Thesis (MMed)-UNiversity of KwaZulu-Natal, Durban, 2008. / Full text available online. Scroll down for electronic link.

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The aim of this study was to construct a theory for women's managerial career development that explained how women in health care services and health science faculties achieved senior management positions and developed their careers. It sought to discover the main barriers to career progress and achievement of senior level positions by women in health related organisations and to identify how women managers dealt with obstacles. In-depth interviews with 35 women managers in senior positions in 19 different organisations from three different cultural regions formed the major data source; observations, field notes, personal and operational journals, documents, and literature supplemented this data.This research was conducted in two phases. In phase one a descriptive approach was used to develop propositions about women managers and their careers. These propositions formed the guidelines for phase two. The second phase used grounded theory methods, incorporating feminist and interpretative perspectives to identify the previously inarticulated core problem shared by participants. The barriers that women encountered were the contradictory, inconsistent and incompatible assumptions about their potential to have long term careers and ability to move into senior level management positions.These assumptions had been received during their life and educational experiences, as well as from their organisations. The gendered context of health care organisations and university educational institutions contributed to the limited career aspirations and career progress of women with health professional qualifications. By applying grounded theory strategies for analysis of the data, it was discovered that the women managers dealt with this problem through a core process, labelled metamorphosis, a four stage process for overcoming assumptions. This core variable was the way these women ++ / managers moved from managing without confidence to managing with confidence and assurance.This process occurred over time having four stages, each involving different activities and strategies. The progressive spiral stages were: being in a quandary (struggling with incompatible and contradictory assumptions); observing, examining and reflecting (on the impact of internal and external assumptions on their behaviour in organisational contexts, then realising that opportunities existed); learning and reframing (the managerial skills in order to re-frame their assumptions about the traditional characteristics of a manager); and finally change and transformation into being confident managers, so developing women's presence in management.The findings generated a theory which proposed a managerial career development model for enabling women to manage with confidence and assurance. The outcome was a theoretical model which recognised the dynamic interaction between contexts (professional, organisational, political, economic, cultural, and research); a picture of women managers (personal beliefs, skills, characteristics, attributes of life long learning, relationship between life and career roles, and ways of changing contexts); and the inner energy force creating women's presence in health related organisations (core process and power of their metamorphosis).Contributing to the development of this theory of metamorphosis was the recognition that being and doing research with women involved valuing the personal learning process. This thread has been integrated into the research fabric to strengthen the reflective and personal experiences of research. Using and valuing women's stories enabled their voices and visibility to be taken out of the shadows and demonstrated that they can be pioneers in their own lives. The sense of collaboration in research, education, and community ++ / healing will gain from encouraging women to aspire to leadership and management positions.

This study explored the complex world of nursing at a time of humungous change in the delivery of health care services. The initial focus of the research was registered nurses' use of knowledge in professional practice; however this was largely displaced by contextual issues, which emerged from the data. Eraut's (1992,1994) concepts of professional knowledge informed the data generation and the analysis. A broadly qualitative approach drawing on grounded theory and constructivism provided the methodological framework and the research methods involved observation and interview. The sample comprised registered nurses undertaking a four-year part-time degree in nursing studies. Twenty-seven were observed in a variety of clinical settings: sixteen of this group were subsequently interviewed. Six of their managers were then interviewed. Data analysis followed a pattern of literal, interpretive and reflective coding and revealed a number of key issues for registered nurses working in the United Kingdom at the time of the research. The nurses fell into three categories, the survivors, the battle weary and the battle hardened; the largest group being the battle weary. The key causes of the weariness originated from organizational constraints such as low staffing levels, poor teamwork and an inability to give appropriate care to their patients. The effects of battle weariness included low morale, which affected their motivation, tearfulness and a general fatigue. The 'survivors' (a minority) were characterized by a sense of purpose and a fulfillment from their work. The contexts in which the battle weary worked were likened to a war zone with a clearly defined battlefield. Significant changes to the traditional role of the ward sister/charge nurse have left the majority of nurses in this study feeling unsupported and with a lack of clinical leadership. The nurses, often only working at 'D' or 'E' grade, frequently found themselves trying to cope with conflicts in practice with nursing colleagues, with patients and with doctors.Professional knowledge used in practice included communication and interpersonal skills, teamwork, delivering 'hands on' care to patients and coping with the ever changing demands on the nursing time. A number of recommendations are made and include an 'enabling curriculum' for educating nurses at initial and post registration level, a return of the clinical leadership role for ward sisters and charge nurses and a renewal of the focus of nursing practice.

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The sustainability of publicly funded Canadian health care services is an ongoing debate. Timely access to services and the availability of qualified health care professionals are vital to the survival of emergency health care services in rural and small towns. One of many factors threatening sustainability is the lack of qualified professionals. The current nursing shortage and the aging nursing workforce present rural hospitals with recruitment and retention challenges that threaten the sustainability of emergency services and thus have the potential to compromise the health of Canadians living in rural communities. Health care decisions are primarily based upon economics without consideration of the diversity of rural communities. Challenges in health care delivery including access to emergency services affect Canadians living in rural communities. These challenges need to be highlighted in the context of rural health as a unique entity in order to build awareness in policy makers to ensure appropriate health care service delivery to rural communities. It is important for researchers and policy makers to recognize that rural hospitals are not mini-urban centres and thus have differing needs. This two phase study focused on the sustainability of emergency health care services in rural and small town Ontario. Using a mixed methods approach, this study explored a descriptive analysis of emergency departments in rural Ontario and concluded with in-depth case studies of three rural emergency departments with varying travel distances to tertiary care facilities. These findings have validated pre-existing frameworks and can be used to assist policy makers at all levels to develop recommendations for sustaining emergency health care services in rural Ontario including ways to recruit, train, retain, and maintain resources that are vital to the survival of rural emergency services. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-24 16:23:27.162

Introduction: This study aimed to explore private General Practitioners' perceptions of Managed Health Care CMHC) for health service delivery in the Republic of South Africa (RSA). The specific objectives were to review perceptions regarding issues in MHC including ethics of care, quality of care, design ofMHC programmes and regulation and monitoring ofMHC. The study also reviewed demographic profile of respondents and associations between demographic profile and perceptions. A literature survey indicates that MHC was introduced in a Western context as a means ofregulating cost of healthcare. Models ofMHC generally involve a need to obtain authorization and a restriction of services available. There are ongoing debates about MBC and in particular the potential conflict between managing healthcare provision using business and profit principles and the principles of other stakeholders in health care. Providers, such as General Practitioners, are concerned that their autonomy and their ability to offer best possible care for their patients may be compromised. Patients feel that their ability to access optimal care is not a primary consideration in a model of MBe. The popularity ofMBC in the United States of America is declining and MBC companies have been making financial losses on the Stock Market. MBC has been introduced in South Africa and there has not been any recent assessment of healthcare provider perceptions of the model. This study aimed to address this gap in literature. Methods: The study design was mixed with quantitative and qualitative components. The study population was all private General Practitioners in RSA as this population would have most experience of MBC. The data collection tool was designed by the researcher and comprised closed-ended questions and one open-ended question around perceptions of MBe. Demographic data, and other data relating to experience of MBC, was collected on a separate questionnaire. Questionnaires were posted to a representative sample of private General Practitioners; this constituted 30% of all active private General Practitioners. Results and discussion: The response rate was poor at 13.6%. Respondents generally had negative perceptions of MHe. They cited problems with ethics ofMBC, quality of service and felt that it affected their ability to act independently. They felt that MHC should be monitored by an independent regulatory body and that there should be more teaching around differing models of healthcare. There were no significant associations between gender, place of work, experience oftvtHC and perceptions. However, there was a significant correlation between doctors employed by Iv1HC companies and perceptions. A major limitation of this study was the predominant use of quantitative methodology. A qualitative methodology, using focus group discussion, may have highlighted major issues and following initial qualitative methods a quantitative tool could have been developed. The low response rate is of concern. Respondents may be biased and may have only responded if they felt strongly about the subject. However, respondents did raise some important issues, especially with regards to ethics which must be explored further. There should be ongoing research into differing models of healthcare provision (for example private-public partnerships). Medical school curricula should include training around models of healthcare. Consideration should be given to monitoring MBC using an independent monitoring authority. / Thesis (M.Med)-University of KwaZulu-Natal, Durban, 2008.

Thesis (Ph.D. (Demography))--Mahidol University, 2007. / LICL has E-Thesis 0031 ; please contact computer services.