<p>Hypoxic ischemic encephalopathy (HIE) is a serious birth complication of full term infants; 40-60% of affected infants die by 2 years or have severe disabilities. Infants with HIE often have a normal gestation and parents anticipate a healthy birth. HIE can be managed with aggressively with moderate hypothermia < 6 hours of life, cardiopulmonary support, and seizure management. Experimental interventions such as moderate hypothermia > 6 hours of life and umbilical cord stem cell transplant are also available. Additional decision-making for these infants may include long-term developmental therapy, nutritional support, and respiratory support. However, who makes these decisions, what factors influence decision-making and the long-term impact of decision-making on parents and health care providers remains unknown. Therefore, the purpose of this study was to explore parental and health care provider decision-making for infants with HIE.</p><p>A longitudinal case study design was used to study 11 cases of infants with HIE. Each case included the infant, the parent, and the infant's providers. Infant medical record data, interviews and questionnaires were used to collect data from infant birth through 6 months of age. Content analysis was used to analyze the interviews. Descriptive statistics were used with the questionnaires. Visualization techniques were used to search for patterns and trends in the assembled data. </p><p>All infants required resuscitation and their treatment plans included aggressive care or aggressive and experimental care. The level of parental participation varied with in the first week of life depending on whether the infant was enrolled in experimental interventions plus aggressive care or only aggressive care. Parental hopefulness was lower in parents of infants who received experimental interventions, but the infants receiving experimental interventions were less critically ill than infants who received aggressive care only. Parental stress was also lower among parents of infants who received experimental interventions over the first 2 months of life. </p><p>Parents were concerned about the short and long-term impact of HIE, few parents understood that even though their infant had appropriate developmental outcomes at 6-months that did mean that neurological damage occurred. However in one case of an infant, the neurological development became central to the parental decision-making for the infant. Parents became less hopeful as diagnostic examinations continued find more complex conditions that were individually not problematic for the parents, but when the complexity of the infant's illnesses continued to unfold, parents feared that too many complications existed for their daughter to have an acceptable quality of life. Yet, when parents broached the topic of transitioning from aggressive care to palliative care with providers, they were told that withholding/withdrawing treatment was not appropriate for the infant. Not discussing withholding or withdrawing treatment ultimately created conflict between parents and providers due to differences in opinions about the predicted neurological outcomes for the infant. The conflict led to distrust and parents regretted most decisions they made for their infant. </p><p>Parental and provider decision-making is complex and many of the decisions within the 6-month trajectory were made within the first 6 hours of birth. Parents felt that the decision-making was appropriate in most cases, but the extent of the infant's injury remains unknown. How parents will evaluate the decision-making when the infant begins to miss developmental milestones is unknown. Results from this dissertation suggest that decision-making is a trajectory and decisions are not made in isolation. Implications for practice include discussing and educating parents during the first 6 months and later about developmental milestones and the importance of continuing therapy, even when the infant appears normal. Providers can also acknowledge to parents, up front, that the extent of the neurological injury is unknown and different providers may have different opinions about the long-term effects. By acknowledging these differences, providers can begin discussing the treatment options with parents and educating them about the specific needs of their infant.</p> / Dissertation

It has been well established that many people will suffer with pain at the end of life, and untreated pain contributes to reduced quality of life. Many barriers contribute to this issue including a lack of knowledge in nurses who care for dying patients. Many nurses in general practice settings do not possess adequate knowledge about basic pain management principles; and the same may be true about hospice nurses despite the assumption that hospice nurses are more adept at pain management. Contributing to this problem may be the attitudes that nurses, including hospice nurses, have regarding pain and its management. This study sought to identify the knowledge levels of hospice nurses. Because attitudes may affect the delivery of effective pain management, the study also sought to determine attitudes of hospice nurses regarding pain and its management. Thirty-five hospice nurses completed two instruments: The Pain Management Principles Assessment Test measured levels of knowledge and the Nurses Pain Management Attitude Survey determined attitudes. Data was analyzed using means, standard deviations, frequencies and percentages. A correlation between knowledge level and attitude was also calculated, along with a correlation between knowledge level and certification status. The overall mean knowledge score for the nurses studied was 21.74 (72.3%), which falls below accepted standards. The mean attitude score found was 82.34, which demonstrates only slightly positive attitudes. These findings support the idea that knowledge and attitude are not synonymous and that a nurse may have a positive attitude about the management of pain, without sufficient knowledge to effectively alleviate pain. It is often said that hospice nursing is a calling, and these are the nurses who are at the forefront of pain management. This study demonstrates that slightly more positive attitudes may indicate that this group of nurses is motivated to gain a better knowledge base. This should motivate hospices and other education institutions to incorporate more specific instruction regarding pain management into their curricula. Despite some common misconceptions pain does not have to be an unavoidable part of life, and with a better knowledge base hospice nurses could more effectively deliver compassionate, expert care.

Background: Homelessness is increasing, and health care is still difficult for many homeless people to achieve. If they get sick, it is both technically challenging to get a clinic they can go to, but also an economic problem because most of the homeless have no gainful employment. The fact that many homeless people experience bad attitudes of health care professionals is one reason why they don’t seek healthcare until an emergency arises. In the profession as a nurse, all people should be given equal treatment regardless of background. A nurse's obligation is to provide equal care to all.Aim: The aim of this study was to describe how homeless persons experience the encounter with health care providers.Method: The study was designed as a literature review with aim to critically review and compile the results from the found articles results. Five articles from CINAHL, two from PubMed and two from an unsystematic review were analyzed from their results of homeless person’s experience of the encounter with health care providers.Results: Four different themes were revealed in the analysis of the articles: Communication, Involvement, Subject – Object and Attitudes. Both positive and negative feelings perceived by the homeless persons emerged. Not being treated with respect because being homeless and not listened to where frequently mentioned. Even a wish that health care providers would be more human in the encounter with the homeless persons was a desire.Conclusion: Many homeless persons experience bad treatment from health care providers. Few studies has been done on this subject, wich needs to be explored to give health care providers a better understanding for a vulnerable group of people.Keywords: Encounter, experience, Halldorsdottir, health care provider, homeless

Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients’ health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers’ skills and clients’ satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities.

Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients’ health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers’ skills and clients’ satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities.

Bakgrund: Antalet människor med psykisk ohälsa har på senare år ökat. Dessa påträffas inom vårdens olika instanser och vårdare har stor sannolikhet att möta någon drabbad oavsett arbetsplats. Studier visar att vårdare har en "negativ attityd" till att vårda patienter med psykisk ohälsa och känner sig oförberedda inför patienternas behov. Det behövs mer kunskap om hur mötet mellan vårdare och patient upplevs ur ett patientperspektiv. Syfte: Att beskriva hur patienter med psykisk ohälsa upplever mötet med vårdare i hälso- och sjukvården. Metod: Studien hade kvalitativ ansats och beskrev patienters upplevelser genom kvalitativ innehållsanalys utifrån sex självbiografier. Resultat: I mötet med vårdare upplevde patienter med psykisk ohälsa att de kände förtroende och misstroende, att de stod under vårdares makt, att de blev behandlade med omtanke och kyla, blev sedda och avvisade, att de inte blev respekterade och att de inte blev tagna på allvar. Slutsats: Mötet beskrevs i form av både positiva och negativa upplevelser. Förtroende, respekt, att bli sedd och omhändertagen bidrog till att mötet upplevdes positivt. Genomgående flest negativa upplevelser beskrevs rörande brist på respekt, makt och patienters trovärdighet. Negativa upplevelser hämmar återhämtningsprocessen vilket gör det angeläget att öka kunskapen hos vårdare hur livsvärlden ser ut hos patienter med psykisk ohälsa. Klinisk betydelse: Resultatet av studien kan användas för att få kunskap och ökad förståelse för hur patienter med psykisk ohälsa upplever mötet med vårdare. På detta sätt kan de brister uppmärksammas som finns i vårdares sätt att bemöta dessa patienter, vilket kan bidra till förbättrade förutsättningar för att vårdmöten skall ge positiva upplevelser. / Background: In recent years the number of people with mental illness has increased. It is happening everywhere within healthcare and therefore care workers have a high probability of encountering someone suffering from mental illness. Studies show that care workers display a "negative attitude" towards caring for patients with mental illness and feel unprepared to meet their needs. Increased knowledge from a patient’s perspective is needed to show how the encounter between care workers and patient is perceived. Aim: To describe how patients with mental illness experience the encounter with care workers within healthcare. Method: The study had a qualitative approach that described patients' experiences through the use of qualitative content analysis based on six autobiographies. Results: In the encounter with care workers, patients with mental illness experienced both trust and mistrust, powerlessness, as well as thoughtfulness but also coldness. They sensed concern but also rejection, disrespect and feeling of insignificance. Conclusion: The encounter was described in terms of positive and negative experiences. Trust, respect, to sense concern and to be shown consideration contributed to the encounter being perceived as positive. Most negative experiences were described concerning lack of respect, power and feeling of insignificance. Negative experiences are a hindrance to the recovery process which makes it important to increase knowledge in health care providers about what the life world of patients with mental illness contains. Clinical significance: The results of the study can be used to gain knowledge and increase understanding of how patients with mental illness experience the encounter with care workers. This provides a way to address the shortcomings of care workers’ way of responding to these patients and may contribute to improved conditions for healthcare encounters to be perceived as positive.

Made available in DSpace on 2016-08-03T16:34:23Z (GMT). No. of bitstreams: 1 Juliana Martinez Pieroni final.pdf: 2028266 bytes, checksum: d4848411f294e50d76722943449d6adb (MD5) Previous issue date: 2012-09-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The current perspective of psychological science, coupled with all aspects of positive psychology and health, allows researching of the resilience phenomenon, turning old questions into new understanding possibilities, and admitting a positive outlook of human beings, rather than looking at its negative aspects, focusing instead on all virtuous aspects, such as resilience, happiness, optimism, altruism, hope, as favorable resources for health maintenance and promotion. The perception of social support protects individuals against destabilization, and human values contribute to human decision-making and choices for conflict resolution. The aim of this research was to determine whether human values and perceptions of social support predict resilience in health care professionals. 127 Brazilians took part on the research, all of them being health professionals, 76% female, mean age of 38 years, and mostly married. The instruments used for data collection were a sociodemographic questionnaire, the Resilience Assessment Scale, the Questionnaire Profiles QPV Values Scale and Perceived Social Support EPSS. Calculations of descriptive statistics, t tests and standard multiple linear regression analysis were made. The results showed that the participants have high levels of resilience, apprehending that they receive more emotional support, move and guide their actions and behaviors for the positive welfare of others. Results of regression analysis revealed that only human values are predictors of resilience. These findings contribute to the understanding of the construct of resilience as a state or process, and therefore, as a dynamic phenomenon that takes into account the context in which the human being is inserted. It also reveals the importance of individual characteristics in explaining this phenomenon. Given the limitations of this study and considering that no empirical study was found prior to this research on the influence of values on human resilience, the results indicate the need for development of further researching to better understand the predictors of resilience. A research agenda is suggested at the end of the conclusions. / A perspectiva atual da ciência psicológica, somada aos aspectos da psicologia positiva e da saúde, permite estudar o fenômeno da resiliência, transformando velhas questões em novas possibilidades de compreensão, permitindo um olhar positivo dos seres humanos, focando ao invés de aspectos negativos, os aspectos virtuosos, tais como: resiliência, felicidade, otimismo, altruísmo, esperança, como sendo recursos favoráveis para manutenção e promoção da saúde. A percepção do suporte social protege os indivíduos contra a desestabilização, e os valores humanos contribuem na tomada de decisão e nas escolhas para a resolução de conflitos. O objetivo deste estudo foi verificar se valores humanos e percepção de suporte social predizem resiliência em profissionais da saúde. Participaram 127 brasileiros, profissionais da saúde, sendo 76% do sexo feminino, com idade média de 38 anos, em sua maioria, casados. Os instrumentos utilizados para a coleta de dados foram um questionário de dados sociodemográficos, a Escala de Avaliação de Resiliência, o Questionário de Perfis de Valores QPV e Escala de Percepção de Suporte Social EPSS. Foram calculadas estatísticas descritivas, testes t e análises de regressão lineares múltiplas padrão. Os resultados revelaram que os participantes possuem bons níveis de resiliência, percebem que recebem mais suporte afetivo e movem e guiam suas ações e comportamentos pelo bem-estar dos outros. Resultados das análises de regressão revelaram que apenas valores humanos são preditores de resiliência. Estes achados contribuem para a compreensão do constructo de resiliência como um estado ou processo, portanto, como um fenômeno dinâmico que leva em consideração o contexto onde o ser humano está inserido, mas revela também a importância das características individuais na explicação deste fenômeno. Tendo em vista as limitações deste estudo e considerando que não foi encontrado nenhum estudo empírico acerca da influencia dos valores humanos sobre a resiliência, os resultados indicam a necessidade de desenvolvimentos de mais estudos para melhor compreensão dos preditores de resiliência e uma agenda de pesquisa é sugerida ao final das conclusões.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients' health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers' skills and clients' satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities. / South Africa