Thesis (Ph.D.)--Kent State University, 2008. / Title from PDF t.p. (viewed Oct. 29, 2009). Advisor: Donna S. Martsolf. Keywords: Organizational culture; Clinical pathway; Ethnography; Thailand; Conscientiousness. Includes bibliographical references (p. 133-140).

Thesis (M.S.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains x, 108 p. : ill. (some col.), maps. Vita. Includes abstract. Includes bibliographical references (p. 71-73).

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background South Africa is burdened by consistently high maternal and perinatal mortality rates. In a move to alleviate this burden the South African National Department of Health (DoH) instructed the adoption of the Basic Antenatal Care (BANC) approach in all antenatal care (ANC) facilities. Whereas many facilities have begun the implementation of the BANC approach, in the eThekwini district, not all of the facilities have been successful in doing so. The study was conducted in those eThekwini Municipality Primary Health Care (PHC) facilities that have been successful in order to identify the factors influencing their success in implementing BANC. Methods The facilities that had been successful in implementing BANC were identified, followed by a review of the past records of the patients who had completed their ANC and had given birth. This was done in order to establish whether the facilities that were said to be implementing BANC, were in fact, following BANC guidelines. The factors that influenced successful implementation of BANC were identified based on information obtained from the midwives who were working in the ANC facilities that were successfully implementing BANC. The sample size was comprised of 18 PHC facilities that were successfully implementing BANC from which a total of 59 midwives were used as the study participants. Results Several positive factors that influenced successful implementation of BANC were identified. These factors included; availability and accessibility of BANC services: Policies, Guidelines and Protocol; various means of communication; a comprehensive iii package of services and the integration of services; training and in-service education; human and material resources and the support and supervision offered to the midwives by the PHC supervisors. Other factors included BANC programme supervisors’ understanding of the programme and the levels of experience of midwives involved in implementation of BANC. There were, however, certain challenges and negative factors that were identified and these included: shortage of staff; lack of cooperation from referral hospitals; lack of in-service training; problems in transporting specimens to the laboratory; lack of material resources; lack of management support and the unavailability of BANC guidelines.

Objectives 1. To determine drug misusers' views about their primary health care and their relationship with general practitioners. 2. To undertake a controlled evaluation of small group education of general practitioners in the management of drug misusers. Method 1. Drug misusers attending five treatment services in north east London - a general practice with a special interest in managing drug misuse; a private drug clinic; a community drug team; a drug dependence unit and a street agency - were interviewed using a semi-structured interview and the Social Functioning Questionnaire. 2. All general practitioners who practised within the former North East Thames Regional Health Authority were approached to take part in small group teaching about drug misuse. This was conducted over two consecutive afternoons in a general practice, with four follow-up seminars. The trained doctors were compared with two groups of untrained general practitioners. Outcome measures included: Drug Training Questionnaire responses at the outset and 9 months after training; evaluation of the training appraised on a ten point Likert scale; Home Office Addicts Index and North Thames Regional Drug Misuse Database figures for notification of newly presenting subjects, for each of the three groups of general practitioners, 8 months prior to training and 8 and 16 months after training. Results Ninety percent of the drug misusers were registered with a non-specialist general practitioner and 88% of these doctors were aware of their patients' drug use. Half of the non-specialist general practitioners aware of their patient's drug use were reported as prescribing substitute medication. Sixty percent of misusers attending the non-specialist doctors perceived their general practitioners to hold negative or neutral views about them. Doctors in the specialist general practice were more likely to prescribe, compared to the other four centres, and 97% of their patients believed these doctors had a positive view of drug misusers. The specialist general practice was more active in providing counselling and/or education about drug misuse. 2. Forty doctors attended the teaching programme. Twenty-eight doctors comprised comparison group one (interested but unable to attend the teaching) and 30 formed comparison group two(not interested in training but completed questionnaires). The about to be trained group were seeing and treating more drug misusers compared to the comparison groups. The overall ratings for the teaching programme were high (7.9 for usefulness and 8.0 for interest - maximum score 10). Doctors in the trained group were found to be notifying significantly more drug misusers to the Home Office and prescribing methadone more frequent1y 16 months after the teaching, than doctors in the comparison groups. Over 9 months, the Drug Training Questionnaires demonstrated no significant changes. The cost of the course per doctor was £127. Conclusions 1. The majority of drug misusers attending treatment centres are registered with general practitioners and regarded them as an important health resource in managing both their drug use and wider medical issues, despite the reluctance of non-specialist general practitioners to be involved in prescribing and a high prevalence of unfavourable attitudes towards drug misusers. 2. The participating doctors assessed the teaching programme positively and it was relatively cheap to run. The self-report questionnaires as a single determinant of outcome revealed no significant change in attitudes, knowledge or behaviour but when assessed by more objective means, demonstrated a rise in notification rates and methadone prescribing by the trained doctors.

Thesis (MNursing (Advanced Practice))--University of South Australia, 1996

Thesis (Ph.D.)--Ohio University, August, 2005. / Includes bibliographical references (leaves 145-152)

Thesis (M.S.)--Boston University

D.Cur. / It was established during research that I have done for my master’s degree that therapists experience secondary traumatisation in a specific private psychiatric clinic when they listen to the trauma filled stories of their clients. This often led to the therapist’s personal and professional disintegration. The main purpose of this research was to describe, operationalise and evaluate a model for the advanced psychiatric nurse practitioner to facilitate the mental health of therapists who experience secondary traumatisation in a specific private psychiatric clinic in South Africa. I used a qualitative, descriptive, contextual and theory-generating research design to achieve the above purpose. The development of the model consisted of four steps. Step one consisted of concept analysis that included the identification, classification and defining of the central, essential and relational concepts in the model. During concept analysis, facilitation of wholeness was identified as the most relevant concept for the model instead of mental health. It was evident that personal disintegration became the specified concept and focussed aspect in terms of secondary traumatisation in this research project. Step two consisted of a description of how the identified and defined central concepts interrelate with each other as part of the model. During step three, the model to facilitate wholeness in therapists with personal disintegration due to secondary traumatisation in a specific private psychiatric clinic was described. The structure of the model was described in terms of its purpose, assumptions and context. Definitions of the central concepts, as well as the relationship statements between the central and essential concepts, were described. The structure of the model was also described in terms of a visual representation that included the dynamic and interactive narrative process of deconstruction, choosing of alternatives and celebration.

This thesis is an ethnographic account of the daily life of an outpatient centre for the treatment of non-psychotic patients. The centre is located in a university setting and is nominally attached to a university mental hospital. The setting is described and the case is made that it normally allows for only two categories of participant: patients and therapists. The situated activity of these two groups in structuring the setting is a major focus of the work. The roles embodied in the two categories are described in detail and the way in which these roles interlock to create the social reality that is understood by the participants as a "therapeutic community" is set out. A belief system which is embedded in, and a determinant of each role is proposed. The practice of "doing therapy" is described and a preliminary formulation of this practice as a situated activity which depends on the social structure of the setting is attempted. A section which describes the observer's experiences in the setting is included as an appendix. It is argued that because the setting allows for only two classes of participant, the observer role is seen as deviant and that this leads to mistrust on the part of both sets of participants. / Arts, Faculty of / Anthropology, Department of / Graduate

MPH (Occupational Hygiene), Faculty of Health Sciences, University of the Witwatersrand, 2009 / The study of medical waste management practices in Ekurhuleni Metropolitan Municipality clinics in South Africa took place in the absence of the relevant parliamentary law governing such waste, but governed by the final published Gauteng Health Care Waste Management Regulations 3003 of 2003. In accordance with the Gauteng Health Care Waste Management Regulations 303 of 2003, Medical Waste Management Practices are such that where medical waste is generated, it should be segregated at the point of generation, be properly containerised, labelled, stored, treated and finally be disposed of. The researcher studied 29 out of 112 clinics in Ekurhuleni Metropolitan Municipality on whether medical waste management practices in these clinics comply with the Gauteng Health Care Waste Management Regulations 3003 of 2003. The study also intended to help practising and managing nurses to reduce occupational health risks, while further increasing the safety of clinic service users from unforeseen infections by communicable diseases. Materials and methods The study followed a cross-sectional descriptive survey method wherein data acquisition was by means of interviewing clinic managers with regard to medical waste management iii practices in their clinics using a structured questionnaire; and by observations of medical waste management practices through a walkthrough survey checklist. The study sample composed of 30 clinics selected from a total of 112 clinics, where a total population of 7 maternity and 23 day clinics were included through random selection. A response rate of 29 out of 30 clinics selected was obtained. The interview questionnaire consisted of six dimensions of measurement of medical waste management practices, while the walkthrough survey checklist consisted of twenty six items measuring medical waste management practices. Both were developed in line with the stipulations of the Gauteng Health Care Waste Management Regulations 3003 of 2003. A pilot study was conducted to further refine the contents of the above two measuring tools. The study setting comprised individual sections of each clinic such as primary health care, maternity, HIV/AIDS, mental health, antenatal care, family planning and the communicable diseases section, wherein a nurse is assigned per shift to examine patients and to administer injections and medicines. Observations were done on all medical waste management practices in the examination rooms of all sections of the clinics in order to carefully record both negative and positive practices. Such observations made followed the required medical waste management process as per the Gauteng Health Care Waste Management Regulations 3003 of 2003. iv Results The operations of Ekurhuleni municipal clinics revealed a 67 percent (4 out of 6 required documentation) non-existence of the required documentations, predominantly in the areas of medical waste policy; written safe work procedures; a training programme; and conducting of risk assessments. Specifically, The majority (65.5%) of clinics in Ekurhuleni Metropolitan Municipality have no medical waste management policy. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality have no safe work procedures. The majority (93%) of clinics in Ekurhuleni Metropolitan Municipality have no waste management training programme. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality do not conduct risk assessment for their operations. Of the 26 medical waste management practices observed, positive medical waste management practices were observed in 46 percent of the observations compared to 50 percent of negative observations, made in operating conditions of clinics. Discussion The findings of the study revealed a high degree of non-compliance of Ekurhuleni Metropolitan Municipality with the Gauteng Health Care Waste Management Regulations v 3003 of 2003 with regard to the required documents and the acceptable observed practices. Conclusions Medical waste management training in Ekurhuleni Metropolitan Municipality does not happen due to both the lack of policy documents and budgetary problems. Health care workers are exposed to both ergonomic and biological hazards due to a lack of proper medical waste storage, storage signage and incorrect handling of medical waste. No medical waste management audits and risk assessments are conducted in Ekurhuleni Metropolitan Municipality clinics. Non accountability over disposal of medical waste may promote illegal dumping of medical waste generated from Ekurhuleni municipal clinics. Recommendations Managers of clinics in Ekurhuleni Metropolitan Municipality need to be informed of the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003. Based on the developed policies, clinic managers need to develop medical waste management training programmes wherein the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003 will be incorporated. Designated medical waste management storage facilities to be provided for all Ekurhuleni Metropolitan Municipality clinics. vi Clinic management and appointed medical waste management officers to ensure that medical waste management audits and risk assessments are conducted and that corrective measures are implemented in Ekurhuleni Metropolitan Municipality clinics.