Global ETD Search

21	Residência Médica em hospital assistencial no estado de Roraima: uma análise / Residency in Care Hospital in Roraima: an analysis Santana, Denise Moreth de [UNIFESP] 01 March 2014 (has links) (PDF) Made available in DSpace on 2018-06-06T11:36:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01 / Este trabalho analisa as especificidades da residência médica em hospitais assistenciais do estado de Roraima. Foi uma pesquisa qualitativa, de caráter descritivo-exploratório, utilizando dois instrumentos de coleta: questionário e entrevista. O questionário foi aplicado a trinta e dois preceptores e quarenta e três residentes das unidades hospitalares de referência e utilizou escala Likert avaliando grau de concordância. A construção das assertivas foi feita a partir dos seguintes núcleos direcionadores: relevância de um programa de residência médica (PRM) em hospital assistencial; estrutura e organização dos PRMs; preceptoria; relação ensino-assistência. Após análise destes questionários, foram elaboradas questões de aprofundamento em um roteiro para entrevistas semi-estruturadas com seis gestores e nove preceptores. O estudo foi autorizado pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo, parecer 51411/2012. A residência médica em hospitais assistenciais do estado de Roraima promove melhoria na assistência, maior satisfação da população atendida e possibilidade de retaguarda no atendimento. Estimula a educação permanente e a pesquisa, contribuindo para a fixação médica local. Sua implantação foi demandada pela instituição hospitalar e universidade, encontrando estrutura hospitalar não concebida para o ensino, falta de protocolos, resistência inicial do corpo clínico e falta de autonomia da gestão local. Existe dificuldade na organização, na articulação com instâncias gestoras, no estabelecimento de uma cultura de planejamento e na integração com a equipe de saúde do hospital. Porém, há envolvimento das direções nas dificuldades enfrentadas, com interesse para a solução da infraestrutura. Para alguns, existe uma boa interação ensino-assistência, com potencialização da assistência, adequação da rotina assistencial, otimização do aprendizado e possibilidade de desenvolvimento de pesquisa aplicada. Observam-se também dificuldades nesta interação, na diferenciação entre direções e residentes, número reduzido de preceptores, sobrecarga de trabalho, dificuldades de pactuação com a preceptoria, despreparo do preceptor e responsabilidade isolada do residente pela assistência. A preceptoria mostra potencialidades, como crescimento pessoal, orientação ética aos residentes, desenvolvimento do papel de educador e aprimoramento da postura. Promove apoio operacional à assistência com otimização e acompanhamento do trabalho assistencial oferecendo segurança através do apoio técnico aos residentes. Enfrenta dificuldades como a necessidade de preceptores qualificados, escassez de profissionais para a demanda assistencial, falta de compromisso com a função e falta de rotina acadêmica dentro do serviço. É requerida contrapartida da gestão com definição de carga horária à preceptoria, remuneração da função, planejamento conjunto e reconhecimento do seu papel. Acredita-se que o estudo trouxe informações que possibilitam melhor entendimento sobre a residência médica em hospital assistencial. Espera-se contribuir para a discussão sobre o tema e para o desenvolvimento dos programas na região norte do Brasil. / This work objectifies to analyze the medical residency specificities in care hospitals in the state of Roraima. It was a qualitative, descriptive and exploratory research. Using, in an integrated manner, two collection instruments: questionnaire and interview. The questionnaire was applied to thirty-two preceptors and forty-three residents in the reference care hospital units in the state and used the Likert scale in the evaluation of the degree of agreement. The making of the assertive was made from the following core drivers: relevance of a medical residency program (MRP); structure and organization of the MRPs in care hospital; preceptorship; the relation teaching-assistance. After analysis of those questionnaires, it was prepared deepening issues, in a guide for semi-structured interviews with six managers and nine preceptors. The study was authorized by The Research Ethics Committee of The Federal University of São Paulo, sight no 51411/2012. The medical residency in care hospitals of Roraima promotes improvement in the assistance, bigger satisfaction of the population served and possibility of rearguard in the treatment. It stimulates to the continuing education and the research, contributing to local medical setting. Its implementation was sued by the hospital and university, finding hospital structure not designed for teaching, lack of protocols, initial resistance of the clinical staff and lack of autonomy of the local management. There is difficulty in the organization, in conjunction with management levels, establishing a culture of planning and integration of MRPs with the health staff of the hospital. But there is involvement of the hospital directions on the difficulties faced, with their interestand resolve the infrastructure. For some, there is a good interaction teaching-assistance, with potentiation of the assistance, adequacy of the care routine, optimization of the learning and possibility of development of applied research. It is also observed difficulties in this interaction, in the differentiation among residents and directions, reduced number of preceptors, work overload, difficulties of agreement with the preceptorship, unpreparedness of the preceptor and the resident's responsibility alone for assistance. The preceptorship shows potential as: personal growth, ethical guidance to residents, developing the role of educator and improving posture. Promotes operational support to assist with optimization and monitoring of relief work providing security through technical support to residents, faces difficulties such as the need for qualified tutors, shortage of professionals for assistance requirements, lack of commitment to the role and lack of academic routine within the service. It is required consideration of the management with the definition of workload to the preceptorship, compensation to the function, joint planning and recognition of their role. It is believed that the study provided information that enables better understanding of the medical residency in care hospital. It is expected to contribute to the discussion on the topic and the development of programs in northern Brazil. Residência Médica Hospital Assistencial Preceptoria Ensino Interação ensino/assistência Residency Care Hospital Preceptorship Teaching Interaction Teaching-Assistance.
22	Orientação multiprofissional e visita domiciliar no cuidado de pacientes com dieta enteral domiciliar / Multiprofessional orientation and home visit to care of patients with home enteral nutrition Franca, Sarah Cândido 27 February 2018 (has links) Submitted by Sarah Candido Franca (sarahcandidof@yahoo.com.br) on 2018-04-23T01:14:45Z No. of bitstreams: 1 Dissertacao Sarah final corrigida.pdf: 1050975 bytes, checksum: 722ef3e9e84bb0b5adfc654669ee65a3 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-23T17:57:44Z (GMT) No. of bitstreams: 1 franca_sc_me_bot.pdf: 1050975 bytes, checksum: 722ef3e9e84bb0b5adfc654669ee65a3 (MD5) / Made available in DSpace on 2018-04-23T17:57:44Z (GMT). No. of bitstreams: 1 franca_sc_me_bot.pdf: 1050975 bytes, checksum: 722ef3e9e84bb0b5adfc654669ee65a3 (MD5) Previous issue date: 2018-02-27 / É importante que o cuidador ou manipulador das dietas receba as orientações necessárias para que sejam diminuídas as variações de composição, garantida a oferta adequada de nutrientes e reduzidos os riscos de contaminação durante seu preparo, manuseio e administração, evitando com isso as possíveis intercorrências na saúde do paciente.Objetivo: Compreender a experiência de cuidadores de pacientes com dieta enteral domiciliar que receberam orientação multiprofissional na alta hospitalar e visita domiciliar. Método: estudo de abordagem qualitativa com uso de entrevista não diretiva para coleta de dados, seguindo o referencial metodológico da Análise de Conteúdo e como referenciais teóricos a Portaria 825 do Ministério da Saúde (Brasil), as publicações do Programa Melhor em Casa e a literatura atual sobre o tema disponível. A amostragem se deu por saturação teórica. Resultados: Participaram da pesquisa 15 cuidadores, sendo a maioria do sexo feminino, com idade entre 26 e 65 anos. A partir da análise do conteúdo das falas dos cuidadores emergiram as seguintes categorias: a orientação recebida sobre os cuidados com a Terapia Nutricional Enteral (TNE), a dificuldade de gerenciamento da sonda, o enfrentamento da nova situação (adaptação), os cuidados com a TNE e em saúde, a rede de cuidado familiar, em caso de intercorrências e a preocupação que permeia os cuidadores. Considerações finais: Pôde-se compreender a experiência dos cuidadores de pacientes em uso de dieta enteral domiciliar, após receberem orientação de equipe multiprofissional, observando que a presença da equipe, conforme prevê a legislação, é indispensável, pois seu suporte propicia melhora da qualidade do cuidado, segurança ao paciente e ao cuidador e diminuição de sobrecarga para o cuidador. / It is important that the caregiver or manipulator of the diets receive the necessary guidelines to reduce variations in the composition, ensure the adequate supply of nutrients and reduce the risk of contamination during preparation, handling and administration, therefore, avoiding possible health complications of the patient. Objective: To understand the experience of the patient caregivers with home enteral diet who received multiprofessional guidance at hospital discharge and home visit. Method: The qualitative study using a non-directive interview for data collection, following the methodological framework for the Content Analysis and as theoretic references to Portaria 825 from the the Ministry of Health (Brazil) and the publications from the Programa Melhor em Casa and the literature in place about the available topic. The sampling was selected by theoretical saturation. Results: Fifteen caregivers participated in the study, being the majority female, aged between 26 and 65 years. Based on the analysis of the caregivers speeches, the following categories emerged: the orientation received on care with Enteral Nutritional Therapy (ENT), difficulty in managing the catheter, handling with the new situation (adaptation), care with enteral nutrition and in health, the network of family care, in case of intercurrences and the concern that saturates the caregivers. Final considerations: It was possible to understand the experience from the caregivers with the patient taking home enteral diets after receiving guidance from the multiprofessional team. In addition, the presence of the team, is in comply with the local legislation, which is crucial to improve the quality of the caregiver safety, and reduced burden to the caregiver. dieta enteral domiciliar cuidadores equipe multiprofissional home enteral nutrition caregivers multiprofessional team home care hospital services
23	När vården blir sjuksköterskans ansvar. : sjuksköterskors upplevelser av att ge palliativ vård i livets slut på en strokeenhet / When caring becomes the nurse´s responsibility : nurses´experiences of giving palliative care at the end-of-life within a stroke unit Listermar, Karin January 2013 (has links) No description available. Nurses´experience Palliative care End-of-life care Acute care hospital Stroke unit Qualitative interview study Sjuksköterskans upplevelse Palliativ vård Vård i livets slut Akutsjukhus Strokeenhet Kvalitativ intervjustudie
24	The impact of healthcare-associated infectious disease outbreaks on the nature of the healthcare professionals daily work Musau, Joan 10 1900 (has links) <p><strong>ABSTRACT</strong><strong></strong></p> <p><strong>Background</strong>: Healthcare-associated infections (HAIs) and HAI disease outbreaks present challenges for healthcare facilities. In 2008, a <em>Clostridium difficile</em> outbreak in Ontario resulted in the deaths of 91 patients and raised awareness of HAIs. Over the last 5 years, the outbreak rate has risen dramatically. Traditionally, HAI research has focused on epidemiology, healthcare systems, and the economic burden. Little is known about the impact HAI disease outbreaks have on the work of healthcare professionals.</p> <p><strong>Purpose</strong>: The purpose of this study was to examine the effects of HAI outbreaks on healthcare professionals in a large acute care hospital in Ontario.</p> <p><strong>Methods</strong>:<strong> </strong>A retrospective exploratory case study approach was used, including individual interviews, document analysis, and incidence analysis of HAIs hospital data. The sample was frontline nurses, clinical managers, infection control professionals, and environmental service staff. Document analysis included hospital policies and protocols related to infectious diseases and HAI disease outbreaks.</p> <p><strong>Findings</strong>: The incidence rates of Methicillin-resistant s<em>taphylococcus aureus</em>, <em>Clostridium difficile</em>, and Vancomycin-resistant<em> </em>enterococci<em> </em>have decreased but remained above the provincial benchmarks. The daily work of healthcare professionals was impacted by HAI outbreaks. Nurses experienced workload challenges, time pressures, and increased documentation. Infection control professionals' responsibilities have expanded. The environmental services staffs' cleaning processes have become more intensive. In response, several unique innovations were developed by hospital staff.</p> <p><strong>Conclusion</strong>: The daily work of healthcare professionals at the study site has been affected by HAI outbreaks. Implications for future research include the need to review healthcare professionals’ workloads and evaluate contributing factors to HAI outbreaks.</p> / Master of Science in Nursing (MSN) healthcare professionals daily work healthcare associated infections Acute care hospital Health Services Research Health Services Research
25	The influence of the acute care nurse practitioner on healthcare delivery outcomes : a systematic review / Rejzer, Courtney Brynne. January 2009 (has links) (PDF) Project (B.S.)--James Madison University, 2009. / Includes bibliographical references.
26	Getting going on getting better : how is systematic quality improvement established in a healthcare organization? : implications for change management theory and practice / Thor, Johan, January 2007 (has links) Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.
27	Understanding end-of-life admissions : an interview study of patients admitted to a large English hospital shortly before death Hoare, Sarah January 2017 (has links) Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.
28	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

Search results