This study included three projects which investigated aspects of decision-making in a nursing context. The specific decision studied concerned selection of a long term management strategy for use by a patient with a newly fashioned colostomy. Literature reviewed reveals debate about the extent to which patients should participate in decisions about their health care, but ongoing work using the Autonomy Preference Index provides an argument for partnerships in decision-making between patients and health care professionals. This research contributed to the knowledge base in stomal therapy nursing, decision theory, collaborative practice in nusing, assessment of patient satisfaction and health communication theory. The clinical implications and applications of the findings are far reaching because of the pervasiveness of patient decision-making in nursing practice / Doctor of Philosophy (PhD)

Introduction Air ambulances transport patients to their home country or to centres of medical excellence when they are critically ill or injured. From stranded hikers to cancer patients, individuals worldwide use air ambulance transport when they need care that cannot be provided in the country or area where they are situated. Aim The overall aim of this study was to explore the challenges experienced by health care professionals during air ambulance transport of patients in sub-Saharan Africa. Research method A quantitative, non-experimental, descriptive, exploratory design was used. The study was conducted in three phases. Phase 1 was the planning of the questionnaire, Phase 2 was the pre-testing of the questionnaire and Phase 3 was the execution phase in which the questionnaires were distributed, and data were captured and analysed. Results The researcher used the data generated from the questionnaires to indicate short falls within air ambulance transport services in sub-Saharan Africa. Conclusion The researcher made recommendations in order to increase the level of air ambulance services in sub-Saharan Africa. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

People with learning disabilities constitute about 2% of the general population. Epilepsy is more prevalent among people with learning disabilities compared with the general population. Effective communication is central to the management of people with learning disabilities and epilepsy. It has both therapeutic and health promotion functions including psycho-social benefits to the individual and their carers. Carers play vital roles in supporting individuals who live in the community to manage their conditions and the need for effective communication between service users and health care professionals is crucially important. Effective communication may not only lead to improved quality of life but may reduce mortality through the promotion of better understanding of seizures and encouraging efficient use of medication. Despite this communication regarding community-based adults with mild learning disabilities has not been fully studied, in particular the service users‘ views and experiences regarding communication has been a neglected area. Yet, the service users‘ views may be the best source for the definition of effective communication. This study was triggered by the paucity of research that investigated service users‘ views and experiences regarding communication. Furthermore, numerous health policies have been formulated that emphasise the involvement of patients as consumers in the provision and delivery of health services. This study is purported to bridge this communication gap by offering service users a rare opportunity for them to express their views and experiences regarding communication to inform health policies and clinical practice. This study adopts a naturalistic qualitative approach and employs in-depth semi-structured interviews to solicit service users‘ and their carers‘ views and experiences regarding communication. The interviews also investigated service users‘ and carers‘ perspectives in regard to communication with health care professionals‘. Carer communication diaries were used to supplement the carers‘ interview data and also to endorse the credibility of the study findings. Six main findings emerged from this study that described service users‘ and carers‘ views and experiences regarding communication: communication needs and expectations; ‗engagement‘ as a predictor of effective communication; strategies of communication; facilitating factors of communication; methods of communication; barriers to communication. This study suggests that effective communication with people with learning disabilities and epilepsy requires a reflective model that incorporates self-assessment and awareness of the individual‘s communication needs and expectations. The model and recommendations that emerged from this study may be a useful resource for health and social care professionals.

Magister Scientiae (Physiotherapy) - MSc(Physio) / BACKGROUND: Access to basic health care services through the primary health care (PHC) settings, was affirmed as a fundamental human right by the World health organisation (WHO) in 1978 in Alma Ata (Kazakhstan). Internationally, interdisciplinary collaboration among health care professionals (HCPs) have been the preferred approach to addressing the health and psychosocial needs of the populace. The PHC being the first point of contact for most Nigerians and the cornerstone of health care policies in Nigeria, covers promotive, preventative, curative and rehabilitative services. Although, Physiotherapy has ideally qualified personnel to contribute to the attainment of the goals and objectives of the PHC policies, these services are mostly carried out by other HCP’s subdivided as clinicians (medical doctors, dentists, nurses/midwives, optometrists, pharmacists, radiographers, laboratory scientists) and clinical assistants (pharmacy technicians, radiography technicians, laboratory technicians and community health extension workers). Physiotherapy services are mostly concentrated at tertiary and secondary health care settings. AIM: To determine the awareness and explore the perceptions of clinicians and clinical assistants employed in the type 3 primary health care (PHC) settings of Rivers East Senatorial district of Rivers State, Nigeria, regarding the roles of Physiotherapy in a PHC setting.

<p> </p><p>The number of hidden refugees in Sweden is estimated to be at least 15,000. The law, which only allows this group a very limited access to health care, can be considered to clash with the human rights and the ethical codes related to the health care professionals.</p><p>The aim of the study was to examine how the personnel in public health care may experience treating hidden refugees and which ethical conflicts that may be connected to this. The study, which is of a qualitative descriptive design, is based on eight semi-structured interviews. The interviewees were trained nurses and mid-wives in an emergency room, a maternity ward and a health care centre for asylum seekers.</p><p>The experience of treating hidden refugees amongst the informants was limited. The study proved that the knowledge of laws and guidelines regarding hidden refugees amongst the interviewed health care personnel was poor. The interviewees presumed that it would be mentally trying if the law impeded them from giving a patient the care needed.</p><p>The lack of knowledge of laws and guidelines that appeared from the interviews, may lead to an insecurity for the patient, as well as for the personnel. An increasing knowledge and accurate guidelines at the work place would improve the treatment of hidden refugees.</p> / <p> </p><p>I Sverige uppskattas att det finns minst 15000 gömda flyktingar. Lagstiftningen, som endast tillåter en begränsad vård för den gruppen, kan anses stå i konflikt med de mänskliga rättigheterna och sjukvårdspersonalens yrkesetiska koder.</p><p>Syftet med studien var att undersöka hur sjukvårdspersonal som arbetar inom landstinget kan uppleva vård av gömda flyktingar och vilka etiska konflikter som kan vara kopplade till detta. Studien, som är en intervjustudie med kvalitativ deskriptiv design, baseras på åtta semistrukturerade intervjuer. Informanterna utgjordes av sjuksköterskor och barnmorskor på akutmottagning, BB-avdelning och en vårdcentral för flyktingar.</p><p>Informanternas erfarenhet av att vårda gömda flyktingar var begränsad. Det framkom av studien att kunskapen om lagar och riktlinjer gällande vård av gömda flyktingar hos den intervjuade sjukvårdspersonalen var bristfällig. Informanterna förutsatte att det skulle vara psykiskt påfrestande om lagen hindrade dem att ge vård till en patient.</p><p>Den brist på kunskap om lagar och riktlinjer som framkom av intervjuerna, leder till en osäkerhet för både patienten och personalen. Ökad kunskap om lagar och ordentliga riktlinjer på arbetsplatsen skulle underlätta vården av gömda flyktingar.</p><p> </p>

This study was conducted with the focus on medical and nursing education programs in the U.S. in order to learn if they include training for their students on dealing with victims of human trafficking. In order to address this goal, the survey among professors and instructors of 650 randomly selected medical and nursing education programs was conducted, where they were asked if their programs' curricula include training on recognizing victims of trafficking, as well as providing them with health care services and assistance to escape from their traffickers. The analysis of 116 received responses revealed that the majority of medical and nursing education programs do not train their students on recognizing victims of trafficking, and providing them with relevant assistance. / McAnulty College and Graduate School of Liberal Arts / Graduate Center for Social and Public Policy / MA / Dissertation

Syftet med studien var att beskriva hur kvinnor med fibromyalgi upplever vårdpersonalens bemötande och hur de önskar att bli bemötta. Studien hade en kvalitativ ansats med en beskrivande design. Datainsamling skedde genom individuella intervjuer med åtta kvinnor, som alla var medlemmar i en fibromyalgiförening i Mellansverige. Data analyserades med hjälp av manifest innehållsanalys. Huvudresultatet var att vårdpersonalens bemötande av informanterna beskrevs som en upplevelse av att inte bli bekräftad. Detta grundades i deras upplevelse av att vårdpersonalen inte trodde, eller lyssnade på dem. De upplevde även att kunskapen om fibromyalgi hos vårdpersonalen var bristfällig. Informanterna beskrev även att de upplevde att de kunde känna förtroende för vårdpersonalen men att de önskade att de i större grad blev bemötta så.  De beskrev en önskan om att vårdpersonalen i högre grad skulle lyssna på dem, visa förståelse och ge dem information om sin sjukdom. Slutsatsen var att känna förtroende för vårdpersonalen bygger på att bli lyssnad till och få förståelse för sin sjukdom av vårdpersonalen samt att få information. Att bli misstrodd och/eller ej lyssnad på av vårdpersonalen samt brist på kunskap hos vårdpersonalen upplevdes som att inte bli bekräftad. / The aim of the study was to describe how women with fibromyalgia experienced health care professionals´ response and how they wish to be responded. The study had a qualitative approach with a descriptive design. Data were obtained from individual interviews with eight women, who were all members of a fibromyalgia association in central Sweden. Data were analyzed using manifest content analysis. The main result was that the informants experienced the health care professionals as not confirming them. This was based on the informants’ experience of not being believed or listened to. They also felt that the knowledge of fibromyalgia among health care professional was poor. The informants also described that they could trust the health care professionals but that they wished that they to a greater extent was responded that way. They described a desire that the health care professionals in greater extent should listen to them, show an understanding and give them information. The conclusion was that the confidence of health care professionals is based on being listened to and to be showed an understanding of their disease and to receive information. To be discredited and / or not being listened to and lack of knowledge among the health care professionals about fibromyalgia was perceived as not being confirmed.

The number of hidden refugees in Sweden is estimated to be at least 15,000. The law, which only allows this group a very limited access to health care, can be considered to clash with the human rights and the ethical codes related to the health care professionals. The aim of the study was to examine how the personnel in public health care may experience treating hidden refugees and which ethical conflicts that may be connected to this. The study, which is of a qualitative descriptive design, is based on eight semi-structured interviews. The interviewees were trained nurses and mid-wives in an emergency room, a maternity ward and a health care centre for asylum seekers. The experience of treating hidden refugees amongst the informants was limited. The study proved that the knowledge of laws and guidelines regarding hidden refugees amongst the interviewed health care personnel was poor. The interviewees presumed that it would be mentally trying if the law impeded them from giving a patient the care needed. The lack of knowledge of laws and guidelines that appeared from the interviews, may lead to an insecurity for the patient, as well as for the personnel. An increasing knowledge and accurate guidelines at the work place would improve the treatment of hidden refugees. / I Sverige uppskattas att det finns minst 15000 gömda flyktingar. Lagstiftningen, som endast tillåter en begränsad vård för den gruppen, kan anses stå i konflikt med de mänskliga rättigheterna och sjukvårdspersonalens yrkesetiska koder. Syftet med studien var att undersöka hur sjukvårdspersonal som arbetar inom landstinget kan uppleva vård av gömda flyktingar och vilka etiska konflikter som kan vara kopplade till detta. Studien, som är en intervjustudie med kvalitativ deskriptiv design, baseras på åtta semistrukturerade intervjuer. Informanterna utgjordes av sjuksköterskor och barnmorskor på akutmottagning, BB-avdelning och en vårdcentral för flyktingar. Informanternas erfarenhet av att vårda gömda flyktingar var begränsad. Det framkom av studien att kunskapen om lagar och riktlinjer gällande vård av gömda flyktingar hos den intervjuade sjukvårdspersonalen var bristfällig. Informanterna förutsatte att det skulle vara psykiskt påfrestande om lagen hindrade dem att ge vård till en patient. Den brist på kunskap om lagar och riktlinjer som framkom av intervjuerna, leder till en osäkerhet för både patienten och personalen. Ökad kunskap om lagar och ordentliga riktlinjer på arbetsplatsen skulle underlätta vården av gömda flyktingar.

The overall aim of this thesis was to investigate predefined headings in a Swedish county council multi-professional EHR system in terms of their shared application, what aspects of health and health care they reflected, and their correspondence to legal requirements. An analysis of 3 596 predefined headings, applied to 20 398 104 occasions by eight professional groups, was conducted. Less than 2% of the predefined headings were applied by all eight professional groups, whereas 60% were not shared at all between the professional groups. A classification of the predefined headings revealed that 13% were “Specialist terms”, which were the least ambiguous predefined headings, 46% were “Terms for specific purposes”, which are less ambiguous than the “Common words” (28%), which were the most ambiguous predefined headings according to the sociolinguistic method employed. The remaining predefined headings (13%) were sorted into “Unclassified headings”. A qualitative content analysis of the predefined headings yielded 23 subcategories grouped into five categories: Description of the patient, Health care process, Resources employed, Administrative documentation, and Development and research. A comparison of the 23 subcategories to the Patient Data Act showed, first, that 15 of 23 subcategories corresponded to four legal requirements, second, that there were legal requirements with a focus on patient rights that were not being met, and third, that there were eight subcategories of predefined headings that could not be attributed to the legal provisions of the Patient Data Act. In conclusion, the proportion of shared predefined headings in the EHRs was limited. The predefined headings in the multi-professional EHRs did not constitute a joint language for specific purposes. A meaningful structure comprising categories and subcategories of different aspects of health and health care as reflected in the applied predefined headings was identified. The structure reflected a wide range of health and health care. No subcategory corresponded to the three legal requirements concerning patient rights. Future research should include professionals’ and patients’ understanding of predefined headings, the correspondence of documented notes to predefined headings and how the documentation in the EHR has had an impact on patient safety.

Philosophiae Doctor - PhD / The Wellness Leadership White Paper states that leadership is needed in a supportive environment with the purpose of guiding clients to lasting wellness. Wellness can be defined as an active process that enables an individual to become aware of all aspects of the self and to make choices in terms of a more healthy existence by means of balancing and integrating various life dimensions. Health care professionals are leaders who play an important role in creating an environment that contributes to wellness. Their leadership is, therefore, viewed as a wellness strategy. Leadership has been identified as an essential role of health care professionals with a responsibility to attend to the needs of their clients, such as youth victims of violence, with the aim of leading them towards wellness. The Provincial Nursing Strategy of the Western Cape in South Africa emphasises the need for health care professionals to demonstrate their leadership capacity in practice. In the communities of the Western Cape Province of South Africa, many youth victims of violence report for treatment at the health care facilities; it places a high burden on the health care system. Even though health care professionals provide treatment to this group of youth, it is not clear how health care professionals lead them towards wellness after an incidence of violence. The purpose of this study was to develop a conceptual framework that can be implemented by health care professionals to gain a better understanding about the important role they play in leading youth victims of violence towards wellness in a rural community in the Western Cape Province of South Africa. This research study applied a qualitative, exploratory, descriptive and contextual design. The study population who were selected by means of a purposive sampling technique consisted of youth attending a high school and who had been victims of violence and of health care professionals (professional nurses, medical doctors and social workers) working at the health care facilities in the community where the study was conducted. The study was conducted in four phases. Phase 1 of the study focused on the exploration and description of the expectations of the youth victims of violence about how health care professionals should lead them towards wellness. Focus group discussions (FGDs) were conducted at a high school at the study site. Phase 2 explored and described the experiences of health care professionals who were supporting youth victims of violence at the health care facilities in the community of study. The execution of this phase comprised of unstructured individual interviews. The total number of the FGDs and unstructured individual interviews conducted in this study was determined by data saturation. Data analysis of the data collected involved transcription of the voice recordings of the all the interviews and writing up of field notes. The steps of Tesch’s coding technique were used at the end of Phases 1 and 2. To ensure trustworthiness of the collected data, Guba and Lincoln’s strategies of credibility, transferability, dependability, confirmability and authenticity were applied. Phase 3 of this study entailed the development of a conceptual framework for health care professionals to lead youth victims of violence towards wellness. It was based on the findings from Phases 1 and 2 of the study; Phase 4 of the study involved peer debriefing and validation of the developed conceptual framework. In Phase 1 of the study, a total of nine (n = 9) FGDs were conducted among fifty eight (n = 58) youth participants between the ages of 15 and 19 years. Each group consisted of 6 to 8 participants and the interviews did not last more than an hour per session. The data analysis in this phase showed that the youth victims of violence did have expectations from the health care professionals in guiding them towards wellness. They shared their interpretation of the term wellness and were also quite aware of the challenges in their community. Four categories emerged from the data in Phase 1: Category 1 - Dimensions of wellness as it related to healthy body, mind, spirit and positive interactions: The findings of this category revealed that youth participants described wellness as a holistic concept that comprised healthy living, self-care and a healthy personality and mind (emotional, psychological) as well as spiritual well-being. They did not necessarily consider wellness as the absence of sickness or illness, Category 2 - Common problems among youth in the context of the community: They articulated that drug abuse, teenage pregnancy and violent behaviour were important issues of concern to them in their community. Category 3 – Building a sound and trusting relationship: They expressed their need for health care professionals to have a positive attitude towards them, to be respectful and to provide them with accurate information, as well as confidential and supportive services. Category 4 - Guidance of youth to wellness: The youth also proposed strategies that they believe could be used by the health care professionals while guiding them towards wellness. These strategies were: Provision of information / health education, school and community outreach programmes, provision of counselling services and role modelling. For the second phase, seven (n = 7) health care professionals were interviewed. Two (n = 2) were professional nurses, three (n = 3) medical doctors and two (n = 2) social workers. The findings of the individual interviews indicated that the health care professionals recognised the fact that wellness is very important. However, they felt that guiding youth victims of violence toward wellness was a challenging process. Three categories emerged from the data in Phase 2: Category 1 - Different points of view about the concept of wellness: The health care professionals described wellness as the holistic wellbeing of a person, an absence of illness or disease and living a healthy lifestyle. Category 2 - Barriers to leading youth victims of violence towards wellness: The health care professionals reported challenges while attempting to lead youth victims of violence towards wellness which included low socioeconomic status of families, unsupervised youth, violent behaviour, drug and substance abuse, a lack of resources in the community, negative staff attitudes, inadequate physical infrastructure and human resources as well as the absence of a process of guiding youth victims to wellness. Category 3 - Guidance to leading youth victims to wellness: The health care workers proposed strategies for guiding youth victims towards wellness. Those strategies included the provision of support in the form of counselling services, use of support groups, family and community support; recreational activities, dedicated staff to work with youth victims of violence and a multidisciplinary team approach. The findings from the first two phases were triangulated during the third phase of this study with the purpose of developing a conceptual framework. The survey list of Dickoff, James and Wiedenbach formed the foundation of the reasoning map for the development of the framework. The unique contribution of this study is the development of an original, participative leadership framework that provides health care professionals with information for leading youth victims of violence towards wellness in a rural community in the Western Cape. This study was conducted in a single rural community of the Western Cape Province of South Africa. Despite this limitation, the framework could be evaluated for use in similar settings. Finally, guidelines to implement the framework and recommendations for improving community health care practice, nursing education and nursing research were suggested based on the findings from the study.