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This study examined the societal factors and subjective beliefs that are hypothesized to be affecting the lives of trans persons accessing Ontario health care services. The purpose of this study was to uncover information pertaining to trans persons’ needs and fulfillments within Ontario’s health care system in order to discover what the specific health care needs of trans persons accessing health care services are as well as if they are alienated and/or systemically discriminated against when seeking medical attention. The research questions were addressed through a secure, anonymous, online questionnaire taking approximately 30 to 45 minutes to complete. A small sample of 18 to 26 individuals who identified as trans, living in Ontario and have accessed, or are currently accessing, Ontario health care services were recruited through relevant list-servs and website postings. Participants accessed a variety of open-ended and closed questions concerning sociodemographics, sexuality, health care access experiences, and health care needs. Qualitative results showed that access to Ontario health care is complicated by race, class and language for participants in this study. Experiences for trans persons with Ontario health care services varied from individual to individual; some reported no negative experiences at all, some have been refused services by the Center for Addiction and Mental Health’s Gender Identity Clinic, and some avoided health care services entirely due to discrimination from medical professionals. / Thesis (Master, Gender Studies) -- Queen's University, 2011-09-20 12:42:59.005

This thesis provides an account of the discussions of the "team" concept in health care literature since the early 1920s. It is argued that by adopting a historical, social constructionist stance, this thesis makes an original contribution to the literature. The research consisted of an inductive analysis of the "team" literature aiming to typify the ways in which the "team" concept has been constructed and historical, national or professional differences which have occurred. Historically, claims about "teamwork" in health care have occurred in four phases: (1) a statement of basic issues and themes; (2) the emergence of ideas of flexibility and adaptability; (3) a period of optimism; and (4) the co-existence of positive, sceptical, and critical claims. The professional and national differences in claims-making activities are also discussed. The least challenged claims about, and recent re-evaluations of, the "team" concept are also discussed. (Abstract shortened by UMI.)

<p> A nursing shortage has resulted in hospitals seeking ways to meet their staffing needs. One strategy is the use of travel nurses (travelers) employed by staffing agencies. Hospitals are challenged with providing travelers an adequate orientation to assure their patients receive safe care while placing the travelers where they are urgently needed&mdash;at the bedside. The goals of this project are to identify best practices to provide a quality orientation and to propose an orientation program. To address these goals, pertinent literature has been reviewed, and input from travelers has been examined. As a result, an orientation program has been developed with a module for travelers to review prior to their assignments. An onsite orientation program follows with one day of didactic training and two shifts with a preceptor at the bedside. The recommendation is that organizations use the proposed program as a template when developing their orientation programs.</p>

Triggered by a chance pastoral encounter with a nurse who articulated a sense of the presence of God in the midst of existential darkness, this study seeks to explore two underlying questions: “In the context of health care, where is God in the “dark places” of human experience”? and “How is that experience discerned and communicated to others?” It will show how a greater understanding of these questions will add value to the provision of pastoral care in the health care environment by enabling a tailored intervention to be offered that will be to the benefit of the patient and their clinical and pastoral outcome. The research uses insights gained from academia, including theological and health care literature, to explore the former, and a musicological review to explore the latter. These are set alongside qualitative material in the form of case studies and taped interviews. Whilst this study suggests that credible belief in God is possible if God can be seen to be involved with, and supportive of, humanity in the midst of its suffering, it also shows that the way that experience is discerned and thus communicated to others, involves a process of listening and performing comparable with the act of music-making. As with its musical counterpart (incorporating elements of melody, rhythm, dynamics and timbre), this research maintains that the process of pastoral listening and performing is also multi-faceted, existing on a number of different levels. An awareness of these enables the pastoral encounter to begin to be rooted in a process of meaning-making analogous with wisdom emerging out of lament. This research further suggests that one way such wisdom can be discerned is in the way that the lament within the pastoral encounter is itself framed, using musical form as one way of holding in relationship the tradition of faith with pastoral praxis. In using specific examples of music-making as a guide to effective pastoral care, this study concludes with recommended pastoral interventions pertaining to the pastoral practice of healthcare chaplaincy, advocating that through reclaiming the spiritual space and reframing the pastoral encounter, it is still possible for chaplains to model the presence of God.

The aim of this thesis is to develop analytic methods to support the implementation of decentralization in primary health care. Decentralization may be defined as the delegation of decision-making power from central management to middle or local management for coordinated control. To be an effective mechanism for coordinated control it needs to be implemented by systematic methods. This doctrine generally comes from the experience of implementing decentralization in the industrial sector. This thesis develops systematic methods of resource allocation to support the implementation of decentralized primary health care in Britain. The thesis also considers the transferability of methods to support the implementation of decentralization to Pakistan. The work reported in this thesis is based on case studies carried out in health districts in both Britain and Pakistan. Based on the reported work this thesis concludes that decentralization could be beneficial for both British and Pakistani primary health care systems, provided its implementation is supported by appropriate analytic methods.

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This thesis proposes a critical, systemic and pluralist approach to evaluating health programs. It examines ways in which efforts to promote equality and plurality are undermined by the application of foundationalist and universal conceptions of social justice and evaluation. This approach is developed within the current debate taking place in the field of Critical Systems Thinking, particularly in the area of the evaluation of social and health programs. It is argued that the potential for equality and plurality in Western societies goes beyond the questions of economic exploitation, military, cultural and political oppression and encompasses the relation between power and knowledge which is inherent in rationalities governing the formulation, the implementation and the operation of health programs. The thesis offers an alternative view of social justice that conciliates equality with plurality, and promotes these values through an evaluative procedure. Using Foucault's philosophy, it is proposed that a nonfoundationalist conception of social justice should be understood in terms of the interactions between three areas of human activity, namely knowledge, morality, and techniques and technologies of government. As regards the possibilities for developing a non-foundational and non-universal evaluative judgement, the thesis assumes a decentered conception of truth in the analysis of society and morality, and acknowledges the role of power as factor of generalisation or diversification of truth. Thus complexes of power-knowledge-morality are at the centre of our evaluative judgements of social justice. In order to encourage equality and plurality, this thesis proposes a rationale for evaluation that includes three main methodological guidelines: a decentered conception of critique regarding the problems and negative effects of a health program (unfolding in reverse); the promotion of subjectivity (autonomy, diversity, solidarity) through self-knowledge and self-regulation of desires (folding); and participation in the reordering of society through an ethical and political process of decision-making (ethical and political unfolding of the situated truths of the subjects). The processes are designed to interrelate and iterate in a complex way. They should include the exploration, choice and combination of methods and/or their parts, and of the strategic positions in scientific and ethical discursivities by thinking critically and acting in a situated and participative way.

Holistic health care recognises that body, mind and spirit operate as an integrated whole yet spirituality remains a neglected element of total health care. A co-operative inquiry group, comprising staff from two cancer care centres, met for one year to explore spirituality. The aim of the inquiry was to explore participants' own spirituality with a view to how that affected their work. The eight health care professionals involved in the co-operative inquiry brought varied religious and non- religious perspectives as well as different professional roles. A church based journey into faith group also contributed to the research. A significant outcome of the co- operative inquiry group was the development of a continuing professional education module for health care staff about spiritual care. Although spirituality is a word used increasingly today, there seems little clarity about the concept. Confusion between spirituality and religion aggravates this lack of clarity. Significant influences in the development of the post modern, western world have marginalised the spiritual to the extent that it can be argued that people have lost a cohesive voice with which to discuss spirituality. For those contributing to this research, the experience of talking about spirituality with others in a safe but challenging environment was both enlightening and encouraging. From this experience emerged a greater clarity about spirituality which influenced both personal and professional experience. Clearer understanding led to greater confidence, enabling individuals from different professions to become more effectively involved in spiritual assessment and spiritual care. Continuing professional education about spirituality, particularly involving reflection on experience, offers an opportunity to extend this work to others.