could reduce their size by 34% on average (around 6 acute beds) to achieve the optimal size. The study also found that the spending on diagnosis tests and the nursing as the percentages of total hospital spending (cost shares) are positively and significantly related to the scale efficiency. / Thesis / Doctor of Philosophy (PhD) / A hospital is technically efficient if it uses its resources (its budget) to get the most in terms of quantity (number of stays) and quality of care it can. A hospital can be more or less technically efficient for reasons independent of its control (typically, because of the environment in which the hospital operates) and efficiency is a value-neutral measure. This thesis aims to: 1) estimate the technical efficiency of acute inpatient care in Canada and identify the potential factors that influence the level of efficiency achieved by a given hospital; 2) uncover the existence of possible geographic clusters of efficiency (hospitals that are close geographically are also close in the efficiency scale, something called spatial spillovers in the literature) in Canada.; and 3) examine the role that size plays in the variation of technical efficiency among small and rural hospitals across Canada. The major findings are: 1) hospital output could be increased by 24 percent with the same resources by eliminating technical inefficiency; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care: being close to an efficient hospital increases the efficiency score of a hospital, everything else being the same; and 3) The level of technical efficiency of small and rural hospitals across Canada is low overall and, perhaps surprisingly, larger rural hospitals are among the least efficient: among small hospitals, scale does not yield economies of resources.

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on July 12, 2010). Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 59-62).

Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [119]-125).

A concept of "total patient care" was developed in Hong Kong to enhance public hospital services. The development of this concept aimed to resolve two major concerns about patient care delivery. First, for historical reasons, there were differences among public hospitals in their emphases on the scientific medicine and social aspects of caring. Secondly, the health care system was under pressure to change due to rising expectations, in particular to an increasing number of patients requiring complex care in the community. The purposes of this study were (1) to investigate the historical influence on the development of patient services and (2) to examine the determinants affecting the development of new initiatives. The path-finding process to shift care practice from a traditional institutional orientation to a person-centred approach was studied through a focal point of study in all 38 public hospitals, serving a population of 6.3 millions. An analysis of the "successful" examples of the implementation of the concept of total patient care was initially conducted. The subsequent development of a variety of hospital patient care models was traced back to the different origins of patient care orientations through collecting views of hospital stakeholders and the support provided for patients outside the hospitals. A pluralistic approach, which involved site visits, interviews, focus group discussion and survey, was chosen to understand the complexity of historical influence and contemporary determinants in the development of the totality of patient care. A "mapping" method was adopted to analyse the data reflected different levels of concerns. The findings in this study indicated that, technological and financial factors often identified as the more important determinants in development of health care system, might have ignored the historical development of the hospitals and health traditions in the community in the development of totality of patient care. This study suggested that influences of these informal factors, as experienced in a Chinese community, would likely to continue and diffuse the goal of a planned policy. Formalisation of the informal and community involvement in formal hospital settings, through a concept of total patient care, had resulted in the consolidation of some diversified experience in the support of a diversified range of patient needs. The strengthening of a hospital-community linkage was highlighted as a possible solution to bring a full transformation of patient care into a model of totality.

Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. Includes bibliographical references (leaves [119]-125).

no / This research aims to develop a better understanding of how cardiology patients experience the care provided by community pharmacy after discharge from hospital. • Contact with community pharmacists is infrequent and can be via a proxy. Patients’ experiences of community pharmacy care are limited and many patients have unmet medicines use support needs. • Community pharmacy misses opportunities to support patients in their medicines use after hospital discharge / Conference abstract.

Human immunodeficiency virus (HIV) is a worldwide problem, with more than 34 million people infected with HIV/AIDS in 2011. At the end of 2011, in Nigeria, an estimated 3.7% of the adult population were living with HIV/AIDS. HIV services in Nigeria are secondary-care led, involving multidisciplinary teams and access to free antiretroviral. However, evaluations of service provision from both patient and healthcare professional perspectives, especially, pharmacists in Nigeria have never been conducted, and are the aims of this research. This study involved grounded theory methodology, using In-depth semi-structured interviews with adults infected with HIV, pharmacists, and administrators involved in the management and care of those patients at Maitama District Hospital in Abuja. HIV pharmacists working for the NHS in the UK were interviewed for comparative purposes. Thirty-five patients were interviewed. Five concepts were identified that influenced how they accessed hospital services after diagnosis. These include faith in God and antiretroviral, social issues with emphasis on HIV stigma and discrimination, patient journeys at the hospital with delays and repeat visits, obstacles such as ARV unavailability and their expectations. Also, five concepts were identified from the pharmacists’ interviews which include clinical service, impressions of service provided, social issues the patients encountered, the obstacles faced with clinical service provided and expectations for improvement. Ten patients were shadowed on their clinic days to observe the patient journey articulated. Furthermore, the administrators interviewed re-affirmed the opinions of the patients and pharmacists about many patients attending HIV clinic, few staff attending to patients, medicines unavailability, especially ARV drugs, and lack of working space for staff. Delays, few pharmacists/many patients and shortage of ART as barriers to service provision ii emerged as dominant themes across the three groups of interviewees in Nigeria. Also, it has been found that there is a wide gap between HIV patients’ hospital management in the UK and Nigeria as regards availability of antiretroviral, staff strength, number of patients in attendance on clinic days and weekly clinic days. Pharmacy was found to have a substantial role in the management of HIV/AID patients but it appears from this study that service improvements, both human and material resources are needed. Twenty three recommendations, which are further synthesised into six potential areas, are made, which, if implemented, would dramatically improve the service provision for HIV/AIDS patients at Maitama District Hospital.

Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004. / Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.

::Dissertation (D.P.H.)--University of Michigan.