Estudio de tipo cualitativo, que utilizó como abordaje metodológico estudio de caso. Sus objetivos fueron caracterizar, analizar y comprender la percepción de enfermeras y pacientes sobre el respeto a la intimidad en el servicio de ginecología del Hospital Regional Docente las Mercedes de Chiclayo. Para la obtención de datos se aplicó la entrevista semiestructurada a profundidad y la observación no participante, estos datos se procesaron a través del análisis de contenido temático y de la técnica de triangulación. El estudio se desarrolló basándose en los principios éticos de Ellio Sgreccia y de rigor científico planteados por Guba y Linconl. Las categorías emergidas fueron: Apreciaciones de enfermeras y pacientes sobre el respeto a la intimidad, desposesión de la intimidad de la paciente mujer, condiciones desfavorables para ejercer el cuidado de la intimidad y reacciones de la mujer frente a la intimidad vulnerada. Los resultados demostraron que las enfermeras perciben la intimidad como una dimensión holística, pero se ve violentada por el gran número de pacientes, la inadecuada infraestructura, los deficientes recursos materiales, la intervención de otros profesionales, deficiente empatía, formación y resistencia al cambio. La mujer percibe la intimidad como el respeto a su cuerpo, enfocado a sus partes íntimas, asegurando sufrir situaciones de desposesión durante los cuidados, por falta de vocación y empatía, manifestando actitudes pasivas, sentimientos de vergüenza e incomodidad, tristeza y llanto, justificando dichas reacciones de pasividad por estar enferma, sentirse vulnerable y por miedo a que los profesionales tomen venganza, renieguen o se desquiten con ellas.

The number of forensic psychiatric commitments has drastically increased over the last decade, now surpassing civil commitments in Texas. This uptick is a result in part of two main policy shifts during the middle of the 20th century: deinstitutionalization and over incarceration fueled primarily by the War on Drugs. Although the Community Mental Health Centers Act of 1963 was meant to replace inpatient services, few centers are adequately funded. As highlighted in the news, the combined effect is illustrated in the numbers: 1 million individuals with serious mental health disorders are booked into local jails each year and half of all incarcerated individuals are experiencing a mental health problem of some kind. To address this growing population and to prevent individuals who are criminally court-ordered to receive mental health treatment from lingering in jail for unconstitutional lengths of time, many states including Texas have been forced to find or create new forensic beds, sometimes even building new facilities. This demand for forensic beds has created opportunities for private prison companies to expand into mental health. GEO Group, one of the largest prison corporations in the world, already owns or operates five psychiatric facilities in the U.S., including one in Montgomery County, Texas, before it was acquired by Correct Care Solutions. Much like in the private prison industry, for-profit private corporations have an incentive to continue to grow the forensic psychiatric population, which contradicts best practices regarding treatment for individuals with mental illness taking place in the least restrictive environment. In order to prevent opportunities where states rely on private prison corporations because of cost savings promises, research and advocacy regarding alternatives for states attempting to curb a growing forensic psychiatric population are needed. / text

Loss of control is a well-documented human response to hospitalization. The purpose of this study was to construct and test a theoretical model of perceived territorial control among hospitalized adults. Territorial control was defined as the freedom or choice one has in regulating or influencing the objects, activities, and social intereactions within a particular space claimed or identified as one's own. The space of concern in this study was the patient's hospital room. The study focused not on the negative aspects of a loss of control but on the positive outcomes of having a sense of control. A three-stage, multivariate, causal-modeling design was used to estimate the impact of perceived territorial control on state anxiety and satisfaction with care in a convenience sample of 80 Hispanic and Anglo-American males and females between the ages of 18 and 79 who were in the hospital for short-term orthopedic care. Attitudinal, self-report measures were used predominantly. Instruments were constructed to index centrality of territory and territorial control perceptions. Correlational and multiple regression statistical techniques were used to estimate the theoretical model. Tests for violations of the statistical and causal assumptions were performed. Centrality of territory, assistance needs, and the powerful others locus of control significantly influenced patient territorial control perceptions. Temporal duration, internal locus of control, and chance locus of control made no significant impact on perceived territorial control. Patient territorial control perceptions significantly decreased state anxiety and significantly increased satisfaction with care. Perceived territorial control explained 24 percent of the variance in patient state anxiety and 21 percent of the variance in satisfaction with care. An unstaged, empirical test of the model increased the explained variance to 32 percent for state anxiety and 40 percent for satisfaction with care. There was a positive relationship (r = .41) between age and centrality of territory and a negative relationship (r = -.31) between age and state anxiety. The implications were related primarily to continued theory-building and the development of nursing practice theories.

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Syftet med uppsatsen är att undersöka vilka pedagogiska perspektiv som var rådande och vilka metoder som användes för fostran av sinnessjuka patienter på hospitalen under senare hälften av 1800-talet, med fokus på Uppsala hospital. Frågorna som ställs är hur hospitalet fungerade som fostrande institution och vilka pedagogiska tankar överläkaren N. G Kjellberg uttryckte samt vilken pedagogisk funktion arbetet på hospitalet hade och hur den intellektuella undervisningen bedrevs.Källmaterialet består av stadgor, Sveriges officiella statistik, patientjournaler samt artiklar författade av N. G Kjellberg och en historisk hermeneutisk metod används. Foucaults teorier om makt och disciplinering utgör den teoretiska utgångspunkten men utan att uppsatsens tolkningsbas är ensidigt disciplineringsteoretiskt.Resultaten visar på att hospitalets inneboende struktur och ordning hade stor betydelse för fostran av de sinnessjuka. N. G Kjellbergs pedagogiska tankar var inspirerade av de psykiatriker och läkare på kontinenten som förespråkade den pedagogiska behandlingsformen moraltreatment och han var mycket liberal i sin syn på undervisning i stort. Den viktigaste metoden för fostran av de sinnessjuka var arbetet på hospitalet. Utifrån viljan och förmågan att arbeta bedömdes denne som frisk eller sjuk. Undervisningen på hospitalet bestod främst av religiös underdånighetsfostran och fokus låg på religionsundervisningen. Denna undervisning hade främst i syfte att få den intagna att förstå sin roll i samhället och bli nöjd med den. Övrig undervisning var av ringa vikt.

El presente trabajo de investigación,se realizó entre el peronal asistencial que labora en le Cínica del Hospital “Hermilio Valdizán”,el período de estudio fue durante los meses de enero a junio del 2015,tomándose como parámetros de medición los niveles altos,mediosy bajos,según la escala de Maslach Burnout Inventory (MBI) y una encuesta sociodemográfica,la finalidad fue hallar la prevalencia del Síndrome de Burnout y la identificación de los factores de riesgo asociados. El presente estudio se justificó por cuanto posee valor teórico,utilidad práctica y relevancia social en base a los beneficios netos que genera en Salud Pública y se sustenta en las investigaciones realizada en nuestro país y en otros. La metodología utilizada fue la de un estudio epidemiológico de tipo descriptivo,transversal,con la aplicación de un diseño de investigación de campo donde la población etuvo conformada por 47 trabajadores asistenciales,se aplicó una encuesta formada por 7 preguntas correspondientes a las variables sociodemográficas y el Maslach Burnout Inventory (MBI) que consta de 22 preguntas cerradas en escala de Lickert,que miden los niveles alto,medio y bajo,según se trate de las dimensiones Agotamiento Emocional, Despersonalización y Realización Personal. El procesamiento de los datos permitió determinar que si bien no se puede determinar una prevalencia del Sindrome de Burnout en la población estudiada,existen factores de riesgo y niveles del MBI que en corto tiempo pueden producir el Síndrome,por lo tanto se deben tomar en cuenta las recomendaciones en relación a la prevención.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Managed care health plans have become an important new force in the US health care system, changing the delivery of health care and the nature of competition in the health care industry. Lower health care costs of managed care emollees have led many to see 'managed care' as the solution to rising health care expenditures. Therefore, it is important to understand the impact of managed care on the health care industry. This dissertation focuses on the impact of 'managed care' on the acute care hospital industry and physicians who work in inpatient settings, using data on hospitals in Massachusetts between 1992 and 1998. In the first essay, I investigate the impact of managed care penetration on the prices and costs of hospitals. Managed care plans provide coverage for health care through a predetermined group of providers selected by the plan. Their ability to direct demand potentially gives them power to extract lower prices from providers. However, the impact of managed care penetration on prices for the overall patient population depends on whether hospitals raise prices to non-managed care insurers. Using instrumental variables estimation, I find evidence that managed care penetration leads to significant reductions in hospital prices and costs for the overall patient population. Managed care involves methods of financing and delivering health care services that manage, or intervene, in care decisions made by patients and physicians in order to reduce costs. The second essay empirically investigates whether managed care plans are able to reduce the resource use of physicians in inpatient settings. Using instrumental variables estimation, I find evidence that managed care involvement reduces physicians' resource use not only for managed care patients but for nonmanaged care patients as well. / 2031-01-01

research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management MAY 2014 / BACKGROUND: One of the key challenges facing the Limpopo Department of Health and Social Development in the area of Casualty Care is the lack of trained personnel and the inappropriate referral and utilisation of these services. There has been no known study conducted in this area in the South African context and therefore this study was undertaken to evaluate the services rendered within the Casualty Department at the Polokwane Mankweng Hospital Complex with specific reference to material and human resources as well as efficiency of the unit. AIM: To evaluate the Hospital Casualty Department in the Polokwane Mankweng Hospital Complex in terms of caseload, influencing factors and implications on resource utilisation during a one year study period. METHODOLOGY: A cross sectional study design was employed in this study. A retrospective record review was done and information was extracted from various sources of hospital information systems. No primary data was collected for this study. The setting of this study was the Casualty Departments at Polokwane Mankweng Hospital Complex. The two hospitals constituting this complex are situated 30 km apart in Polokwane and Turfloop respectively. Data was collected on various variables that are relevant to the functioning of, and resource utilisation in the Casualty Unit of this Complex. Variables including that of caseload, patient profiles, service costs and workload on human resources were measured. RESULTS: This study based on retrospective review of records of 250 patients’ records selected by a simple random sample from a cohort of 14,113 patients who attended the Casualty Department of the Polokwane Mankweng Hospital Complex during one year study period. One fifth of the patients were referred from other health facilities and more than 60% of the patients were discharged after receiving treatment which implied that these patients could be managed at a regional or district hospital. More patients with medical aid bypassed the referral system. Almost half of the patients arrived after-hours (from 18h00 to 6h00). This is the first study in the Limpopo Province which looked at the direct cost per patient at the Casualty Department. In 2008/09, overall expenditure was R 10,321,401.42 (including R 954,168.45 for pharmacy products, other consumables R 177,261.16 and Laboratory tests R 1,866,233.25). Overall the Department accounts for an estimated R 7,323,804 in personnel annual expenditure of the hospital. Unit personnel cost per patient was estimated at R518.94 (70.96% of total recurrent cost), while the unit costs for the Pharmaceuticals, Stores and Laboratory tests were; R67.23 (9.24%), R12.56 (1.72%) and R132.24 (18.08%) per patient respectively. Overall the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs. CONCLUSION: The results of the study will be used to guide the allocation of appropriate resources, and to highlight the need to implement an effective referral system, which will assist in reducing the workload.

Student no 9500767A Masters Report - School of Therapeutics / The aim and objectives of this study were to explore, interpret and describe young children’s experiences of hospitalisation for cardiac surgery and to describe their parents’ opinions regarding significant changes in the children one month after discharge. A qualitative design, grounded in phenomenology was used. Semi-structured interviews were conducted with the children prior to discharge and with their parents one month later. The children’s interviews were augmented by drawings, which were used to keep the children focused and to highlight themes that were not identified from their verbal accounts of hospitalisation. The expertise of a clinical psychologist was sought for the analysis of the children’s drawings. The results of the analysis of the drawings supported the children’s verbal accounts of their experiences in hospital. Children’s interviews revealed that young children experience and cope with hospitalisation for cardiac surgery very differently. Parents’ presence, pain and boredom were dominant themes that emerged from the children’s interviews. Behavioural changes and emotional responses included withdrawal, tearfulness, disturbed sleep patterns, sadness, fear, anger and happiness. Parents’ interviews one month after discharge revealed a lack of communication between the nurses and the children. iv It is recommended that further research be conducted with older children to determine the effects of stringent visitation regulations followed in the paediatric intensive care setting.

M.P.H., Faculty of health Sciences, University of the Witwatersrand, 2011 / Background: The hospital as an organisation employs many people who may be at risk for Injuries on Duty (IOD). Although IOD occur across the hospital and impact on staff morale and quality of care, no formal study has been conducted within the public hospitals in South Africa on the profile of employees who have sustained these injuries. This study was aimed at comprehensively describing the IOD and related factors at Klerksdorp/Tshepong/Potchefstroom (K/T/P) Hospital Complex in order to better understand and plan appropriate preventive strategies. Methodology: The study was based on a cross-sectional design involving retrospective record review obtained from the hospital information system. No primary data was collected. The study setting was K/T/P Hospital complex. All records of employees who sustained IOD during the study period were reviewed. Data was collected on relevant variables such as employee profile, type of IOD during the study period. Descriptive statistics was used to analyse the data. Results: The study found that the total number of IOD during this period was 152. The annual prevalence rate was 2.3% (Klerksdorp-Tshepong Hospital Complex) and 2.8% (Potchefstroom Hospital). . The category of employees who experienced injuries were administration (5.3%), support (18.8%), medical (34.9%), nursing (36.2%), professional (4.6%). The types of the injuries sustained were cut (8.6%), fall (19.7%), minor injuries (9.2%), needle prick (49.3%), patient related (1.3%), splash (11.8%). With regard to PEP costs, Klerksdorp Hospital incurred the highest costs of R31 231 34, followed by Potchefstroom Hospital with R23 714 83 and Tshepong Hospital with R19 305 57 during the study period