Nursing care is considered a primary predictor of patient assessment of the overall hospital experience. Yet, quality nursing care remains difficult to define. Limited research about nurse or patient perspectives on what constitutes quality nursing care in hospital settings prevents the identification of a shared description or insight into their possible interrelationship. Research about nurse and patient descriptions is needed to establish behaviors, attributes, and activities associated with quality nursing care to improve the health and well-being of hospitalized patients. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

Introdução: A assistência pré-natal adequada é importante para redução da morbimortalidade materna e perinatal, identificando fatores que possam colocar a gestante e o feto frente a maior risco de resultados adversos. A avaliação da adequação da assistência pré-natal se faz por meio de diferentes medidas que envolvem o acompanhamento, acesso e qualidade da assistência. Objetivo: Comparar resultados de diferentes índices de inadequação da assistência pré-natal, como desfechos, em modelos de equações estruturais a partir de um modelo teórico de fatores de risco. Métodos: O estudo empregou dados da Pesquisa Nacional de Saúde (PNS) 2013, que contou com 1.851 mães que fizeram o último parto entre 2011 e 2013, representando 3.818.936 mulheres, a partir de amostragem complexa. Foram utilizados modelos de equações estruturais para a parte de mensuração das variáveis latentes envolvidas no modelo teórico e modelagem de fatores de risco para a inadequação da assistência. Medidas de ajuste foram empregadas para avaliar os modelos. Resultados: Quatro índices foram considerados para estimar a variável de inadequação da assistência pré-natal. A Vulnerabilidade Socioeconômica esteve fortemente associada ao desfecho inadequação do pré-natal e outras covariáveis das dimensões psicossociais e biológicas. Efeitos de hipertensão foram identificados para alguns desfechos. A presença de doenças crônicas influenciou a autoavaliação de saúde, porém esse não apresentou efeito sobre o desfecho. Modelos com e sem peso amostral apresentaram resultados distintos. Conclusão: O aspecto socioeconômico deve ser considerado quando se avalia a inadequação da assistência pré-natal. Os resultados obtidos sugerem que diferentes caminhos causais podem estar associados a diversos aspectos da assistência. / Introduction: The adequate prenatal care is important to reduce maternal and perinatal morbidity and mortality, identifying factors that may put the pregnant woman and the fetus at greater risk of adverse outcomes. The assessment of the adequacy of prenatal care is done through different measures that involve the monitoring, access and quality of care. Objective: Compare results of different indices of inadequacy of prenatal care, as outcomes, in structural equation models from a theoretical model for risk factors. Methods: The study used data from the Brazilian 2013 National Health Survey (PNS), with a sample of 1,851 mothers who had their last births between 2011 and 2013, representing 3,818,936 women, applying the complex sampling weight. Structural equation models were employed for the measurement of the latent variables involved in the theoretical model and for the modeling of risk factors for the inadequacy of the assistance. Fit indices were used to evaluate the models. Results: Four indices were considered to estimate the variable of inadequacy of prenatal care. Socioeconomic Vulnerability was strongly associated with the inadequate outcome of prenatal care and other covariates of the psychosocial and biological dimensions. Effects of hypertension were identified for some outcomes. The presence of chronic diseases influenced the health self-assessment, but had no effect on the outcome. Models with and without sample weight presented different results. Conclusion: The socioeconomic aspects should be considered when assessing the inadequacy of prenatal care. The results suggest that different causal pathways may be associated with different aspects of care.

Effective decision support plays vital roles in people's daily life, as well as for professional practitioners such as health care providers. Without correct information and timely derived knowledge, a decision is often suboptimal and may result in signi cant nancial loss or compromises of the performance. In this dissertation, we study text mining and topic modeling and propose to use text mining methods, in combination with topic models, to discover knowledge from texts popularly available from a wide variety of sources, such as research publications, news, medical diagnose notes, and further employ discovered knowledge to assist social and medical decision support. Examples of such decisions include hospital patient readmission prediction, which is a national initiative for health care cost reduction, academic research topics discovery and trend modeling, and social preference modeling for friend recommendation in social networks etc. To carry out text mining, our research, in Chapter 3, first emphasizes on single document analyzing to investigate textual stylometric features for user pro ling and recognition. Our research confirms that by using properly designed features, it is possible to identify the authors who wrote the article, using a number of sample articles written by the author as the training data. This study serves as the base to assert that text mining is a powerful tool for capturing knowledge in texts for better decision making. In the Chapter 4, we advance our research from single documents to documents with interdependency relationships, and propose to model and predict citation relationship between documents. Given a collection of documents with known linkage relationships, our research will discover e ective features to train prediction models, and predict the likelihood of two documents involving a citation relationships. This study will help accurately model social network linkage relationships, and can be used to assist e ective decision making for friend recommendation in social networking, and reference recommendation in scienti c writing etc. In the Chapter 5, we advance a topic discovery and trend prediction principle to discover meaningful topics from a set of data collection, and further model the evolution trend of the topic. By proposing techniques to discover topics from text, and using temporal correlation between trend for prediction, our techniques can be used to summarize a large collection of documents as meaningful topics, and further forecast the popularity of the topic in a near future. This study can help design systems to discover popular topics in social media, and further assist resource planning and scheduling based on the discovered topics and the their evolution trend. In the Chapter 6, we employ both text mining and topic modeling to the medical domain for effective decision making. The goal is to discover knowledge from medical notes to predict the risk of a patient being re-admitted in a near future. Our research emphasizes on the challenge that re-admitted patients are only a small portion of the patient population, although they bring signficant financial loss. As a result, the datasets are highly imbalanced which often result in poor accuracy for decision making. Our research will propose to use latent topic modeling to carryout localized sampling, and combine models trained from multiple copies of sampled data for accurate prediction. This study can be directly used to assist hospital re-admission assessment for early warning and decision support. The text mining and topic modeling techniques investigated in the dissertation can be applied to many other domains, involving texts and social relationships, towards pattern and knowledge based e ective decision making. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Introdução: A assistência pré-natal adequada é importante para redução da morbimortalidade materna e perinatal, identificando fatores que possam colocar a gestante e o feto frente a maior risco de resultados adversos. A avaliação da adequação da assistência pré-natal se faz por meio de diferentes medidas que envolvem o acompanhamento, acesso e qualidade da assistência. Objetivo: Comparar resultados de diferentes índices de inadequação da assistência pré-natal, como desfechos, em modelos de equações estruturais a partir de um modelo teórico de fatores de risco. Métodos: O estudo empregou dados da Pesquisa Nacional de Saúde (PNS) 2013, que contou com 1.851 mães que fizeram o último parto entre 2011 e 2013, representando 3.818.936 mulheres, a partir de amostragem complexa. Foram utilizados modelos de equações estruturais para a parte de mensuração das variáveis latentes envolvidas no modelo teórico e modelagem de fatores de risco para a inadequação da assistência. Medidas de ajuste foram empregadas para avaliar os modelos. Resultados: Quatro índices foram considerados para estimar a variável de inadequação da assistência pré-natal. A Vulnerabilidade Socioeconômica esteve fortemente associada ao desfecho inadequação do pré-natal e outras covariáveis das dimensões psicossociais e biológicas. Efeitos de hipertensão foram identificados para alguns desfechos. A presença de doenças crônicas influenciou a autoavaliação de saúde, porém esse não apresentou efeito sobre o desfecho. Modelos com e sem peso amostral apresentaram resultados distintos. Conclusão: O aspecto socioeconômico deve ser considerado quando se avalia a inadequação da assistência pré-natal. Os resultados obtidos sugerem que diferentes caminhos causais podem estar associados a diversos aspectos da assistência. / Introduction: The adequate prenatal care is important to reduce maternal and perinatal morbidity and mortality, identifying factors that may put the pregnant woman and the fetus at greater risk of adverse outcomes. The assessment of the adequacy of prenatal care is done through different measures that involve the monitoring, access and quality of care. Objective: Compare results of different indices of inadequacy of prenatal care, as outcomes, in structural equation models from a theoretical model for risk factors. Methods: The study used data from the Brazilian 2013 National Health Survey (PNS), with a sample of 1,851 mothers who had their last births between 2011 and 2013, representing 3,818,936 women, applying the complex sampling weight. Structural equation models were employed for the measurement of the latent variables involved in the theoretical model and for the modeling of risk factors for the inadequacy of the assistance. Fit indices were used to evaluate the models. Results: Four indices were considered to estimate the variable of inadequacy of prenatal care. Socioeconomic Vulnerability was strongly associated with the inadequate outcome of prenatal care and other covariates of the psychosocial and biological dimensions. Effects of hypertension were identified for some outcomes. The presence of chronic diseases influenced the health self-assessment, but had no effect on the outcome. Models with and without sample weight presented different results. Conclusion: The socioeconomic aspects should be considered when assessing the inadequacy of prenatal care. The results suggest that different causal pathways may be associated with different aspects of care.

Com o crescente número de idosos na população mundial surgem preocupações referentes a políticas que acomodem as particularidades desta população. Foi a partir desse crescimento populacional que surgiram novas políticas de saúde para a população idosa. Atualmente, revela-se uma necessidade de avaliar estas políticas. As informações são limitadas nos sistemas de informação de saúde e estão disponíveis somente dados de notificações obrigatórias. O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) pode representar o inicio de um ciclo, instituindo a avaliação da atenção básica no país, para realizar um planejamento com melhores ações e condições de ampliação do serviço. Essa pesquisa busca analisar a percepção dos usuários idosos sobre os serviços de saúde prestados nas Unidades Básicas de Saúde a partir da avaliação do PMAQ-AB. Como objetivos específicos a) descrever as características sociodemográficas e presença de doenças de usuários idosos que utilizam os serviços de saúde nas Unidades Básicas de Saúde no Brasil e suas regiões; b) verificar a percepção de usuários idosos quanto aos serviços de saúde prestados nas Unidades Básicas de Saúde no Brasil. Para isso, foi realizado um estudo descritivo transversal. Como amostra utilizou as entrevistas do módulo de avaliação externa do segundo ciclo do PMAQ respondidas por usuários com 60 anos ou mais, totalizando 26.746 usuários idosos. Os serviços de saúde foram avaliados como acessíveis pelos usuários idosos, sendo utilizados conforme suas demandas de saúde. Os idosos estão em maior concentração nas regiões sudeste e nordeste do país; como maioria são mulheres brancas e pardas com escolaridade de ensino fundamental que não trabalham. A hipertensão e a diabetes são acometimentos presentes. O acesso as unidade de saúde é facilitado pela proximidade dos domicílios e o horário de atendimento é suficiente. Uma das formas de atendimento é a marcação das consultas, porém nem sempre possível para o mesmo dia, mas a equipe busca resolver os problemas apresentados pelos usuários. As equipes estão organizadas, realizando os encaminhamentos necessários. Praticamente todos os usuários recebem a visita dos agentes comunitários e levam o tratamento até a sua conclusão. Os cuidados ofertados pelo sistema de saúde estão de acordo com as políticas contemporâneas de saúde, que indicam buscar a recuperação da saúde, estabilização e prevenção das doenças. Isso mostra que os serviços estão atendendo as necessidades de saúde da população idosa. / With the increasing number of elderly people in the world population arise concerns about policies that accommodate the particularities of this population. From this population growth that new health policies emerged for the elderly population. Currently needs to evaluate these policies. The National Program for the Improvement of Access and Quality of Primary Care (PMAQ-AB) can represent the beginning of a cycle, instituting the evaluation of basic care in the country, to carry out a plan with better actions and conditions for expansion of the service. This research seeks to analyze the perception of the elderly users about the health services provided in the Basic Health Units from the evaluation of the PMAQ-AB. As specific objectives a) to describe the sociodemographic characteristics and presence of diseases of elderly users who use the health services in the Basic Health Units in Brazil and its regions; b) to verify the perception of elderly users regarding the health services provided in the Basic Health Units in Brazil. For this, a cross-sectional descriptive study was carried out. The sample was the interviews of the external evaluation module of the second cycle of the PMAQ answered by users aged 60 years or more, totaling 26,746 elderly users. The health services were evaluated as accessible by the elderly users, being used according to their health demands The elderly are more concentrated in the southeastern and northeastern regions of the country; The majority of whom are white and grizzly women with elementary school education who do not work. Hypertension and diabetes are present complications. Access to the health unit is facilitated by the proximity of the homes and the hours of care are sufficient. One of the forms of service is the marking of appointments, but not always possible for the same day, but the team seeks to solve the problems presented by users. The teams are organized, making the necessary referrals. Practically all users are visited by community agents and take the treatment to completion. The care offered by the health system is in accordance with the contemporary health policies, which indicate the recovery of health, stabilization and prevention of diseases. This shows that services are meeting the health needs of the elderly population.

Made available in DSpace on 2016-01-26T12:51:42Z (GMT). No. of bitstreams: 1 helenaayakomukai_dissert.pdf: 6852127 bytes, checksum: a5131615278936863e837f975418aa5f (MD5) Previous issue date: 2012-05-08 / Introduction: Knowledge on hospitalized patients nursing care demands and the nursing team s workload permit implementing changes in the care process and in care management. Aims: This study aimed to: 1- Identify the sociodemographic and epidemiological profile of patients with mental disorders; 2- Assess their nursing care needs and, 3- Measure the mean number of care hours delivered and the nursing team s workload. Sample and Method: This descriptive and retrospective research (2006-2010) was conducted at a public neuropsychiatric hospital in the Brazilian Southeast. In this study, 105 mental disorder patients were examined through the application of a patient classification instrument. For statistical treatment, Main Components Analysis, Variance Analysis, Kruskal-Wallis test and Bonferroni s adjustment were used. Results: Hospitalization times of up to 15 years were predominant, with 84 (80%), schizophrenia diagnoses 50 (47.7%) and patients in the discrete care category (73.3%). The nursing/bed index ranged from 0.22 to 0.48, and the nurse/bed index from 0.06 to 0.13; the mean number of care hours from 0.57 to 0.88 (nurses) and from 1.97 to 3.16 (nursing auxiliaries) and the workload from 119.6 to 183 hours. Conclusion: The researchers hope these research results can contribute to the elaboration of mental health policies and equip managers for decision-making and the establishment of action strategies aimed at care planning and quantitative/qualitative staff adjustments. / Resumo:Introdução: O conhecimento da demanda de cuidados em relação à enfermagem de pacientes internados e carga de trabalho da equipe possibilitam implementar mudanças no processo de assistir e no gerenciamento da assistência. Objetivos: Este estudo teve como objetivos: 1- Identificar o perfil sóciodemográfico e epidemiológico de pacientes com transtornos mentais; 2- Avaliar suas necessidades cuidativas em relação à enfermagem e, 3- Mensurar as horas médias de assistência dispensadas e a carga de trabalho da equipe de enfermagem. Casuística e Método: Trata-se de uma pesquisa descritiva, retrospectiva (2006-2010) conduzida em hospital neuro psiquiátrico público localizado na região sudeste do Brasil. Foram investigados 105 pacientes portadores de transtorno mental mediante aplicação de instrumento de classificação de pacientes. O tratamento estatístico foi realizado por meio de Análise de Componentes Principais, Análise de Variância, teste de Kruskal-Wallis e ajuste de Bonferroni. Resultados: Houve predomínio de tempo de internação até 15 anos 84(80%), diagnóstico de esquizofrenia 50(47,7%) e pacientes na categoria de cuidados discreta (73,3%). A relação enfermagem/leito variou de 0,22 a 0,48 e a enfermeiro/leito de 0,06 a 0,13; as horas médias de assistência de 0,57 a 0,88 (enfermeiros) e de 1,97 a 3,16 (auxiliares de enfermagem) e a carga de trabalho de 119,6 a 183 horas. Conclusão: Almeja-se que os resultados dessa investigação possam contribuir na elaboração de políticas de saúde mental e instrumentalizar o gestor na tomada de decisão e estabelecimento de xiii estratégias de ação voltadas ao planejamento da assistência e ajuste quanti/qualitativo de pessoal.

The increased prevalence rate of childhood obesity in Saudi Arabia is a nationwide health issue. The doctoral project was instituted in the pediatric out-patient clinic (POPC) of a tertiary university hospital in Riyadh, Saudi Arabia. Child obesity clinic and clinical practice guideline (CPG) for primary prevention were not available in the pediatric outpatient clinic with a high incidence of newly diagnose obese children. The focus of this doctoral project was to improve the clinical nursing practice of POPC nurses through the adoption of CPG on primary prevention of childhood obesity. The knowledge translation into action framework provided a summary of descriptive series of ideal CPG implementation steps in POPC. The search for published CPGs was taken from DynaMed, National Guideline Clearinghouse, Guideline International Network, Pubmed, and Google Scholar. There were 2 tools applied for analysis and synthesis. First, the appraisal of guidelines for research and evaluation II instrument was used to assess the quality of the guidelines. Second, the BARRIERS' scale was used to assess the extent of nurses' perception of barriers in CPG utilization. The 1st findings from this study revealed that RNAO CPG was the best and high-quality CPG over the Endocrine Society and the Institute for Clinical Systems Improvement CPGs. The 2nd findings showed that most of the nurses perceived BARRIERS to utilization towards on the unclear implications of the CPG in their daily nursing practice. Hence, one of the vital recommendations was to have CPG awareness and education before the implementation. Overall, the doctoral project contributed to positive social change through guidelines, policies, and protocol provision for childhood obesity prevention in similar settings.

Total quality management (TQM) approach is often used to carry out company-wide continuous quality improvement plans in manufacturing and service industries. Similarly, TQM can also play a critical role for quality management in health care. Aiming to improve health care quality, experiences showed that major problems of non-patient care, patient records and vital signs monitoring are encountered. In this study, we aim to introduce TQM for quality improvement for intensive care unit (ICU) operations, including some solutions and the prototype of quality management. And vital signs monitoring at ICU is taken as an example of process. For quality improvement of non-patient care, Health Care Quality Development Life Cycle, including (1) quality requirement analysis, (2) quality specification review, (3) quality design, (4) quality implementation, (5) quality testing, (6) quality maintaining, and (7) quality validation, is discussed. The prototype of the first three phases for quality improvement at ICU is explored. Through quality requirement analysis, non-patient care quality at ICU is defined in areas of administration, facility and environment. For quality improvement of patient records maintaining, firstly, scope of health care information systems is categorized as administrative operational system, decision support system, clinical information system, and medical information system. According to this categorization and experience, some interesting result is found. For instance, the current applications of information systems for teaching hospitals in southern Taiwan surveyed are that most applications are administrative and clinical. And the essential information of patient records used in each information system is not complete or not easily accessed. Model of the patient record maintaining is introduced and the prototype design of patient records is recommended for quality improvement of patient records maintaining at ICU. To improve quality of vital signs monitoring is one essential requirement and specification for ICU quality improvement. Effective outcome measures of vital signs monitoring and early detecting of abnormal vital signs is considered important. For quality improvement of vital signs monitoring at ICU, heart rate graphs are taken as examples in our study through the heart rate graphs monitoring. Health professionals can understand the interactions of human autonomic nervous system. By use of digitizer, the computable heart rate data is acquired from each graph and grouped into mortality and near-to-normal cases. Then spectrum form of heart rate data, describing more about heart function, is used for statistical analysis. Several control chart methods have been experimented to detect small heart rate shifts from target, cumulative sum control chart (Cusum) is adopted in our study. The observable variable is the patient¡¦s heart rate, the purpose is to check the alarms pointed out by Cusum that could be partially be ascribed to changes of heart rate trend over time, and to a shift in the monitoring process mean. From summaries of nonconformities in the Cusum charts, mortality cases obviously have more nonconformities. It is obvious that Cusum control charts of mortality cases provide diagnostic information for vital signs monitoring process. In addition, Cusum charts may also inform ICU professionals that there is a small shift of patient heart rate, a continuously increasing or decreasing heart rate, and the adjustment of sympathetic nerve and parasympathetic nerve. In those cases, some special care is needed.

Bakgrund: Sjukvården beskrivs som oerhört komplex och genom bland annat utveckling av ny och dyr teknik, som i sin tur genererar bättre vård, gör det svårt för sjukhus att hålla sin budget. En controller har en fundamental roll i en organisations ekonomistyrning och ska med hjälp av diverse styrmedel styra och kontrollera så att verksamheten drivs mot ekonomiska mål. Syfte: Syftet med uppsatsen var att beskriva och analysera hur en controller inom sjukvården använder ekonomiska styrmedel för att nå ekonomisk måluppfyllelse samt skapa en förståelse för hur en controller hanterar balansgången mellan ekonomisk måluppfyllelse och vårdkvalité. Metod: Uppsatsen är formad med en kvalitativ forskningsdesign. En flerfallstudie har använts som forskningsstrategi där den empiriska datan är insamlad genom ostrukturerade intervjuer med anställda vid två sjukhus i Småland, länssjukhuset i Kalmar och centrallasarettet i Växjö. Det teoretiska avsnittet är byggt med data som insamlats från litteratur och vetenskapliga artiklar som varit tillgängliga via Linnéuniversitetets bibliotekskatalog. Slutsats: De resultat som framkommer av studien påvisar att en controllerns användning av styrmedel tenderar att fokusera på ekonomisk måluppfyllelse. Genom användning i större utsträckning av de styrmedel som är under utveckling finns möjligheter för controllern att även påverka vårdkvalité. / Background: Health care organisations are seen as complex due to the all time ongoing development of new and expensive technology. Which in other hand generates better quality but makes it hard for these organisations to keep within their budget. A controller has an fundamental role in the work with managing accounting within organisations. With the help of a setup of control instruments the controller are to manage and control so that operations helps the organisation to reach its economic targets. Purpose: Our purpose with this thesis were to study a selection of health care organisation. Through explaining and analyzing the controllers usage of control instruments to reach economic targets and develop an understandning for how a controller are handling priority between economic targets and care quality. Method: The thesis were formed with a qualtivive research design. With a strategy of studying multiple cases were the empirical data gathered from interviews with employees at two hospitals in Småland. Our theoretical chapter is built on information collected from litterature and scientific articles that were available through the library catalogue at Linnaeus University. Conclusion: The results of this thesis shows that a controllers usage of control instruments focus on economic targets rather then care quality. With an greater use of the control instruments that are under development the controller has an opportunity to influence on care quality.

The two main goals of my thesis were to further our understanding of how parental effort is related to life-history trade-offs and to see how parental investment is reflected in various potential measures of nestling quality. I looked at how fitness is maximized by examining (1) the trade-off between current and future reproduction, and (2) the trade-off between quantity and quality of offspring. To see how parents responded to energetic demands and whether each sex reacted in a similar way, I experimentally manipulated brood sizes and quantified provisioning rates. Both male and female parents with enlarged broods increased their feeding rates, but provisioning on a per nestling basis declined, so that parents fledged lighter nestlings with shorter wings. Although the incidence of mortality did not differ between control and enlarged broods, nestlings from enlarged broods were lighter than those from control broods with the same brood size, suggesting that clutch size may be individually optimized. I also looked at how nestlings responded to different levels of nutritional stress in the manipulated broods by quantifying size and body condition, plumage colouration, and the physiological measures of T-cell mediated immune responses, and corticosterone levels in nestling feathers as a long-term integrated measure of stress physiology. The size of melanin ornaments on feathers and the saturation and brightness of carotenoid colouration was associated with nestling mass in such a way that suggested that plumage characteristics reflect nestling quality. The immune function of nestlings was negatively related to brood size and nestlings in better body condition could mount greater immune responses to foreign antigens suggesting that immune responses are energetically costly. Corticosterone levels in the feathers were not related to nestling body condition and were unaffected by the experimental brood manipulation. The ii mass of male nestlings, which are the larger sex, was more compromised by brood size than female mass was. I also found sex-specific relationships between plumage characteristics and measures of physiological performance. These findings help to explain optimal clutch size and the classic trade-off between quality and quantity of offspring. They also offer new insights into the reliability of putative measures of quality in nestlings and relationships between physiological and morphological traits.