Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Published also as thesis (PH. D.) Columbia university, 1926.

Published also as Thesis (Ph. D.)--Columbia University, 1926.

Published also as thesis (PH. D.) Columbia university, 1926.

<p> Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students&rsquo; empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students&rsquo; empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb&rsquo;s experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing students in the pre-simulation survey; 123 participants completed the post-simulation survey with 64 in the control group (HFMS) and 59 in the experimental group (SP). Data were analyzed using an independent <i>t</i>-test to determine if there were any mean differences between the HFMS and SP groups in terms of empathy, satisfaction, and self-confidence. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student and the NLN&rsquo;s Satisfaction and Self-Confidence Scales. Results revealed there were no significant difference in students&rsquo; empathy levels, self-confidence, and satisfaction. Positive social change through prioritizing nursing students&rsquo; empathetic communication in patient care may be enhanced in the simulated clinical environment with various approaches. Recommendations for future research are to determine what interventions best develop nursing students&rsquo; empathy, satisfaction, and self-confidence in patient care. </p><p>

<p> Clinical reasoning is the cognitive process and strategies used to understand the significant patient data to identify and diagnose actual or potential problems in order to make competent clinical decisions that will affect patient outcomes (Fonteyn &amp; Ritter, 2000). The purpose of the study was to determine if implementing the Outcome-Present State Test Model of Clinical Reasoning with guided reflection activities was an effective method to improve clinical reasoning skills in senior nursing students at a large southeastern university. The overall research questions involve comparing participants Health Sciences Reasoning Test scores before and after implementation of the OPT Model as clinical paperwork, secondly the experimental group was given a guided reflection activity to complete in conjunction with use of the OPT Model during clinical experience. </p><p> Kolb&rsquo;s Experiential Learning Theory is the theoretical framework used throughout this study. Nursing education has historically blended didactic learning with clinical experiences to transfer knowledge. The OPT offers a frame to organize thoughts and guides the learner to decide what data is important to each patient situation. </p><p> This study reports the findings for 62 senior nursing students that completed the HSRT prior to implementation of the OPT Model and a guided reflection activity. Clinical instructor&rsquo;s scored participants using the Lasater&rsquo;s Clinical Judgment Rubric each week. There were no statistically significant differences between the experimental group and the control group. The only statistically significant difference that was identified was in the Lasater&rsquo;s Clinical Judgment Rubric scores between week one and week 2, and week 3 and week 4.</p><p>

Background: Diabetes remains an incurable disease and as the search for a cure continues, the need to minimise complications and enhance the quality of life of patients is essential. A key UK policy initiative in the management of diabetes is empowerment through education. However, implementation of policy in the context of healthcare delivery in general may be challenging at times and the provision and uptake of diabetes education is not an exception. Aims: This thesis aims to examine the barriers and enhancing factors that are associated with the uptake of structured patient education for patients newly diagnosed with type 2 diabetes. Methods: The study used a sequential mixed methods approach. The data were collected using a focus group and face-to-face individual interviews of multiprofessionals delivering the education, a questionnaire/survey of patients and individual face-to-face interviews of referring practitioners working in GP surgeries within a PCT. Findings: Factors influencing non-attendance at diabetes education centres relate to barriers associated with the patients, practitioners and government regulations. The patients were affected by their healthcare beliefs and personal circumstances such as work patterns, childcare problems, forgetfulness, bad weather and ill health. The practitioners’ barriers were mainly around patient versus practitioner communication, inter-professional collaboration and administrative protocols. The barriers associated with the government directives relate to government regulations and funding issues. In contrast to barriers, the predictors of attendance are personal motivation, individual perceptions and beliefs coupled with the guidance given by the practitioners. Whilst it may be difficult to avoid non-attendance completely, positive steps to reduce nonattendance include enhanced communication, a positive pay-for-performance system and adequate support to develop a positive attitude towards diabetes education. Conclusion: The results indicate that barriers to attendance are multifactorial and complex; therefore, response to improve uptake requires diverse interventions.

Schools and healthcare organizations face questions of validation in leadership and investment in human capital, which raises important public policy questions. External forces such as economics, pressure groups, and oversight organizations as well as worker availability are at issue. Unlike education, segments of the healthcare industry are doing very little long-range planning concerning human capital development. A new paradigm must be developed for the healthcare industry if it is to face the challenges of a shrinking, less prepared workforce, in an aging nation. This case study uses the home health care and supplemental staffing industry to focus on an emerging public policy issue--requiring criminal background checks of healthcare workers. The study looks at the development of the National Healthcare Clearinghouse, critically analyzing the plan to determine how original goals shifted and affected its actualization. The primary and continued concern was on a negative aspect of hiring workers for the industry--that is to "screen-out" persons with an unacceptable criminal record. To assess attitudes among healthcare organizations, 3273 surveys were sent out to agency directors, with 28% responding. Subsequently and through research of the literature and follow-up interviews, a positive agenda emerged related to staff development through firm-specific and industry recognition of a career lattice. This recognition leads to potentially improved employment practices. The negative agenda raises issues such as privacy rights, due process and consumer protection. The positive agenda could reduce turnover, better protect clients and improve competency and salaries. Many significant steps to improve service work are closely linked to political processes and those legislative steps are poorly suited to achieve effective and efficient solutions. An industry based clearinghouse should be a proactive and positive corporate solution to a public concern that has advantages, especially in terms of costs, but may not survive a major financial crisis. This project was no exception. The survey results indicate that current criminal background checks are not effective. An accompanying survey of human resource needs provides a wealth of information to evaluate the current employment environment, and develop collaborative solutions. Recommendations are made to bring the project, although abandoned by a trade association, to fruition.

Thesis (M.P.H.)--University of Michigan, 1945.