The aim of the thesis is to explore pregnant women's decision-making and major influences on their preferences for a place of delivery. The study was prompted by the UK government's policy of a woman centred maternity service (Department of Health 1993b), and the observation that studies had concentrated on professionals' rather than women's views about the place of delivery. Two factors were considered to have potential influence in decision making, one being the individual woman's risk perception related to the process of childbirth, and the other, knowledge about available options for place of birth. First, a systematic review was conducted, looking at available studies on women's views about the place of delivery. Only 9 studies were found, suggesting a need for more studies. Secondly, a primary study was conducted using in-depth interviews with 20 women planning a hospital birth, and 13 planning a home birth to explore factors that led to their respective choices. Results from the primary study indicate that women were not offered information about the availability of home birth. Consequently, 90% of those planning a hospital birth did not give thought to where they were going to have their babies, but assumed they were going to go to hospital. On the other hand, those planning a home birth found information privately and discussed the options with their husbands before making a decision. Additionally, results exposed differences in perception of safety concerning childbirth for subsequent deliveries according to planned place of delivery. Control of the birth process and environment was also found to be important for women planning a home birth. Risk perception and information about available options were found to influence decision-making about the place of birth, thus supporting the hypotheses of the thesis.

The hospital emergency department (ED) is a critical source for health care amid a complex healthcare system in the United States. It is the gateway to care for a broad range of people, arriving from a variety of locations. With this wide reaching net and a decreasing trend in hospital beds, EDs throughout the United States are experiencing overcrowding. ED crowding has various tactical and strategic facility management impacts ranging from facility occupancy issues to adverse health outcomes. Among other factors, recent research has cited the sharp increase in ED visits over the years and ED patient boarding as key contributors to crowding. Home hospital care is a model in which health care is delivered at an individual’s home as a substitute for hospital-level inpatient short-term acute care. Clinical research has shown home hospital to be an effective care model for select illnesses presenting frequently to EDs, such as congestive heart failure, community acquired pneumonia, chronic obstructive pulmonary disease, and cellulitis. While there exist distinct clinical and social criteria for which delineate eligible individuals, home hospital care models have been linked with the potential to free inpatient beds. The overarching objective of this study is to investigate the relationship between home hospital care and ED crowding. To achieve this objective, the study examined the relationship between home hospital care and ED crowding, specific to ED boarding performance at a large, urban, teaching hospital facility. A methodology for identification of potential home hospital patients was used through clinical and social criteria, and a scale for the range of clinical eligibility rates was established for the five suitable illnesses. The study modeled patient flow and bed demand, and utilized computer simulation modeling to assess the impact of home hospital care on ED boarding performance. Various models were simulated to represent different home hospital intervention types. The models incorporated home hospital through an ED Referral program, Inpatient-Transfer Referral program, Community Referral program, and a fully integrated home hospital program. Three scenarios were run for each model to assess practical possibilities for the utilization of the freed bed hours from a home hospital program. This research contributes insight and understanding of home hospital’s impacts on ED crowding. The insight from this study quantifies the effects of a home hospital program on ED boarding and inpatient bed demand. The modeling study is contributes an analytical understanding of the impacts that home hospital could potentially have on crowding, which could prove useful in the struggle against ED congestion. This understanding helps to provide a more thorough understanding of home hospital, and could aid in an organization’s decision-making process of whether to implement a program. The presented modeling methodology for analyzing home hospital and ED crowding can also be used as a model format for researchers and practitioners for analytical purposes in future studies.

Submitted by admin tede (tede@pucgoias.edu.br) on 2018-02-07T16:36:17Z No. of bitstreams: 1 EDNA MARIA DE JESUS.pdf: 2042071 bytes, checksum: e7093879c6c173c6388e59905996eca1 (MD5) / Made available in DSpace on 2018-02-07T16:36:17Z (GMT). No. of bitstreams: 1 EDNA MARIA DE JESUS.pdf: 2042071 bytes, checksum: e7093879c6c173c6388e59905996eca1 (MD5) Previous issue date: 2017-09-27 / The research "Pedagogical Hospital / Home Care in Goiás: gender and teaching in the eyes of the subjects involved" had the purpose of investigating the Pedagogical Hospital / Home Care, seeking their particularities in the quality of public policy, as well as the professional identity of the subjects involved in it and the perception of the subjects involved, about the attendance developed by Naeh / Seduce-GO, considering the question of gender and teaching. The research adopts the assumptions of the qualitative approach and is structured by literature review, from a bibliographic study based on authors such as Aranha (2000, 2001, 2005); Ceccim (1999); Fonseca (2003); Freire (1987, 2001, 2006, 2011); Louro (1997, 2003), Matos and Mugiatti (2009, 2014) among others, and documentary and by the articulation of theoretical assumptions with the empirical context, through field research, through questionnaires and interviews. The study revealed that public policies aimed at inclusion, despite advances, were limited in scope and, therefore, the inclusion / exclusion paradox is still evident. In the view of the research subjects, the Pedagogical Hospital / Home Care, offered by Naeh assumes the role of promoter of inclusion and has expanded significantly. However, it is important to highlight some relevant points of the research: a) lack of training to act in this modality of Special Education; b) the plans and activities are elaborated through the Curriculum Reference of the State Education Network - Seduce / GO; c) Pedagogical practice in the Pedagogical Hospital / Home Care requires the professionals involved / the greater flexibility, greater understanding of the peculiarities of each student; d) the difficulty of the professionals who work in this modality of teaching, in dealing with the loss and mourning of learners; e) the turnover of professionals and students that hinders the continuity of the teaching / learning process; f) most professionals, from Naeh, have an effective link in Seduce-GO, but they are crowded in other educational institutions and only complement the workload in this kind of service; g) although there is no resistance regarding the hiring of teachers and preference for the hiring of teachers, most of the professionals who work in the Pedagogical Hospital / Home Care, in the management and teaching positions, are women; h) those responsible are all female and do not perform paid work outside the home to accompany the child in health treatment; i) the majority of those interviewed declare that they prefer teachers because of the issue of caring and educating, recognized by them, as a feminine activity; j) those responsible state that they learned about the Pediatric Hospital / Home Care at the hospital during the hospitalization of the child and consider the activities of relevance to the beginning or continuity of school activities, as well as social interrelations. In this way, the elements constituting the look of pedagogical work were presented and analyzed, in the Pedagogical Hospital / Home Care Service in Goiás, which still has a long way to go in order to achieve inclusion and equal rights. / A pesquisa “Desafios do Atendimento Pedagógico Hospitalar/Domiciliar em Goiás: gênero e docência no olhar dos/as agentes envolvidos/as” teve como propósito investigar o Atendimento Pedagógico Hospitalar/Domiciliar, buscando suas particularidades na qualidade de política pública, bem como a identidade profissional dos sujeitos que nela atuam e a percepção dos sujeitos envolvidos, acerca do atendimento desenvolvido pelo Naeh/Seduce-GO, considerando a questão do gênero e da docência. A investigação adota os pressupostos da abordagem qualitativa e se estrutura pela revisão de literatura, de estudo bibliográfico baseado em autores como Aranha (2000, 2001, 2005); Ceccim (1999); Fonseca (2003); Freire (1987, 2001, 2006, 2011); Louro (1997, 2003), Matos e Mugiatti (2009, 2014) entre outros, e documental e pela articulação dos pressupostos teóricos com o contexto empírico, por meio da pesquisa de campo, mediante questionários e entrevistas. O estudo revelou que as políticas públicas direcionadas à inclusão, apesar dos avanços, tiveram alcance limitado e, por isso ainda evidencia-se, o paradoxo inclusão/exclusão. Na visão dos sujeitos da pesquisa, o Atendimento Pedagógico Hospitalar/Domiciliar, oferecido pelo Naeh assume o papel de promotor da inclusão e tem se expandido significativamente. No entanto, cabe destacar alguns pontos relevantes da pesquisa: a) a falta formação para atuar nesta modalidade da Educação Especial; b) os planejamentos e atividades são elaborados mediante o Currículo Referência da Rede Estadual de Educação – Seduce/GO; c) a prática pedagógica no Atendimento Pedagógico Hospitalar/Domiciliar exige dos/as profissionais envolvidos/as maior flexibilidade, maior compreensão para as peculiaridades de cada educando/a; d) a dificuldade dos/as profissionais que atuam nessa modalidade de ensino, em lidar com a perda e o luto de educandos/as; e) a rotatividade de profissionais e de educandos/as que dificulta a continuidade do processo de ensino/aprendizagem; f) a maior parte dos/as profissionais, do Naeh, têm vínculo efetivo na Seduce-GO, mas estão lotados/as em outras instituições de ensino e apenas complementam a carga horária nesse tipo de atendimento; g) embora não se perceba resistência quanto à contratação de professores e preferência quanto à contratação de professoras, grande parte dos/as profissionais que atuam no Atendimento Pedagógico Hospitalar/Domiciliar, nos cargos de gestão e docência, são mulheres; h) as responsáveis são todas do sexo feminino e não realizam trabalho remunerado fora de casa, para acompanhar o/a filho/a em tratamento de saúde; i) a maioria das responsáveis entrevistadas, declaram preferir professoras, devido à questão do cuidar e educar, reconhecida por elas, como atividade feminina; j) as responsáveis afirmam que souberam do Atendimento Pedagógico Hospitalar/Domiciliar no hospital durante a internação do/a filho/a e consideram as atividades de relevância para o início ou continuidade das atividades escolares, bem como as interrelações sociais. Desse modo, foram apresentados e analisados os elementos que constituem o olhar sobre o fazer pedagógico, no Atendimento Pedagógico Hospitalar/Domiciliar, em Goiás, que ainda tem um longo caminho a percorrer para alcançar de fato a inclusão e a igualdade de direitos.