This study explores women's experiences of critical illness in Jordanian intensive care units. A narrative approach was employed to access Jordanian women's stories of their critical illness and to study how these accounts changed during the period following their discharge from intensive care. The study was conducted in two hospitals in a major Jordanian city. A purposive sample of 16 women who had spent at least 48 hours in intensive care was recruited over a period of six months, with each woman taking part in between one and three interviews during the six month period. Two focus group discussions were also conducted with 13 ICU nurses drawn from the hospitals in which the women had been patients. These had the aim of encouraging discussion about the development of new supportive care strategies for critically ill women in Jordanian intensive care units. The study findings revealed three main areas: the women's experiences of suffering and pain; their experience of body care; and the impact of the ICU experiences on their lives after discharge home. Experiences of suffering were pervaded with physical, emotional, social and temporal dimensions, interlinked with pain that was often severe, overwhelming, and disturbing to their sleep. The notion of 'nafsi' suffering was employed to describe emotional and social losses, such as loss of family support, which the women experienced. The notion of 'vicarious death' was used to explain the mortal fear women experienced in witnessing the death of others. Loss of body control, the unfamiliar ICU environment, and the sudden onset of illness made it difficult for the women to make sense of their experiences. This study shows that cultural norms and religious beliefs shape the ways in which these Muslim women made sense of their bodies. An analysis of the concept of 'bodywork' is presented: the 'dependent body' captures the women's experiences of changes of their physical status, which meant that from being care providers, they became those in need of care. This involved the experience of a sense of paralysis or disablement, and a complete dependence on their family or nurses. The 'social body' describes the women's feelings and emotions toward their family members. The latter assisted in the care of the women's bodies, but distress, frustration and a sense of loneliness were experienced by the women as a result of the loss of verbal communication with their relatives. The 'cultural body' describes the effect of cultural norms and Islamic religious beliefs on the women's interpretation of their experiences, and the interpretation of male nursing care in the ICU. The 'mechanical body' describes the women's experiences of the ICU machines as extensions of their bodies, and the senses of limbo and ambiguity they encountered during their ICU stay. The recovery period raised many physical, emotional, social, and spiritual issues, which in turn impacted on the women's experiences of their everyday lives. Weakness and tiredness accompanied with difficulties in eating and sleeping made some women feel frustrated and uncertain about their health. Some felt they were a burden upon their families. The meaning of the critical illness experiences were interpreted by some women as an opportunity to value family unity and neighbours' support. For other women, the illness experiences gave them lessons which strengthened their role as mothers and helped them to think positively about their future. This study highlights the importance of considering the cultural and religious preferences among Muslim women in critical care settings. The study recommendations focus on the need to base nursing care on an understanding of the physical, emotional, social, and religious elements of suffering, by exploring the potential of a palliative care approach for nursing critically ill people.

A thesis completed by published work Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 25 November 2016 / Background: In South Africa, nurses form the backbone of the health system, because of their numerical dominance, their skills and training, their close contact with patients and communities and their prominence in managerial and leadership roles at all levels of the health system. Objective: The aim of this PhD was to analyse the nature and dynamics of nursing management at primary health care (PHC) clinics in two South African provinces. The specific objectives were to: describe the social-demographic characteristics of selected PHC nursing managers; determine their job satisfaction levels; examine the work environment; determine the functionality of PHC support systems; and assess their managerial competencies. Methods: In 2012, a mixed methods cross-sectional study was conducted in Gauteng and Free State Provinces. Using stratified random sampling, 111 PHC nursing managers working in eight hour clinics were selected. After obtaining informed consent, these managers were invited to participate in three surveys: job satisfaction, facility assessment and a 360 degree competency evaluation. A sub-set of these managers (n=22) was requested to keep a diary for six weeks. STATA® was used to do quantitative data analysis, while the qualitative data was analysed using thematic content analysis. Results: A 95% response rate was obtained for all surveys. The majority of PHC clinic nursing managers were female (92%), black, married, with a mean age of 49 years (SD = 7.9), 90% were in permanent positions, and 36% had between 21-30 years of professional nursing experience. The overall job satisfaction scores for Gauteng and Free State PHC clinic nursing managers were 142.80 (SD± 24.3) and 143.41 (SD± 25.6) out of a possible score of 215. The predictors of their job satisfaction were: working in a clinic of choice (RRR = 3.10), being tired at work (RRR = 0.19) and experience of verbal abuse (RRR = 0.18). The facility assessment found that none of the selected clinics obtained scores of 100% for the vital elements of the National Core Standards. Overall, clinic nursing managers rated themselves high on the domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was the financial management domain where the nursing managers gave lower ratings (7.94). Health system deficiencies, human resources challenges, leadership and governance, and unsupportive management dominated the diary entries, and coalesced to produce many negative emotions experienced by these PHC clinic nursing managers. Conclusion: This PhD study has underscored the importance of PHC nursing managers, and has generated new knowledge on the overall levels and predictors of job satisfaction, the perceived competencies of these managers, together with information on the work environment and support systems. The successful implementation of PHC revitalisation and universal health coverage reforms cannot be achieved without addressing the concerns of PHC nursing managers and the health system issues affecting them. / MT2017

The important role of efficiency in the health care foodservice sector has been widely addressed in the literature. Different methods for assessing performance have been proposed. In general, most measures were calculated as simple ratios such as food and labour cost per meal or limited parametric techniques such as regression analysis. These approaches are meaningful indicators of which operational performance areas require attentions; however, problems arise when managers interpret partial productivity measures of this type as indicators of overall performance without considering the effects of other related variables. This could create further problems in complex applications such as the health care foodservice sector where multiple inputs (number of full time employees, energy cost, capital, overheads) outputs (number of meals and patient satisfaction) and environmental or interfering variables (age of equipment, quality of labour or skill level of employees and the degree of readiness of materials) should be considered in the assessment of efficiency. This study contributes to overcoming these limitations by introducing the stochastic frontier approach to assess the efficiency of the health care foodservice sector. It is superior to the traditional productivity approaches as it allows for the integrations of multiple inputs and outputs in evaluating relative efficiencies. The overall objective of the study was to determine the level of cost, technical and allocative efficiency in a sample of health care foodservice operations. More specifically, the objective was pursued by estimating stochastic production and cost frontiers models, which provided the basis for measuring technical (TE), allocative (AE) and cost efficiency (CE). The factors that significantly contribute to increasing inefficiency in health care foodservice operations were also identified. In this way, this study has policy implications because it not only provided empirical measures of different efficiency indices, but also identifies some key variables that are correlated with these indices. It goes beyond much of the published literature concerning efficiency because most research in the area of efficiency analysis focuses exclusively on the measurement of technical and cost efficiency. The stochastic frontier approach was tested in a cross sectional data set from a sample of 101 health care foodservice operations in Australia and the USA. Results showed that the models and all the parameters coefficients were plausible, significant and satisfy all theoretical requirements. Further, results also showed that the average cost, technical and cost efficiency were around 70 percent, 80 percent and 88 percent respectively. These figures suggest that substantial gains in output and/or decreases in cost can be attained if hospital foodservice operations were to improve their current performance. Finally, the results indicated that an increase in the level of manager’s experience and the level of manager’s education could have a positive impact on decreasing the level of inefficiency in health care foodservice operations. / Doctor of Philosophy (PhD)

Thesis (M.S.)--University of Missouri--Rolla, 2007. / Vita. The entire thesis text is included in file. Title from title screen of thesis/dissertation PDF file (viewed December 3, 2007) Includes bibliographical references (p. 29-31).

Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2005. / Summary in English. Includes bibliographical references.

Thesis (M. Arch.)--University of Hong Kong, 2000. / Includes special study report entitled: Technical aspect in planning out-patient department. Includes bibliographical references.

Thesis (M. Arch.)--University of Hong Kong, 2000. / Includes special study report entitled: Psycho neuro immunology : the role of the built environment in healing. Includes bibliographical references.

BACKGROUND Patient safety, reducing medical errors and risk management have become a global public health and administrative issue. Population-based studies around the world have alerted high rates of preventable medical errors and deaths. In response, a global effort agreed on a World Health Assembly resolution on patient safety. The World Alliance for Patient Safety guideline and the Conceptual Framework for the International Classification for Patient Safety have been launched by the World Health Organization (WHO) to galvanize and facilitate efforts by all Member States to make health care safer. The guidelines introduced adverse event reporting and focus on reporting and learning to improve the safety of patient care. The WHO suggested a conceptual framework for patient safety providing comprehensive understanding of the domains of patient safety. It represents a continuous learning and improvement cycle emphasizing on proactive (identification of risk, prevention, detection, reduction of risk) and reactive (incident recovery, system resilience) risk management. The ultimate measure of a successful incident reporting system is whether the information it yields is used appropriately to improve patient and organization safety. OBJECTIVES To systematic review literature to determine incident reporting systems improve patient outcomes and organization outcomes, and to identify successful characteristics of incident reporting system which information it yields is used appropriately to improve patient and organization safety, and to investigate if the incident reporting system can serve as an interface to support the (inform and influence) information flows in the WHO’s Conceptual Framework for the International Classification for Patient Safety. METHODS Two bibliography databases, Medline and Embase via OvidSP, were systematically searched using search keywords of ‘incident reporting’, ‘patient / organization outcomes’. Quality appraisal, data extraction were conducted on literature which met the inclusion criteria. Narrative synthesis was conducted. RESULTS A total of 584 citations were initially identified and 6 studies were finally included in this systematic review. The methodological quality of the 6 included studies was generally average to poor. The 6 included studies could be classified into 3 groups by research question and intervention strategies examined 1) case series on incident reporting system; 2) comparison study on two main streams of incident reporting systems: routine incident reporting system versus structured case note / chart review; and 3) review of incident reporting systems. Successful characteristics of incident reporting system identified including confidential, non-punitive, expert analysis, system-oriented, responsive, standardized taxonomy coding, clarified and unified concepts of incident reporting system, voluntary reporting, facilitation reporting, proper training and health informatics infrastructure support. Quantitative and qualitative evidences were identified that incident reporting system could serve as an interface to support inform and influence types of information flows in the WHO’s Conceptual Framework for the ICPS. However, no evidence could be found that incident reporting systems could directly improve patient outcomes and organization outcomes. CONCLUSION This systematic review found no evidence that incident reporting systems could directly improve patient outcomes and organization outcomes, but the systems could serve as an interface to support information flows in the WHO’s Conceptual Framework for the ICPS. Successful characteristics of an incident reporting system were identified coherent to the WHO’s recommendations. Future studies can further examine the causation relationship between incident reporting systems and the process components by applying the Donabedian’s structure-process-outcome model. / published_or_final_version / Public Health / Master / Master of Public Health

In 1994, a Forum on National Health was held in Sun Valley, California to discuss the responsibilities of the university for the health of urban populations. It called for the development of a "New School of Public Health" in the urban centre to deal with community crippling health issues and preventive care. The current state of health care in Canada cannot support the tradition of individual and curative care in the wake of an aging, expanding population and rising medical costs. Efforts must be directed towards preventive, public health education. This thesis will deal with three major issues: (I) the re-establishment of a National School of Public Health as an academic institution and part of a new civic building - an Academic Health Centre; (2) to house in the Academic Health Centre major public and community health related facilities in Vancouver such as the Dr. Peter AIDS Foundation and Hospice; and (3) to urbanize the Academic Health Centre in downtown Vancouver as a way to educate the community about preventive health issues through passive and interactive means such as billboarding, media, and ease of accessibility to lectures, and resource facilities.

No description available.