This qualitative inquiry sought to explore how relationships are experienced in every day moments of care provided to childbearing women, infants, and families. Fifteen health care providers and thirteen childbearing women were interviewed regarding the degree to which these relationships have impacts on women’s health capacities and outcomes of care. These experiences were examined within the context of the broader social and cultural contexts of maternal-infant care. All twenty eight participants in the study were involved with an antenatal home care program and a neonatal intensive care unit within the Lower Mainland Health Authority in British Columbia. The epistemological and methodological approach to the study combined relational and pragmatist perspectives on knowledge and a deconstructionist hermeneutic lens. Findings indicate that participants’ experiences are created in each moment of interpersonal care, and the interactions between health care providers and child-bearing women are far from neutral in terms of their impact on women’s health capacities and outcomes of care. Clear distinctions in perspectives among the two groups emerged: the child-bearing women dismissed the use of the term ‘relationship’ in describing their experiences with health care providers. In contrast, health care providers spoke of their assumption that the basis of engagement was a supportive relationship, the primary vehicle through which neutral and impartial health care is provided. The findings detail that relationships are sites of meaningful experiences and can facilitate as well as constrain women’s agency and self-worth; some of these experiences jeopardized the women’s health capacities and outcomes of care as they endured health challenges in pregnancy and as they mothered their ill infants. Although health care providers and childbearing women drew upon different discursive resources and features of two program contexts, a similar construction of knowledge and experience was evident within participants’ accounts. Whereas health care providers tended to speak with the grain of instrumental and sentimental discourses through a veil of neutrality, the child-bearing women spoke against the grain by resisting the notion that interpersonal spaces are necessarily sites of one-on-one individual interaction. Rather, the data suggests that interpersonal spaces are not individualized spaces. Experiences of relationship were broadly situated and shaped through the relational complexity of each moment of the interpersonal, where the cultural ‘scenes’ of maternal-infant care shaped relationships and constructed the women’s health capacities and outcomes of care. In this way, the face to face is not so innocent.

A grounded theory study (Charmaz, 2006) explored health care providers' (HCPs) hope processes (hopework) caring for cancer patients facing end of life. A critical social work perspective was used to investigate experiences of nurses, doctors and social workers and counsellors in their work with psychosocial and emotional end of life issues. Health care providers' engaged in a core process of hopework as they faced the ambiguous and uncertain terrain of end of life care. They searched for realistic hope by shifting their professional and personal hopes. This core process was achieved by meaning-based actions that enabled HCPs to tolerate tragic circumstances and to build emotional scaffolding to sustain themselves. The findings indicate that HCPs engage in a parallel process of hopework with their patients to achieve `realistic hopes'. Although concepts of hopework are not easily defined, the processes of hope need to be addressed in the professional training of HCPs to optimize patient care and to prevent damage to patients' vulnerable hopes.

Thesis--Auburn University, 2009. / Abstract. Vita. Includes bibliographical references (p. 83-87).

Magister Curationis - MCur / Early infant diagnosis (EID) programmes offer diagnosis of HIV, which facilitates provision of life-saving care to infants infected with HIV. Implementing programmes for EID and treatment has proved challenging in Malawi. Many infants access EID late or not at all. Previous studies have shown that lack of knowledge among health care providers (HCPs) is a challenge to effective EID. Little is known on the knowledge and skills of health care providers in Malawi. Aim: The aim of the study was to investigate the knowledge and skills of HCPs on EID of HIV in Mzuzu, Malawi. Objectives: (i) to examine the knowledge of HCPs on EID of HIV; and (ii) to determine the skills of HCPs on EID of HIV. Methods: A descriptive cross-sectional survey design with a quantitative approach was used. The study was conducted in three hospitals in Mzuzu, Malawi. The population was HCPs (doctors, nurses/midwives, clinical officers and medical assistants) working in maternity, paediatric wards and under-five clinics. A total of 68 HCPs participated in the study. A closed-ended self-administered questionnaire was used to collect data. Data were analysed using the Statistical Package for Social Science version 23. Descriptive statistics were used to present the frequency tables of observations. Ethical approval was sought from the University of the Western Cape Senate Research Committee and Malawi National Health Research Council. Results: The results on the knowledge of HCPs demonstrate that 38% of them had a score of <69% (poor), 25% scored within 70–79% (fair), and 37% scored >80% (good). Results on the skills showed that 69% of the HCPs scored <69% (poor), 15% scored within 70–79% (fair), and 16% scored >80% (good). The results also showed a correlation between the knowledge of HCPs and their level of education achievement (certificate, diploma and degree) as well as the skills of HCPs and their department of work. Conclusion: The study found that more than one-third of the HCPs lacked knowledge and skills on EID of HIV. These findings reflect the need to address the practical challenges of EID service delivery. Recommendations: There is a need to increase the efforts that are being put in place to train HCPs on EID of HIV in order to scale up EID. Training should assess the needs of HCPs regarding the knowledge and skills required in the delivery of EID services.

Magister Public Health - MPH / This study has reveled the levels of knowledge and compliance towards Universal Precautions and examined the factors that are influential in having a positive and negative effect on their adoption by healthcare practitioners in practice. Despite acceptable knowledge regarding the potential for infection and mechanisms to prevent these infections, this study has found out that health care workers are not as compliant with universal precautions as they need to be. The findings that compliance correlated directly with knowledge, with in-service training and with availability of protective equipment, provide important indications for future interventions. Therefore a regular on job refreshing training program on Universal Precautions, a written guideline and reminder poster on Universal Precautions and personal protective equipment need to be made available for all health care providers in every department of the hospital for better compliance.

Purpose: To describe well-being in military reserve health care providers post deployment or mobilization Background: A comprehensive literature review exhibited that during a deployment or mobilization, military health care providers endure stressful and uncomfortable situations, spend time away from their family, friends and usual home comforts leaving them feeling completely changed. These circumstances can negatively affect a provider’s well-being. Moreover, although the literature outlines military and psychological symptoms including combat stressors, mental health concerns such as depression and anxiety, job stress, work performance and resiliency, there is a gap in the literature regarding well-being among military health care providers post deployment or mobilization. Methods: This project used a qualitative descriptive methodology with face-to-face interviews to describe the phenomenon of well-being among three United States reserve military health care providers post deployment or mobilization. Data was collected using semi-structured, open ended questions, allowing the participants an opportunity to discuss and further elaborate on their experiences, perspectives and feelings. Each interview began with pre-established questions and further questions and discussions were guided by the participants’ earlier responses. Interviews were audio recorded and transcribed into text, allowing me to identify commonalities of experiences, perspectives and feelings among the participants. Results: Analysis of the interview data revealed information associated with transitions and can be grouped into five categories. The categories that impacted the participants’ well-being post deployment or mobilization include: separation from family and friends, austere living conditions, exhaustion from long work hours, consecutive work days without days off and being unprepared for what was to come. Implications: This project describes well-being in military reserve health care providers post deployment or mobilization. Findings from this small project may be used to develop research studies to describe and understand the concept of well-being among military health care providers. Armed with better understanding, we could then develop interventions to prepare our military health care providers to deliver high quality care during overseas deployment or mobilization while also maintaining their physical and mental well-being.

The purpose of this study was to explore healthcare providers' awareness and perceptions of complementary and alternative medicine (CAM) use in providing systemic lupus erythematosus (SLE) care. This phenomenolgical study was built upon existing research indicating SLE patients' need to foster better communication about CAM use. Participants were recruited from the Long Island Rheumalogical Clinic in the State of New York. Individual in-depth semistructered interviews were conducted to explore the awareness and perceptions of a purposive sample of 10 healthcare providers who care for patients with SLE. Transcripts were analyzed, and categorical themes were developed. Guided by the use of the shared decision-making model and self-efficacy theory, 5 themes emerged: varied knowledge and experiences with CAM varied, participants' personal experience and perceived effectiveness led to patient guidance and advice, perceived benefits of CAM use, participants as patient advocates, and initiatives for further research. Study findings revealed that the knowledge, attitudes, and beliefs of health care providers regarding the use of CAM shed light on the importance of health promotion to guide future research, both within and beyond CAM. Strategies are recommended to increase awareness and understanding of CAM use through proper education and advocacy. This research may lead to positive social change in that providers may use the information in this research to break down barriers to communication between patients and professionals regarding CAM usage.

Background: Recent studies indicate a rise in the prevalence of obesity in children of various age groups. Obesity was officially recognized as a disease by the American Medical Association (AMA) in June 2013. It has been acknowledged as a progressive epidemic public health crisis in the United States for the past 20 years. This is a health care concern that needs examination and the development of new and more effective prevention and treatment modalities for obesity in children. Environmental, hereditary, behavioral, and socioeconomic factors play a significant role in the prevalence of obesity (Rooney, Mathiason, & Schauberger, 2011). Childhood obesity can generate serious emotional and physical consequences, thereby compromising the quality of life among children. Purpose: The purpose of this capstone project was to assess health care providers’ cultural competency by assessing the management of Hispanic parents with children diagnosed with obesity. A culturally diverse survey was developed to evaluate pediatric health care providers’ daily practice and management of Hispanic parents of children with obesity. Theoretical Framework: Madeleine Leininger’s Theory of Culture Care Diversity and Universality and the Health Belief Model constitute the theoretical framework of this capstone project. Methods: The research project gained support from the private pediatric primary care office for the completion of a questionnaire to assess health care providers’ knowledge of childhood obesity. Results: The data analysis revealed that the health care providers surveyed had at times omitted the evaluation of parameters that were vital in managing the health care of obese or overweight children. Certain parameters, such as weight, were always considered. The data analysis revealed gaps in the care of Hispanic pediatric overweight or obese patients and Hispanic caregivers. As a result of the findings, a better understanding of the importance of providing culturally competent health care was gained. Conclusion: This survey increased health care providers’ awareness of the importance of taking culture into consideration. It identified the gaps, and measures are now being evaluated to improve the quality of care provided to these children.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20085号 / 社医博第76号 / 新制||社医||9(附属図書館) / 33201 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 福原 俊一, 教授 佐藤 俊哉, 教授 古川 壽亮 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

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