The study explored the experiences of nurses regarding in-patients who attempt or succeed in committing suicide in a general hospital. The purpose of the study was to design support guidelines for the nurses who care for patients who attempt or successfully commit suicide whilst admitted at general hospital. A generic qualitative research approach was followed, using an exploratory and descriptive design. Data was collected through in-depth interviews from a purposive sample of six nurses who met the inclusion criteria. Content data analysis was done. The research findings revealed five themes. The findings indicate that the working environment was not safe for both the nurses and the patients; confused patients were unpredictable and withheld their intentions of suicide from the nurses. Nurses blamed themselves for in-patient suicide; as some are still living with feelings of guilt. Nurse unit managers provided support to the affected nurses; however debriefing sessions were not given to the affected employees. There were no clear guidelines on management of confused patients. Support guidelines for the nurses are presented in this study / Health Studies / M.A. (Health Studies)

Die vorliegende Arbeit beschäftigt sich mit der Tätigkeit konsiliarpsychiatrischer Dienste am Allgemeinkrankenhaus. In einem historischen Abriß wird zunächst die Integration des psychiatrischen Fachgebiets in die Allgemeinkrankenhäuser als wesentliche Bedingung für die Entwicklung der Konsiliarpsychiatrie am Beispiel der USA dargestellt, gefolgt von europäischen Perspektiven und der Entwicklung in Deutschland, unter besonderer Berücksichtigung der Psychiatrie-Enquête. Anschließend werden Aspekte somatopsychischer Komorbidät als Grundlage der Konsiliarpsychiatrie und ihre Implikationen für Diagnostik und Therapie skizziert. Vorschläge zur Bestimmung des Bedarfs der konsiliarpsychiatrischen Versorgung werden diskutiert. Das Spektrum konsiliar-liaisonpsych-iatrischer Versorgungsmöglichkeiten wird dargestellt, Interventionsmöglichkeiten mit ihren differentia specifica im Setting des Allgemeinkrankenhauses am Beispiel von supportiver Psychotherapie und Psychopharmakatherapie bei körperlich kranken Patienten werden verdeutlicht. Im empirischen Teil wird auf Grundlage einer Längsschnittstudie über einen 10jährigen Be-obachtungszeitraum eines amerikanischen, sowie einer Vergleichsstudie der Tätigkeit eines deutschen und eines amerikanischen Konsildienstes über einen einjährigen Beobachtungszeitraum versucht, einen Kernbereich konsiliarpsychiatrischer Tätigkeit am Allgemeinkrankenhaus zu definieren. In der Längsschnittuntersuchung wurde ein zeitüberdauernder Bereich konsiliarpsychiatrischer Tätigkeit identifiziert, der im Vergleich mit ähnlichen, allerdings weniger detaillierten Studien (Lipowski & Wolston 1981, Paddison et al. 1989) ebenfalls überwiegend Gemeinsamkeiten deutlich werden läßt. Auch die vergleichende Querschnittsuntersuchung zeigte, daß psychiatrische Konsiliartätigkeit über nationale Grenzen hinweg eine Reihe von Gemeinsamkeiten aufweist. Auch dies konnte im Vergleich mit anderen Studien bestätigt werden (vgl. Übersichten bei Hengeveld et al. 1984, Diefenbacher 1999, Huyse et al. 1997). Anschließend werden Veränderungen im Gefolge der Tätigkeit eines neu beginnenden psychiatrischen Konsiliars über einen einjährigen Beobachtungszeitraum untersucht und im Hinblick auf die Implementation eines Konsildiensten auf für die konsiliarpsychiatrische Praxis bzw. Interventionsforschung wichtige Parameter wie z.B. Zusammenarbeit mit den Stationsteams und Beeinflussung von Krankenhausverweildauer und Zeitintervall zwischen stationärer Aufnahme und Konsilanforderung diskutiert. Zusammenfassend wird ein Kernbereich konsiliarpsychiatrischer Tätigkeit beschrieben, von dem erwartet wird, daß er für die nahe Zukunft konstant bleibt und somit als Orientierungshilfe für administrative und evaluative Zwecke dienen kann. Abschließend werden Perspektiven weiterer Forschung in der Konsiliarpsychiatrie diskutiert und auf Aspekte der Fort- und Weiterbildung im psychiatrischen Konsiliar-Liaisondienst in der psychiatrischen Facharztweiterbildung, sowie auf Schnittstellen für eine mögliche Zusammenarbeit mit dem hausärztlichen Bereich eingegangen. / Psychiatric consultation-liaison (c-l) service delivery in the general hospital is the topic of this study. In the first part, an historical outline of the development of psychiatric c-l-services in the USA is presented, followed by recent developments in Europe and Germany, with special emphasis - for the latter - of the impact of the so-called "Psychiatrie-Enquête" (1975) on the implementation of psychiatric departments in general hospitals since the 1980s. The issue of somato-psychic comorbidity of general hospital inpatients, the very reason of existence of c-l-psychiatry, is discussed, as are its implications for diagnosis and treatment. Proposals for the evaluation of need for such services are presented, as is the scope of c-l-psychiatric interventions and their special nature with the example of supportive psychotherapy and psychopharmaco-therapy in the medically and psychiatrically ill inpatient. The second empirical part consists of a 10-year-longitudinal study of a c-l-psychiatric service in New York City, and a comparative cross-sectional study (over a 1-year-period) of a German and an American c-l-psychiatric service in order to delineate a common core of psychiatric c-l-service delivery in the general hospital. In both studies, a cross-national common core and a time stable course over time, respectively, are identified and then discussed in comparison to other less detailed studies (e.g. Lipowski & Wolston 1981, Hengeveld et al. 1984, Huyse et al. 1997). In addition, the implementation phase of a newly started psychiatric c-l-service is studied over a 1-year-period with regard to variables important for c-l-psychiatric intervention studies, such as influence on length of stay in hospital, lagtime between admission to hospital and day of consultation request, and cooperation with staff. In conclusion, a core field of psychiatric c-l-service delivery in the general hospital is identified, that is expected to remain stable in years to come and thus might help as an orientation for administrative and evaluative purposes. Finally, perspectives for further research in the field, for training and education, and for the cooperation with primary care doctors are discussed.

Made available in DSpace on 2016-04-04T18:28:12Z (GMT). No. of bitstreams: 1 SARA REGINA MOREIRA PANSANI.pdf: 751373 bytes, checksum: c7721f15505511e8790d5110de9614c7 (MD5) Previous issue date: 2013-12-11 / The aim of this research was to grasp the experience of suffering of patients based on the experience of a psychologist in a unit for treatment of burned victims at a hospital located in the state of S?o Paulo. It was developed as a qualitative research phenomenologically based. A narrative was built by psychologist/researcher as a methodological strategy to capture significant elements experienced in the daily activities with patients, families and multidisciplinary team. It included memories, pictures, thoughts and feelings that made possible the emergence of some meanings: the context of the burns unit is an environment that offers, in addition to treatment, care to patients and their families. Over the period of hospitalization, patients go through extensive physical and psychological suffering: they feel vulnerable and unprotected; resent the absence of family and feel isolated. The way they signify the causes that led to the accident that hurt them is important in the recovery process, as well as how they face intense physical pain and addiction that required care. Family members play an important role in the recovery process of patients as they convey security and affection, in this sense, they end up being part of the team, assisting in the process of recovery of autonomy. The multidisciplinary team responds in a contradictory way to the patients complaints. The exhaustive routine seems to hamper their understanding and acceptance of the patient. On the other hand, they demonstrate willingness and commitment to carry out the procedures necessary for recovery. The researcher's experience allowed understanding of new meanings with regard to the relationship between pain and suffering. She noted the importance of specific psychological attention in that context and how it provides space for the patient to express feelings of loneliness, fear and anguish over the unknown. On the other hand, staff and family members also demand attention to be able to carry out the necessary care. We conclude that suffering severe burns and being hospitalized is an experience that requires from the patient a restructuring in their way of being and living that affects both the professionals who make up the team, as well as the families. / O objetivo desta pesquisa consistiu em apreender o sofrimento vivido por pacientes a partir da experi?ncia de uma psic?loga em uma unidade para tratamento de queimados de um hospital localizado no estado de S?o Paulo. Desenvolveu-se como uma pesquisa qualitativa de inspira??o fenomenol?gica. Uma narrativa foi constru?da como estrat?gia metodol?gica pela psic?loga/pesquisadora para apreender elementos significativos vividos no trabalho cotidiano com pacientes, familiares e equipe multiprofissional. Incluiu lembran?as, impress?es, imagens, sentimentos e pensamentos que possibilitaram a emerg?ncia de alguns significados: o contexto da unidade para queimados constitui um ambiente que oferece, al?m de tratamento, acolhimento aos pacientes e seus familiares. Ao longo do per?odo de hospitaliza??o, os pacientes passam por grande sofrimento f?sico e psicol?gico: sentem-se vulner?veis e desprotegidos; ressentem-se da aus?ncia dos familiares e do isolamento. A maneira como significam as causas que provocaram o acidente que os vitimou tem import?ncia no processo de recupera??o, assim como a forma como enfrentam a dor f?sica intensa e a depend?ncia por necessitarem de cuidados. Os familiares desempenham papel importante no processo de recupera??o dos pacientes ao transmitirem seguran?a e afeto; neste sentido, acabam por fazer parte da equipe, auxiliando no processo de retomada da autonomia. A equipe multiprofissional reage de maneira paradoxal ?s queixas dos pacientes. A rotina exaustiva parece dificultar a capacidade de compreender e acolher. Por outro lado, demonstram disponibilidade e empenho para realizar os procedimentos necess?rios ? recupera??o. A experi?ncia da pesquisadora possibilitou entrar em contato com novos significados no que se refere ? rela??o entre dor e sofrimento. Constatou a import?ncia de uma aten??o psicol?gica espec?fica naquele contexto capaz de disponibilizar ao paciente espa?o para expressar sentimentos de solid?o, medo e ang?stia face ao desconhecido. Por outro lado, a equipe e os familiares tamb?m demandam aten??o a fim de poderem desempenhar os cuidados necess?rios. Conclui-se que sofrer queimadura grave e ser hospitalizado constitui uma experi?ncia que imp?e ao paciente uma reestrutura??o no modo de ser e de viver que afeta tanto os profissionais que comp?em a equipe como tamb?m as fam?lias.

O atendimento de saúde mental em hospitais gerais no Brasil vem crescendo em especial na última década, como resultado de políticas sociais específicas para ampliação da rede de atenção psicossocial, constituindo mais um recurso para mudança de paradigmas na produção do cuidado. Assim, um dos maiores desafios para reforma psiquiátrica brasileira tem sido a coexistência de modelos de atenção, que seguem lógicas distintas na relação estabelecida entre os modos de gestão de políticas, oferta e organização dos serviços, e na relação entre os profissionais e os usuários. O Rio Grande do Sul, em especial a política estadual, vem utilizando recursos públicos para incentivo ao atendimento de saúde mental em hospitais gerais, nos últimos três governos, com as devidas diferenças de contextos e políticas propostas, configurando, assim, um cenário de concentração de leitos em relação aos demais estados do país. Uma tese sobre as políticas sociais, que utilizam recursos públicos para complementação do Sistema Único de Saúde, no atendimento de saúde mental, utilizando leitos de saúde mental em hospitais gerais foi um desafio colocado a partir de vários outros questionamentos que envolvem esta temática; possibilitando, assim, discutir os contextos desta modalidade de atenção e em especial os modelos de atenção presentes nos processos de trabalho das equipes. Para a construção desta tese foi utilizada uma pesquisa quantiqualitativa, com o objetivo de compreender quais modelos de atenção em saúde mental se expressam na organização e gestão da atenção, a partir da ampliação de leitos de saúde mental em hospitais gerais no Rio Grande do Sul. Para tanto foram utilizados como fontes legislações, dados do Datasus, relatórios e projetos terapêuticos de hospitais gerais, além da realização de entrevistas e grupos nominais. O cuidado na crise ainda tem no hospital uma referência muito forte; é possível encontrar nas diferentes instituições um modelo híbrido, que contempla diferentes experiências e formações, com potencial de movimento e que pode desacomodar práticas mais rígidas, promover cuidado com acolhimento e singularidade – desafios que se colocam para o trabalho em rede. Estes e outros resultados estão presentes nesta tese que reúne o trabalho de pesquisa conectado com o da experiência profissional da pesquisadora. / The mental health care in general hospitals in Brazil has been growing especially in the last decade as a result of specific social policies to expand the network of psychosocial care and is another resource for paradigm shift in care production. So, one of the biggest challenges for the Brazilian Psychiatric Reform has been the coexistence of care models that follow different logics in the relationship between the modes of management policies, supply and service organization, and the relationship between professionals and user. In Rio Grande do Sul (RS), in particular, the state policy has been using public funds to encourage the mental health care in general hospitals in the last three governments, with appropriate differences in contexts and policy proposals, thus setting a scenario of concentration of beds in relation to other states. A thesis about social policies using public resources to complement the National Health System, in the care of mental health, using mental health beds in general hospitals was a challenge that arose from several other questions that surround this issue, thus enabling discuss the contexts this type of care and in special care models in the processes of work team. To the construction of this thesis we used a quantitative and qualitative research in order to understand which models of mental health care are expressed in the organization and management of attention from the expansion of mental health beds in general hospitals in RS, for this were used as sources laws, Datasus, reports and therapeutic projects general hospitals, as well as interviews and nominal groups. The care crisis in the hospital still has a reference too strong, you can find the different institutions a hybrid model, which includes various experiences and backgrounds, and has the potential of motion that can dislodge stricter practices and promote care with host and uniqueness, challenges to for networking. These and other results are presented in this thesis that meets the research work connected with the professional experience of the researcher.

O atendimento de saúde mental em hospitais gerais no Brasil vem crescendo em especial na última década, como resultado de políticas sociais específicas para ampliação da rede de atenção psicossocial, constituindo mais um recurso para mudança de paradigmas na produção do cuidado. Assim, um dos maiores desafios para reforma psiquiátrica brasileira tem sido a coexistência de modelos de atenção, que seguem lógicas distintas na relação estabelecida entre os modos de gestão de políticas, oferta e organização dos serviços, e na relação entre os profissionais e os usuários. O Rio Grande do Sul, em especial a política estadual, vem utilizando recursos públicos para incentivo ao atendimento de saúde mental em hospitais gerais, nos últimos três governos, com as devidas diferenças de contextos e políticas propostas, configurando, assim, um cenário de concentração de leitos em relação aos demais estados do país. Uma tese sobre as políticas sociais, que utilizam recursos públicos para complementação do Sistema Único de Saúde, no atendimento de saúde mental, utilizando leitos de saúde mental em hospitais gerais foi um desafio colocado a partir de vários outros questionamentos que envolvem esta temática; possibilitando, assim, discutir os contextos desta modalidade de atenção e em especial os modelos de atenção presentes nos processos de trabalho das equipes. Para a construção desta tese foi utilizada uma pesquisa quantiqualitativa, com o objetivo de compreender quais modelos de atenção em saúde mental se expressam na organização e gestão da atenção, a partir da ampliação de leitos de saúde mental em hospitais gerais no Rio Grande do Sul. Para tanto foram utilizados como fontes legislações, dados do Datasus, relatórios e projetos terapêuticos de hospitais gerais, além da realização de entrevistas e grupos nominais. O cuidado na crise ainda tem no hospital uma referência muito forte; é possível encontrar nas diferentes instituições um modelo híbrido, que contempla diferentes experiências e formações, com potencial de movimento e que pode desacomodar práticas mais rígidas, promover cuidado com acolhimento e singularidade – desafios que se colocam para o trabalho em rede. Estes e outros resultados estão presentes nesta tese que reúne o trabalho de pesquisa conectado com o da experiência profissional da pesquisadora. / The mental health care in general hospitals in Brazil has been growing especially in the last decade as a result of specific social policies to expand the network of psychosocial care and is another resource for paradigm shift in care production. So, one of the biggest challenges for the Brazilian Psychiatric Reform has been the coexistence of care models that follow different logics in the relationship between the modes of management policies, supply and service organization, and the relationship between professionals and user. In Rio Grande do Sul (RS), in particular, the state policy has been using public funds to encourage the mental health care in general hospitals in the last three governments, with appropriate differences in contexts and policy proposals, thus setting a scenario of concentration of beds in relation to other states. A thesis about social policies using public resources to complement the National Health System, in the care of mental health, using mental health beds in general hospitals was a challenge that arose from several other questions that surround this issue, thus enabling discuss the contexts this type of care and in special care models in the processes of work team. To the construction of this thesis we used a quantitative and qualitative research in order to understand which models of mental health care are expressed in the organization and management of attention from the expansion of mental health beds in general hospitals in RS, for this were used as sources laws, Datasus, reports and therapeutic projects general hospitals, as well as interviews and nominal groups. The care crisis in the hospital still has a reference too strong, you can find the different institutions a hybrid model, which includes various experiences and backgrounds, and has the potential of motion that can dislodge stricter practices and promote care with host and uniqueness, challenges to for networking. These and other results are presented in this thesis that meets the research work connected with the professional experience of the researcher.

O atendimento de saúde mental em hospitais gerais no Brasil vem crescendo em especial na última década, como resultado de políticas sociais específicas para ampliação da rede de atenção psicossocial, constituindo mais um recurso para mudança de paradigmas na produção do cuidado. Assim, um dos maiores desafios para reforma psiquiátrica brasileira tem sido a coexistência de modelos de atenção, que seguem lógicas distintas na relação estabelecida entre os modos de gestão de políticas, oferta e organização dos serviços, e na relação entre os profissionais e os usuários. O Rio Grande do Sul, em especial a política estadual, vem utilizando recursos públicos para incentivo ao atendimento de saúde mental em hospitais gerais, nos últimos três governos, com as devidas diferenças de contextos e políticas propostas, configurando, assim, um cenário de concentração de leitos em relação aos demais estados do país. Uma tese sobre as políticas sociais, que utilizam recursos públicos para complementação do Sistema Único de Saúde, no atendimento de saúde mental, utilizando leitos de saúde mental em hospitais gerais foi um desafio colocado a partir de vários outros questionamentos que envolvem esta temática; possibilitando, assim, discutir os contextos desta modalidade de atenção e em especial os modelos de atenção presentes nos processos de trabalho das equipes. Para a construção desta tese foi utilizada uma pesquisa quantiqualitativa, com o objetivo de compreender quais modelos de atenção em saúde mental se expressam na organização e gestão da atenção, a partir da ampliação de leitos de saúde mental em hospitais gerais no Rio Grande do Sul. Para tanto foram utilizados como fontes legislações, dados do Datasus, relatórios e projetos terapêuticos de hospitais gerais, além da realização de entrevistas e grupos nominais. O cuidado na crise ainda tem no hospital uma referência muito forte; é possível encontrar nas diferentes instituições um modelo híbrido, que contempla diferentes experiências e formações, com potencial de movimento e que pode desacomodar práticas mais rígidas, promover cuidado com acolhimento e singularidade – desafios que se colocam para o trabalho em rede. Estes e outros resultados estão presentes nesta tese que reúne o trabalho de pesquisa conectado com o da experiência profissional da pesquisadora. / The mental health care in general hospitals in Brazil has been growing especially in the last decade as a result of specific social policies to expand the network of psychosocial care and is another resource for paradigm shift in care production. So, one of the biggest challenges for the Brazilian Psychiatric Reform has been the coexistence of care models that follow different logics in the relationship between the modes of management policies, supply and service organization, and the relationship between professionals and user. In Rio Grande do Sul (RS), in particular, the state policy has been using public funds to encourage the mental health care in general hospitals in the last three governments, with appropriate differences in contexts and policy proposals, thus setting a scenario of concentration of beds in relation to other states. A thesis about social policies using public resources to complement the National Health System, in the care of mental health, using mental health beds in general hospitals was a challenge that arose from several other questions that surround this issue, thus enabling discuss the contexts this type of care and in special care models in the processes of work team. To the construction of this thesis we used a quantitative and qualitative research in order to understand which models of mental health care are expressed in the organization and management of attention from the expansion of mental health beds in general hospitals in RS, for this were used as sources laws, Datasus, reports and therapeutic projects general hospitals, as well as interviews and nominal groups. The care crisis in the hospital still has a reference too strong, you can find the different institutions a hybrid model, which includes various experiences and backgrounds, and has the potential of motion that can dislodge stricter practices and promote care with host and uniqueness, challenges to for networking. These and other results are presented in this thesis that meets the research work connected with the professional experience of the researcher.

Recognising the enormous challenges in South Africa confronting the nursing of the mentally ill, the project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perception of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff using a self-administered tool. The study looked at four different types of perceptions guided by categories of conceptual framework proposed by Mavundla (2000:1569-1570), namely perception of self, perception of patients, perception of environment and perceived feelings. The study found that the majority of professional nurses have a predominantly positive self- perception of nursing mentally ill people in a general hospital, although a significant number have a negative perception of patients, the nursing environment and perceived feelings. Lack of knowledge, skill and experience affect the nursing care of mentally ill people in the general hospital. / Health Studies / M.A. (Health Studies)

Recognising the enormous challenges in South Africa confronting the nursing of the mentally ill, the project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perception of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff using a self-administered tool. The study looked at four different types of perceptions guided by categories of conceptual framework proposed by Mavundla (2000:1569-1570), namely perception of self, perception of patients, perception of environment and perceived feelings. The study found that the majority of professional nurses have a predominantly positive self- perception of nursing mentally ill people in a general hospital, although a significant number have a negative perception of patients, the nursing environment and perceived feelings. Lack of knowledge, skill and experience affect the nursing care of mentally ill people in the general hospital. / Health Studies / M.A. (Health Studies)

Text in English / This study investigated practices, motivations, perceived benefits and barriers to outsourcing of support services by general hospitals in Uganda. The aim was to contribute to the evidence base to increase adoption and effectiveness of outsourcing by hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data was collected from hospital managers in 32 randomly selected hospitals using a self-administered questionnaire. Qualitative data was collected through in-depth interviews from 8 purposively selected hospital managers using an interview guide. Quantitative data was statistical analysed (frequencies, contingency tables and Wilcoxon-Mann-Whitney tests) using SAS 9.3. Qualitative data was managed using ATLAS ti 7, coded manually and content analysis conducted to identify emerging themes, subthemes and categories. A cost benefit analysis was conducted for outsourcing cleaning services in a selected hospital using financial data provided by the managers. Quantitative findings indicate that many (72%) hospitals were outsourcing some of their support services; many were satisfied with their outsourcing (>60%). The key motivation for outsourcing was to gain access to quality service (68%). Most hospitals have a system for monitoring outsourcing (71%). Managers perceive improved productivity and better services as the main benefit from outsourcing (90%). The main barrier to outsourcing is limited financing. A key challenge encountered during outsourcing was limited number of service providers (57%). Managers perceive regulatory violations as a key risk during outsourcing (87%). Hospital location is a determinant of outsourcing (p=0.0033). Managers’ perceptions towards outsourcing have no impact on outsourcing (p>0.05). These findings were confirmed and explained by the qualitative data. Qualitative findings reveal masquerading, impersonation and extortion of patients by outsourced staff as an outsourcing risk. They reveal a concern that outsourcing may lead to job loss for community members. The cost benefit analysis indicates that outsourcing in the studied hospital for the year considered was cheaper than insourcing by UGX 669,575.00. The savings increase to UGX 48,753,689.94 when adjusted for quality differences between insourced and outsourced services. Sensitivity analysis shows that the assumptions used in the analysis were robust. Recommendations, interventions and guidelines are proposed for increasing outsourcing and its effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study is to critically examine whether hospitals located in high seismic risk areas such as Vancouver can respond as post-disaster facilities in the aftermath of a major earthquake. Earthquake experience in California during the 1971 San Fernando and the 1989 Loma Prieta earthquakes in particular demonstrate that hospitals may be vulnerable and rendered unable to fully respond to their communities needs. In the case of earthquakes, risk management methods are limited to two strategies: pre-event mitigation to reduce the effects of the earthquake on life safety and loss of property; and providing recovery services after the event. In the case of post-disaster hospitals, experience shows that mitigation strategies ensure the functionality of the facility. Therefore, mitigation strategies must not only include structural mitigation to protect the life safety of its occupants, they must also include strategies which ensure the functionality of both the building operations as well as that of therapeutic and diagnostic medical equipment in the aftermath of an earthquake. Vancouver General Hospital is used as a case study to critically examine seismic pre-event mitigation strategies which include: the structures; building operation and medical equipment which are dependent on the supply of potable water and power. Findings of this study indicate that the current supply of potable water is not reliable and that some of VGH's essential building operations and medical equipment will not be functional due to losses in water pressures and disruptions in service. This study recommends that VGH should consider mitigation strategies which make the hospital independent of outside sources of both water and power supply in order to meet its emergency role as a post-disaster facility following an earthquake. The functionality of VGH in the aftermath of a major earthquake will be seriously curtailed unless there is adequate storage of potable water on site to meet the emergency needs of this hospital.