The purpose of this study was to survey registered dietitians in Northeast Tennessee to determine attitudes toward implementation of the nutrition care process prior to and following education about the nutrition care process and/or implementation of the nutrition care process in their respective healthcare facilities. Approximately 100 registered dietitians were involved in the study. Data were collected through electronic submission and written inquiries. The findings of the study identified that there was a need for further research regarding implementation of the nutrition care process and that negative attitudes, opinions, and barriers were broken down by education, implementation, and exposure to the nutrition care process.

Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.

Although provision of palliative care on the United States is growing, referrals to the service are often late or non-existent. The simultaneous care model provides a blueprint for the most progressive form of palliative care, which is palliation and disease-oriented treatments delivered concurrently. Research indicates the existence of a widespread misconception that associates palliative care with imminent death, and some organizations have chosen to re-brand their palliative care services to influence this perception. The goal of this study was to assess the effects of a name change from palliative care to supportive care on the communicative process during referrals to the service.

A prática da enfermeira no Serviço de Assistência Domiciliar (SAD) da Secretaria Municipal de Saúde de Ribeirão Preto-São Paulo, constitui-se o objeto desta investigação. Elegemos como objetivo analisar o processo de instituição da assistência de enfermagem no domicílio através do SAD da SMS-RP, apontando seus limites e potencialidades enquanto um disparador para transformação da prática de enfermagem e do modelo assistencial, tendo como premissa a compreensão da prática de saúde e de enfermagem enquanto trabalho. Tomamos por pressuposto que a assistência no domicílio apresenta potência de se constituir um espaço para a construção de um agir pautado pela integralidade das ações, pela responsabilização em relação à clientela, por uma identidade de equipe, com o estabelecimento de espaços interssessores com intensa utilização de tecnologias leves, de modo a possibilitar o vínculo, escuta, autonomização, fugindo de uma perspectiva estrita de controle da clientela no âmbito domiciliar. Os sujeitos da pesquisa constituiram-se nas enfermeiras que atuam no SAD, sendo o material empírico coletado através da técnica do grupo focal, ainda utilizamos de entrevista semi-estruturada junto ao staff do SAD no nível central da SMS-RP. Recorremos também a fontes documentais. A ordenação dos dados se deu pelo método do Discurso do Sujeito Coletivo- DSC, onde buscamos articular as Expressões Chaves dos depoimentos individuais com as Idéias Centrais, buscando resgatar a fala do social. A pesquisa revelou dois conjuntos temáticos apresentados separadamente, mas que guardam efetivamente estreita articulação teórico-prática, apontando que de foram ainda incipiente, há uma potencialidade do SAD se configurar como um dispositivo para a transformação da prática de saúde/enfermagem e ir processualmente se instalando pelo menos na prática das enfermeiras que realizam este trabalho. A vivência no SAD tem oportunizado o auto questionamento, a reflexão e o processo de rever condutas. Destacamos com relevância a importância atribuída pelas enfermeiras às tecnologias leves, consideradas fundamentais para o trabalho em saúde e pricipalmente na assistência domiciliar, incorporando a dimensão subjetiva inerente a toda produção no processo de trabalho em saúde. Também foi apontado como fundamental investir-se no preparo dos trabalhadores em habilidades para atuar em assitência domiciliar, na perspectiva de se estabelecer vínculos e uma relação mais humanizada e acolhedora. Ainda, foi possível evidenciar a produção do trabalho no SAD vivenciada com limitações, frustações, mas também com envolvimento, criatividade, responsabilização e satisfação. Reconhecem essas agentes a necessidade de aprender o processo de mudança como lento, sendo ainda necessário espaços para se discutir as conquistas e obstáculos, como também o trabalhador precisa estar disposto a constantemente aceitar ser revisto, e sempre estar revendo o processo de trabalho. / The nurse\'s practice in the Home Care Service (SAD) provided by the Municipal Health Secretariat of Ribeirão Preto - São Paulo State (SMS-RP) comprises the object of this investigation. We aimed at analyzing the process of organization of nursing home care through the SAD of the SMC-RP by pointing out its limits and potentialities as a triggering element for transformation in the nursing practice as well as in the current care model by understanding healthcare and the nursing practice as types of work. We assumed that home care can constitute a space for the construction of a way to perform which is based on the integrality of actions, responsibility in relation to clients, team identity and the establishment of various intersectional spaces with the intense use of light technology so as to enable the formation of ties, listening and autonomy, thus escaping from a strict perspective of controlling clients at home. The subjects of the research were nurses working in the SAD and empirical data were collected through the focal group technique. Semi-structured interviews with the staff of the SAD in the central level of he SMS-RP and documental sources were also utilized. Data were organized by means of the Collective Enunciator\'s Discourse - DSC, where we sought to articulate Key Expressions in the individual accounts with Main Topics, aiming at recovering social discourse. The research showed two thematic sets which were separately presented, but effectively contained a close theoretical and practical articulation demonstrating that, although incipient, there is a potentiality for the SAD to become a device in the transformation of healthcare and the nursing practice which can be processually installed at least in the practice of nurses performing this type of work. The experience in the SAD has provided the opportunity for self-questioning, reflection and the process of reviewing conducts. We emphatically point out the importance attributed by nurses to light technology which is considered to be fundamental for healthcare work and particularly in home care, thus incorporating the subjective dimension inherent to all types of production in the healthcare work process. Investment on the preparation of workers for the development of skills in order to perform in home care, the perspective of establishing ties and a more humanized and welcoming relationship has also been pointed out as fundamental. Furthermore, it was also possible to evince the work production in the SAD, which is experienced with limitations, frustrations, but also with involvement, creativity, responsibility and satisfaction. These agents recognize the need to apprehend the process of change as a slow means as well as the need for spaces in order to discuss their achievements and obstacles. In addition, workers must be willing to constantly accept to be reviewed as well as review the work process.

Congestive heart failure (CHF) affects an estimated 5.1 million Americans over the age of 20. The purpose of this quantitative study was to determine whether there is a difference in the Quality of Life (QOL) for Congestive heart failure patients receiving care through telehealth compared to patients receiving face-to-face care (usual care). Guiding this project was the Self-Care Model of Chronic Illness because the primary outcome of the self-care model is illness stability, well-being, and quality of life. Seventy-seven veterans with Heart Failure (HF) from the Washington D.C. Veterans Affairs Medical Center (VAMC) participated in the project. Forty reported they were receiving telehealth and 37 reported that they were receiving face-to-face care. The average participant age was 67 years with a range of 44 to 93 years. Seventy-five of the participants were male and 2 were female. Sixty-four participants were Black and 12 were White. The Minnesota Living with Heart Failure (MLHF) questionnaire average score for the telehealth group was 49.4 (SD = 28.7) and the face-to-face care group was 37 (SD = 27.9). With equal variance assumed, there was no significant difference between MLHF scores in the telehealth group compared to the usual care group (t = -1.91, p > .05). Thus, opportunities for using telehealth without negatively affecting patient outcomes, such as QOL, are plausible. It can be concluded that providing services using home telehealth for HF patients may produce outcomes that are equivalent to those receiving traditional services.

AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

As a chronic disease, asthma presents a significant public health challenge nationally and in Georgia. In 2007, over 22 million people, including over 9 million children, had asthma in the United States. In Georgia, 230,000, or 10% of children have asthma, which is more prevalent among children less than 18 years of age than among adults. While asthma affects people of all ages and socioeconomic status, low income and minority populations have the highest asthma morbidity. This has proven to be the case with residents of Neighborhood Planning Unit V (NPU-V), a low-income minority community located in southeast Atlanta. Children comprise 35% of NPU-V's population, and over half of them live below the poverty line. Among other concerns, children with asthma have higher rates of hospitalization and absenteeism from school than their peers. The hospitalization rates for children with asthma in South Atlanta aged 0-17 years of age is almost five times the rate of North Fulton County. The Georgia State University Institute of Public Health received grant funding for the planning and implementation of the Accountable Communities: Healthy Together-Asthma (ACHT-A) program to help address the problems associated with asthma in NPU-V and among patients of Southside Medical Center (SMC). The capstone project involved development of an evaluation plan for future determinations about the program’s effectiveness in achieving desired outcomes. The evaluation process included development of a logic model and putting systems in place to track and measure specific indicators. The project culminated in a preliminary assessment of selected program activities to establish baseline information for the program, its participants, and SMC staff.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2018-05-11T12:07:45Z No. of bitstreams: 2 Dissertação - Lorrany Rodrigues do Nascimento - 2018.pdf: 3597687 bytes, checksum: 3b002994dad46043df8b92f4c93bcc02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-05-11T12:16:56Z (GMT) No. of bitstreams: 2 Dissertação - Lorrany Rodrigues do Nascimento - 2018.pdf: 3597687 bytes, checksum: 3b002994dad46043df8b92f4c93bcc02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-11T12:16:56Z (GMT). No. of bitstreams: 2 Dissertação - Lorrany Rodrigues do Nascimento - 2018.pdf: 3597687 bytes, checksum: 3b002994dad46043df8b92f4c93bcc02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-04-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Bearing in mind a context where the Deinstitutionalization process is threatened by the adoption of privatization measures on the SUS context, a master’s dissertation about the Psychiatric Reform in the city of Goiânia was developed, where the expansion and legitimization of the Psychosocial Care Network deals with challenges related to the persistence of the asylum type devices. The main objective was the understanding of the political and theoretical foundation where the defense of the psychosocial care from the representations of the agents with a relevant role into the city’s mental health policies model is based upon. A qualitative methodology was adopted, employing semi-structured individual interviews as a research technique. Ten agents involved in the Deinstitutionalization process in the city (militants, managers, academicians and professionals of the network) were interviewed, in addition to two agents connected to the Sanitary Reform. The interviews, after being transcribed, went through a content analysis process, wherein the approached speech themes were used as classification criteria. In the idea of the respondents, the psychosocial care model is seen as the most adequate for the care of the psychic individual in pain because it is lined on the horizontal, on the respect of the human rights and territorialization. Despite this, it would face difficulties to become legitimized due to the interests that are behind the maintenance of the asylum model. In this regard, the necessity of a bigger articulation of the social movements is pointed out, with the construction of new leaderships. The conclusion was that the Deinstitutionalization process in Goiânia is still underdeveloped, presenting, beyond the difficulties associated to a national anti-democratic and neoliberal context, obstacles related to decision making techniques based on political criteria (as the managers selection), the operation of sectors which are contrary to the reform and because the sociocultural dimension of the reform in the city is still not yet well developed. / Tendo em vista um contexto em que o processo de Desinstitucionalização mostra-se ameaçado pela adoção de medidas privatizantes no âmbito do SUS, foi desenvolvida uma dissertação de mestrado sobre a Reforma Psiquiátrica no município de Goiânia, onde a expansão e legitimação da Rede de Atenção Psicossocial (RAPS) enfrenta desafios relacionados à persistência de dispositivos de caráter manicomial. O objetivo central foi o entendimento da fundamentação teórica e política sobre a qual se baseia a defesa do modelo de atenção psicossocial a partir das representações de agentes com um papel relevante nas políticas de saúde mental do município. Foi adotada a metodologia qualitativa, com o emprego da entrevista individual semi-estruturada como técnica de pesquisa. Foram entrevistados 10 agentes envolvidos no processo de Desinstitucionalização no município (militantes, gestores, acadêmicos e profissionais da rede), além de 2 agentes ligados à Reforma Sanitária. As entrevistas, depois de transcritas, passaram por um processo de análise de conteúdo, em que se adotou como critério de classificação os temas abordados nas falas. Na concepção dos entrevistados, o modelo de atenção psicossocial é visto como mais adequado ao cuidado do indivíduo em sofrimento psíquico por estar pautado na horizontalidade, no respeito aos direitos humanos e na territorialização. Apesar disso, enfrentaria dificuldades para se legitimar devido aos interesses que subjazem a manutenção do modelo manicomial. Nesse sentido, é apontada a necessidade de uma maior articulação dos movimentos sociais, com a construção de novas lideranças. Conclui-se que o processo de Desinstitucionalização em Goiânia ainda é pouco desenvolvido, apresentando, além das dificuldades associadas a um contexto nacional anti-democrático e neoliberal, obstáculos relacionados a tomada de decisões técnicas com base em critérios políticos (como a escolha dos gestores), a atuação de setores contrários à reforma e ao fato da dimensão sociocultural da reforma no município ainda não ter sido bem desenvolvida.

A prática da enfermeira no Serviço de Assistência Domiciliar (SAD) da Secretaria Municipal de Saúde de Ribeirão Preto-São Paulo, constitui-se o objeto desta investigação. Elegemos como objetivo analisar o processo de instituição da assistência de enfermagem no domicílio através do SAD da SMS-RP, apontando seus limites e potencialidades enquanto um disparador para transformação da prática de enfermagem e do modelo assistencial, tendo como premissa a compreensão da prática de saúde e de enfermagem enquanto trabalho. Tomamos por pressuposto que a assistência no domicílio apresenta potência de se constituir um espaço para a construção de um agir pautado pela integralidade das ações, pela responsabilização em relação à clientela, por uma identidade de equipe, com o estabelecimento de espaços interssessores com intensa utilização de tecnologias leves, de modo a possibilitar o vínculo, escuta, autonomização, fugindo de uma perspectiva estrita de controle da clientela no âmbito domiciliar. Os sujeitos da pesquisa constituiram-se nas enfermeiras que atuam no SAD, sendo o material empírico coletado através da técnica do grupo focal, ainda utilizamos de entrevista semi-estruturada junto ao staff do SAD no nível central da SMS-RP. Recorremos também a fontes documentais. A ordenação dos dados se deu pelo método do Discurso do Sujeito Coletivo- DSC, onde buscamos articular as Expressões Chaves dos depoimentos individuais com as Idéias Centrais, buscando resgatar a fala do social. A pesquisa revelou dois conjuntos temáticos apresentados separadamente, mas que guardam efetivamente estreita articulação teórico-prática, apontando que de foram ainda incipiente, há uma potencialidade do SAD se configurar como um dispositivo para a transformação da prática de saúde/enfermagem e ir processualmente se instalando pelo menos na prática das enfermeiras que realizam este trabalho. A vivência no SAD tem oportunizado o auto questionamento, a reflexão e o processo de rever condutas. Destacamos com relevância a importância atribuída pelas enfermeiras às tecnologias leves, consideradas fundamentais para o trabalho em saúde e pricipalmente na assistência domiciliar, incorporando a dimensão subjetiva inerente a toda produção no processo de trabalho em saúde. Também foi apontado como fundamental investir-se no preparo dos trabalhadores em habilidades para atuar em assitência domiciliar, na perspectiva de se estabelecer vínculos e uma relação mais humanizada e acolhedora. Ainda, foi possível evidenciar a produção do trabalho no SAD vivenciada com limitações, frustações, mas também com envolvimento, criatividade, responsabilização e satisfação. Reconhecem essas agentes a necessidade de aprender o processo de mudança como lento, sendo ainda necessário espaços para se discutir as conquistas e obstáculos, como também o trabalhador precisa estar disposto a constantemente aceitar ser revisto, e sempre estar revendo o processo de trabalho. / The nurse\'s practice in the Home Care Service (SAD) provided by the Municipal Health Secretariat of Ribeirão Preto - São Paulo State (SMS-RP) comprises the object of this investigation. We aimed at analyzing the process of organization of nursing home care through the SAD of the SMC-RP by pointing out its limits and potentialities as a triggering element for transformation in the nursing practice as well as in the current care model by understanding healthcare and the nursing practice as types of work. We assumed that home care can constitute a space for the construction of a way to perform which is based on the integrality of actions, responsibility in relation to clients, team identity and the establishment of various intersectional spaces with the intense use of light technology so as to enable the formation of ties, listening and autonomy, thus escaping from a strict perspective of controlling clients at home. The subjects of the research were nurses working in the SAD and empirical data were collected through the focal group technique. Semi-structured interviews with the staff of the SAD in the central level of he SMS-RP and documental sources were also utilized. Data were organized by means of the Collective Enunciator\'s Discourse - DSC, where we sought to articulate Key Expressions in the individual accounts with Main Topics, aiming at recovering social discourse. The research showed two thematic sets which were separately presented, but effectively contained a close theoretical and practical articulation demonstrating that, although incipient, there is a potentiality for the SAD to become a device in the transformation of healthcare and the nursing practice which can be processually installed at least in the practice of nurses performing this type of work. The experience in the SAD has provided the opportunity for self-questioning, reflection and the process of reviewing conducts. We emphatically point out the importance attributed by nurses to light technology which is considered to be fundamental for healthcare work and particularly in home care, thus incorporating the subjective dimension inherent to all types of production in the healthcare work process. Investment on the preparation of workers for the development of skills in order to perform in home care, the perspective of establishing ties and a more humanized and welcoming relationship has also been pointed out as fundamental. Furthermore, it was also possible to evince the work production in the SAD, which is experienced with limitations, frustrations, but also with involvement, creativity, responsibility and satisfaction. These agents recognize the need to apprehend the process of change as a slow means as well as the need for spaces in order to discuss their achievements and obstacles. In addition, workers must be willing to constantly accept to be reviewed as well as review the work process.

Purpose: To describe family perceptions about pediatric primary care management following diagnosis of type 1 diabetes mellitus (T1DM) in preschool-aged children living in the Pacific Northwest region of the United States. Study Design and Method: Mothers of children diagnosed with T1DM before the fifth birthday and within the past two years were recruited anonymously through two regional support groups. Perceptions about pediatric primary care management following T1DM diagnosis were elicited through an anonymous 30-item online survey. Demographic characteristics of mother and child were obtained as well as information about five important domains of health care management for a young child with T1DM: (1) multidisciplinary, (2) holistic and compassionate, (3) accessible and communicative, (4) uses current standards and technology, and (5) actively promotes safe self-management. Results: Twenty-one biological mothers participated in this study, each on behalf of a child diagnosed with T1DM who fit inclusion criteria. Overall mothers held positive perceptions about care management by PCPs and endocrinologists within context of each of the five domains. Most mothers felt included in care planning, valued periodic well-child exams, and believed the child's providers were accessible, communicated effectively, and usually demonstrated consideration/compassion for the family. Although a majority of mothers at least somewhat agreed that the PCP used current standards and technology to care for the child, and functioned as the center of his/her health care coordination, these domains elicited a slightly greater number of responses indicating uncertainty or disagreement. Clinical Implications: Nurses and pediatric practitioners can use findings from this study to plan continued exploration into the perceptions and care management needs of families following diagnosis of a very young child with T1DM. The domains of care used to assess mothers' perceptions about care management-based on tenets of the Chronic Care Model (CCM) and Patient Centered Medical Home (PCMH)-can be used by pediatric PCPs and endocrinologists to dialogue with patients and staff about how care management may be improved for these families. Providing opportunities for feedback to the families of young children with T1DM should be encouraged so future research can examine relationships between care management variables and clinical outcomes.