The study aimed to explore and describe factors which impacted on the satisfaction of patients using the curative component of primary health care in the Ekurhuleni Metropolitan area. A qualitative, explorative and contextual design was followed in this study. Focus group interviews were used to collect data from clients, nurse clinicians and community health committee members. Findings indicated that there was lack of facilities, resources and supplies, lack of safety and security measures, negative attitudes of nurse clinicians, lack of community involvement and lack of clinic management involvement. Suggestions were made by the groups on how to improve the curative primary health care service and intervention strategies were identified from the suggestions made. The implementation of these strategies will help with the improvement of the service delivery at the clinic for primary health care. / Health Studies / (M.A. (Health Studies)

Les banques de données recueillant systématiquement des données-cibles sur leur clientèle permettent de décrire celle-ci, ses besoins et de répondre à plusieurs questions de recherche clinique. Un projet pilote pour déterminer la faisabilité d’un tel système a lieu à la Clinique universitaire de psychologie de l’Université de Montréal (CUP). Sous un angle qualitatif inductif inspiré de la phénoménologie descriptive de Husserl, la présente étude vise à décrire les répercussions potentielles et les impressions des cliniciens quant à l’implantation de cette procédure. Des entretiens individuels semi-directifs ont été effectués en télépratique avec 14 cliniciens volontaires en utilisant un canevas d’entrevue. Des considérations concernant cinq thèmes centraux ont émergées des analyses : les obstacles à l’implantation, les impacts potentiels sur la thérapie, certaines recommandations pour améliorer la participation, l’utilité perçue et une attitude d’ouverture. La consultation des cliniciens s’avère une caractéristique essentielle dans l’élaboration de l’implantation. Les implications cliniques et des pistes d’amélioration sont discutées. / Databases that systematically collect key data on their clientele make it possible to describe who consults, their needs and allow to answer several clinical research questions. A pilot project to determine the feasibility of such a data-collecting procedure is taking place at the University of Montreal’s Psychology Clinic (CUP). Using a qualitative inductive approach inspired by Husserl's descriptive phenomenology, the study aims to describe the potential impact and clinicians’ impressions of the implementation of this procedure. Semi-structured individual interviews were conducted with 14 volunteer clinicians using an interview outline. Five central themes emerged from the analyses: barriers to implementation, potential impacts on therapy, recommendations for improving participation, perceived usefulness, and an open attitude. Consultations with clinicians was an essential feature in the development of the implementation. Clinical implications and avenues for improvement are discussed.

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Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Introdução: Esse estudo investigou a violência de gênero contra mulheres profissionais de enfermagem perpetrada por parceiros íntimos (VPI), familiares e outros agressores. Objetivos: Estimar a ocorrência de violência psicológica, física, sexual; caracterizar os agressores, a busca de ajuda e locais procurados; analisar as diferenças entre enfermeiras e auxiliares/técnicas de enfermagem quanto à freqüência da violência de gênero e verificar a nomeação de violência aos atos de agressão identificados. Métodos: Nesse estudo transversal foram entrevistadas 179 profissionais de 20 a 59 anos (50 enfermeiras e 129 auxiliares/técnicas de enfermagem), utilizando-se um questionário validado e aplicado face a face por entrevistadoras treinadas. Resultados: A VPI foi a mais freqüente (63,7%; IC95%:55,7-70,4) seguida pela violência por outros (45,8%; IC95%:38,3-53,4) perpetrada por pacientes/acompanhantes, colegas de trabalho da área da saúde, estranhos, chefia de enfermagem e conhecidos. A violência por familiares ocupou o terceiro lugar (41,3%; IC95%: 34,0-48,9) e foi cometida, principalmente, por pai, irmãos (homens), tios e primos. Houve importante sobreposição dos tipos de VPI, sendo a forma exclusiva de violência psicológica a mais comum (19,2%), seguida pelas três formas (17,5%) e violência psicológica conjugada à física (14,7%). Auxiliares/técnicas de enfermagem referiram mais VPI que enfermeiras (p<0,05). As profissionais de enfermagem, de forma geral, buscaram pouca ajuda: 20,3% para a violência por outros, 29,3% para a violência por familiares e 29,7% para a VPI. Não perceberam o vivido como violento, 31,9% das entrevistadas. Conclusões: Os elevados índices de violência de gênero identificados evidenciam a presença dessa forma de violência também entre mulheres profissionais de saúde de alta escolaridade. Propõe-se que essa temática seja foco de atenção das equipes supervisoras nos locais de trabalho, através de uma abordagem acolhedora e ética. Sugere-se que o tema seja abordado para a proteção da saúde das profissionais e para uma melhor prática assistencial. / Background: This study investigated gender violence against female nursing staff perpetrated by male intimate partners (IPV), family members and other aggressors. Objectives: To estimate the occurrence of psychological, physical and sexual violence; characterize the aggressors, as well as the attempt to seek help and where it was sought; analyze the differences between nurses and nursing aides/technicians as to the frequency of gender violence and to verify if the acts of aggression are designated as violence. Methods: In this cross sectional study, 179 professionals, aged 20 to 59 years old, were interviewed (50 nurses and 129 nursing aides / nurse technicians). A validated questionnaire was applied in face to face interviews conducted by trained interviewers. Results: IPV was the most frequent form of violence (63.7%; IC95%:55.7-70.4), followed by violence perpetrated by others (45.8% IC95%: 38.3-53.4) including patients and people accompanying them, colleagues within the field of health, chiefs of the nursing staffs, acquaintances and strangers. Family members occupied the third place as aggressors, (41.3%; IC95%:34.0-48.9), and the majority of these were fathers, brothers, uncles and cousins. There was an important amount of overlap of the types of IPV, being that the most common exclusive form was psychological violence (19.2%), followed by psychological, physical and sexual violence in conjunction (17.5%) and then by both psychological and physical violence (14.7%). Nursing aides/ technicians mentioned the occurrence of IPV more frequently than did the nurses (p<0.05). In general, the nursing staff did not seek help frequently: only 20.3% of those who suffered violence from other aggressors, 29.3% from family members and 29.7% from IPV sought help. Those who did not perceive their experience as a form of violence represented 31.9% of the subjects interviewed. Conclusions: The high rates of gender violence identified in this study are evidence of the occurrence of this form of violence among female health professionals with high levels of education. It is suggested that team supervisors be encouraged to focus on this theme in the workplace, addressing it by means of an ethical and supportive approach. By contributing towards the protection of health professional\'s well being, this could also help improve the quality of assistance for which they are responsible.

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.

Introdução: Esse estudo investigou a violência de gênero contra mulheres profissionais de enfermagem perpetrada por parceiros íntimos (VPI), familiares e outros agressores. Objetivos: Estimar a ocorrência de violência psicológica, física, sexual; caracterizar os agressores, a busca de ajuda e locais procurados; analisar as diferenças entre enfermeiras e auxiliares/técnicas de enfermagem quanto à freqüência da violência de gênero e verificar a nomeação de violência aos atos de agressão identificados. Métodos: Nesse estudo transversal foram entrevistadas 179 profissionais de 20 a 59 anos (50 enfermeiras e 129 auxiliares/técnicas de enfermagem), utilizando-se um questionário validado e aplicado face a face por entrevistadoras treinadas. Resultados: A VPI foi a mais freqüente (63,7%; IC95%:55,7-70,4) seguida pela violência por outros (45,8%; IC95%:38,3-53,4) perpetrada por pacientes/acompanhantes, colegas de trabalho da área da saúde, estranhos, chefia de enfermagem e conhecidos. A violência por familiares ocupou o terceiro lugar (41,3%; IC95%: 34,0-48,9) e foi cometida, principalmente, por pai, irmãos (homens), tios e primos. Houve importante sobreposição dos tipos de VPI, sendo a forma exclusiva de violência psicológica a mais comum (19,2%), seguida pelas três formas (17,5%) e violência psicológica conjugada à física (14,7%). Auxiliares/técnicas de enfermagem referiram mais VPI que enfermeiras (p<0,05). As profissionais de enfermagem, de forma geral, buscaram pouca ajuda: 20,3% para a violência por outros, 29,3% para a violência por familiares e 29,7% para a VPI. Não perceberam o vivido como violento, 31,9% das entrevistadas. Conclusões: Os elevados índices de violência de gênero identificados evidenciam a presença dessa forma de violência também entre mulheres profissionais de saúde de alta escolaridade. Propõe-se que essa temática seja foco de atenção das equipes supervisoras nos locais de trabalho, através de uma abordagem acolhedora e ética. Sugere-se que o tema seja abordado para a proteção da saúde das profissionais e para uma melhor prática assistencial. / Background: This study investigated gender violence against female nursing staff perpetrated by male intimate partners (IPV), family members and other aggressors. Objectives: To estimate the occurrence of psychological, physical and sexual violence; characterize the aggressors, as well as the attempt to seek help and where it was sought; analyze the differences between nurses and nursing aides/technicians as to the frequency of gender violence and to verify if the acts of aggression are designated as violence. Methods: In this cross sectional study, 179 professionals, aged 20 to 59 years old, were interviewed (50 nurses and 129 nursing aides / nurse technicians). A validated questionnaire was applied in face to face interviews conducted by trained interviewers. Results: IPV was the most frequent form of violence (63.7%; IC95%:55.7-70.4), followed by violence perpetrated by others (45.8% IC95%: 38.3-53.4) including patients and people accompanying them, colleagues within the field of health, chiefs of the nursing staffs, acquaintances and strangers. Family members occupied the third place as aggressors, (41.3%; IC95%:34.0-48.9), and the majority of these were fathers, brothers, uncles and cousins. There was an important amount of overlap of the types of IPV, being that the most common exclusive form was psychological violence (19.2%), followed by psychological, physical and sexual violence in conjunction (17.5%) and then by both psychological and physical violence (14.7%). Nursing aides/ technicians mentioned the occurrence of IPV more frequently than did the nurses (p<0.05). In general, the nursing staff did not seek help frequently: only 20.3% of those who suffered violence from other aggressors, 29.3% from family members and 29.7% from IPV sought help. Those who did not perceive their experience as a form of violence represented 31.9% of the subjects interviewed. Conclusions: The high rates of gender violence identified in this study are evidence of the occurrence of this form of violence among female health professionals with high levels of education. It is suggested that team supervisors be encouraged to focus on this theme in the workplace, addressing it by means of an ethical and supportive approach. By contributing towards the protection of health professional\'s well being, this could also help improve the quality of assistance for which they are responsible.

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)