Indiana University-Purdue University Indianapolis (IUPUI) / A manpower survey was conducted by the Great Lakes Society of Orthodontists in early 1977. Permission was obtained from the Society to use a portion of the survey for this thesis, namely: Years since graduation of the respondents, community size in which the respondents practiced, busyness of their practices, number of new patient starts in 1976, change in patient load, and the respondents' opinion of the need for more orthodontists. Statistically, the data was compiled as to percent response by state and as a Region. Mean and standard deviation were obtained and the above factors were then correlated yielding the following findings: The number of orthodontists has increased for the Great Lakes Region, but this increase is showing a leveling off. Except for the province of Ontario and the State of Indiana, the community size in which orthodontists practice is dispersed and not located in large communities. Most orthodontists are starting 90 or more patients per year. Most orthodontists report an increase in their practices, but feel they are seeing fewer patients than they could accommodate comfortably and are less busy than they would like. Few orthodontists in the United States section of the Great Lakes Region feel increases in the numbers of orthodontists are warranted.

The migration of nurses is stimulating international debate around globalisation, ethics, and the effects on health systems. This thesis examines this phenomenon through nurses trained in Nepal who migrate to the UK. Since 2000, increasing numbers of Nepali nurses have started crossing national borders to participate in the global healthcare market, particularly in the affluent west. By using qualitative multisited research and in-depth interviews with key stakeholders in both Nepal and the UK, this thesis explores why nurses aspire to migrate, how they fulfil these aspirations, and their experience of living and working in the UK. The thesis begins by examining the historical development of nurse training in Nepal, particularly from the mid 1950s. This period saw profound socio-political transformations, including in the position of women in Nepali society and in the perception of nursing in Nepal. Previously, many families were very reluctant to send their daughters into nursing. By the late 1990s, middle-class women and their families were increasingly attracted to nursing, both as a vocation and as a means to migrate. The thesis explores the rise of private training colleges to meet the increased demand for nurse training, and the new businesses that have grown up around the profession to facilitate nurse recruitment and migration. Around one thousand nurses have migrated to the UK since 2000, and the second part of the thesis presents their experiences of the migration process and of working and settling in the UK. Nurses have faced complex bureaucratic and professional hurdles, particularly after UK nurse registration and work-permit policies changed in 2006. The thesis also highlights how highly qualified nurses with many years of work experience in Nepal have become increasingly deskilled in UK. Frequently sent to rural nursing-homes by recruiting agencies, they create and join new diasporic support networks. Further, many have left their loved ones behind, and experience homesickness and the pain of family separation. Often, they plan for their husbands and children to join them after several years, and the research explores this and the issues faced by their families, as they relocate and adapt to life in the UK. Finally, the thesis makes some important policy recommendations. For Nepal, these relate to greater regulation of nurse training and the brokering of nurses abroad. In the UK, they relate to increasing the flexibility of registration and visa regulations to assist in supporting Nepali nurses' work choices, and to value and utilise their professional skills in the UK better.

Life expectancy and overall health have improved in recent years for most Americans, thanks in part to an increased focus on preventive medicine and dynamic new advances in medical technology. However, not all Americans are benefiting equally. This suggests a level of urgency for need to assist our public health professionals in obtaining specific skills sets that will assist them in working better with ethnic and racial minority populations. The overall goal of the research was to assess cultural competence knowledge and programmatic skill sets of individuals employed by an urban department of health located in the southwest region of the US. The Theory of Planned Behavior (TPB) guided the research design to effectively evaluate the correlation between behavior and beliefs, attitudes and intention, of an individual, as well as their level of perceived control. Within the program design, 90 participants were identified using convenience sampling. In order to effectively evaluate these constructs, a quantitative research approach was employed to assess attitudes, beliefs, knowledge and competencies of the subject matter. Participants completed the Cultural Competence Assessment (CCA), which is designed to explore individual knowledge, feelings and actions of respondents when interacting with others in health service environments (Schim, 2009). The instrument is based on the cultural competence model, and measures cultural awareness and sensitivity; cultural competence behaviors and cultural diversity experience on a 49 item scale. It seeks to assess actual behaviors through a self report, rather than self-efficacy of performing behaviors. In addition, information was obtained to assess participant perception of organizational promotion of culturally competent care and; availability of opportunities to participate in professional development training. The analysis suggested healthcare professionals who are more knowledgeable and possess attitudes which reflect increased cultural sensitivity, are more likely to engage in culturally competent behaviors. In addition, positive attitudes and increased knowledge were associated with diversity training participation. Respondents reported high levels of interaction with patients from ethnic and racial minorities. Observing the clinical and non-clinical respondents, approximately 47% and 57% respectively, stated their cultural diversity training was an employer sponsored program.

Background: As a result of heightened occupational stress throughout the COVID-19 pandemic,nurses in hospitals are experiencing high rates of depression, anxiety, and burnout. However,nurses in obstetrical departments have had unique challenges and have experienced specificsources of stress that remain unclear.Methods: Semi-structured interviews were conducted with twenty obstetrical nurses that workedat an Ontario tertiary care centre during the COVID-19 pandemic. Participants shared theirexperiences of working during the pandemic, focusing on job stressors, personal resources, anddesires for job resources. Interviews were audio-recorded, transcribed verbatim and coded usingNVivo. Data was analyzed using a theoretical thematic approach based on the Job Demands-Resources (JD-R) model.Results: Key job stressors identified included having an increased workload, fear of COVID-19transmission, providing proper patient care, and overwhelming physical demands. Moreover,participants expressed they felt undervalued, inadequately supported, and burned-out during thepandemic. The most common personal resources used to cope with additional stress were relyingon family members, friends, and colleagues for support, in addition to utilizing personal hobbiesto decompress. Lastly, participants were able to provide suggestions on how to improve jobresources, focusing on improving mental and physical support, communication, and retention.Conclusion: This study provides an in-depth understanding of the COVID-19 workingconditions of Ontarian obstetrical nurses, while highlighting that they were provided withinadequate levels of job resources to manage increased job demands. Findings from this studycan help inform hospital management on how they can better support and meet the needs ofthose working in maternal care during major disease outbreaks. À la demande de l'auteur, le résumé a été retiré en raison de la nature confidentielle de la thèse. Il sera ajouté une fois la période d'embargo terminée.

In Ontario, supporting "a system of care that provides women and their families with equitable choice in birth environment and provider," (PCMCH & MOHLTC, 2017, p.33) has been identified as one of the central objectives of the Provincial Council for Maternal and Child Health's Low Risk Maternal Newborn Strategy. In theory, pregnant people in Ontario can choose to seek maternity care from a midwife, a family physician, or an obstetrician; however, in practice, pregnant people's choice of provider remains constrained. Extant literature suggests that in order to afford pregnant people the opportunity to exercise autonomous choice of provider, health systems must ensure that an acceptable range of provider options is available and accessible within the local organization of maternity care, that pregnant people are made aware of and knowledgeable about the available provider options, and that pregnant people have the ability and resources to navigate access to their provider of choice (Mackenzie, 2014; Sutherns, 2004). As a result, I designed this thesis to fill a gap in the evidence base to determine whether or not provincial policies had translated into the levels of access, awareness, and resourcing required to afford pregnant people the opportunity, ability and propensity to exercise autonomous choice of provider within the local maternity care system in Ontario's Champlain Region. I sought to elicit the structural conditions that would be necessary to equitably support pregnant people's access to and choice of a maternity care provider. In the pursuit of these objectives, I adopted an integrated knowledge translation approach (Bowen & Graham, 2013), using an explanatory sequential mixed methods design (Creswell, 2014), which encompassed two complementary stages: (1) quantitative geospatial mapping to assess pregnant people's access to the full range of maternity care providers across the Champlain Region; and (2) qualitative focus groups and individual interviews with parents, providers, and policy-makers to explore the individual, organizational, and system-level factors that are enabling or restricting access and autonomy. Using a systems approach to the investigation of this locally-identified issue, I demonstrate in this thesis that pregnant people within the Champlain Region have inequitable opportunities to exercise autonomous choice of maternity care provider due to (1) system and organizational-level factors that are creating imbalances in the supply, distribution and mix of maternity care provider options, and (2) pregnant people's differential access to the enabling information and resources required to exercise autonomous choice of provider and to navigate access to their services.

No / Though Bangladesh has made tremendous strides forward in health and other socio-economic indicators in the recent past, basic needs of health still remain largely unmet and only less than half of the population has access to basic healthcare. The health spending is far below the optimum level which is needed to scale up essential health intervention. Bangladesh is also experiencing a critical and chronic shortage and imbalance of skill mix and deployment of health workforce. The important achievements in health indicators include life expectancy, infant mortality, and vaccinations. However, overall burden of mortality and morbidity in most of the key health indicators is higher compared to other regional countries. Despite remarkable progress, except child mortality, targets are not expected to be met by 2015 if the prevailing trends persist in several areas. Major reforms are needed in health and medical education to ensure quality healthcare for the population of Bangladesh.

The mental health workforce is continually evolving and competing for resources, influenced by local and national factors however effective, provision of mental health care depends on the most important resource—staff.

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

Critical thinking is crucial in public health due to the increasingly complex challenges faced by this field, including disease prevention, illness management, economic forces, and changes in the health system. Although there is a lack of consensus about how practitioners and educators view critical thinking, such skills are essential to the functions of applying theories and scientific research to public health interventions (Rabinowitz, 2012). The purpose of this research was to examine the relationship between critical thinking skills used by public health practitioners and critical thinking skills taught to graduate students in schools/programs of public health. Through interviews with public health practitioners and instructors twelve distinct critical thinking skills were identified. Findings of this study indicate that many critical thinking skills used by practitioners are aligned with those taught in courses, such as analysis, identification and assessment of a problem, information seeking, questioning, and reflection. This study also identified conceptualizing, evaluating, interpreting, predicting, reasoning, and synthesizing as critical thinking skills that may not be receiving the explicit attention deserved in both the workplace and the classroom. A high percentage of practitioners identified explaining as a critical thinking skill often used in the field, while few instructors reported teaching this skill. The results of this study have important implications for informing public health curricula and workforce development programs about critical thinking. Further, this research serves as a model for other professions to explore the relationship between critical thinking skills used by practitioners and those taught in higher education.

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.