The health care industry is currently experiencing many changes. Managed care is altering the way health care is delivered through advances in technology and new approaches in financing. As part of this transition, importance will be placed on patients becoming better consumers and participants in determining their health care service needs. The focus of this study is on the non-compliant patient and the many factors that revolve around this topic.

The objective of this study is to evaluate the impact of the Diabetes Nurse Care Manager on an at-risk diabetic population using a Primary Group Visit Model in Outlying Medical Offices within the Kaiser-Permanente Health Care System upon the process and outcome of care in this population.

Attacks on public administration are commonplace in today’s anti-bureaucratic approach to government. The legitimacy of public administration has long been questioned. Public administration is not one of the three branches of government explicitly formed by the Constitution. Further, public administrators are not elected by the people. Numerous attempts have been made to develop an idea of legitimacy that is grounded in the Constitution and that renders public administration consistent with the representative character of American government. A recent attempt presents public administration as an institution of governance that is derived from, and grounded in, the Agency Perspective. This perspective provides a new foundation stone for the legitimacy of public administration. Central to the perspective is public administration’s ability to evoke dialogue in a way that takes into account the public interest and brings about communities of shared meaning. This literature, however, does not provide a specific enough perspective, i.e., a perspective that has been given a practical specification. Simply exhorting public administrators to evoke dialogue is not sufficient. Public administrators who are encouraged in this general manner will have no choice but to look to what they know: interest group liberalism. Public administration needs a more specific alternative to interest group liberalism and a new methodology from which public administrators can work. In the research at hand, a new methodology is developed and demonstrated. The outline of the new methodology can be seen through the lens of principled negotiation. This literature maintains that negotiation from the positions of the various parties involved in a conflict, as is characteristic of interest group liberalism, is inefficient. Principled negotiation, on the other hand, recognizes that vital interests, not positions, are the key to creating consensus and achieving collaboration. The difficulty with this approach is that people, either as individuals or as role occupants in organizations, typically are unaware of their vital interests. Therefore, it is the task of the negotiator or, in this case, the public administrator to help surface these deeper interests. The new methodology is grounded in the literature of structuralism. Structuralism is a social theory and a method of inquiry (Gibson, 1984:2) that provides a means of looking beneath the surface of events or issues to identify patterns of meaning that are not evident at the surface. The work of linguist Ferdinand de Saussure served as the basis for modern structuralism (Sturrock, 1988:6). Working from Saussure’s writings, Claude Levi-Strauss "treats all forms of cultural expression as language and he assumes that like language it is all [structured] by unconscious laws that constitute a grammar for each" (White, 1983:12). In a similar vein, the structuralist undertaking in this research views the vital interests of the related groups and role occupants as the "underlying grammar" that structures the various approaches to policy formulation. This research employs a case study design to which the theory of structuralism and the technique of structural analysis have been applied. The case study is that of national long-term care policy. Role occupants from 23 national organizations involved in long-term care policy were interviewed. The role occupants are key people involved in long-term care policy formulation for the organizations for which they work. The organizations' long-term care position papers were obtained. Using a process of structural analysis, the position papers and interview transcripts were analyzed to identify vital interests. An analysis of linguistic elements such as metaphors and other figures of speech, justifications, preferred meanings, and recurrent terms was conducted. In addition, content analysis was carried out with the aid of a computer program. The vital interests identified through these analyses served as the basis for the development of a strategy to shape the national long-term care policy debate. / Ph. D.

Thesis (MTh)--Stellenbosch University, 2001 / ENGLISH ABSTRACT: Humankind has made great progress over the centuries in gaining an understanding of how the human body works. This has all been in an attempt to bring about health and healing where there appeared to be an unbalance in the body's normal functions. The mind also later became an object of study to address its relation to humankinds physical health. Later, social dimensions of health were also identified and were attended to. Yet, much disease and ailments seem to still plague our societies and communities. Theology in the name of pastoral care had been faithfully adding the spiritual dimension to healing. But it was only in the recent wake within practical theology that the theological sciences had entered into meaning conversations with other disciplines. These developments within practical theology raised a lot of question both inside and outside of the theological discipline. At the same time, this new fibrant branch of theology built bridges with the medical sciences, social and behavioural SCiences, management sciences, just to name a few. This study highlights the developments specifically around the scientific nature of theology and the conversation it had over the decades with medical science. It becomes clear that this dialogue is necessary as both theology and medicine have a common interest. They both complement each others dimensions and they address humankind in their state of pain and suffering. By covering the historical development of theology and medicine, proving their credibility as scientific disciplines, and pointing to their struggle with the dualistic concept, this study proposes to the Church and its healing ministry to restore wholistic healing in collaboration with the goverment services and local community structures. / AFRIKAANSE OPSOMMING: Mensdom het groot vordering gemaak oor die eeue deur kennis te versamel aangaande hoe die menslike liggaam werk. Dit was alles 'n poging om gesondheid en geneesing te voorsien waar dit gelyk het na 'n wanbalans in die liggaam se normale funksies. Die verstand het ook later 'n objek geword van studie om die verhouding van die mensdom se fiesiese gesondheid te ondersoek. Later was die sosiale dimensies van gesondheid ook geidentifiseer en aandag gekry. Tog, het vele siektes en Iyding nog steeds die gemeenskap geyl. Teologie het in die naam van pastorale sorg toewyding gewys deur spiriteule dimensies van gesondheid bygedra. Maar dit was in die onlangse ontwaking binne praktiese teologie dat die teologiese wetenskap die ander dissipline as waardevol gesprek ingegaan. Hierdie ontwikkelinge in praktiese teologie het baie vrae laat onstaan binne as ook buite die teologiese dissipline. Terselfdetyd, het hierdie nuwe stralende tak van teologie brue gebou met mediese wetenskap, sosiale en gedrags wetenskap, en bestuurswetenskap, net om a paar te noem. Hierdie studie fokus op die spesifieke ontwikkelings roundom die wetenskaplike natuur van teologie en die gesprek wat die oor die dekades voer met die mediese wetenskap. Dit word duidelik dat hierdie dialoog is nodig want beide teologie and medies het 'n gemeenskaplike belang. Beide komplementeer mekaar se dimensies en adreseer mensdom in hulle staat van pyn en leiding. Deur die historiese ontwikkelinge van teologie en medies te dek, om hulle te krediet te gee as wetenskaplike dissipline, en hulle stryd met die dualisties konsept uit te wys, maak die study 'n voorstel aan die Kerk en sy geneesing dienste om 'n holistiese geneesing te herstel in samewerking met goverment dienste end die plaaslike gemeenskap's strukture.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-08-15T12:22:02Z No. of bitstreams: 1 Tatiana de Fátima Domingues Bruno.pdf: 1688868 bytes, checksum: 60011b7b2900818356d43480ec7b1699 (MD5) / Made available in DSpace on 2018-08-15T12:22:02Z (GMT). No. of bitstreams: 1 Tatiana de Fátima Domingues Bruno.pdf: 1688868 bytes, checksum: 60011b7b2900818356d43480ec7b1699 (MD5) Previous issue date: 2018-06-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study is devoted to the examination of the triangular relationship between the ephemeral subject - here dependent on multiple care -, home care and family care. The management of this study considers that the relationship between the family and care-dependent persons does not take place in a single or homogeneous way, since it derives from a lot of social elements, economic, cultural, demographic and biological elements, based on the social and cultural historicity of its actual construction. These elements configure the objective and subjective conditions for the act of caring. The presence of the State is predominant, since it is responsible for guaranteeing the society's standards of civility, and the establishment of a relationship between the State and the family, based essentially on complementarity, not on the substitution of one or the other. Little submission of the family to the state. In order to identify the interfaces of protection and social deprotection in this process, the family's protective capacity, composed by the assessment of the objective conditions of the families, living territories and social ties, was used as the matrix. The qualitative research had as a locus the Home Care Service of the municipality of São Bernardo do Campo, called PID SBC and carried out the study of multiple cases through a home visit and interview. The complexity of the reality confronted by the families in care and, insofar as their protective capacity is concerned, reveals that the interactions between territory, links and objective conditions may reveal a tendency of the triangular relationship to present itself with more than one dependence be faced. The first one is due to the imperative biological condition of those who are ill, and the second concerns the social violations that the family caregivers are subjected to in this process / Este estudo se dedica ao exame da relação triangular entre o sujeito enfermo – aqui um dependente de cuidados múltiplos –, a atenção domiciliar e a atenção familiar. Considera-se que a relação da família com pessoas dependentes de cuidados não se concretiza de modo único ou homogêneo, pois decorre de vários elementos sociais, econômicos, culturais, demográficos e biológicos, tendo por base e premissa a historicidade social e cultural de sua construção real. Tais elementos configuram as condições objetivas e subjetivas para o ato de cuidar. Tem-se como preponderante a presença do Estado, visto que é o responsável por garantir padrões de civilidade da sociedade, e o estabelecimento de uma relação entre Estado e família fundamentalmente de complementariedade, não de substituição de um ou de outro, tampouco de submissão da família para com o Estado. Para a identificação das interfaces de proteção e desproteção social nesse processo, utilizou-se como matriz de análise a capacidade protetiva da família, composta pela apuração das condições objetivas das famílias, dos territórios de vivência e dos vínculos sociais. A pesquisa de caráter qualitativo teve como locus o Serviço de Atenção Domiciliar do município de São Bernardo do Campo, denominado PID SBC, e realizou o estudo de casos múltiplos, através de visita domiciliar e entrevista. Constata-se a complexidade da realidade enfrentada pelas famílias em atendimento e, no que tange à sua capacidade protetiva, verifica-se nas interações entre território, vínculos e condições objetivas tendência de a relação triangular apresentar-se com mais de uma dependência a ser enfrentada. A primeira pela imperativa condição biológica de quem é enfermo, e a segunda diz respeito às violações sociais a que são submetidos os cuidadores familiares nesse processo

This study is a Time 4 (T4) follow-up interview of ninety-three caregivers of persons who experienced a first stroke between 2 to 4 years (mean = 36 months) prior to the T4 interview. The first wave of data collection occurred within two months after the stroke. The second and third waves occurred six and twelve months, respectively, after the first interview. The caregivers were identified by the person with stroke as being the person closest to him/her who would be responsible for care after the stroke. Data were gathered at all four interviews using reliable and valid measures for depressive symptomatology (CES-D; Radloff, 1977), psychological well-being (IPWB; Berkman, 1971), and caregiver burden (Zarit, 1980). The contribution of social support to caregiver well-being was also investigated. Additional areas of investigation at T4 included coping strategies (F-Copes; McCubbin, Larsen, and Olson, 1981), caregiver adjustment, and the respondents' perception of themselves as "caregivers". The mean scores of depressive symptomatology, perceived burden, negative well-being, and positive well-being did not change significantly over the four points in time. However, the percentage of the sample having CES-D levels of 16 and above (indicating potential diagnosis of clinical depression) decreased by ten percent between T1 and T4. About ten percent of the respondents who were at risk for clinical depression at T4 reported high levels of depressive symptoms at all four interviews. Respondents who specifically thought of themselves as "caregivers" (sixty-two percent) were significantly more likely to report high levels of depressive symptoms, to experience high levels of strain and caregiver burden, and to be caring for persons who were more severely impaired by the stroke than those who did not. Caregiver characteristics contributed more to the variance in depressive symptoms and psychological well-being than did characteristics of the stroke. However, depressive symptomatology and perceived burden were significantly associated with both the functional capacity of the person with stroke and with an index of stroke severity comprised of communication impairments and negative personality/behavior changes since the stroke. The findings from this study have implications for stroke management programs, caregiver intervention planning, and health care policy.

Aquesta tesi planteja la vivència de persones afectades de Fibromiàlgia, malaltia crònica de difícil maneig clínic, des d’una perspectiva Infermera i adoptant la investigació qualitativa com a paradigma d’investigació, fent un disseny d’etnografia enfocada. S’ha fet Observació Participant (OP) a contextos clínics i contextos socials i s’han fet un total de 18 Entrevistes en Profunditat Obertes (EPO) a homes i a dones amb FM, a familiars, a polítics i a professionals. L’objectiu general de l’estudi és indagar en els significats de l’experiència viscuda al voltant del diagnòstic i les perspectives de vida de persones amb FM, amb la finalitat d'elaborar estratègies per a una millor cura infermera. L’anàlisi interpretatiu i simultani al marc teòric i treball de camp ha estat dinàmic i complex, adoptant ulleres infermeres graduades amb els models de Merle Mishel i Boykin i Shoenhofer, entre d’altres, i partint de les narratives i notes de camp, ens permeten la mirada Infermera en una malaltia crònica que genera dolor i malestar en els diferents espais i contextos de vida. Com a conclusions remarcar el trencament vital que suposa, per a les persones afectades i el seu entorn, la malaltia, tot i que aconsegueixen valorar l’experiència vital amb pèrdues i guanys, pèrdues per a la dificultat en el dia a dia per a homes i dones, en les tasques de la llar, la vida en família i de parella, el treball i les relacions socials; guanys en la presa de consciència de qui són, del que tenen, del nou valor que atorguen a cada moment, a les relacions familiars i amistats, a la possibilitat que han tingut de fer coses que d’altra manera no hagueren fet. Es percep malestar, frustració i conflictes en les relacions de cura i tractament. L’associacionisme és valorat, tot i que hi ha qui prefereix desenvolupar-se en altres contextos, es parla que a les associacions hi podrien participar professionals amb una actitud desinteressada. El diagnòstic diferencial, un tractament individualitzat i unes cures infermeres professionals esdevenen essencials per a una adaptació harmònica. El tractament es fa segons prescripció mèdica i hi ha forta adherència. Mostren un fort interès per mantenir-se actives i només el cansament i el dolor les fan desistir en les activitats tant personals i de lleure com socials i de treball. El temps es viu de manera particular i es pensa poc en el futur. Pel que fa a aportacions d’aquesta investigació podem parlar de la mirada global i complexa que fa de la vivència de la FM; el constatar que les persones afectades mostren un gran interès per ser protagonistes de les seves vides i mantenir-se actives en els diferents àmbits, també en el laboral; dir que les infermeres hi són poc visibles i, quan hi són, estan representades per un rol delegat i tradicional, manifestant que una atenció infermera centrada en els significats de l’experiència, i que utilitza la narrativa, va més enllà de la patologia i afavoreix que la persona cuidada esdevingui protagonista de la seva vida com és el desig que manifesten. Pel que fa als professionals mèdics representen els més visibles del sistema salut. El col•lectiu afectat diu que els necessita, i diferencia aquells que els comprenen i ajuden d’aquells que els desqualifiquen; el col•lectiu de persones afectades te la percepció que quan es cataloga algú de FM qualsevol queixa s’associa a la malaltia, podent passar desapercebudes altres alteracions senzilles o greus; les associacions cobreixen necessitats específiques que les administracions obliden, es planteja la possibilitat de participació professional sempre i quan tinguin una actitud de servei desinteressada, mostren una forta consciència de temporalitat, es gaudeix de les coses petites i dels moments sense crisis i es pensa poc en el futur. Pel que fa a propostes adoptar models infermers centrats en la persona que rep els cuidatges, contemplar la narrativa com instrument per a la coneixença de l’altra i els fenòmens al voltant de la salut i la vida, treballar de manera inter-poli-trans-disciplinar contemplant un diàleg fluït i incorporar el compromís social i polític en la salvaguarda de les necessitats globals de salut. / "The meanings of the experience of people with fibromyalgia. A view from the nursing" This thesis presents the experiences of people suffering from fibromyalgia, chronic disease management of difficult clinical nurse perspective and adopting qualitative research as a research paradigm, with a design focused ethnography. Participant observation has been made (OP) in clinical contexts and social contexts and have a total of 18 in-depth interviews Open (EPO) in men and women with FM, relatives, politicians and professionals. The overall objective of the study is to investigate the meanings of lived experience about diagnosis and life prospects of people with FM, in order to develop strategies for better care nurse. The interpretive analysis and simultaneous theoretical and field work has been dynamic and complex, taking prescription glasses with nurses models and Merle Mishel and Shoenhofer Boykin, among others, and considering the narratives and field notes, we Nurse can look into a chronic disease that creates pain and discomfort in different spaces and contexts of life. In summary noted that the break is vital for the affected people and the environment, disease, although able to assess life experience gains and losses, losses due to the difficulty in every day for men and women in the household chores, family life and marital, work and social relations gains in awareness of who they are, what they have, the new value assigned to each point, the family and friends, who have had the possibility to do things you would not otherwise have made. Perceived discomfort, frustration and conflicts in care and treatment. The association is valued, although some people prefer to develop in other contexts, there is talk that it could participate in professional associations with a selfless attitude. The differential diagnosis, individualized treatment and a professional nursing care becomes essential for a harmonious adaptation. The treatment is carried out under medical prescription and there is strong adhesion. Show a strong interest in staying active and just tiredness and pain make them desist in both personal and leisure activities, social or labor. Weather you live in a particular way and think little of the future. Regarding contributions of this research we can speak of global and complex look that makes the experience of FM; establish that the affected people show great interest in becoming protagonists of their lives and remain active in various fields, including the labor nurses say there are barely visible, and when there are, are represented by a traditional CEO role, saying that attention focused on the meanings of nursing experience, and uses narrative goes beyond the pathology and favors the person cared become the protagonist of his life and the desire to manifest. With regard to medical professionals representing the most visible health system. The group affected says it needs, unlike those who understand and help those who are disqualified, the collective has affected the perception that when someone is cataloged FM complaints associated with the disease , simple changes can go unnoticed or other serious; associations covering specific needs that government neglect, raises the possibility of professional participation provided they have an attitude of selfless service shows a strong awareness of temporality, enjoying the small things and moments of crisis and without little thought for the future. Regarding proposals to adopt models nurses focused on the person receiving the Caring contemplate narrative as an instrument for the knowledge of the other and the phenomena around health and life, to work inter-poly-trans looking-disciplinary dialogue seamlessly incorporate social and political commitment to safeguard global health needs.

Students¡¦ life counseling and guidance has always been the center in student affairs, and life education stands out in school education work. The main goals of students¡¦ life counseling and guidance include cultivating students¡¦ adapting abilities in life and healthy characters. Students are expected to have high self-esteem and autonomous attitude, and hence can be law-abiding, responsible, caring for life, and contributing to the society. In the recent years, however, the social environment has been changing rapidly, and so has the school campus which has always been regarded as a relatively stable organization. Many school incidents can be heard constantly and the previously warm, harmonious and peaceful campus is no more what it used to be. Therefore it has become a crucial issue to make a balance between an open, democratic campus and the securing of campus ethics, cultural passing, and campus security. The military training system is currently gradually transforming into a new style based on ¡§guiding service¡¨ idea. This study is aimed to explore the effects of this new style, meanwhile taking care of campus democracy, openness, ethics, and security, on students¡¦ life counseling and guidance and how students perceive it. The participants in this study are students from three private technological colleges: Chung Hwa University of Medical Technology (CUMT), Diwan University (DU), and Shu Zen College of Medicine and Management (SZMM). After research into related literature and deep investigation in the current military training system in life counseling and guidance, a questionnaire is made to understand how students perceive the military science officers conducting behavioral guidance, maintaining campus security, dealing with contingency, and taking care of sick or injured students. Besides, students¡¦ perceptions are also analyzed in quantitative data to see the differences and relations in terms of their different backgrounds. The following are the findings of this study: 1. Students in general expressed high approval in the four aspects: conducting behavioral guidance, maintaining campus security, dealing with contingency, and taking care of sick or injured students. 2. Students in CUMT showed higher approval in the aspect of conducting behavioral guidance and maintaining campus security than those in DU. Students in SZMM showed higher approval in maintaining campus security than those in DU. 3. Students in the third and fourth year showed higher approval in maintaining campus security, dealing with contingency, and taking care of sick or injured students than those in the first or second year. Those with higher family income also showed higher approval than those with lower family income According to the research findings, this study also provides practical suggestions as reference for related education authorities, military science officers and future researchers. 1. Students¡¦ life counseling and guidance in private technological colleges should focus on ¡§maintaining campus security.¡¨ a. Strengthen security management in selected areas in open campus. b. Crack down on those violating the rule: ¡§riding with a helmet¡¨ out of campus and highlight its importance on campus. c. Keep improving the serving quality in the four aspects: conducting behavioral guidance, maintaining campus security, dealing with contingency, and taking care of sick or injured students. 2. ¡§Good deeds can offset the wrongdoing¡¨ concept should be incorporated into ¡§moral teaching program.¡¨ 3. General education or military science should be incorporated into ¡§contingency management¡¨ instruction and practices. 4. School should set up a joint unit to serve the sick or injured students. Keywords: military training system, military science officer, students¡¦ life counseling and guidance, behavioral guidance, maintaining campus security, contingency management, taking care of the sick and injured students

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

Thesis (M.S.)--Florida State University, 2005. / Advisor: Sandra Faria, Florida State University, School of Nursing. Title and description from dissertation home page (viewed Feb.1, 2006). Document formatted into pages; contains x, 133 pages. Includes bibliographical references.