Syfte: Att utifrån litteratur beskriva hur sjuksköterskan kan identifiera tecken på depression hos tonåringar med typ 1 diabetes och hur hon kan stödja dessa tonåringar. Metod: En deskriptiv litteraturstudie som baseras på 15 artiklar sökta i databaserna CINAHL och PubMed samt genom manuella sökningar. Huvudresultat: Tecken på depression hos tonåringar med typ 1 diabetes är högt HbA1c-värde, låg frekvens av blodsockerkontroller och lägre livskvalité. Sjuksköterskan kan använda sig av standardiserade mätinstrument för att identifiera tecken på depression hos tonåringar med typ 1 diabetes, till exempel CDI, CES-D, YSR, WHO-5 och VAS. Tonåringar med typ 1 diabetes önskar stödåtgärder i form av skräddarsydda strukturerade undervisningsprogram, roliga aktiviteter och uppföljning via SMS. Sjuksköterskan kan använda sig av gruppintervention, internetbaserade egenvårdsprogram samt be tonåringarna skriva själva om sin diabetes, vilket har visat sig ha positiva effekter på tonåringens välbefinnande. Vårdgivare uppger flera hinder i hanteringen av depression hos diabetespatienter, bland annat otillräcklig utbildning och tidsbrist. Slutsats: Det är viktigt med utbildning för sjuksköterskor inom området tonåringar, typ 1 diabetes och depression. Mer forskning är nödvändigt för att möta kombinationen typ 1 diabetes och depression hos tonåringar. / Aim: To describe according to the literature how the nurse can identify signs of depression in adolescents with type 1 diabetes and how the nurse can support them. Method: A literature study with descriptive design based on 15 scientific articles searched in the databases CINAHL, PubMed and by ancestry approach. Main results: Signs of depression in adolescents with type 1 diabetes are high HbA1c, low frequency of blood glucose monitoring and lower quality of life. The nurse can use standardized questionnaires to identify signs of depression in adolescents with type 1 diabetes, for example CDI, CES-D, YSR, WHO-5 and VAS. Adolescents with type 1 diabetes wish supportive measures such as tailored, structured education programs, fun activities and follow-up by text messaging. The nurse can use group interventions, internet-based self-care programs and ask adolescents to write about their diabetes, because this has positive effects on the adolescent’s well-being. Health care providers report several obstacles in the management of depression in patients with diabetes, among other things inadequate training and lack of time. Conclusion: It is important with training for nurses in the field of adolescents, type 1 diabetes and depression. More research is needed to meet the combination of type 1 diabetes and depression in adolescents.

Patients are the key stakeholders in health care providers and it is extremely important to increase their satisfaction level. Patient satisfaction is a subject of great interest to the health care providers and researchers alike. As there are a lot of factors related to health care providers that causes patient selection and rejection. Since competition has increased in recent years, this exerts more pressure on health care providers to render more improved service quality in addition to build trust and gain high reputation. Improved quality of service has now become an important aspect of patient satisfaction, building trust is now a crucial milestone and gaining high reputation is considered the key for any health care provider. In practice and theory it has been proven that service quality dimensions, trust and reputation is related to patient satisfaction. For this, we took 5Q model of the service quality combine with trust and reputation, and how it affects patient satisfaction is the main theme of the study. Purpose: The purpose of this study is to investigate that how 5Q model of the service quality, trust and reputation can effect patient satisfaction in health care sectors, for this study we researched Umeå hospital. This research is focused towards exploring the perceptions of patients who consume or undertook Umeå hospital services. It also provides an effective model for health care organization in practice and the study also contribute to literature from educational point of view.  Method: In this study hypothesis developed to investigate how 5Q model of the service quality, trust and reputation can effect patient satisfaction. For service quality 5Q model was used while several attributes were taken for trust and reputation to investigate the patient perception. Quantitative research strategy was adopted and convenience sampling technique was used to collect quantitative data from patients of Umeå hospital to get their satisfaction levels. Hypotheses were tested by using multiple regression analysis to the obtained data in SPSS. Findings: The study revealed interesting results for patient satisfaction regarding the 5Q model of the service quality, trust and reputation. Meanwhile 5Q model was used for service quality, which composes quality of object, quality of process, quality of infrastructure, quality of interaction and quality of atmosphere. Out of five dimensions, two gave positive effect and three gave no effect result by the patient for their satisfaction from the Umeå hospital. Trust gave no effect result, whereas reputation gave positive effect result by the patient for their satisfaction from the Umeå hospital. Implication/Contribution: The findings imply that 5Q model of the service quality is not the only factor that could lead to patient satisfaction in health care sectors but trust and reputation are also factors of great importance. Organizations need to improve every dimension of service quality, creating trust and achieve high reputation to gain high level of patient satisfaction. This study contributes to existing theories by confirming or adding value that have positive effect on patient satisfaction. 5Q model is a comprehensive model and it needs to be implemented in health care sector but with additional factors i.e. trust and reputation.  Key words: Patient satisfaction, Service quality, 5Q model, Trust, Reputation, Health care providers.

<p><img src="file:///C:/DOCUME~1/staff/LOCALS~1/Temp/moz-screenshot-13.jpg" alt="" /> <meta http-equiv="Content-Type" content="text/html / charset=utf-8"> <meta name="ProgId" content="Word.Document"> <meta name="Generator" content="Microsoft Word 12"> <meta name="Originator" content="Microsoft Word 12"> <link rel="File-List" href="file:///C:DOCUME~1staffLOCALS~1Tempmsohtmlclip11clip_filelist.xml" /> <link rel="themeData" href="file:///C:DOCUME~1staffLOCALS~1Tempmsohtmlclip11clip_themedata.thmx" /> <link rel="colorSchemeMapping" href="file:///C:DOCUME~1staffLOCALS~1Tempmsohtmlclip11clip_colorschememapping.xml" /><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves /> <w:TrackFormatting /> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF /> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> <w:SplitPgBreakAndParaMark /> <w:DontVertAlignCellWithSp /> <w:DontBreakConstrainedForcedTables /> <w:DontVertAlignInTxbx /> <w:Word11KerningPairs /> <w:CachedColBalance /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math" /> <m:brkBin m:val="before" /> <m:brkBinSub m:val="&#45 / -" /> <m:smallFrac m:val="off" /> <m:dispDef /> <m:lMargin m:val="0" /> <m:rMargin m:val="0" /> <m:defJc m:val="centerGroup" /> <m:wrapIndent m:val="1440" /> <m:intLim m:val="subSup" /> <m:naryLim m:val="undOvr" /> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true" DefSemiHidden="true" DefQFormat="false" DefPriority="99" LatentStyleCount="267"> <w:LsdException Locked="false" Priority="0" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Normal" /> <w:LsdException Locked="false" Priority="9" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="heading 1" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8" /> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9" /> <w:LsdException Locked="false" Priority="39" Name="toc 1" /> <w:LsdException Locked="false" Priority="39" Name="toc 2" /> <w:LsdException Locked="false" Priority="39" Name="toc 3" /> <w:LsdException Locked="false" Priority="39" Name="toc 4" /> <w:LsdException Locked="false" Priority="39" Name="toc 5" /> <w:LsdException Locked="false" Priority="39" Name="toc 6" /> <w:LsdException Locked="false" Priority="39" Name="toc 7" /> <w:LsdException Locked="false" Priority="39" Name="toc 8" /> <w:LsdException Locked="false" Priority="39" Name="toc 9" /> <w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption" /> <w:LsdException Locked="false" Priority="10" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Title" /> <w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font" /> <w:LsdException Locked="false" Priority="11" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtitle" /> <w:LsdException Locked="false" Priority="22" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Strong" /> <w:LsdException Locked="false" Priority="20" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Emphasis" /> <w:LsdException Locked="false" Priority="59" SemiHidden="false" UnhideWhenUsed="false" Name="Table Grid" /> <w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text" /> <w:LsdException Locked="false" Priority="1" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="No Spacing" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 1" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 1" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 1" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 1" /> <w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision" /> <w:LsdException Locked="false" Priority="34" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="List Paragraph" /> <w:LsdException Locked="false" Priority="29" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Quote" /> <w:LsdException Locked="false" Priority="30" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Quote" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 1" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 1" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 1" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 1" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 1" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 2" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 2" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 2" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 2" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 2" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 2" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 2" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 2" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 2" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 3" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 3" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 3" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 3" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 3" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 3" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 3" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 3" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 3" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 4" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 4" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 4" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 4" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 4" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 4" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 4" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 4" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 4" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 5" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 5" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 5" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 5" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 5" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 5" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 5" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 5" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 5" /> <w:LsdException Locked="false" Priority="60" SemiHidden="false" UnhideWhenUsed="false" Name="Light Shading Accent 6" /> <w:LsdException Locked="false" Priority="61" SemiHidden="false" UnhideWhenUsed="false" Name="Light List Accent 6" /> <w:LsdException Locked="false" Priority="62" SemiHidden="false" UnhideWhenUsed="false" Name="Light Grid Accent 6" /> <w:LsdException Locked="false" Priority="63" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6" /> <w:LsdException Locked="false" Priority="64" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6" /> <w:LsdException Locked="false" Priority="65" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 1 Accent 6" /> <w:LsdException Locked="false" Priority="66" SemiHidden="false" UnhideWhenUsed="false" Name="Medium List 2 Accent 6" /> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6" /> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6" /> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6" /> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 6" /> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 6" /> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 6" /> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 6" /> <w:LsdException Locked="false" Priority="19" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis" /> <w:LsdException Locked="false" Priority="21" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis" /> <w:LsdException Locked="false" Priority="31" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference" /> <w:LsdException Locked="false" Priority="32" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Reference" /> <w:LsdException Locked="false" Priority="33" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Book Title" /> <w:LsdException Locked="false" Priority="37" Name="Bibliography" /> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading" /> </w:LatentStyles> </xml><![endif]--><style type="text/css"> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math" / panose-1:2 4 5 3 5 4 6 3 2 4 / mso-font-charset:0 / mso-generic-font-family:roman / mso-font-pitch:variable / mso-font-signature:-1610611985 1107304683 0 0 159 0 / } @font-face {font-family:Calibri / panose-1:2 15 5 2 2 2 4 3 2 4 / mso-font-alt:Calibri / mso-font-charset:0 / mso-generic-font-family:swiss / mso-font-pitch:variable / mso-font-signature:-1610611985 1073750139 0 0 159 0 / } /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no / mso-style-qformat:yes / mso-style-parent:"" / margin-top:0in / margin-right:0in / margin-bottom:10.0pt / margin-left:0in / line-height:115% / mso-pagination:widow-orphan / font-size:11.0pt / font-family:"Calibri","sans-serif" / mso-ascii-font-family:Calibri / mso-ascii-theme-font:minor-latin / mso-fareast-font-family:"Times New Roman" / mso-hansi-font-family:Calibri / mso-hansi-theme-font:minor-latin / mso-bidi-font-family:"Times New Roman" / mso-bidi-theme-font:minor-bidi / } .MsoChpDefault {mso-style-type:export-only / mso-default-props:yes / font-family:"Univers Condensed","sans-serif" / mso-ascii-font-family:Calibri / mso-ascii-theme-font:minor-latin / mso-hansi-font-family:Calibri / mso-hansi-theme-font:minor-latin / mso-bidi-font-family:Calibri / mso-bidi-theme-font:minor-latin / } .MsoPapDefault {mso-style-type:export-only / margin-bottom:10.0pt / line-height:115% / } @page WordSection1 {size:8.5in 11.0in / margin:1.0in 1.0in 1.0in 1.0in / mso-header-margin:.5in / mso-footer-margin:.5in / mso-paper-source:0 / } div.WordSection1 {page:WordSection1 / } --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" / mso-tstyle-rowband-size:0 / mso-tstyle-colband-size:0 / mso-style-noshow:yes / mso-style-priority:99 / mso-style-qformat:yes / mso-style-parent:"" / mso-padding-alt:0in 5.4pt 0in 5.4pt / mso-para-margin-top:0in / mso-para-margin-right:0in / mso-para-margin-bottom:10.0pt / mso-para-margin-left:0in / line-height:115% / mso-pagination:widow-orphan / font-size:11.0pt / font-family:"Calibri","sans-serif" / mso-ascii-font-family:Calibri / mso-ascii-theme-font:minor-latin / mso-fareast-font-family:"Times New Roman" / mso-fareast-theme-font:minor-fareast / mso-hansi-font-family:Calibri / mso-hansi-theme-font:minor-latin / mso-bidi-font-family:"Times New Roman" / mso-bidi-theme-font:minor-bidi / } </style> <![endif]--> </meta> </meta> </meta> </meta> </p> <p class="MsoNormal"><span style="font-size: 12pt / line-height: 115% / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / ">This study has reveled the levels of knowledge and compliance towards Universal Precautions and examined the factors that are influential in having a positive and negative effect on their adoption by healthcare practitioners in practice. Despite acceptable knowledge regarding the potential for infection and mechanisms to prevent these infections, this study has found out that health care workers are not as compliant with universal precautions as they need to be. The findings that compliance correlated directly with knowledge, with in-service training and with availability of protective equipment, provide important indications for future interventions. Therefore a regular on job refreshing training program on Universal Precautions, a written guideline and reminder poster on Universal Precautions and personal protective equipment need to be made available for all health care providers in every department of the hospital for better compliance. <span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><o:p></o:p></span></p> <p>&nbsp / </p>

Background: Alzheimer???s disease and related dementias (ADRD) are often improperly or under-diagnosed in primary care; yet, it is expected that community-based care will be an increasingly important source of support for ADRD patients. In Ontario, primary care has continued to expand its services to include health team models, such as family health teams (FHTs) to provide multidisciplinary collaborative care for patients. Within such teams, memory clinic teams have also been implemented, which are clinic days set up typically once or twice a month to provide interprofessional collaborative care specifically for ADRD patients by trained health care providers (HCPs). Objective: Little is known about the experience of HCPs who work in primary care memory clinic team settings to provide care for ADRD patients. This study explored these experiences. Specifically, questions were asked around the rewards, challenges and motivations with working in the memory clinic structure and providing support to ADRD patients. Methods: A phenomenological approach was used. One-on-one semi-structured interviews were completed with 12 interprofessional team members in two primary care memory clinic teams. Interviews were transcribed and analyzed using Colaizzi???s (1978) method of analysis. Results: Overall, seven subthemes were found which describe the HCP experience. The first two subthemes describe experiencing the journey with the patient and caregiver. HCPs want to support patients while maintaining the patient???s dignity. They also balance emotional dilemmas with responsibilities. The next two subthemes describe experiencing the journey with the team. HCPs feel valued and connected to their team members. The memory clinic structure offers unique care provider experiences. Lastly, three subthemes were found which describe the personal and professional rewards of the experience. HCPs found thrilling complexities within the patient population in the memory clinic and that working in the clinic they are able to experience ongoing learning opportunities. HCPs also described that the memory clinic offers personal and professional fulfillment. Discussion: HCPs described an overall positive experience working in the memory clinic to support ADRD patients. HCPs take pride in being able to support patients and caregivers. Knowing that they are making a difference and doing good work are motivations to continue to work with complex populations, such as ADRD patients. HCPs enjoy working in close proximity to one another, respect their team members, and enjoy learning from each other. Team members motivate each other to stay and work with the ADRD population in primary care memory clinics. HCPs reap many rewards associated with working in a ???tight-knit??? memory clinic team setting for ADRD patients. As the number of HCPs working in team settings continues to grow in Canada, it is important to look at the experiences of these teams to understand the rewards, challenges and motivations of team members. Conclusions: These findings provide more context in understanding how to motivate future HCPs to work with more complex populations such as ADRD patients. Future research should address the outcomes of these clinics by exploring patient and family caregiver experiences with specialized teams, as it is important to gain their experiences to enhance the care practices for these individuals.

This qualitative inquiry sought to explore how relationships are experienced in every day moments of care provided to childbearing women, infants, and families. Fifteen health care providers and thirteen childbearing women were interviewed regarding the degree to which these relationships have impacts on women’s health capacities and outcomes of care. These experiences were examined within the context of the broader social and cultural contexts of maternal-infant care. All twenty eight participants in the study were involved with an antenatal home care program and a neonatal intensive care unit within the Lower Mainland Health Authority in British Columbia. The epistemological and methodological approach to the study combined relational and pragmatist perspectives on knowledge and a deconstructionist hermeneutic lens. Findings indicate that participants’ experiences are created in each moment of interpersonal care, and the interactions between health care providers and child-bearing women are far from neutral in terms of their impact on women’s health capacities and outcomes of care. Clear distinctions in perspectives among the two groups emerged: the child-bearing women dismissed the use of the term ‘relationship’ in describing their experiences with health care providers. In contrast, health care providers spoke of their assumption that the basis of engagement was a supportive relationship, the primary vehicle through which neutral and impartial health care is provided. The findings detail that relationships are sites of meaningful experiences and can facilitate as well as constrain women’s agency and self-worth; some of these experiences jeopardized the women’s health capacities and outcomes of care as they endured health challenges in pregnancy and as they mothered their ill infants. Although health care providers and childbearing women drew upon different discursive resources and features of two program contexts, a similar construction of knowledge and experience was evident within participants’ accounts. Whereas health care providers tended to speak with the grain of instrumental and sentimental discourses through a veil of neutrality, the child-bearing women spoke against the grain by resisting the notion that interpersonal spaces are necessarily sites of one-on-one individual interaction. Rather, the data suggests that interpersonal spaces are not individualized spaces. Experiences of relationship were broadly situated and shaped through the relational complexity of each moment of the interpersonal, where the cultural ‘scenes’ of maternal-infant care shaped relationships and constructed the women’s health capacities and outcomes of care. In this way, the face to face is not so innocent.

A grounded theory study (Charmaz, 2006) explored health care providers' (HCPs) hope processes (hopework) caring for cancer patients facing end of life. A critical social work perspective was used to investigate experiences of nurses, doctors and social workers and counsellors in their work with psychosocial and emotional end of life issues. Health care providers' engaged in a core process of hopework as they faced the ambiguous and uncertain terrain of end of life care. They searched for realistic hope by shifting their professional and personal hopes. This core process was achieved by meaning-based actions that enabled HCPs to tolerate tragic circumstances and to build emotional scaffolding to sustain themselves. The findings indicate that HCPs engage in a parallel process of hopework with their patients to achieve `realistic hopes'. Although concepts of hopework are not easily defined, the processes of hope need to be addressed in the professional training of HCPs to optimize patient care and to prevent damage to patients' vulnerable hopes.

Magister Curationis - MCur / Early infant diagnosis (EID) programmes offer diagnosis of HIV, which facilitates provision of life-saving care to infants infected with HIV. Implementing programmes for EID and treatment has proved challenging in Malawi. Many infants access EID late or not at all. Previous studies have shown that lack of knowledge among health care providers (HCPs) is a challenge to effective EID. Little is known on the knowledge and skills of health care providers in Malawi. Aim: The aim of the study was to investigate the knowledge and skills of HCPs on EID of HIV in Mzuzu, Malawi. Objectives: (i) to examine the knowledge of HCPs on EID of HIV; and (ii) to determine the skills of HCPs on EID of HIV. Methods: A descriptive cross-sectional survey design with a quantitative approach was used. The study was conducted in three hospitals in Mzuzu, Malawi. The population was HCPs (doctors, nurses/midwives, clinical officers and medical assistants) working in maternity, paediatric wards and under-five clinics. A total of 68 HCPs participated in the study. A closed-ended self-administered questionnaire was used to collect data. Data were analysed using the Statistical Package for Social Science version 23. Descriptive statistics were used to present the frequency tables of observations. Ethical approval was sought from the University of the Western Cape Senate Research Committee and Malawi National Health Research Council. Results: The results on the knowledge of HCPs demonstrate that 38% of them had a score of <69% (poor), 25% scored within 70–79% (fair), and 37% scored >80% (good). Results on the skills showed that 69% of the HCPs scored <69% (poor), 15% scored within 70–79% (fair), and 16% scored >80% (good). The results also showed a correlation between the knowledge of HCPs and their level of education achievement (certificate, diploma and degree) as well as the skills of HCPs and their department of work. Conclusion: The study found that more than one-third of the HCPs lacked knowledge and skills on EID of HIV. These findings reflect the need to address the practical challenges of EID service delivery. Recommendations: There is a need to increase the efforts that are being put in place to train HCPs on EID of HIV in order to scale up EID. Training should assess the needs of HCPs regarding the knowledge and skills required in the delivery of EID services.

Magister Public Health - MPH / This study has reveled the levels of knowledge and compliance towards Universal Precautions and examined the factors that are influential in having a positive and negative effect on their adoption by healthcare practitioners in practice. Despite acceptable knowledge regarding the potential for infection and mechanisms to prevent these infections, this study has found out that health care workers are not as compliant with universal precautions as they need to be. The findings that compliance correlated directly with knowledge, with in-service training and with availability of protective equipment, provide important indications for future interventions. Therefore a regular on job refreshing training program on Universal Precautions, a written guideline and reminder poster on Universal Precautions and personal protective equipment need to be made available for all health care providers in every department of the hospital for better compliance.

Purpose: To describe well-being in military reserve health care providers post deployment or mobilization Background: A comprehensive literature review exhibited that during a deployment or mobilization, military health care providers endure stressful and uncomfortable situations, spend time away from their family, friends and usual home comforts leaving them feeling completely changed. These circumstances can negatively affect a provider’s well-being. Moreover, although the literature outlines military and psychological symptoms including combat stressors, mental health concerns such as depression and anxiety, job stress, work performance and resiliency, there is a gap in the literature regarding well-being among military health care providers post deployment or mobilization. Methods: This project used a qualitative descriptive methodology with face-to-face interviews to describe the phenomenon of well-being among three United States reserve military health care providers post deployment or mobilization. Data was collected using semi-structured, open ended questions, allowing the participants an opportunity to discuss and further elaborate on their experiences, perspectives and feelings. Each interview began with pre-established questions and further questions and discussions were guided by the participants’ earlier responses. Interviews were audio recorded and transcribed into text, allowing me to identify commonalities of experiences, perspectives and feelings among the participants. Results: Analysis of the interview data revealed information associated with transitions and can be grouped into five categories. The categories that impacted the participants’ well-being post deployment or mobilization include: separation from family and friends, austere living conditions, exhaustion from long work hours, consecutive work days without days off and being unprepared for what was to come. Implications: This project describes well-being in military reserve health care providers post deployment or mobilization. Findings from this small project may be used to develop research studies to describe and understand the concept of well-being among military health care providers. Armed with better understanding, we could then develop interventions to prepare our military health care providers to deliver high quality care during overseas deployment or mobilization while also maintaining their physical and mental well-being.

The purpose of this study was to explore healthcare providers' awareness and perceptions of complementary and alternative medicine (CAM) use in providing systemic lupus erythematosus (SLE) care. This phenomenolgical study was built upon existing research indicating SLE patients' need to foster better communication about CAM use. Participants were recruited from the Long Island Rheumalogical Clinic in the State of New York. Individual in-depth semistructered interviews were conducted to explore the awareness and perceptions of a purposive sample of 10 healthcare providers who care for patients with SLE. Transcripts were analyzed, and categorical themes were developed. Guided by the use of the shared decision-making model and self-efficacy theory, 5 themes emerged: varied knowledge and experiences with CAM varied, participants' personal experience and perceived effectiveness led to patient guidance and advice, perceived benefits of CAM use, participants as patient advocates, and initiatives for further research. Study findings revealed that the knowledge, attitudes, and beliefs of health care providers regarding the use of CAM shed light on the importance of health promotion to guide future research, both within and beyond CAM. Strategies are recommended to increase awareness and understanding of CAM use through proper education and advocacy. This research may lead to positive social change in that providers may use the information in this research to break down barriers to communication between patients and professionals regarding CAM usage.