This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions. Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them. This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation. This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.

Summary: The subject of this paper is providing of lege artis health care in the system of public health insurance. The aim of the thesis is to analyse the basic terminology, current legislation and its application in practice. Lex artis is in law an uncertain term, difficult to define, therefore its frequent usage should be restricted in the future. Due to the personal experience of the author there are many practical examples from the Czech health care system used in the paper. Related case law is taken into account continuously with the exception of the separately stated recent court judgment of the Constitutional Court of the Czech Republic. The study is divided into four main chapters, introduction and conclusion. The first chapter is dedicated to the concept of lege artis in detail, its terminology and relation to the current legislation. Further subchapters deal with available health care standards and their obligation. The final parts analyze the lege artis restrictions and way of its assessment. The second chapter is dedicated to the concept of public health insurance. First, the term is defined and the current law is considered. The following parts examine the issue of health insurance companies and the network of health care facilities. Chapter three presents the labor law aspects of lege artis...

Submitted by Nara Lays Domingues Viana Oliveira (naradv) on 2015-06-11T13:31:13Z No. of bitstreams: 1 carolineLimadeACosta.pdf: 537155 bytes, checksum: 199e3b5b634a0aeaaad09bc4fbf206f7 (MD5) / Made available in DSpace on 2015-06-11T13:31:13Z (GMT). No. of bitstreams: 1 carolineLimadeACosta.pdf: 537155 bytes, checksum: 199e3b5b634a0aeaaad09bc4fbf206f7 (MD5) Previous issue date: 2013-02-22 / UNISINOS - Universidade do Vale do Rio dos Sinos / A regulamentação dos planos de saúde no Brasil trouxe avanços significativos em relação ao funcionamento das operadoras de planos de saúde, impondo normas de funcionamento e fiscalização. As operadoras, por sua vez, enfrentam pressões crescentes causadas pelo aumento dos seus custos operacionais. Os serviços da operadora são fornecidos por meio de uma rede de fornecedores a ela credenciados, que oferecem o cuidado aos beneficiários em todos os níveis de atenção à saúde. A partir do credenciamento, o fornecedor passa a representar a operadora na execução do atendimento ao beneficiário. Esta pesquisa tem por objetivo investigar os elementos que induzem os fornecedores ao credenciamento junto aos planos de saúde, e propor um conjunto de diretrizes para o desenvolvimento da gestão da cadeia de fornecedores de serviços na saúde suplementar. Dois estudos de caso foram executados e apresentados em artigos distintos. No primeiro estudo de caso, que investigou os elementos indutores ao credenciamento, foram entrevistados 12 fornecedores. No segundo estudo de caso, focado em propor diretrizes para o desenvolvimento da rede credenciada, foram entrevistados 10 fornecedores e 10 gestores atuantes junto a operadoras de planos de saúde. Os achados indicam que os principais elementos indutores ao credenciamento estão relacionados a garantia de demanda, garantia de pagamento e captação de novos clientes. A pesquisa também propôs um conjunto de diretrizes para o desenvolvimento da gestão da cadeia, considerando elementos como seleção e avaliação do fornecedor, orientações da operadora, remuneração, incentivo da operadora e indicadores. Os resultados apontam que assim como as operadoras, os fornecedores de serviços de saúde e as operadoras ainda carecem de desenvolvimento no que diz respeito à gestão da cadeia e aos serviços prestados. / The government regulation of health plan operators in Brazil, with its operating and inspection standards, has brought about significantadvancements as regards the way health plans serve their customers. The health plan operators, however, are faced with the increasing pressure from soaring operating costs. The health plan operators use the services of a chain of accredited health care providers to serve their beneficiaries with a full range of health care services. When these health care providers join up with the health plan operators, they start acting as their representatives in providing the services beneficiaries require. This research work looks into the elements that induce the suppliers to join up with the health plan operators and proposes a set of guidelines for the development of a management system for the chain of non-governmental health service providers. Two casestudies were carried out and presented in distinct articles. In the first case study, which looks into the elements that lead health care providers to join the health plan operators, 12 health care providers were interviewed. In the second case study, aimed at proposing guidelines for the development of the chain of health care providers, 10 health care providers and 10 managers were interviewed who work closely with health plan operators. The findings indicate that the major elements that induce health care providers to join up are the prospect of an assured demand, assurance of payment and an increased customer base. The research proposed a set of guidelines for the development of a management system for the chain of providers, taking into account elements such as provider selection and evaluation, operator guidance, compensation, operator incentive and indicators. The results show that the health care providers andthe health plan operators still lack development as regards the management of the chain and the services rendered.

O presente estudo desenvolve-se numa perspectiva prática, visando à integração de conhecimentos gerados pela pesquisa a atividades assistenciais no hospital geral universitário, dirigindo-se, especificamente, à questão da detecção da depressão. A depressão é um problema de saúde pública no mundo inteiro, transtorno mental de alta prevalência, com elevado custo para os sistemas de saúde. Entre pacientes clínicos e cirúrgicos, hospitalizados, aumenta a complexidade dos tratamentos, implica maior morbidade e mortalidade, importando também no aumento do tempo e dos custos das internações. Por outro lado, a depressão é subdiagnosticada. Este estudo, originado de um projeto cujo objetivo foi criar um instrumento para a detecção de depressão, utilizável na rotina assistencial, a partir da avaliação do desempenho de escalas de rastreamento já existentes, desdobra-se em três artigos. O primeiro, já aceito para publicação em revista indexada internacionalmente, é a retomada de estudos anteriores, realizados no final da década de 1980. É apresentada a comparação da detecção de depressão, realizada por médicos não-psiquiatras e por enfermeiros, no Hospital de Clínicas de Porto Alegre (HCPA), em 1987 e em 2002. O segundo artigo apresenta o processo de construção da nova escala, a partir da seleção de itens de outras escalas já validadas, utilizando modelos logísticos de Rasch. A nova escala, composta por apenas seis itens, exige menos tempo para sua aplicação. O terceiro artigo é um estudo de avaliação de desempenho da nova escala, denominada Escala de Depressão em Hospital Geral (EDHG), realizado em uma outra amostra de pacientes adultos clínicos e cirúrgicos internados no HCPA. O segundo e terceiro artigos já foram encaminhados para publicação internacional. Esses estudos, realizados em unidades de internação clínicas e cirúrgicas do Hospital de Clínicas de Porto Alegre, permitiram as seguintes conclusões: a) comparando-se os achados de 1987 com os de 2002, a prevalência de depressão e o seu diagnóstico, em pacientes adultos clínicos e cirúrgicos internados, mantêm-se nos mesmos níveis; b) foi possível selecionar um conjunto de seis itens, que constituíram a nova Escala de Depressão em Hospital Geral (EDHG), baseando-se no desempenho individual de cada um dos 48 itens componentes de outras três escalas (BDI, CESD e HADS); c) a EDHG apresentou desempenho semelhante aos das escalas que lhe deram origem, usando o PRIME-MD como padrão-ouro, com a vantagem de ter um pequeno número de itens, podendo constituir-se num dispositivo de alerta para detecção de depressão na rotina de hospital geral. / This study unfolds from a practical perspective. Its purpose is to integrate knowledge generated by research into care provided in general hospitals, specifically to detecting depression. Depression is a public health problem all over the world. It is a highly prevalent mental disorder that generates high costs to the health system. Depression increases treatment’s complexity, morbidity and mortality rates, time and costs of clinical and surgical hospitalizations. On the other hand, depression is under diagnosed. This study was originated from a project to develop an instrument for the detection of depression in general hospitals inpatients. This instrument was based on the evaluation of the performance of other already existing rating scales and was designed to be integrated in clinical routine. This study was developed as three papers. The first paper, accepted for publication in an international indexed journal, compares depression detection carried out by non-psychiatric physicians and nurses of Hospital de Clínicas de Porto Alegre (HCPA) between 1987 andandand 2002. The second paper describes the developing process of a new depression scale by Rasch models using items from other previously validated scales. The new scale, with only six items, requires less time for its use. The third paper is the performance evaluation of the new scale, General Hospital Depression Scale (GHDS). This evaluation was conducted in a sample of clinical and surgical adult inpatients at HCPA. The second and third papers have already been submitted to international journals for publication. The conclusions from these studies are: a) comparing the findings of 1987 and 2002, the prevalence rates and the diagnosis of depression in clinical and surgical adult inpatients have not significantly changed; b) it was possible to select a subset of six items to create the new General Hospital Depression Scale (GHDS); these items were selected by individual performance analysis of 48 items from three other scales (BDI, CESD and HADS); c) GHDS has similar performance, using PRIME-MD as gold-standard, to the three other scales from which the items were selected. GHDS has the advantage of a smaller number of items, and may serve as an alert instrument to depression in general hospitals routine.

abstract: Most studies on refugee populations tend to focus on mental health issues and communicable diseases. Yet, reproductive health remains a major aspect of refugee women's health needs. African refugee women in the United States continue to experience some difficulties in accessing reproductive health services despite having health insurance coverage. The purpose of this study was to understand the reproductive health journey of African refugee women resettled in Phoenix, Arizona. This study also explored how African refugee women's pre-migration and post-migration experiences affect their relationships with health care providers. The study was qualitative consisting of field observations at the Refugee Women's Health Clinic (RWHC) in Phoenix, verbally administered demographic questionnaires, and semi-structured one-on-one interviews with twenty African refugee women (between the ages of 18 and 55) and ten health care providers. The findings were divided into three major categories: pre-migration and post migration experiences, reproductive health experiences, and perspectives of health care providers. The themes that emerged from these categories include social isolation, living between two cultures, racial and religious discrimination, language/interpretation issues and lack of continuity of care. Postcolonial feminism, intersectionality, and human rights provided the theoretical frameworks that helped me to analyze the data that emerged from the interviews, questionnaire and fieldnotes. The findings revealed some contrasts from the refugee women's accounts and the accounts of health care providers. While refugee women spoke from their own specific social location leading to more nuanced perspectives, health care providers were more uniform in their responses leading to a rethink of the concept of cultural competency. As I argue in the dissertation and contrary to conventional wisdom, culture per se does not necessarily translate to resistance to the American health care system for many African refugee women. Rather, their utilization (or lack thereof) of health services are better conceived within a broader and complex context that recognizes intersectional factors such as gender, racialization, language, displacement, and class which have a huge impact on the reproductive health seeking patterns of refugee women. / Dissertation/Thesis / Ph.D. Gender Studies 2011

O presente estudo desenvolve-se numa perspectiva prática, visando à integração de conhecimentos gerados pela pesquisa a atividades assistenciais no hospital geral universitário, dirigindo-se, especificamente, à questão da detecção da depressão. A depressão é um problema de saúde pública no mundo inteiro, transtorno mental de alta prevalência, com elevado custo para os sistemas de saúde. Entre pacientes clínicos e cirúrgicos, hospitalizados, aumenta a complexidade dos tratamentos, implica maior morbidade e mortalidade, importando também no aumento do tempo e dos custos das internações. Por outro lado, a depressão é subdiagnosticada. Este estudo, originado de um projeto cujo objetivo foi criar um instrumento para a detecção de depressão, utilizável na rotina assistencial, a partir da avaliação do desempenho de escalas de rastreamento já existentes, desdobra-se em três artigos. O primeiro, já aceito para publicação em revista indexada internacionalmente, é a retomada de estudos anteriores, realizados no final da década de 1980. É apresentada a comparação da detecção de depressão, realizada por médicos não-psiquiatras e por enfermeiros, no Hospital de Clínicas de Porto Alegre (HCPA), em 1987 e em 2002. O segundo artigo apresenta o processo de construção da nova escala, a partir da seleção de itens de outras escalas já validadas, utilizando modelos logísticos de Rasch. A nova escala, composta por apenas seis itens, exige menos tempo para sua aplicação. O terceiro artigo é um estudo de avaliação de desempenho da nova escala, denominada Escala de Depressão em Hospital Geral (EDHG), realizado em uma outra amostra de pacientes adultos clínicos e cirúrgicos internados no HCPA. O segundo e terceiro artigos já foram encaminhados para publicação internacional. Esses estudos, realizados em unidades de internação clínicas e cirúrgicas do Hospital de Clínicas de Porto Alegre, permitiram as seguintes conclusões: a) comparando-se os achados de 1987 com os de 2002, a prevalência de depressão e o seu diagnóstico, em pacientes adultos clínicos e cirúrgicos internados, mantêm-se nos mesmos níveis; b) foi possível selecionar um conjunto de seis itens, que constituíram a nova Escala de Depressão em Hospital Geral (EDHG), baseando-se no desempenho individual de cada um dos 48 itens componentes de outras três escalas (BDI, CESD e HADS); c) a EDHG apresentou desempenho semelhante aos das escalas que lhe deram origem, usando o PRIME-MD como padrão-ouro, com a vantagem de ter um pequeno número de itens, podendo constituir-se num dispositivo de alerta para detecção de depressão na rotina de hospital geral. / This study unfolds from a practical perspective. Its purpose is to integrate knowledge generated by research into care provided in general hospitals, specifically to detecting depression. Depression is a public health problem all over the world. It is a highly prevalent mental disorder that generates high costs to the health system. Depression increases treatment’s complexity, morbidity and mortality rates, time and costs of clinical and surgical hospitalizations. On the other hand, depression is under diagnosed. This study was originated from a project to develop an instrument for the detection of depression in general hospitals inpatients. This instrument was based on the evaluation of the performance of other already existing rating scales and was designed to be integrated in clinical routine. This study was developed as three papers. The first paper, accepted for publication in an international indexed journal, compares depression detection carried out by non-psychiatric physicians and nurses of Hospital de Clínicas de Porto Alegre (HCPA) between 1987 andandand 2002. The second paper describes the developing process of a new depression scale by Rasch models using items from other previously validated scales. The new scale, with only six items, requires less time for its use. The third paper is the performance evaluation of the new scale, General Hospital Depression Scale (GHDS). This evaluation was conducted in a sample of clinical and surgical adult inpatients at HCPA. The second and third papers have already been submitted to international journals for publication. The conclusions from these studies are: a) comparing the findings of 1987 and 2002, the prevalence rates and the diagnosis of depression in clinical and surgical adult inpatients have not significantly changed; b) it was possible to select a subset of six items to create the new General Hospital Depression Scale (GHDS); these items were selected by individual performance analysis of 48 items from three other scales (BDI, CESD and HADS); c) GHDS has similar performance, using PRIME-MD as gold-standard, to the three other scales from which the items were selected. GHDS has the advantage of a smaller number of items, and may serve as an alert instrument to depression in general hospitals routine.

O presente estudo desenvolve-se numa perspectiva prática, visando à integração de conhecimentos gerados pela pesquisa a atividades assistenciais no hospital geral universitário, dirigindo-se, especificamente, à questão da detecção da depressão. A depressão é um problema de saúde pública no mundo inteiro, transtorno mental de alta prevalência, com elevado custo para os sistemas de saúde. Entre pacientes clínicos e cirúrgicos, hospitalizados, aumenta a complexidade dos tratamentos, implica maior morbidade e mortalidade, importando também no aumento do tempo e dos custos das internações. Por outro lado, a depressão é subdiagnosticada. Este estudo, originado de um projeto cujo objetivo foi criar um instrumento para a detecção de depressão, utilizável na rotina assistencial, a partir da avaliação do desempenho de escalas de rastreamento já existentes, desdobra-se em três artigos. O primeiro, já aceito para publicação em revista indexada internacionalmente, é a retomada de estudos anteriores, realizados no final da década de 1980. É apresentada a comparação da detecção de depressão, realizada por médicos não-psiquiatras e por enfermeiros, no Hospital de Clínicas de Porto Alegre (HCPA), em 1987 e em 2002. O segundo artigo apresenta o processo de construção da nova escala, a partir da seleção de itens de outras escalas já validadas, utilizando modelos logísticos de Rasch. A nova escala, composta por apenas seis itens, exige menos tempo para sua aplicação. O terceiro artigo é um estudo de avaliação de desempenho da nova escala, denominada Escala de Depressão em Hospital Geral (EDHG), realizado em uma outra amostra de pacientes adultos clínicos e cirúrgicos internados no HCPA. O segundo e terceiro artigos já foram encaminhados para publicação internacional. Esses estudos, realizados em unidades de internação clínicas e cirúrgicas do Hospital de Clínicas de Porto Alegre, permitiram as seguintes conclusões: a) comparando-se os achados de 1987 com os de 2002, a prevalência de depressão e o seu diagnóstico, em pacientes adultos clínicos e cirúrgicos internados, mantêm-se nos mesmos níveis; b) foi possível selecionar um conjunto de seis itens, que constituíram a nova Escala de Depressão em Hospital Geral (EDHG), baseando-se no desempenho individual de cada um dos 48 itens componentes de outras três escalas (BDI, CESD e HADS); c) a EDHG apresentou desempenho semelhante aos das escalas que lhe deram origem, usando o PRIME-MD como padrão-ouro, com a vantagem de ter um pequeno número de itens, podendo constituir-se num dispositivo de alerta para detecção de depressão na rotina de hospital geral. / This study unfolds from a practical perspective. Its purpose is to integrate knowledge generated by research into care provided in general hospitals, specifically to detecting depression. Depression is a public health problem all over the world. It is a highly prevalent mental disorder that generates high costs to the health system. Depression increases treatment’s complexity, morbidity and mortality rates, time and costs of clinical and surgical hospitalizations. On the other hand, depression is under diagnosed. This study was originated from a project to develop an instrument for the detection of depression in general hospitals inpatients. This instrument was based on the evaluation of the performance of other already existing rating scales and was designed to be integrated in clinical routine. This study was developed as three papers. The first paper, accepted for publication in an international indexed journal, compares depression detection carried out by non-psychiatric physicians and nurses of Hospital de Clínicas de Porto Alegre (HCPA) between 1987 andandand 2002. The second paper describes the developing process of a new depression scale by Rasch models using items from other previously validated scales. The new scale, with only six items, requires less time for its use. The third paper is the performance evaluation of the new scale, General Hospital Depression Scale (GHDS). This evaluation was conducted in a sample of clinical and surgical adult inpatients at HCPA. The second and third papers have already been submitted to international journals for publication. The conclusions from these studies are: a) comparing the findings of 1987 and 2002, the prevalence rates and the diagnosis of depression in clinical and surgical adult inpatients have not significantly changed; b) it was possible to select a subset of six items to create the new General Hospital Depression Scale (GHDS); these items were selected by individual performance analysis of 48 items from three other scales (BDI, CESD and HADS); c) GHDS has similar performance, using PRIME-MD as gold-standard, to the three other scales from which the items were selected. GHDS has the advantage of a smaller number of items, and may serve as an alert instrument to depression in general hospitals routine.

Magister Artium (Medical Anthropology) - MA(Med Ant) / Women are the principle providers of their families when it comes to issues of health care, even though their health needs and efforts are neglected. The contributions that they make to health development seem to be undervalued, and their working conditions ignored. Societies depend heavily on women as role players in the welfare of their families and of national economics together with their physical well-being which determines the ability to be productive. The study has provided an overview of the experiences of women concerning primary health care and the quality of service in Nolungile PHC Khayelitsha, Cape Town. Primary health care (PHC) forms an integral part both of the country‘s health system and the overall social and economic development of the community. Central to the PHC approach is full community participation in the planning, provision, control and monitoring of services. Priority has to be given to the improvement of women‘s social and economic status.A much neglected perspective in health issues is that, a number of questions arise from the provision of PHC. Does PHC rely on the contribution of women and if so, why women? Women in their communities have joined their hands together as community health workers, educating community members on issues of health. The study has provided an insight of the work that women are doing in their communities, and how do they give meaning to their experiences in PHC. The study also answered questions that raise fundamental issues on gender stereotyping and disparities in PHC. The study gave me an opportunity to work closely with the women while observing the challenges that they are facing and how to they overcome them in the daily lives.Changes are called towards the attitudes of health care providers working in the formal and nonformal sectors. The provision of health education for women ultimately empowers them as health educators for the community.

Bakgrund: Kunskapen om compassion fatigue behöver belysas i den palliativa vårdens kliniska vardag. Att arbeta med palliativ vård innebär komplexa relationer med patienter och närstående samt dagliga möten med lidande, död och sorg. Vårdpersonal inom vårdgivande yrken har stor risk att drabbas av compassion fatigue. Syfte: Syftet var att beskriva upplevelsen av compassion fatigue hos vårdpersonal som utför palliativ vård. Metod: En systematisk litteraturöversikt har genomförts av vetenskapliga forskningsresultat genom användandet av reflexiv tematisk analys. Fynden i resultatet har relaterats till det vårdvetenskapliga teoretiska ramverket Compassion Fatigue Model. Resultat: Fyra teman framkom: upplevelser av bristande resurser, upplevelser av svåra relationer i vårdandet, upplevelser av existentiell stress och bristande palliativt sammanhang samt upplevelser av otillräcklig coping och egenvård. Vårdpersonalens upplevelser av compassion fatigue grundades i de känslor som blev ohanterliga i samband med vårdandet av svårt sjuka patienter och närstående. Hög arbetsbelastning och bristen på återhämtning bidrog till att dränera vårdpersonalen på energi, vilket gav dem obalans mellan deras professionella och privata liv. För att minska risken att drabbas av compassion fatigue blev det palliativa sammanhanget, coping och egenvård betydelsefullt. Slutsats: Compassion fatigue kunde påverka vårdpersonalens hela livsvärld. Vårdpersonal är självmedvetna, men behöver bli bättre på att förstå hur betydelsefullt egenvård och positiv coping är för att bibehålla sin hälsa. Arbetsmiljöns betydelse för vårdpersonalens upplevelser av compassion fatigue är väsentlig. Arbetsgivare behöver uppmärksamma och prioritera resurser som förstärker vårdpersonalens hälsa. Palliativ vård är en vårdform som är resurskrävande och det behövs empatisk vårdpersonal som orkar vara närvarande i den vårdande relationen. / Background: Compassion fatigue is a concept that needs to be further established in the line of palliative care praxis. The concept compassion fatigue is well studied within scientific research. Compassion fatigue occurs as physical, mental, and emotional damage through work-related stress. Healthcare professionals are at high risk of suffering from compassion fatigue. Working in palliative care involves daily encounters with suffering, death, and grief through relationships with patients and relatives. Awareness of compassion fatigue needs to be highlighted and studied within the work field of palliative care. Aim: The purpose of this study was to describe experiences of compassion fatigue in healthcare professionals who work within palliative care settings. Method: A systematic literature review has been conducted on scientific research papers using reflexive thematic analysis. The findings in the results have been related to the theoretical framework Compassion Fatigue Model. Results: Four themes were identified: experience with lack of resources, experiences of difficult relationships in care, experience of existential stress and lack of palliative context, as well as the experience of insufficient self-care and coping. The care staff's experiences of compassion fatigue were based on the emotions that became unmanageable in connection with the care of seriously ill patients and relatives. High workload and lack of recovery contributed to draining healthcare staff of energy, giving them an imbalance between professional and private life. To reduce the risk of suffering from compassion fatigue, the palliative context, coping and self-care became important. Conclusion: Compassion fatigue could affect the entire lifeworld of healthcare professionals. Healthcare professionals do have self-awareness but need to improve their knowledge about the importance of self-care and positive coping strategies to maintain their health. A healthy work environment is essential for the healthcare professionals’ experiences of compassion fatigue. Employers need to pay attention and prioritize resources that strengthen the health of healthcare professionals. Palliative care requires resources and empathic healthcare professionals who can be present when caring for patients and their relatives.

Indiana University-Purdue University Indianapolis (IUPUI) / Intimate partner violence (IPV) has been declared a public health epidemic. Initial and annual training of healthcare providers regarding guidelines for identification and response to intimate partner violence has been mandated by the Joint Commission and endorsed by the Institute of Medicine. However, many providers/institutions lack the preparation necessary to implement such guidelines. The purpose of the feasibility study was to test the efficacy of an existing IPV training curriculum on participants’ perception of knowledge, cultural competence, confidence (self-efficacy), and attitudes related to identifying and responding to victims of IPV. A sample of convenience including twenty-three registered nurse home-visitors and one social work intern participated in the mandatory one-day training program. However, consent to enroll in the study was voluntary and indicated by completing the study instruments. Participants were asked to complete three evaluative measures: The 11-item Plunkett Demographic Questionnaire (pre-training), a 15-item Training Program Evaluation (post-training), and the 21-item Instructional Measurement Subscales across three time points (pre-Training, post-Training, and six weeks follow-up). All items were numerically coded so the higher the score, the more favorable the response. Data were analyzed using descriptive and inferential statistics (percentages; minimum-maximum, mean, and composite scores; standard deviations; repeated measures analysis of variance; and, paired samples dependent t tests). Four hypothesis statements were made regarding participation in the training program on IPV: “There will be an overall increase in healthcare providers’ perceived level of knowledge and cultural competence,” (hypothesis 1); “There will be an overall increase in healthcare providers’ perceived level of confidence in implementing routine enquiry,” (hypothesis 2); “There will be an overall positive change in healthcare providers’ attitudes towards routine enquiry,” (hypothesis 3); and, “There will be an overall positive change in healthcare providers’ attitudes towards victims of abuse following participation in Improving the Health Care Response to Domestic Violence,” (hypothesis 4). Findings supported previous research outcomes that presently recognized barriers to routine screening/ assessment for IPV can be overcome and positive changes can persist over time as a result of participation in a standard IPV training program. Future research involving larger, random sample populations, are needed to confirm these results.