<p>Birth doulas help women plan for and carry out the most &ldquo;satisfactory birth&rdquo; possible. The purpose of this study was to explore the roles of privately hired doulas serving women in the St. Louis and St. Louis Metro East region and their influence on patient-provider interactions before, during, and after childbirth, within the framework of patient-centered communication. This study is based on in-depth interviews with six doulas offering support to childbearing women giving birth at hospitals. The findings of this study suggest that doulas believe they enhance communication between patients and their providers, by taking on the roles of advocates and liaisons. Aspects of the training and scope of practice of participant doulas, the type of clients seeking their services and their motivations, as well as common misconceptions and challenges arising when communicating with clients and providers, are also discussed. </p><p> <i>Keywords</i>: doulas, patient-provider communication, patient-centered communication, childbirth, decision-making, advocacy </p>

<p> In the U. S. approximately 795,000 people experience a new or recurrent stroke yearly. Stroke survival has increased with advances in medical technology. The impact of stroke on a patient&rsquo;s neurological status poses critical challenges for nurses. Communication is one area impacted by stroke. Strokes affecting the brain&rsquo;s right hemisphere (RHS) have been described in the literature as negatively impacting communication behaviors of patients, often in a subtle manner. The purpose of this exploratory descriptive study was to examine the knowledge that RNs in North Carolina possess about communication impairments associated with RHS and how these nurses anticipate using knowledge gained about these impairments in the care of these patients. The study also explored perceived barriers and facilitators to participating in continuing education about RHS associated communication impairments. </p><p> The RHS Communication Impairment Knowledge Assessment tool assessed demographic variables, knowledge of RHS associated communication impairments, perceived barriers and facilitators to participating in continuing education about communication clusters associated with RHS, as well as how nurses anticipate using education about these impairments in caring for patients following RHS. The study setting was North Carolina. A purposive sample of North Carolina RNs was contacted through email; and a sample size of 2495 was recruited. The study was guided conceptually by Ajzen&rsquo;s theory of planned behavior. </p><p> Results indicated that a large percentage (78.2%) had received education about RHS associated communication impairments in their undergraduate nursing programs. The mean score on the 12-item knowledge assessment was 6.15 with less than 50% answering 3 specific application of knowledge questions correctly. The KR-20 for these 12 items was 0.532 which is an acceptable KR-20 for short tests (10&ndash;15 items). Cost of continuing education courses (23.5%), work responsibilities (32.9%), and family responsibilities (23.7%) were infrequently reported as barriers to participating in continuing education about these communication impairments while identified education need (87.1%), interest in learning (72.2%), providing better patient care (89.3%), improved decision making (87%), and increased competency (71.4%) were all frequently reported as facilitators to participating in RHS communication cluster continuing education. Three themes emerged regarding how RNs would use knowledge gained to change their patient care. These themes were: awareness of the need for education, improved nursing management of patients, including patient teaching and critical thinking, and better communication with survivors of RHS. The research contributed to the current body of nursing science by identifying knowledge gaps of NC RNs on RHS associated communication impairments, barriers and facilitators to participation in RHS continuing education, and intended changes in care based on continuing education.</p><p>

<p> When the HITECH Act of 2009 set mandates for the transition from paper to electronic health records (EHRs), few realized the far-reaching impact this technological change would have on the entire healthcare environment. This dissertation examines the many facets of this adoption process by exploring perceptions, responses, and reactions of physicians and patients alike as they navigate through this transformative &ldquo;medicological environment.&rdquo; Characterized by influences from legal, political, governmental, medical, social, geographical, economic, and technological factors, this multi-faceted space reveals how a new medium for communication&mdash;the electronic message within secured health portals&mdash;transforms the way in which healthcare is managed and utilized today. </p><p> Multiple methods of observation, including oral histories, surveys, critical incident reports, and content analyses of data mined messages, together reveal the many challenges faced by patients and healthcare professionals alike as they attempt to adapt to this change while still maintaining (or improving upon) primary healthcare needs. As demonstrated by the varied responses from those living in rural and urban areas, it was found that each population approached the transition process from different vantage points. The early-adopting, urban physicians provided patient online communication simply because they felt patients expected it while rural physicians tended to resist the process, arguing that patients were media illiterate, lacked Internet access, and preferred face-to-face interactions. Others cited implementation costs and personnel training issues as a deterring factor. This provides insight into how such a new medium can affect user perceptions about online healthcare, including physician availability, online relationship factors, and overall patient care. Future research suggestions include expanded content analyses of the electronic messages themselves and follow-up, longitudinal research once implementation is more widespread. </p><p> As the Institute of Medicine (2008) states, all patients have the right to varied means of communicating with their physicians, including but not limited to online interactions. Evidence of a paradigmatic shift exists in physician training as well as patient expectations. The influence of online communication within secured health portals certainly has contributed towards this shift as more personalized, patient-centered care becomes a vital part of this ever-changing medicological environment.</p>

<p> This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson&rsquo;s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.</p>

<p> Medical errors cost the United States&rsquo; healthcare system approximately $19.1 billion annually. A failure to communicate or speak up is said to be a contributing factor. The purpose of this quantitative correlational study was to examine the relationship between managerial responsiveness, managerial approachability, and prosocial voice among acute-care registered nurses (RNs) from a Greater Northwest facility. The participants were 108 acute-care RNs. Instrumentation included the Supervisor as a Voice Manager developed by Saunders, Sheppard, Knight, and Roth (1992) to measure managerial responsiveness and managerial approachability. Prosocial voice was measured using Van Dyne and LePine&rsquo;s (1998) Prosocial Voice Scale. The relationship between managerial approachability and prosocial voice was positively correlated (<i>p</i> = .001). A positive relationship (<i>p</i> = 0.001) between the linear combination gender, education, years of experience within current acute-care facility, managerial responsiveness and managerial approachability and the RN&rsquo;s use of prosocial voice was found and accounted for 20.0% of the variance in the prosocial voice score. An unexpected serendipitous finding occurred when applying a backward elimination regression to three variables: managerial approachability, managerial responsiveness, and prosocial voice. RNs use of prosocial voice was positively correlated with the RN&rsquo;s level in the organization (<i>p</i> =.01), the RN&rsquo;s perception of managerial approachability (<i>p</i> = .001) while negatively correlated with the RN&rsquo;s perception of managerial responsiveness score ( <i> p</i> = .05). This research adds to current prosocial voice literature and expands the research on managerial approachability and managerial responsiveness. Future research recommendations were identified.</p>

<p> The number of those seeking a kidney donation in the United States continues to increase while the number of donors is not growing at the same rate (U.S. Department of Health and Human Services USDHHS, 2010). The lack of donations is more prevalent in low health literate communities which suffer from misinformation and ultimately negative beliefs toward organ donation. Thus, it is important to understand how marketing efforts can effectively change individuals&rsquo; beliefs about organ donation. </p><p> Drawing on the Self-Determination Theory and Schema Theory, I proposed that the effectiveness of health education programs, which is to motivate individuals to be involved with organ donation, can be increased by creating interventions that engage individuals&rsquo; senses. I used the term sensory activation to capture the number of senses being activated (visual, auditory, and kinesthetic). I proposed that sensory activation is related to message recall and motivation. According to Schema Theory, sensory cues are batches of information that can be stored in memory, thus affecting recall. The more senses involved in an experience, the more nodes of information available for recall, and the higher the likelihood that recall will affect motivation structures. Thus, I hypothesized that the relationship between sensory activation and motivation is positive, and, yet, mediated by recall. </p><p> In addition, research findings in sensory marketing suggest that the relationship between sensory strength and recall should be stronger for individuals with low, rather than high, health literacy. Low health literate individuals lack the cognitive ability to understand and interpret the information provided, hence, sensorial information allows them to recall the message. For high health literate individuals, understanding the message is relatively easier, hence, the addition of sensorial cues may lead to disinterest. That is, high health literate individuals may disregard additional sensorial information due to redundancy. Therefore, I hypothesized that the relationship between sensory activation, recall, and beliefs will be stronger for low, rather than for high, literacy individuals. </p><p> Lastly, Schema Theory suggests that individuals tend to simplify multiple information cues and form abstract knowledge structures. Instead of storing (and recalling) multiple information cues independently, individuals convert multiple pieces of information into abstract concepts. This abstraction process increases over time because it is easier to remember concepts rather than multiple batches of detailed information. Thus, I hypothesized that, in the long term, recall of specific information will be higher for individuals with high, rather than low, health literacy. High health literacy individuals can incorporate specific information into existing knowledge structures. Low health literacy individuals lack knowledge structures to further develop. Accordingly, low health literacy individuals will create an abstract representation of the experience. That is, low health literacy individuals will not remember specific information, but will remember the event in broad terms (abstractly). Consequently, overtime, the motivation will be stronger for high, rather than for low, health literacy individuals. </p><p> I tested my hypotheses by conducting a 3 (Sensory Strength: sight, sight + hearing, sight + hearing + touch) &times; 2 (Literacy: low, high), between-subjects factorial design. Sensory activation was manipulated, while health literacy was measured. I conducted the study in three phases. Phase 1 included a questionnaire of health information, motivation, beliefs, learning styles, and psychological measures prior to the experiment. Phase 2 included the manipulation of sensory activation and a questionnaire including manipulation checks and dependent variables. Phase 3 included a follow-up questionnaire two weeks later. </p><p> This dissertation, although having non-significant findings, adds to marketing literature by involving information processing and testing the role of sensory cues in message recall and motivation. Also, this work sheds light on the interplay between individual differences and the cognitive processing of sensory cues. To practitioners, this study provides normative recommendations regarding the design health interventions. Specifically, it is suggested that interventions should activate several sensory cues in order to enable short-term recall among low health literate consumers. Similarly, trends in the data suggest that health educators increase health literacy, as health literacy is a predictor for long-term recall and behavior modification. Finally, this work informs advertising professionals on how to apply sensory marketing in health promotion.</p><p>

Evidence available shows that the ethics review process in Malaysia suffers from a range of problems (Kaur, 2011). These problems may be the result of a lack of training given for REC members and relatedly, it may stem from a lack of understanding of the role of RECs. Since Malaysia is striving to promote the country as a research hub for international collaboration, it is important that the ethics review system that is in place is well set up to ensure only ethical research are being approved. The aim of this thesis is to develop three important key elements of a framework that can be used to provide practical guidance for RECs and their governance in Malaysia. These three important elements of the ethics review process are: - the role of RECs, the criteria of REC membership and the acceptability of variation in decisions made between different RECs. These analysis is then applied to the Malaysian context. My initial recommendation is for RECs to adopt the Daniels and Sabin (1997) accountability for reasonableness model to assist with the decision-making process. The adoption of the model helps to clarify the role of RECs and can be used as a basis to develop the criteria for REC membership as well as to provide a better understanding of the acceptability of variation in decisions between different RECs.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 113-133).

Changes to the technological landscape of the National Health Service (NHS) in the UK have often raised debates on information privacy and patient confidentiality. This has been especially pertinent in the context of HIV health services, where patient records have been historically segregated from hospital notes to protect confidentiality and account for the nature of the condition as a stigmatised terminal illness. However, as current anti-retroviral treatment extends life expectancy, HIV is increasingly managed in ways similar to other chronic conditions and integrated patient management has been proposed as best practice. This shift offers a unique opportunity to study reconfigurations of privacy and confidentiality practices from the perspective of data users. This thesis focuses on a technological integration project between the stand-alone systems used in two HIV specialist outpatient centres and the centralised Electronic Patient Records (EPR) of their respective NHS Hospital Trusts. The case study methodology draws on 46 semi-structured interviews with health and IT professionals, supplemented by an analysis of organisational documents and observation of work practices over a period of six months in the two clinics. In weaving together different theoretical concepts, this thesis contributes to an in-depth, empirically informed understanding of privacy and confidentiality practices in healthcare. Firstly, by looking at how HIV practitioners cultivate their professional identities at the intersection of general medical and HIV-specific confidentiality, this thesis argues that identity work is an important component in the reconfiguration of privacy practices. Secondly, this research draws attention to the role of political negotiations for privacy change, as HIV professionals and EPR developers came in conflict over the ethics of the technological integration project in the hospitals studied here. Thirdly, this thesis illustrates how confidentiality practices are shaped within the co-construction of information infrastructures and medical work, especially in relation to HIV normalisation. A number of implications for practice and policy also emerge from this study.

The aim of my thesis is to analyze and evaluate instruments and methods used by public relations in selected health facilities. Determine which instruments of public relations are used most often and whether the effects brought by the organization expects from them. Will be discussed and possible solutions the shortcomings and problems in this sphere.