Decision-making by hospital pharmacy directors when deciding which clinical pharmacy services to implement and/or continue to provide was assessed. Also examined was how these decision-making activities, hospital characteristics, pharmacy characteristics, and pharmacy director demographics might be associated with the number and quality of clinical pharmacy services provided, as well as the number of clinical services implemented under the current pharmacy director. Hospital pharmacy directors reported considering a relatively large number of perceived goals for a clinical service and also indicated they use a rather broad range of decision-making methodologies in evaluating those goals when determining clinical services. Numerous variables were found to be significantly associated with the number of clinical services provided by the pharmacy department and the number of clinical services implemented under the current pharmacy director. However, relatively few variables were found to be significantly related to the quality of clinical pharmacy services being provided.

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This study was undertaken to assess factors contributing to difference in nutritional status of patients at high risk for malnutrition. Twenty-five patients hospitalized for treatment of cancer and other disorders and for surgery were assessed using anthropometric, biochemical and dietary measures.Significant malnutrition was found. Males, as compared with females, had lower percent triceps skinfold, percent weight-for-height, percent hemoglobin, decreased appetites and total iron binding capacity. Mean total iron binding capacity for males was 62 percent of normal suggesting acute malnutrition similar to kwashiorkor. Cancer patients had lower total lymphocyte counts than those with other diagnosis. Patients hospitalized more than 23 days showed evidence of marasmus, with lower percent mid-arm muscle circumference, percent hematocrit, percent hemoglobin and a tendency for decreased weight/height than those hospitalized for a short time. Compared with patients with good appetites, those experiencing poor appetites had increased caloric and protein needs but lower protein intake compared to needs and lower creatinine-height-index.Five subjects with decreased weight/height had lower total iron binding capacity. The mean was 61 percent of normal indication severe depletion. The mid-arm muscle circumference was 82 percent of normal suggesting acute malnutrition imposed upon compromised somatic protein stores. Nine subjects showed evidence of frank kwashiorkor, three other subjects experienced marasmic-kwashiokor indication acute malnutrition imposed upon chronic malnutrition.In conclusion, this study suggests several characteristic features of hospitalized patients at risk for malnutrition: hospitalization for over three weeks, inadequate caloric and protein intake relation to need and anorexia. These patients are candidates for nutritional assessment and support.

Spiritual dimensions are an important focus for nursing care and nurses can be catalysts for spiritual care. The purpose of this descriptive comparative analysis is to examine the spiritual care needs as perceived by terminally ill clients, non-terminally ill clients, and well adults. The theoretical framework for this study is Leininger's "Cultural Care Theory" that supports the notion that spiritual care needs to be culturally congruent.Participants were obtained from a 225-bed hospital, hospice, home care, and a wellness program in a midwestern city. Permission was obtained from the hospital President, Vice President of Nursing, the directors of Hospice and Home Care, and the community's Wellness Program. The number of participants was 76. The process for the protection of human rights was followed.Findings were that terminally ill, non-terminally ill, and well-adults all agree that receiving spiritual care that is congruent with beliefs is important. The terminally ill clients rated spiritual needs higher than both non-terminally ill and well-adults. All groups rated the same in the persons from whom it was wished to receive spiritual care. Common themes of spiritual care desired from these persons for the terminally ill group was: pray for/with me and talk to me. For the non-terminally ill group it was: give me information, The understanding, and provide emotional and spiritual support. Finally, for the well-adults it was: listen to me, talk to me, be confident, and support me.No statistical difference between groups (.940) on the SPS. On the SPC, the terminally ill group was more satisfied (5.20) with spiritual support they were receiving than the non-terminally ill group or well-adults.It was concluded that regardless of the stage of illness, the same spiritual needs are prominent, all individuals have spiritual needs, and several types of interventions are preferred. It has been demonstrated in this study that prayer is the most sought after component of spiritual care among all three groups. Second to that would be someone to talk to and someone to listen to them.Implications call for nurses to facilitate spiritual care from family, friends, minister or priest, and hospital chaplain. This could be written into the plan of care by having the client describe the type of spiritual care they want to receive. Nursing Administration needs to work with nursing staff to define spirituality and religion and what they mean to the nurse. / School of Nursing

During the twentieth century, Nursing Education in South Africa was traditionally provided by the public sector and religious orders. Sr Henriëtta Stockdale played a major role in the development of nursing education and the governing thereof. In 1914, the establishment of the South African Trained Nurses’ Association (SATNA) marked the drive for an improved system of education for professional nurses. Medical practitioners and members of the Colonial Medical Council supported this initiative. The Provincial Medical Councils recommended a uniform system of education, to abolish the apprenticeship system of training and that students should be supernumerary. However, it was difficult to persuade authorities to accept the recommendations. The apprenticeship system prevailed, except for Groote Schuur Hospital where a block system was introduced (Searle, 1965b:287). Nursing training at university level has been advocated by SATNA since 1914. Due to financial responsibilities and the limited number of recruits that met the entry requirements of tertiary institutions, it was unsuccessful. Furthermore, university training of nurses restricted the placement of student nurses at large hospitals linked to universities. In 1933, the University of Cape Town and the University of the Witwatersrand became the first two universities in South Africa to have nurses on campus (Potgieter, 1984:1). In 1916, the training of male nurses in the mining industry was allowed for the first time. All training interventions were funded by mining houses and could therefore be regarded as the first Private Nursing Education Institution (PNEI). In 1946, a small nursing school was established on the East Rand under the Simmer and Jack Native Hospital. The purpose was to train white male orderlies for medical stations at mines. This was the beginning of PNEI in South Africa. PNEI are still functioning presently. The role and contribution of these institutions to nursing education in South Africa are often ignored. The researcher strove to answer the following question: What is the history and development of PNEI and their contribution with regard to nursing education in South Africa from a historical perspective? The objectives of the study were to explore, describe and record the history of the development of PNEI and their contribution to nursing education in South Africa. The motivation for the private health care industry to embark on the establishment of Nursing Education Institution (NEI) was investigated and described. A qualitative research design and an explorative, descriptive, contextual, historical research approach were applied. Explorative research involves the exploration of the phenomenon to divulge its core components. A descriptive study design aimed to find more information on the topic within this particular field of study was also used. The topic and context of this study is PNEI in South Africa between 1946 and 2006. The purpose of the study is to preserve the history of the development and contribution of PNEI including Gold Fields Nursing College, Netcare Training Academy, Life Nursing College, Medi-Clinic Learning Centres and Gandhi Mandela Nursing Academy between 1946 and 2006. This research study is presented as a chronological narrative report (Objective 1). Data collection was done by individual oral history semi-structured interviews with information-rich individuals as well as document analysis. Oral history semi-structured interviews had been recorded after which each interview was transcribed verbatim. Data analysis was done by narrative and document analysis. Scientific rigour was ensured throughout the study. Objective 2 and Objective 3 were achieved through data collection and analysis. Recommendations based on the findings are made for nursing research, nursing education and nursing practice. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2012

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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.

Class of 2010 Abstract / OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.