The purpose of this study was to examine the relationships between perceived organizational support, perceived coworker support, and debriefing on the one hand, and compassion satisfaction, burnout, and secondary traumatic stress on the other hand in Florida law enforcement, fire, emergency medical services, and dispatch public safety workers. In order to explore the relationships between these constructs, the research questions examined the relationships of the work environment of Florida public safety by administering surveys gauging perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities that the personnel participate in. The Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue Version 5 was also sent out to establish the self-reported levels of compassion satisfaction, burnout, and secondary traumatic stress. The study found that there were differences in the levels of compassion satisfaction, burnout, and secondary traumatic stress between the public safety fields. It also found that there was a positive relationship between the presence of perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities on at least one of the constructs of compassion satisfaction, burnout, or secondary traumatic stress within the different public safety fields. This study furthers the literature by being the first study to compare the four different public safety fields in the state of Florida and with regards to those constructs.

The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA patients in the outpatient setting with 675 UKA patients in the inpatient setting. The primary analytical tools for this study are Ordinary Least Squares Regression, Logistic Regression, and Ordinal Regression adjusting for comorbidity, social history, demographics, and surgery related characteristics. Outpatient UKAs outperformed inpatient UKAs across 11 of 18 variables analyzed. Process Time will be less for outpatient UKAs in all phases with the exception of Surgery Breakdown Time. The risk-adjusted quality outcomes of UKAs in the outpatient setting were better across Non-Surgery Related Complications, Follow-Up Pain, and Follow-Up Functional Range of Motion Limitation. Patient Satisfaction was higher for outpatient UKAs. There was a lack of consistent and appropriate information to conduct a substantial statistical analysis of the costs. These findings point towards outpatient UKAs being a viable option in the future. This research serves as a platform to launch a system-wide effort of transitioning procedures to the outpatient setting across different specialties.

American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this investigation explored the relationship of acute-care hospitals' performance to the contextual, organizational and patient characteristics, using a cross-sectional study design. This study developed and evaluated the quality and efficiency of hospitals with respects to the structural complexity, process adequacy, efficiency, and quality of care. The structure-process-outcome theory in quality of care developed by Donabedian (1980), is adopted for this investigation. Statistical methods such as confirmatory factor analysis (CFA) and covariance structure model are employed. The population surveyed by the American Hospital Association (AHA) are acute care hospitals throughout the United States, including more than 3000 acute care hospitals of all types of ownership. The data provided by HIMSS Analytics and AHA are available for 2015 and the data provided CMS quality indicators are available for 2016. The key finding of this research is that process adequacy mediates the relationship between hospital structure and performance variables. The efficiency variable played an important role in shaping quality. The location and hospital teaching status have a moderate impact in determining hospital performance by affecting the structure and process of hospitals.

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Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Department of Nursing, Durban University of Technology, Durban, South Africa, 2016. / Background In response to the advances made in information technology (IT), many healthcare institutions worldwide have integrated IT into their healthcare systems. Some hospitals in South Africa have changed to a computer- based system for the delivery of nursing care and nursing documentation, whereas others still use a paper-based system. The main aim of introducing IT in nursing is to improve the quality of nursing care. Research has shown, however, that IT can negatively impact on the quality of nursing care rather than improve it. This study compared the delivery of nursing care in two public hospitals in the eThekwini district in KwaZulu-Natal: one hospital which uses a computer-based documentation system for patient care and one hospital which uses a paper-based documentation system. Aim of the study The aim of the study is to determine the effects of IT on the delivery of nursing care as experienced by registered and enrolled nurses working in the hospital setting. Methodology A quantitative comparative descriptive design was used in this study. The delivery of nursing care in a hospital which uses a computer-based documentation system for patient care was compared with a hospital which uses a paper-based documentation system. The participants in this study were registered and enrolled nurses working in the wards and units of the two selected hospitals. Data was collected through the administration of a questionnaire (Appendix G) directed at the registered and enrolled nurses in the two hospitals involved in the study. One hundred percent of registered and enrolled nurses in the two selected hospitals at the time of data collection were approached and invited to participate in the study. One hundred and four participants for the hospital which uses a computer-based documentation system and 104 participants for the hospital which uses a paper-based documentation system were willing to participate in the study. Data was summarised and described using descriptive statistics such as frequencies, measures of central tendency such as means and modes, as well as means of variability such as range, variance and standard deviation. Graphs and tables were used to graphically represent the data. Data analysis was done using the Statistical Package for the Social Sciences (SPSS), version 22. Findings The effects of IT on the delivery of nursing care was measured by the quality of nursing documentation, the amount of time nurses have available for hands-on patient care and the reduction of medication errors. This study revealed that IT positively affected the experiences of nurses with the delivery of nursing care, with only a few exceptions. Information technology did not decrease the use of unauthorised abbreviations. It also did not improve the time nursing care was rendered being reflected in nursing documentation. Errors being made when entering patient data from, for example, cardiac monitors, intravenous pumps or results to investigations into the patient’s record were not decreased by IT. Furthermore, IT failed to improve nurses being alerted to drug interactions and to contra-indications of prescribed medications. There were a few instances where IT had a negative effect on the delivery of nursing care. Information technology increased the need to copy the same data when creating and updating a nursing care plan as well as documenting nursing care. Although the need for taking telephonic orders was reduced through the use of IT, it was found that when nurses in the hospital with a computer-based documentation system took telephonic orders, errors were made more often than when nurses in the hospital with a paper-based documentation system took telephonic orders. / M

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.