The purpose of this study was to investigate the attitudes and treatment knowledge of medical student professionals regarding rape victims. In addition to generating normative data for a population which, as a function of their vocation may come in contact with victims, comparisons were made between a sample of those beginning their medical education process and those at the end of training in order to measure change in treatment knowledge and attitudes towards rape victims which occur during medical school. Also investigated were differences which exist in the attitude and treatment knowledge measures for rape victims compared to other emergency room patient populations, and the effect of gender of the physician upon those measures. A final element investigated the physicians' perceptions of a "real" rape as it relates to those measures.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Bad news in the hospital scenario creates difficulties for professionals who need to accomplish this task. But, also, it is a difficult time and that changes the perspective of patients and their families about their future. Faced with this assumption, the research that led to this thesis aimed to understand the process of bad news communication in the context of the Intensive Care Unit for adults, from the perspective of physicians and family members involved in the hospitalization. This is a qualitative study of an exploratory and descriptive nature, covering all 23 participants, including 12 doctors, working in the Intensive Care Unit of a teaching hospital in the interior of Rio Grande do Sul, and 11 family members of patients admitted in this unit. We interviewed all doctors working in the unit, while the number of family participants was achieved by the criterion of sample saturation. We used semi-structured interviews and non-participant observation to collect the information, which was analyzed from the content analysis. The categories of information coming from the analysis were described and discussed in two articles that make up the essence of this work. The results show that each doctor search, in line with your style, a way of communicating based on personal experience and common sense. Both the lack of formation as the difficulty of dealing with suffering and death are related to the difficulty in communicating bad news by the doctor, giving it the need to exclude the feelings, coming from the hospital routine through the use of mechanisms aimed at appeasement of emotions. One should also consider that the family is in a moment of anguish, which can cause difficulty in understanding the information given by the doctors. Based on these appointments is considered that, in the doctor/family relationship the communication is even more technical and prioritizes unique clarifications the disease and treatment. The doctors did not feel prepared to communicate, and especially to listen to the suffering. But one should also consider how the families are underserved. / Comunicar más notícias no cenário hospitalar gera dificuldades para os profissionais que precisam realizar essa tarefa. Porém, igualmente, é um momento difícil e que altera a perspectiva do paciente e de seus familiares em relação ao seu futuro. Frente a este pressuposto, a pesquisa que originou a presente dissertação teve como objetivo geral compreender o processo de comunicação de más notícias no contexto da uma Unidade de Tratamento Intensivo para adultos, na perspectiva de médicos e familiares envolvidos na situação de internação. Trata-se de um estudo qualitativo, de cunho exploratório e descritivo, que abrangeu a totalidade de 23 participantes, sendo 12 médicos, atuantes na Unidade de Tratamento Intensivo de um hospital escola do interior do Rio Grande do Sul, e 11 familiares de pacientes internados nesta unidade. Foram entrevistados todos os médicos que trabalham na unidade, já o número de familiares participantes foi atingido mediante o critério de saturação da amostra. Foram utilizadas entrevistas semiestruturadas e observação não participante para a coleta das informações, que foram analisadas a partir da análise de conteúdo. As categorias procedentes da análise das informações foram descritas e discutidas em dois artigos, que compõem a essência do presente trabalho. Os resultados apontam que cada médico, busca, em concordância com seu estilo, uma forma de comunicar baseada em experiências pessoais e no senso comum. Tanto a falta de formação quanto a dificuldade de lidar com o sofrimento e a morte relacionam-se na dificuldade do médico em comunicar más notícias, trazendo a este a necessidade de excluir os sentimentos, oriundos da própria rotina hospitalar, através do uso de mecanismos voltados ao apaziguamento das emoções. Deve-se considerar, ainda, que o familiar se encontra em um momento de angústia, o que pode ocasionar dificuldades em compreender as informações passadas pelos médicos. Partindo destes apontamentos considera-se que, na relação médico/familiar, a comunicação ainda é mais técnica e prioriza esclarecimentos exclusivos da doença e do tratamento. Os médicos não se sentem preparados para comunicar e, principalmente, para escutar o sofrimento. Mas, se deve ponderar igualmente o quanto os familiares estão desassistidos.

Page 1 of 2 Abstract The diploma thesis deals with the topic of autonomy of the mother's will during childbirth. The main goal of the work is to analyze the legal regulation concerning the provision of healthcare in connection with childbirth and the limits of the autonomy of the patient's will in this situation. The aim of the thesis is to examine the issue of the autonomy of the patient's will according to the valid and effective legal regulation in the Czech Republic, with respect to gradual enforcement of the principle of patient and healthcare provider equality, this issue being related to a relatively specific area of childbirth. There is general legal regulation, relating to the position of the patient, healthcare provider and their mutual relationship outlined in this thesis. This legislation is then subsequently used for the provision of healthcare in relation to childbirths. The case law of both domestic courts and the European Court of Human Rights is then applied to specific problems in this area. One of the described problems is the legal nature of the delivery plan as one of the basic means of expressing the autonomy of the patient's will. In particular, the legal nature of the birth plan is handled as institute which is not regulated by law. Possible legal consequences of the delivery plan as...

La maîtrise de la résistance bactérienne passe par une amélioration de la prescription des anti-infectieux en pathologie humaine. L'objectif de ce travail était de mettre au point et d'évaluer l'impact d'une intervention destinée à améliorer la qualité de l'antibiothérapie, en ciblant en priorité les prescriptions hospitalières. Nous avons voulu utiliser des stratégies dérivées des sciences sociales et de l'industrie, notamment les techniques d'amélioration continue de la qualité, pour changer le comportement des prescripteurs. Nous avons ensuite ciblé une étape-clé de la prescription antibiotique, i.e. la réévaluation des antibiothérapies probabilistes 24-96 heures après leur initiation, que nous avons sélectionnée à l'issue d'une revue de la littérature et d'une analyse quantitative par questionnaire des perceptions, attitudes et connaissances des prescripteurs ; le questionnaire permettait également d'approcher les barrières locales à cette intervention. Puis nous avons mis au point des indicateurs de processus permettant de mesurer cette réévaluation des antibiothérapies. Enfin, nous avons étudié l'impact sur la qualité de l'antibiothérapie d'une intervention utilisant une stratégie d'audit et de retour d'information, visant à améliorer la documentation de la réévaluation des antibiothérapies par des médecins non-infectiologues dans deux services. En conclusion, les stratégies d'amélioration continue de la qualité s'avèrent utiles pour promouvoir le bon usage des anti-infectieux. / Antibiotic stewardship is essential to curb bacterial resistance in humans. Our aim was to design an intervention to improve the quality of prescription of antibiotics, focusing on the inpatient setting. We used strategies derived from the social sciences and the industry, particularly continuous quality improvement techniques, to lead the doctors to change their behaviour. We focused on a key process of antibiotic prescribing, i.e. reassessment of antibiotic therapies 24-96 hours after their start ; we selected this process based on a review of the literature and on the results of a survey designed to assess the perceptions, attitudes and knowledge of the prescribers. This survey also enabled us to approach potential barriers to the intervention. We designed then a set of process measures of quality of care in the reassessment of inpatient empirical antibiotic prescriptions. Finally, we assessed the impact of an intervention designed to improve the documentation of the reassessment of inpatient empiric antibiotic prescriptions on the quality of these prescriptions ; this intervention was conducted on two wards and targeted non-infectious diseases specialists, using an audit and feedback approach. In conclusion, continuous quality improvement strategies are a valuable tool to improve antibiotic use.

En autorisant tout médecin à prescrire du Subutex, la législation française désigne les généralistes comme acteurs essentiels d’une politique publique liée aux drogues : la dispensation de traitements de substitution aux opiacés (TSO). Cette thèse vise à comprendre comment la médecine générale compose avec cette prérogative. L’appropriation des TSO par les généralistes se décline à un niveau collectif – à quelles conditions cette mission peut-elle être assumée par ce groupe professionnel ? –, et sur le plan interactionnel – comment une personne dépendante devient-elle le patient d’un généraliste ? La question de l’appropriation d’une politique publique rejoint donc celle de l’acquisition du statut de "patients" pour des individus socialement stigmatisés, relevant parallèlement d’une politique pénale. Ce travail, fondé sur des entretiens et observations de consultations, montre que les généralistes s’approprient les TSO au moyen d’un processus de tri des patients et des tâches accomplies. Loin de manifester un refus de mettre en œuvre la politique substitutive, le tri vise à la rendre compatible avec les valeurs et modes d’organisation propres à la médecine générale. Cependant, les critères de sélection produisent des inégalités d’accès aux traitements : tous les "toxicomanes" ne deviennent pas des patients dans les mêmes conditions. L’ethnographie des consultations suggère que le statut de patient s’acquiert au cours de la construction d'une relation où la prescription devient progressivement routinière. Cette thèse invite à confronter plusieurs échelles d’analyse, en envisageant la mise en œuvre d’une politique de santé au prisme des interactions médecin-patient. / French legislation allows any physician to prescribe Subutex. Consequently, general practitioners are key actors of a public policy related to drug use: providing opiate substitution treatments (OST). This thesis aims to understand how general practice copes with this prerogative. Appropriation of OST by general practitioners comes at a collective level – how can this mission be assumed by this professional group? –, and also at an interactional level – how does an opiate addicted person become the patient of a general practitioner? The issue of appropriating a public policy is related to that of acquisition of patient status for socially stigmatized persons, who are, at the same time, the subjects of a penal policy. Our qualitative study (interviews and observations) shows that general practitioners appropriate OST by a sorting process. Sorting is a heuristic notion to describe practitioners’ adaptations with extension of their prerogatives by public policies: they don’t refuse to implement the substitution policy. On the contrary, they try to make it compatible with their values and their professional daily organization. However, selection criteria produce inequalities in access to treatments: every addict doesn’t become a patient in the same conditions. Consultations ethnography suggests that the patient status can be acquired while building a relationship with the doctor, in which the prescription is gradually becoming routine. This thesis invites to confront multiple scales and levels of analysis, by studying the implementation of a health policy through the prism of doctor-patient relationship.

The patient's autonomy is very important part of medical and nursing practice and every patient should have a right to express their opinion about their treatment. Advance directives give person an opportunity to express even in situations when it is not possible to communicate with others. Although it is possible to write advance directives in the Czech Republic only negligible percentage of people take advantage of this possibility. Why is it so? I have set two goals in my thesis. My first goal is to determine the awareness of the general public about the advance directives in the Czech Republic and also I want to find out awareness about the possibility to appoint a guardian as a mediator of fulfilment of advance directives of an individual. It is also my goal to discover whether respondents would welcome greater awareness of this topic. My second objective is to determine the attitudes of respondents to the problematics of advance directives. I want to discover if the respondents have ever dealt with the idea of being in a situation which they could not communicate with their environment and if they would like to have an opinion to decide about their treatment and also if they would like to name their mediator. I would like to provide the results of my thesis to the department of quality...

This qualitative study represents an examination of the perceptions of 18 recent business college graduates of their transition experiences from college to the workplace. The participant’s ages ranged from 23 to 28 years including 4 males and 14 females of diverse racial and ethic groups. One-on-one, semi-structured, open-ended interviews were the primary method for data collection. Using excerpts from the participants’ interviews, the data were examined and analyzed using content analysis (Patton, 2002) and educational criticism (Eisner, 1998). The data were organized into three main topics: the importance of organizational socialization, the complexity of mentoring in the workplace, and the continuation of young adult development. The findings include the newly hired graduates’ feelings regarding the support received from educators and employers in their transition into the workplace, what should be done to assist them in the transition process, and their continued optimism about their futures with their employers and their desire to succeed.

Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it. The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and nursing practice, (b) design a formal residency program for new graduates based on the evidence, and (c) implement and evaluate the residency program. Based on the evidence, a 16-week new nurse residency was developed in which Residents were each assigned both a Preceptor and Mentor to assist their progress. Weekly educational offerings were targeted at specific competency deficits identified by Residents, Preceptors and Mentors at the beginning of the residency program. Seven out of the original 10 Residents completed the Residency. Pre-residency, the Residents were very confident of their clinical skills and abilities and this was unchanged post-residency. The Preceptors and Mentors were much less confident of the clinical skills and abilities of the Residents pre-residency. Post-residency, the confidence level of the Preceptors and Mentors was improved, but significantly so only for the Mentors. It is imperative that nursing administrators be aware of the discrepancy between the confidence new nurses have in their own skills and the perceptions of the nurses who work side by side with them on a daily basis. Residencies for new graduate nurses are costly. Nursing administrators must make the determination if the benefits outweigh the costs. They may find the results of not having a residency are far more costly.

Standards of practice for hospital electrocardiogram monitoring were recommended in 2004 by the American Heart Association; however they are not widely followed. Many nurses monitor in a single lead regardless of diagnosis and are unable to differentiate wide QRS complex tachycardias. The purpose of this project was to evaluate the effectiveness of an interactive web-based education program combined with unit-based collaborative learning activities on both telemetry staff nurses‘ knowledge of dysrhythmias and their monitoring practices for patients at risk for wide QRS complex tachycardias. This interventional, one group before-and-after cohort study design consisted of four components: interactive web-based educational program with a pretest and posttest, unit-based collaborative activities, competency skills validation, and patient audits of electrode placement and lead selection at baseline, six weeks, and 18 weeks. There were 34 nurses who consented to participate, 16 started the program, and nine finished all the components. The pretest scores ranged from 0 – 60% with median of 36.5%. The posttest scores ranged from 47 – 93% with median of 80%. The Wilcoxon Signed Ranks test showed a significant difference between the pretest and posttest scores (p = .008). The patient audit results did not indicate significant differences in proportions of correct electrode placement and correct lead selection between baseline, 6 weeks, and 18 weeks. The program was effective in increasing nurses‘ knowledge about dysrhythmias; however, it was not effective in changing monitoring behavior. More research is needed to see if this type of program is more effective if it involves all the staff on the unit who are responsible for monitoring, and if additional strategies are used, such as unit champions and group rewards.

This retrospective study used the language of political ecology to describe the dynamics of a school board decision to hire a nontraditional superintendent. Those dynamics were described as contextual variables that existed within the community as well as mediating variables that were negotiated among the key players who were part of the selection process. This study confirmed that the school board did not make the decision in isolation from the community power structure. The methodology of this descriptive case study was qualitative, using a basic interpretive design informed by symbolic interactionism. Data were collected primarily through interviews with key players of the superintendent selection event, as well as from local news articles and artifacts. This research identified variables that were part and parcel of the superintendent selection process. It also helped to explain why most of Jacksonville, Florida, favored a candidate with a military background over three other candidates who had served as superintendents of other large, urban school districts. The environmental and mediating variables were presented as key constructs that affected the superintendent selection process and influenced the final decision to hire a nontraditional superintendent.