Thesis (MPH) --University of Limpopo, 2011 / The aim of the study was to assess breastfeeding practices of healthcare providers at level one hospitals in Capricorn District of Limpopo province. Methods: Five level one district hospitals within the Capricorn district of Limpopo province were the study sites. Two focus groups with members ranging from three to nine members were conducted. Two managers per hospital were interviewed. In both focus groups and in-depth interviews an audio tape recorder was used. This was transcribed and from the first transcription categories were developed. These formed a basis for data analysis, although the categories had undergone transformation as the analysis unfolded. Results: The study found that there are three practices that are adopted with regard to breastfeeding practices. Most employees choose to breastfeed as the first choice in baby feeding. Majority succeeded in breastfeeding their babies for sometime. There are those who feed their babies’ breast milk as the only source of milk during infancy. Others practice mixed feeding, where the baby is given breast milk and supplemented by formula. However, others fed their babies formula only. They indicate that this was not the initial choice in baby feeding. Conclusion: Healthcare providers have the same needs as the rest of the population with regard to breastfeeding and work. Their challenges are more work-related; which affect their decision whether to breastfeed or not to.

Objective: A significant number of children suffer from life-limiting illnesses, with many dying each year in the U.S. Services, beyond standard medical care, aimed at increasing overall quality of life for children with life-limiting illnesses, are greatly needed within and outside of our hospitals. Palliative care is conceptualized as treatment provided to relieve symptoms and improve quality of life. Despite the empirically supported benefits of providing pediatric palliative care, only a small percentage of pediatric patients actually receive these services. Thus, there is a great need for the development and provision of these services. The first aim of the current study was to compare results from Holtz Children’s Hospital (HCH) at the University of Miami with those from Lucile Packard Children's Hospital (LPCH) at Stanford University, where a survey assessing pediatric healthcare providers’ palliative care needs was originally developed. The second aim was the modification and further development of the measure, including an evaluation its psychometric properties. The third aim was to identify the educational and training needs of healthcare providers in providing pediatric palliative care. The fourth aim was to evaluate whether completing the survey improved awareness of a palliative care team. Method: Two hundred and twenty five healthcare providers at HCH completed the Survey on Pediatric Palliative Care for Healthcare Providers (SPPCHP). Participants were diverse with regards to ethnicity/race and profession. Results: Healthcare providers at both hospitals reported feeling inexperienced in similar aspects of delivering palliative care and desired further training and support. The SPPCHP demonstrated strong internal consistency and good construct validity, evidenced in factor analyses. Pediatric healthcare providers at HCH reported only feeling “somewhat” experienced in all aspects of pediatric palliative care and rated families’ inability to accept terminal diagnosis as the top barrier to providing this care; half of healthcare providers reported not receiving adequate support. Although referrals did not increase six months after study completion, awareness at the hospital was improved. Conclusions: Clinical implications include the need for systematic training and support in palliative care for a range of pediatric professionals, with an emphasis on addressing key barriers to care. Given the similarity of the findings at HCH and LPCH, these results appear generalizable to a variety of children’s hospitals.

This thesis is an ethnographic study of AIDS-related stigma in the work and discourse of healthcare providers in Wamena. Wamena is located in the highlands of Papua, the eastern-most province of Indonesia. HIV/AIDS rates in Papua are dramatically rising and stigma continues to hinder HIV/AIDS programs and initiatives. This thesis looks at assumptions about stigma and shows intersections of stigma with Christianity and racism to be integral aspects of AIDS-related stigma in Wamena. The connection between stigma and HIV/AIDS as a disease is not as strong as intervention programs appear to assume. In 2010, I conducted ethnographic research among health care providers in Wamena. I employed semi-structured interviews, participant observation, and casual interviews to collect materials and assess current practices that contribute to stigma in the healthcare setting. The results of this research challenges current HIV/AIDS-focused approaches to stigma by showing stigma is expressed in subtle ways even among well-trained healthcare providers, that stigma is expressed through Christian values and through assessments of racism, and that some aspects of stigma can also work to protect patients from other forms of discrimination. / Graduate

No description available.

There are over 700,000 individuals living with Crohn's disease in the United States. Crohn's disease is a chronic inflammatory bowel illness that can have debilitating effects on individuals and their partners. There is ample literature on the various medical effects of Crohn's disease on the diagnosed individual but a dearth of literature on how Crohn's disease affects young adult individuals and their partners. This dissertation endeavors to fill this gap in the literature. Through Interpretative Phenomenological Analysis, this study explores how an individual's diagnosis of Crohn's disease is perceived to affect the couple relationship and young adult life-cycle transitions. From this study, healthcare providers can better understand how the numerous physical symptoms of Crohn's disease cause psychological and social implications for the diagnosed individual and partner. This understanding will allow healthcare providers to complete couple level clinical assessment and increase systemic interventions, promoting greater resilience among young adult couples. / Ph. D.

Background: An estimated 125 million women live with Female Genital Mutilation (FGM) worldwide. Despite it being internationally recognized as a human rights violation. FGM is still practiced in approximately 29 countries, most of them in Africa and the Middle East. FGM has no health benefits, whereas there are short and long terms negative consequences that can cause physical and psychological problems. Aim: To describe the experiences of women who live with FGM and their subsequent interactions with healthcare providers in countries where FGM is not a tradition. Method: A literature study based on ten studies with a qualitative research design. Results: Five main themes were found; Knowledge of FGM, Language Barriers, The Gender of Healthcare Provider, Interactions with Healthcare Provider and On Display. Conclusion: Patients had difficulties due to the language barriers. There was a preference for female healthcare providers. Patients were affected by interactions with healthcare providers as well as lack of knowledge. Patients also had their genitals put on display for others. Clinical significance: With increasing migration, it is important that healthcare providers do not judge, but instead treat and care for these women with respect and empathy. / Bakgrund: Runt 125 miljoner kvinnor i världen idag är könsstympade, även fast det är internationellt erkänt som ett brott mot de mänskliga rättigheterna. Trots detta praktiseras könstympning fortfarande i cirka 29 länder, mestadels i Afrika och i Mellanöstern. Det finns inga hälsovinster för kvinnor som är könsstympade, däremot medför det kort- och långsiktiga negativa konsekvenser som kan leda till fysiska och psykiska problem. Syfte: Att beskriva könsstympade kvinnors erfarenheter av vårdpersonal i länder där det inte finns någon tradition av könsstympning. Metod: En litteraturstudie baserad på tio studier med kvalitativ ansats. Resultat: Fem huvudteman framkom och beskrevs; Kunskap om könstympning, Språksvårigheter, genus av personal, samspelet med vårdgivare och att den könsstympade kvinnan kände sig uttittad av vårdpersonalen. Slutsats: Patienterna hade svårt att kommunicera med sjukvårdspersonalen. Patienterna föredrog kvinnlig sjukvårdspersonal. Interaktionen med sjukvårdspersonalen påverkade patientens relation till vården. Patienterna kände sig uttittade av sjukvårdpersonalen. Patienterna upplevde att vårdpersonalen hade kunskapsbrister om FGM. Klinisk betydelse: Med ökad migration är det nödvändigt att vårdpersonalen ger en respektfull vård och visar empati för de könstympade kvinnorna.

Magister Public Health - MPH / Background: Cerebral malaria (CM) kills up to 25% of its patients and about one third of its survivors develop neurological impairments (NIs). With advancements in diagnostic and management techniques for CM, more children are likely to survive. The increase in the number of CM survivors may increase the prevalence of children with NIs. In Malawi, rehabilitation for children with NIs is mostly institution-based with erratic community-outreach services, resulting in poor long-term outcomes. To date, community-based rehabilitation (CBR), a comprehensive rehabilitation approach that also addresses socio-economic impact of NIs and may supplement institution-based rehabilitation services, has not been well explored and documented. Presented here are experiences and perceptions on CBR programmes for NIs following CM in Blantyre, Malawi.

Trots att så många kvinnor drabbas av missfall är det ett ämne som det inte talas om i Västerländsk kultur. Kvinnor som genomgår missfall upplever därför ofta brister i socialt stöd i samband med missfallet. Av denna anledning spelar bemötandet från vårdpersonal en betydande roll då det kanske är den enda möjligheten kvinnan har att tala med någon om sitt missfall, men också för att få svar på viktiga frågor.      Den här uppsatsen syftar till att öka kunskapen om kvinnors upplevelser av missfall och bemötande från vårdpersonal. En induktiv forskningsansats med en kvalitativ metod har använts i denna studie. Sex halvstrukturerade intervjuer har genomförts med kvinnor från olika geografiska områden i Sverige.      Resultatet visar att kvinnorna delar upplevelsen av att ha förlorat ett önskat barn. De beskriver även sina upplevelser av de känslomässiga reaktioner som följer efter ett missfall och som handlar och chock, skuld och om sorg. Vidare beskrivs vilka reaktioner de fått från personer i omgivningen i samband med sin förlust och hur de upplevt den fysiska smärtan i samband med missfallet. Slutligen framkommer kvinnornas upplevelser av bemötandet från vårdpersonal som de beskriver i form av att få information, förmågan att förmedla en känsla och visa sig personligt berörd, att ge tid och utrymme för samtal och även återkoppling och uppföljning.      Diskussionen av resultatet har gjorts med hjälp av Cullbergs kristeori och tidigare forskning. Som avslutning redovisas allmänna reflektioner och förslag på fortsatt forskning. / Despite the significant number of miscarriages that occur, miscarriage is not an often discussed topic in Western culture. Therefore, women that are affected by miscarriage often experience a lack of social support from people in the environment.      Because of this reason, treatment from healthcare providers has an important role because it may be the only opportunity the women have to discuss her feelings about the miscarriage and to get answers about important questions that she may have.      This essay is referring to increase the knowledge about women’s experience of miscarriage and healthcare providers. An inductive research approach with a qualitative method has been used in this essay. Six semi structured interviews has been fulfilled with women from different geographical areas around Sweden.      My results show that women share the experience of the loss of child that they have been longing for. They describe their experience of their emotional reactions that fallows after miscarriage in the variety of chock, guilt and grief. They also describe different reactions from people in the environment in association with their loss and how they experience the physical pain.      Finally, women’s experience of the treatment from healthcare providers are described in the variety of information, the ability to convey a feeling and express personal concerns, time and space to talk but also feedback and fallow up care.      Discussion of the results has been done with help from Cullbergs crisis theory and previous research. As a finish, general reflections and suggestions to further research is presented.

Bakgrund: Att leva som hemlös kan innebära hälsoproblem. Forskning visar att hemlösa på grund av dåligt bemötande inte söker sig till vården. Mötet med hemlösa personer ska bygga på respekt och omtanke. Vårdpersonal behöver därför vara medvetna om och reflektera över beroendet av varandra i mötet. Kunskap och förståelse för hemlösa personers problematik kan bidra till att förbättra omvårdnaden. Syfte: Att beskriva mötet mellan hemlösa personer och vårdpersonal. Metod: Studien utfördes som en allmän litteraturstudie och tretton vetenskapliga studier granskades, analyserades och delades in i tre kategorier. Resultat: Resultatet visade att respekt för värdighet och integritet, upplevelser av tillit och respekt för självbestämmande påverkade mötet mellan hemlösa personer och vårdpersonal. Slutsats: En ökad kunskap om problematiken i mötet mellan hemlösa personer och vårdpersonal behövs för att kunna förverkliga målet om lika vård på lika villkor. / Background: Living as a homeless person may cause health problems. Research shows that persons who are homeless avoid seeking health care due to bad attitudes experienced in health clinics. Interaction with homeless people should be based on respect and caring. Healthcare providers thus need to be aware of and reflect upon interdependence when interacting with homeless people. Knowledge and understanding homeless people´s predicaments can contribute to improving care. Purpose: To describe the interaction between homeless people and healthcare providers. Method: The study conducted is a general literature review, including thirteen scientific studies that were reviewed, analyzed and subsequently divided into three categories. Result: The result illustrate that respect for dignity and integrity, as weel as perceptions of trust and respect for autonomy affect the interaction between homeless people and healthcare providers. Conclusion: Increased knowledge of the various problems concerning the interaction between homeless people and healthcare providers is necessary to achieve the vision of equal care on equal terms.

abstract: Despite the widely recognized health benefits of breastfeeding and its endorsement by leading health organizations, as a preventative public health intervention, inadequate breastfeeding knowledge and lactation management skills among healthcare providers continues to be a major barrier for women who choose to initiate breastfeeding. Breastfeeding competencies are not standardized in healthcare education for any of the health professions. To address this gap, a few continuing education and professional development programs have been implemented, but paucity in research regarding the efficacy of these programs exists. The purpose of this study was to explore the changes in healthcare providers’ learning outcomes related to breastfeeding support and promotion. A non-experimental pre-posttest self-report survey design was used to assess the feasibility and preliminary efficacy of an online breastfeeding educational intervention for healthcare providers. The Theory of Planned Behavior (TPB) provided the framework for exploring the participants’ psychological and behavioral outcomes. The research questions were: (1) What is the feasibility of an online breastfeeding course for healthcare providers? (2) What are healthcare providers’ psychological and behavioral changes occurring after completion of an online course? (3) How do the post-intervention psychological and behavioral outcomes of the online format compare with those of the previous format (hybrid) of this breastfeeding course? Although participants’ favorably assessed the feasibility (i.e., acceptability) of the 45-hour course, several factors contributed to participants’ satisfaction level: Previous online learning experience, connectedness with others, and the degree of structural support. Significant positive changes occurring in participants were increases in their knowledge and beliefs about breastfeeding; attitudes toward formula feeding; perceived behavioral control; perceptions about being able to perform breastfeeding supportive behaviors; and intentions to perform actions that are consistent with evidence-based breastfeeding supportive behaviors. Significant changes in the beliefs about formula feeding were not in the expected direction raising conceptual and pedagogical issues. Participants had negative perceptions about being able to implement what they learned in their workplaces or to affect policy. Findings support the use of online breastfeeding education programs for healthcare providers; changes at both individual and institutional levels are necessary to change provider practices. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015