Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

Sepsis is associated with high mortality and morbidity. Immediate recognition and treatment is crucial to prevent complications that can be highly detrimental and cause a significant impact on the U.S. healthcare economy. Numerous studies have been conducted to improve patient outcomes and lower healthcare costs from sepsis and septic shock. Many of these studies were focused on exploring healthcare providers' knowledge and compliance to the Surviving Sepsis Campaign (SSC) guidelines. This study aimed to explore and identify barriers to the implementation of the sepsis bundles and strategies to enhance healthcare providers' adherence to these bundles. A systematic review of articles was conducted using the ACE Star Model of Knowledge Transformation. Studies such as randomized controlled trials (RTC's), systematic reviews, retrospective studies, and prospective observational studies conducted in Intensive Care Units (ICUs) within the past 10 years were utilized, guided by the American Association of Critical Care Nurses' (AACN's) grading system. Sources of evidence were obtained from PubMed, CINAHL, and GoogleScholar. The results of this study are aimed at helping support the evidence-based clinical practice among providers caring for patients with sepsis and septic shock in an ICU setting using evidence-based guidelines. The results of this study provide an opportunity for healthcare systems to relieve financial burdens from sepsis and thus contribute to pos

Breast cancer is the second leading cause of cancer death among women in the United States. Nonadherence to recommended screening guidelines and lack of screening contribute to late stage diagnosis and increased morbidity and mortality among racial and ethnic women in the United States. The purpose of this study was to assess breast cancer screening practices, knowledge, and beliefs among Cameroonian immigrant women who were 40 years and older living in the metropolitan Washington, D.C. region. This quantitative cross-sectional study was guided by the health belief model and used the revised version of Champion's health belief model scale. A convenience sample (N=267) responded to a 60-item self-administered online survey that assessed knowledge of breast cancer screening, demographic variables, constructs of the health belief model and adherence (defined as obtaining a mammogram within two years). Data analyses performed included descriptive analysis, correlational and multiple linear regression. Results of this study revealed that increased level of education and self-efficacy were associated with greater knowledge of the benefits of mammography. Additionally, women who had more self-efficacy in obtaining a mammogram, perceived less cultural barriers, lived longer in the United States, and who had a regular healthcare provider were more likely to be adherent. Study findings suggest that positive social change can be achieved by empowering women to take control of their health. Efforts promoting awareness of breast cancer screening guidelines and facilitating access to a regular healthcare provider could significantly increase uptake of screening services and lead to better health outcomes and reduced mortality.

Thesis (Ph.D.)(Political Science) --University of Limpopo, 2009. / The primary aim of this study was to advocate for a collaborated health care delivery system that includes indigenous African medicine and is administered and controlled by the government. The objectives were:  To demonstrate how apartheid disrupted the natural development of indigenous healing practices. To dispel the misconception about the use of indigenous African medicine in the treatment of diseases. To demonstrate the need to protect both indigenous African and western European medicine. To demonstrate that African patients consult both indigenous African and western European doctors for various aspects of their treatment in their health care choices. To demonstrate that patients expect the government to provide an effective health delivery system. The main research question was: How can South Africa develop a collaborated health care delivery system using both indigenous African and biomedical health professionals that is effective and open to everyone on an equal basis? The theoretical framework for this study was the Afro-centric worldview in which events and ideas are perceived from an African perspective with the African people as the main players rather than victims. At the centre of the study were the African people, their health, disease pattern and healing practices. The Afro-centric qualitative research design was used. A sample size of 15 indigenous African doctors, 50 western European oriented health professionals and 84 patients participated in the study. The open coding method of data analysis was used to analyze data obtained from semi-structured in-depth interviews. The major findings of the study are that:  The belief of the African people in the existence of the ancestors and spirituality remains unshakeable. The strong belief n the ancestors make the diagnosis and treatment of diseases essentially religious practices. In the African culture, there are no preventative measures against natural illnesses, but there are preventative measures that are used against witchcraft/sorcery from entering a homestead and causing illness among members of a family. African people utilize both health care systems simultaneously and/or interchangeably depending on the seriousness of the illness and the knowledge and experiences that the illness can be effectively treated using indigenous African medicine or biomedicine. Both indigenous African doctors and biomedical health professionals play an important role in the provision of health. Recommendations The study recommends that when policy guidelines on the collaboration of indigenous African and western European medicine are drawn up, the following should be considered: Legislation to protect indigenous knowledge on African medicine Legislation that controls the qualification and registration of indigenous African doctors. Inclusion of indigenous African medicine in the curricula of all health professionals. / N/A

Philosophiae Doctor - PhD / Introduction: Maternal alcohol consumption during pregnancy can result to birth defects, which may be developmental, intellectual and physical. Fetal alcohol spectrum disorder (FASD) is a term used to describe an array of disorders related to alcohol consumption during pregnancy. FASD is a severe public health problem globally, with South Africa having the highest prevalence (29 to 290 per 1000 live births). What makes the FASD problem severe in the country is rife of maternal risk factors and widespread binge drinking during pregnancy. There is no policy specifically addressing FASD despite being pervasive in South Africa. Government programmes to prevent and manage FASD remain limited and fragmental across relevant departments. Herein, we aimed to conduct a multi-method study with a modified Delphi approach to developing a guideline to inform the development of a comprehensive and multi-sectoral policy for the prevention and management of FASD. Method and analysis: We used a modified version of the World Health Organization’s approach to guideline development in three phases. In phase 1, we conducted four different studies to design the initial guideline prototype. The studies include an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions employed for the prevention and management of FASD. The second phase involved using the initially developed guideline prototype to engage with the local and international experts on FASD for improvement on the content. In the third phase, we refined the prototype using a modified Delphi approach. Framework method and content analysis were used to analyse the qualitative data while the Statistical Package for Social Science (SPSS) software was used to analyse the quantitative data.

Vårdpersonalens låga följsamhet av riktlinjer för handhygien är ett globalt problem och en av orsakerna till vårdrelaterade infektioner (VRI). Att förmedla säker vård och arbeta förebyggande så att vårdskador undviks är en av vårdpersonalens kärnkompetenser. Syftet var att belysa vad som kan påverka vårdpersonalens följsamhet till riktlinjer för handhygien inom hälso- och sjukvården. Examensarbetet utfördes som en allmän litteraturstudie där 18 vetenskapliga artiklar fördes till resultatet, vilket visade att följsamheten påverkas av både arbetsmiljö och mänskliga faktorer. Arbetsmiljö innefattade Fysisk miljö; Organisatorisk och Social arbetsmiljö; Teknik. I de mänskliga faktorerna ingick Individ; Vårdteam; Kunskap och Utbildning. Två huvudresultat lyftes till diskussion. I den organisatoriska och sociala arbetsmiljön sågs tidsbrist och ett tydligt ledarskap ha en påverkan på vårdpersonalens följsamhet till riktlinjer för handhygien. I vårdteamet kunde patientinvolvering och fler medarbetare i personalens närhet, samt positiva eller negativa förebilder påverka vårdpersonalens följsamhet till riktlinjer för handhygien. Vidare forskning behövs om vad som kan leda till ökad och mer bestående följsamhet av riktlinjer för handhygien. Ny teknik kan komma att skapa nya förutsättningar för vårdpersonalen att öka följsamheten till riktlinjer för handhygien. / Healthcare workers´ (HCW) low adherence to guidelines on hand hygiene is a global challenge and one of the causes of healthcare associated infections (HCAI). HCW are to provide safe care and take precautions as not to harm the patient. Safe care is one of the core competences for HCW. The aim was to illustrate factors that can have an impact on HCW adherence to guidelines on hand hygiene in a healthcare setting. The thesis was carried out as a general literature study, where 18 articles were included in the result. The result showed that both the work environment and human factors have an impact on HCW adherence to guidelines on hand hygiene. Work environmental factors included the Physical environment; the Organizational and Social work environment; Technical equipment. Human factors included the Individual; the Nursing team; Knowledge and Education. Two main findings were lifted for discussion from the result; in regards of the organizational work environment, lack of time and a clear leadership was found to have an effect on HCW adherence to guidelines on hand hygiene. In regards of the nursing team; involvement of the patient reminding about hand hygiene, more coworkers in near proximity and positive or negative role models, affected adherence to guidelines on hand hygiene. Further research is required as to what can lead to increased and sustained adherence to guidelines on hand hygiene. New technical equipment may become important in the future and create new ways for HCW to follow the guidelines on hand hygiene.

Tonsillectomy, adenoidectomy and myringotomy are the most common surgical procedures undergone by children. Medical opinion regarding the appropriateness of these procedures remains contentious, and considerable resources have been expended in the formulation and distribution of relevant practice guidelines. The impact of this surgery on the child, community and private and public health resources is considerable, yet there has been little examination of surgery rates and trends, or of the characteristics of children who undergo surgery. This thesis addressed five major questions regarding this surgery in New South Wales, Australia. The first three related to population rates: the level of surgery among NSW children, comparability with international rates, trends over time and the effect of guidelines. Comprehensive hospital data between 1981 and 1999 were analysed. Major findings were a higher myringotomy rate in NSW than reported internationally, the short-term effect of guidelines, and a major shift towards children having surgery at a younger age. The remaining questions asked whether children who had surgery differed from other children in their use of health services prior to surgery, and if so, whether their utilization reverted to the norm following surgery. Matched records of a population cohort of 6239 NSW children, born during January 1990, were extracted from Health Insurance Commission data, and their claims for medical services followed retrospectively from birth to 8 years. Children who had privately funded surgery were found to use more medical services than other children, and, most unexpectedly, this did not change following surgery. The results suggest potential non-clinical factors influencing this excess utilization. This is the first population study to examine health service utilisation by these children and it has identified an important new risk factor for surgery.

The purpose of the study was to develop a greater understanding of the experiences of school life for students who consistently found learning difficult, their perceptions of the difficulties they faced with their learning and how this had influenced their lives, socially and academically. It was hoped that their perspectives would highlight those structures and strategies that were of the most value in supporting them, as well as those that had a negative impact on their achievement and adjustment. Eight people with learning difficulties each participated in a series of three individual, in-depth interviews about their experiences of school. The participants, five male and three female, ranged in age from ten to twenty five years. Four were primary school students, in Years Four, Five and Six. Two students were in Year Nine at high school, while a further two participants had completed their schooling. One was currently unemployed, while the other had completed a university degree and had been teaching for three years. Participants were chosen from randomly selected government schools in the ACT, nominated by the school as fitting the selection criteria. Learning difficulties were defined in tenns of their meeting criteria that were indicative of teacher and parent concern for academic underachievement over a period of at least two years. The selection process was also guided by criteria to locate key informants, i.e. individuals who may have been able to highlight specific issues related to the relationships between learning difficulties and socioeconomic status, social competence and employment opportunities. Interviews with each participant .took place over three separate sessions of approximately fifty minutes' duration. Data was analysed using Hycner's guidelines for phenoinenological analysis. Interviews were transcribed and coded, with an independent researcher validating identified themes. An agreement rate of 88% was achieved. Interviews were then summarised and returned to the participants to confirm whether the interpretation of their perspectives was accurate. Themes that were common across the interviews were discussed in relation to current research. The results of this research study confirmed the central role played by quality teachers and best teaching practices in being able to enhance learning and to meet the needs of individual students. These factors were an integral part of engaging students in the learning process and promoting successful learning experiences. The study also emphasised the importance of parents, particularly mothers, in the adjustment of the participants to the everyday demands, academic and social, of school life. The necessity of establishing and sustaining effective early intervention programs was also highlighted, as was the value of listening to the voices of individuals with learning difficulties when making decisions on their behalf.

The Australian and New Zealand Environment and Conservation Council (ANZECC) and the Agriculture and Resource Management Council of Australia and New Zealand (ARMCANZ) have announced that the 1997 review of the Australian Water Quality Guidelines will include for the first time, consideration of sediment quality guidelines. For this reason, it is timely to review the methods for establishing such guidelines, and the manner in which they could be used in managing the quality of sediments in Australian rivers, lakes and drainage systems. In this thesis, the problem of the development of sediment quality guidelines is introduced and basic questions relating to the development of such guidelines are addressed. The importance of sediment monitoring and sediment quality assessment in aquatic ecosystem management is demonstrated, and the role of sediment quality guidelines in the process of sediment quality assessment is discussed. The arguments considered in this thesis are illustrated by specific reference to the setting and use of sediment quality guidelines for heavy metal contamination. A number of physico-chemical factors (grain size distribution, pH, redox potential, alkalinity and hardness, salinity, organic matter) can affect the bioavailability and toxicity of contaminants in sediments, and these factors may vary spatially and temporally within and between sediment deposits. Changes in physico-chemical conditions as a result of natural or anthropogenic processes may lead to major changes in bioavailability of sediment contaminants. The variability of these physico-chemical factors has ramifications for the way in which sediment quality guidelines are derived and used. Factors affecting the way in which toxicity is measured (test species chosen, toxicological end-point measured, duration of test relative to life-cycle), and toxicity data is interpreted, are also important to the development of useful sediment quality guidelines. All of these factors must be taken into account in deriving sediment quality guidelines for Australian conditions. The large number of factors affecting the sensitivity and efficiency of sediment quality guidelines means that a simple set of numerical guidelines, as has been used in the past, is not appropriate. A multi-step assessment procedure will be required. Methods of setting sediment quality guidelines that have been used by authorities in overseas jurisdictions were reviewed. Advantages and disadvantages of the various methods were compared. None of the methods used overseas has been shown to be applicable to Australian conditions. In the absence of a suitable method for deriving Australian sediment quality guidelines in the short term, the adoption of the Canadian Interim Sediment Quality Guidelines as interim sediment quality guidelines for Australia is recommended. Sediment quality guidelines need to be viewed in the context of the overall environmental management process, of which they form an integral part. The policy background to environmental management in Australia, and the management frameworks that have been put in place to implement the policy, are outlined. The AS/NZS/ISO 14000 series of standards for environmental management systems provides a framework which is consistent with the principles and objectives of environmental management in Australia. It therefore provides an appropriate framework within which to develop and use sediment quality guidelines. Within the broad AS/NZS/ISO 14000 policy, a framework for the development and use of sediment quality guidelines is proposed, which will provide a technically and legally defensible basis for the management of aquatic sediments in Australia, in the short term and long term. The proposed framework involves the setting of Interim Sediment Quality Guidelines for Australia, based on the best scientific knowledge currently available. The framework recognises that the factors affecting the bioavailability and toxicity of sediment contaminants are complex, and that the current level of knowledge of sediment processes is incomplete. Therefore, a conservative approach to setting guidelines is taken, and a highly sensitive guideline based on that used in Canada, is proposed. The framework further recognises that this approach will lead to over protection of the environment in some cases, so a "Decision Tree" approach is taken. The "decision tree" allows the consideration of more complex interactions than can be incorporated into simple numeric guidelines, while attempting to simplify the assessment process. In keeping with the ISO 14000 series of standards for environmental management, the framework also explicitly includes steps designed to ensure that monitoring data are regularly collated, and analysed, and where necessary, guidelines are able to be updated in light of new knowledge gleaned from the review process. The proposed framework is appropriate to, and supportive of, the principles of environmental management as set out in Australian Government policy documents, inter governmental and international agreements, and legislation. It provides a basis for the on-going collection of data suited to increasing our understanding of the factors influencing the behaviour of contaminants in sediments, and thereby lead to continual improvement in sediment quality guidelines for use in Australian conditions.

Ever since its promulgation, in the late 1960s, the curriculum document entitled The Melbourne Religious Education Guidelines for Primary Students in the Archdiocese of Melbourne has attracted strong criticism from various members of the Roman Catholic community. This adverse criticism has prompted me to undertake an evaluation of the 1984 edition of this document. To enable me to analyze the document, both theologically and educationally, I have constructed classifications of theologies and education models. These classifications have been used to identify the dominant theological basis of the suggested curriculum and the religious education model used in its implementation. My analysis established that the theological basis of the document was Propositional, tempered by some of the characteristics of Heilsgeschichte theology. The content of the program contained both secular and religious material but, since they were not integrated, they gave the impression of two separate syllabi, used independently of each other. The methodology commenced with the students' experience but proceeded to the transmission of doctrinal religious knowledge. The language used in the expression of aims and goals contained characteristics of Heilsgeschichte theology and the Kerygmatic model of religious education. It was, therefore, seen to be in tension with the teaching methodology which emphasized transmission of doctrine, thus causing internal tensions and inconsistencies.