This thesis, 'Living with HIV/AIDS: An ethnography of care in Western Kenya', is based upon 18 months of ethnographic fieldwork carried out in Central Nyanza, Kenya, between 2005-2007. It studies practices of care against the backdrop of the HIV/AIDS epidemic, which has impacted the region severely. The thesis explores how home and hospital are established as domains of care through practice. It draws upon ethnographic material collected from within a District Hospital, a Community-Based Organisation and people's homes. The thesis follows practices of care across divergent domains of social life to consider how practices of care within Luo networks of kinship and relatedness intersect with governmental interventions to manage HIV/AIDS. The thesis describes two governmental projects introduced to administer HIV/AIDS care in this region. It considers Home-Based Care, an HIV/AIDS response in which Community Health Workers are trained to support particular aspects of care at home, focusing on the practices of care employed by Community Health Workers as they visit sick people at home and attend organisational meetings. The thesis also describes the landscape of HIV care in the District Hospital, including the delivery of antiretroviral therapy. The focus here is on the relationships between caring practices in the hospital and at home, and the divergent responsibilities to care experienced by hospital staff and family members. The main argument of the thesis is that care is a particularly useful analytical tool for anthropology because practices of care take place across many different domains of social life, cutting across the boundaries that have formed the traditional focus of anthropological study. Studying practices of care illuminates the production of bounded domains of social life whilst simultaneously drawing attention to similarities of practice across different domains. Care provides a way of understanding the complex social landscape that has developed as people in Western Kenya endeavour to live with HIV/AIDS.

Analysis of current russian legislation regarding health insurance. Detailed overview of russian private health insurance market. Comparison with foreign health insurance systems.

The author studied the welfare state typology in China from a health care perspective. This study aims to figure out what type of welfare typology works in Chinese health care system through comparative welfare state typology, specifically the decommodification principle proposed by Esping-Andersen (2019) and health care decommodification index put forward by Bambra (2006). Studying the classification of Chinese welfare state typology by analysing the Chinese health care system and comparing it with other countries in the world within the scope of welfare state typology, helps China enhancing the public administration. The author found that China belongs to medium decommodification group which means it is the same decommodification level as Conservative-Corporatist regimes, but also indicates there's a huge improvement potential to high decommodification group in the future. Keywords Welfare State Typology; China; Chinese Health Care System; Health Decommodification Index Range of the Thesis: 66 pages

The documented experiences and perceptions of lesbian, gay, bisexual, and transgender (LGBT) patients receiving hospice or palliative care gives merit to the need for the implementation of LGBT affirming environments in hospice care settings. The guidelines for creating these affirming environments are described in this paper. Applying the Donabedian (1988) model of structure, process, and outcome this thesis project analyzes identified interventions relevant to the implementation of LGBT affirming environments in hospice care settings. Utilizing a formal PICO questioning method, a search strategy was devised and studies were identified based on established criteria. The results suggest that there is a paucity of data in relation to the implementation of LGBT affirming environments in hospice care settings. In an effort to assist in identifying existing interventions that have not been studied this project also includes a recommended survey tool to measure the active efforts of hospice organizations to implement LGBT affirming environments.

The purpose of this thesis is to examine the Affordable Care Act through an analysis of the United States Supreme Court's holding in The National Federation of Independent Business v. Sebelius. In order to better understand the Supreme Court's reasoning in that case, this paper will first examine the history and the function of the Supreme Court, which will demonstrate the Court's power to either augment or diminish the power of the states in relation to the federal government. This paper will then discuss the background of the Affordable Care Act, the procedural history of the case, and the majority's analysis supporting its decision. The concurring and dissenting opinions of the other justices will be discussed to present the various viewpoints regarding the proper role of the federal government and the implications this case may have on federal/state conflict. The Supreme Court ruled in favor of the Department of Health and Human Services. The 5-4 decision was extremely close and the opinions given by each Justice highlighted the various flaws and benefits of the Act it was looking to uphold. Further research of Supreme Court cases in our country's history reveal the trend of augmenting and diminishing state's rights. This thesis will examine the constitutionality of the aforementioned decision, the effects it will have on each of the states within the United States, and the impact the citizens will experience.

<p>Primary care multi-disciplinary teams were central to recent reform plans for Canadian primary care, in response to limited resources and increasing demands. Health Information Technology was also an integral part of those plans as supporting infrastructure for the modernization of healthcare services, facilitating coordination, collaboration and access to services. As provider-centric Health Information Technology matures, attention turns to the patient. The hallmark of patient-centered applications is the electronic Personal Health Record System (PHR). These systems have grown beyond simple repositories of personal health information, extending to a range of information collection, sharing, self-management and exchange functions.</p> <p>The implementation of PHRs in primary care multi-disciplinary teams involves many stakeholders including patients, physician, allied health professionals and support staff. There is significant literature on physician and patient perspectives on all PHR functions. However, little attention has been given to the other stakeholders: allied health professionals and support staff.</p> <p>In this study, we explored the views of Allied Health Professionals (AHPs) and support staff, working in a primary care clinic adopting a patient-centered, multi-disciplinary model called the Family Health Team (FHT) model. Participants provided their insight on benefits, concerns and recommendations regarding the implementation of MyOSCAR, a PHR, at their clinic. Qualitative data was collected through semi-structured one-on-one interviews that were analyzed to extract common themes and summarize participant views. Process diagrams were produced to highlight opportunities for improvement of current work processes through the integration of MyOSCAR functions.</p> <p>As more teams are created in primary care and they attempt to implement new technologies, it is important to get a complete picture of all stakeholder views. This is the first study that focuses on the views of AHPs and support staff, contributing to the literature on PHR implementations. Findings from this study can contribute to future PHR implementations by informing planning and implementation.</p> / Master of Science (MSc)

A sistematização da assistência de enfermagem tornou-se um instrumento valioso no trabalho do enfermeiro, por nortear as consultas, produzir registro de suas práticas por meio de processo organizado com linguagem padronizada, pensamento crítico e habilidades lógicas. Na Atenção Básica, para o enfermeiro realizar a SAE, necessita de classificação voltada não apenas para o modelo fisiopatológico, mas que contemple o ser humano de forma integral, respeitando os princípios do SUS de universalidade, equidade, integralidade, resolutividade e de qualidade. A Classificação Internacional de Práticas de Enfermagem em Saúde Coletiva, CIPESC®, atende a essas características, constituindo a opção de classificação para esta elaboração. Assim, o presente estudo teve como objetivo reformular e validar roteiro para primeira consulta de enfermagem à gestante de baixo risco utilizando a CIPESC®. A pesquisa buscou consistência teórica no histórico das classificações das práticas de enfermagem para contribuir no aprimoramento do conhecimento, assim como, na consulta de enfermagem e da saúde da mulher para entendermos a evolução do atendimento à gestante, grupo populacional escolhido como foco do roteiro. Trata-se de Estudo Metodológico realizado em duas fases. A primeira constituiu-se no desenvolvimento de revisão integrativa, analisando as produções científicas sobre Cuidados de Enfermagem, Enfermagem em Saúde Pública, Atenção Primária à Saúde, Saúde da Mulher, Classificação Internacional de Atenção Primária, Gestante e Pré-Natal para fundamentar a reconstrução do roteiro em uso em uma unidade básica de saúde. Foram utilizadas três bases de dados: Lilacs, Pubmed e Cinahl. Obteve-se nove publicações que possibilitaram extrair evidências das informações para aprimorar o roteiro. O resultado da Revisão Integrativa acrescido de analise de documentos oficiais do Ministério da Saúde sobre o tema forneceram os elementos para a formulação do roteiro, que também foi apreciado pelo grupo de trabalho sobre a SAE, constituído de enfermeiras da rede de Atenção Básica, gerando a versão para a próxima fase. Na segunda fase, foi realizada validação por oito experts que, após duas apreciações com incorporação das observações e sugestões, obteve-se como produto final, o roteiro de SAE para primeira consulta da gestante na Atenção Básica. Conclui-se que o roteiro validado oferece subsídios para direcionar os enfermeiros a documentarem a consulta de enfermagem, permitindo além da adequação das exigências do Conselho de Enfermagem espaço para novos estudos relacionados à sua aplicabilidade. O roteiro reformulado e validado, de sistematização de assistência de enfermagem da primeira consulta à gestante na Atenção Básica visa, como finalidade, à sua aplicação prática, para tanto, será apresentado à Secretária Municipal de Saúde do município de Ribeirão Preto para ser incorporado aos protocolos municipais, propondo-se a substituição da Versão inicial atualmente em uso. Palavras-chave: Cuidados de Enfermagem. Enfermagem em Saúde Pública / The Nursing Care Systematization (NCS) has become a valuable tool in the nurses\' work for guiding the consultations and producing a record of their practices through an organized process with standardized language, critical thinking and logical skills. In Primary Care, to perform the NCS, nurses need of the classification not only for the pathophysiological model, but also to contemplate the human being integrally, respecting the SUS principles of universality, equity, integrality, problem solving and quality. The International Classification of the Nursing Practices in Collective Health - CIPESC® meets these characteristics, constituting the option of classification for this development. Thus, this study aimed to reformulate and validate a guide for the first nursing consultation of the low-risk pregnant women using the CIPESC®. The research sought theoretical consistency in the history of the classification of nursing practices to contribute to the improvement of knowledge as well as of the nursing consultation and women\'s health to understand the evolution of care to pregnant women, a population group chosen as the focus of the guide. This is a Methodological Study carried out in two phases. The first was the development of an integrative review, analyzing the scientific productions on Nursing Care, Public Health Nursing, Primary Health Care, Women\'s Health, International Classification of Primary Care, Pregnant Women and Prenatal Care to support the reconstruction of the guide which was being used in a basic health unit. Three databases were used: Lilacs, Pubmed and Cinahl. There were 9 articles that made it possible to extract evidence of the information to improve the guide. The result of the Integrative Review and the analysis of official Ministry of Health documents on the theme provided the elements for the development of the guide, which was also appreciated by the work group on NCS composed by nurses from the Primary Care network, generating the version for the next phase. In the second phase, the validation was performed by 8 experts, and after two evaluations with incorporation of the observations and suggestions, it was obtained as final product, the NCS guide for the first consultation of the pregnant women in Primary Care. It was concluded that the validated guide offers subsidies to help nurses to document the nursing consultation, allowing the adequacy of the requirements of the Nursing Board and the opportunity for further studies related to its applicability. The revised and validated guide of the systematization of first nursing consultation of the pregnant woman in Primary Care aimed at its practical application. For this purpose, it will be presented to the Municipal Health Secretary of the city of Ribeirão Preto to be incorporated into the municipal protocols with the proposal to replace the initial version, which is currently in use

A sistematização da assistência de enfermagem tornou-se um instrumento valioso no trabalho do enfermeiro, por nortear as consultas, produzir registro de suas práticas por meio de processo organizado com linguagem padronizada, pensamento crítico e habilidades lógicas. Na Atenção Básica, para o enfermeiro realizar a SAE, necessita de classificação voltada não apenas para o modelo fisiopatológico, mas que contemple o ser humano de forma integral, respeitando os princípios do SUS de universalidade, equidade, integralidade, resolutividade e de qualidade. A Classificação Internacional de Práticas de Enfermagem em Saúde Coletiva, CIPESC®, atende a essas características, constituindo a opção de classificação para esta elaboração. Assim, o presente estudo teve como objetivo reformular e validar roteiro para primeira consulta de enfermagem à gestante de baixo risco utilizando a CIPESC®. A pesquisa buscou consistência teórica no histórico das classificações das práticas de enfermagem para contribuir no aprimoramento do conhecimento, assim como, na consulta de enfermagem e da saúde da mulher para entendermos a evolução do atendimento à gestante, grupo populacional escolhido como foco do roteiro. Trata-se de Estudo Metodológico realizado em duas fases. A primeira constituiu-se no desenvolvimento de revisão integrativa, analisando as produções científicas sobre Cuidados de Enfermagem, Enfermagem em Saúde Pública, Atenção Primária à Saúde, Saúde da Mulher, Classificação Internacional de Atenção Primária, Gestante e Pré-Natal para fundamentar a reconstrução do roteiro em uso em uma unidade básica de saúde. Foram utilizadas três bases de dados: Lilacs, Pubmed e Cinahl. Obteve-se nove publicações que possibilitaram extrair evidências das informações para aprimorar o roteiro. O resultado da Revisão Integrativa acrescido de analise de documentos oficiais do Ministério da Saúde sobre o tema forneceram os elementos para a formulação do roteiro, que também foi apreciado pelo grupo de trabalho sobre a SAE, constituído de enfermeiras da rede de Atenção Básica, gerando a versão para a próxima fase. Na segunda fase, foi realizada validação por oito experts que, após duas apreciações com incorporação das observações e sugestões, obteve-se como produto final, o roteiro de SAE para primeira consulta da gestante na Atenção Básica. Conclui-se que o roteiro validado oferece subsídios para direcionar os enfermeiros a documentarem a consulta de enfermagem, permitindo além da adequação das exigências do Conselho de Enfermagem espaço para novos estudos relacionados à sua aplicabilidade. O roteiro reformulado e validado, de sistematização de assistência de enfermagem da primeira consulta à gestante na Atenção Básica visa, como finalidade, à sua aplicação prática, para tanto, será apresentado à Secretária Municipal de Saúde do município de Ribeirão Preto para ser incorporado aos protocolos municipais, propondo-se a substituição da Versão inicial atualmente em uso. Palavras-chave: Cuidados de Enfermagem. Enfermagem em Saúde Pública / The Nursing Care Systematization (NCS) has become a valuable tool in the nurses\' work for guiding the consultations and producing a record of their practices through an organized process with standardized language, critical thinking and logical skills. In Primary Care, to perform the NCS, nurses need of the classification not only for the pathophysiological model, but also to contemplate the human being integrally, respecting the SUS principles of universality, equity, integrality, problem solving and quality. The International Classification of the Nursing Practices in Collective Health - CIPESC® meets these characteristics, constituting the option of classification for this development. Thus, this study aimed to reformulate and validate a guide for the first nursing consultation of the low-risk pregnant women using the CIPESC®. The research sought theoretical consistency in the history of the classification of nursing practices to contribute to the improvement of knowledge as well as of the nursing consultation and women\'s health to understand the evolution of care to pregnant women, a population group chosen as the focus of the guide. This is a Methodological Study carried out in two phases. The first was the development of an integrative review, analyzing the scientific productions on Nursing Care, Public Health Nursing, Primary Health Care, Women\'s Health, International Classification of Primary Care, Pregnant Women and Prenatal Care to support the reconstruction of the guide which was being used in a basic health unit. Three databases were used: Lilacs, Pubmed and Cinahl. There were 9 articles that made it possible to extract evidence of the information to improve the guide. The result of the Integrative Review and the analysis of official Ministry of Health documents on the theme provided the elements for the development of the guide, which was also appreciated by the work group on NCS composed by nurses from the Primary Care network, generating the version for the next phase. In the second phase, the validation was performed by 8 experts, and after two evaluations with incorporation of the observations and suggestions, it was obtained as final product, the NCS guide for the first consultation of the pregnant women in Primary Care. It was concluded that the validated guide offers subsidies to help nurses to document the nursing consultation, allowing the adequacy of the requirements of the Nursing Board and the opportunity for further studies related to its applicability. The revised and validated guide of the systematization of first nursing consultation of the pregnant woman in Primary Care aimed at its practical application. For this purpose, it will be presented to the Municipal Health Secretary of the city of Ribeirão Preto to be incorporated into the municipal protocols with the proposal to replace the initial version, which is currently in use

This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.

The need for Registered Nurses (RNs) in the long-term care of older people is being questioned, particularly in the context of nursing shortages, while suggestions for 'professionalising' Care Assistant (CA) roles are emerging. Despite ongoing debates about the importance of their work, research has so far been unable to provide an evidence-base for the outcomes of the work of either RNs or CAs in UK care homes. Using a multi-method interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer, this qualitative research sought to illuminate the distinct contributions made by RNs and CAs to outcomes for older people in care homes. RNs and CAs from around the UK contributed 'significant' examples of their work for Phase 1 of the study and Phase 2 comprised researcher fieldwork (observation, interviews and documentary analysis) in three care homes around England. Participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. The findings offer a rich and detailed analysis of the realities of the work, much of which takes place 'behind closed doors' and has been described to a limited extent in the literature. They suggest that the CAs' daily support helps residents to function and to feel valued, and that close, reciprocal, family-type relationships develop. The health knowledge and clinical expertise of good RNs is critical in determining residents' health outcomes, particularly in the long-term, and RNs' 24-hour 'perceptual presence' can make life or death differences in acute or emergency situations. RNs also influence the environment, atmosphere and quality of care in the home. In the context of the literature, the findings offer new insights into the role and contribution of RNs and CAs, the outcomes of their work and the priorities of residents. The study produced new models of RN and CA roles in care homes, encompassing dimensions not previously acknowledged in the literature or their job descriptions, and a new framework within which the outcomes of care for older people could be evaluated. The research offers a positive image of work with older people in independent sector care homes.