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The purpose of this Heideggerian phenomenological study was to understand the meaning of the lived experience of seclusion in a psychiatric hospital. Five people with a long standing mental illness who had spent time in a locked seclusion room in a psychiatric hospital were asked to describe their experience in seclusion.Consistent with the method, purposive sampling was used in order to obtain an understanding from those who had lived the experience of seclusion and could articulate their experience. Interviews were audiotaped and the data were transcribed by the researcher. Audiotapes were destroyed when the study was completed. Transcribed data were shared with other researchers who were familiar with Heideggerian phenomenology and hermeneutics for the purpose ofgaining insight into the interpretations. When data were shared, names of participants and other identifying information were removed. Sharing of data for purpose of interpretation is inherent in the Heideggerian method as described by Diekelmann, Allen, and Tanner (1989). Data were analyzed using Diekelmann, Allen, and Tanner's (1989) seven stages. The following patterns emerged constituted pattern- Seclusion, A Paradox Being Powerless yet Hopeful with the supporting themes of 1.) Being Punished, 2) Being Abandoned, and 3) An Opportunity for Reflection and Self Growth. / School of Nursing

The purpose of the study was to examine critical care nurses' perceptions of the usefulness of hospital ethics committees as a coping strategy for resolving ethical dilemmas. The conceptual framework was Lazarus and Folkman's theory of stress, appraisal, and coping (1984).The convenience sample was five critical care nurses from five midwestern hospitals. Confidentiality was maintained by identifying participants as numbers.The research design for the study was an exploratory case study. The research question, nurses perceptions' of the usefulness of hospital ethics committees as a coping strategy to resolve ethical dilemmas, was analyzed using a qualitative methodology. Findings indicated that the nurses did not perceive hospital ethics committees as useful resources in ethical conflicts. Barriers to use of committees included lack of education about the committees, lack of timely intervention by committees in a crisis and risks involved in confronting physicians via committees.Conclusions were that ethics committees were not fulfilling a role as support systems empowering nurses to act as patient advocates in ethical dilemmas. Results can be used to develop strategies to increase the ethics committees' effectiveness in ethical dilemmas. / School of Nursing

This thesis focuses on the cultural construction of cancer experience in a modern clinical context. A French Canadian center, specializing in cancer treatment, was the main source of information for this study. Facts obtained from this setting served for the analysis. The first step in the proposed method, consisted of an ethnographic description of the clinical milieu observed. Next, five additional steps in the analysis indicated the principal elements of this cultural encounter with cancer. These steps included: (1) An analysis of the staff exchange; (2) An analysis of the patient's exchange; (3) An analysis of the documents on Terry Fox and Johnny Rougeau, heroic victims of cancer; (4) An exploration of the patients' lay knowledge on cancer; (5) A life story of a cancerous patient where by the dialectic trends between exchange, knowledge and experience are analysed. / The resultant three hypotheses deal with the emergence of a new exchange on cancer with an emphasis on hope and god morale, the homology of cancer exchanges in the clinical and social spheres, and finally concerning the nature of the layman's knowledge on cancer as making sense out of a troubling experience of liminality and alienation as well as the more open and dynamic character of the layperson's knowledge of cancer.

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The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.

The provision of equitable access to health care, particularly acute care remains a challenge. This challenge is often met through the provision of outreach critical care services. These services may take the form of Medical Emergency Teams responding to hospital in-patients who become acutely ill outside a hospital critical care environment (eg a general medical ward) or medically staffed retrieval services that respond to patients who become acutely ill in an out of hospital environment for which critical care resources are not immediately available and are delivered to the patient by a responding retrieval team. In both circumstances the intention is early recognition of the acutely ill patient, a timely response by a team with the desired critical care skills, where appropriate deliver the patient to a Critical Care environment (eg an Intensive Care Unit) for ongoing management and by doing so prevent potential adverse patient events. Retrieval services are becoming increasingly important as centralisation of specialty and acute medical services is increasing. These processes involve many complex interactions, with the potential for adverse patient events. Thus it is important to better understand the nature, frequency of occurrence and patient outcomes associated with out of hospital patient transportation, particularly with critically ill patients requiring admission to an Intensive Care Unit. This body of work, across a number of studies, showed that patients whose ICU source of admission was another hospital had a severity of illness that was higher than for other ICU admissions, had a greater than expected mortality and a mortality and hospital length of stay that exceeded that of similar patients, matched for demographics and casemix who had not undergone a interhospital transfer. These findings varied according to the diagnostic category (being stronger for trauma, respiratory illness, sepsis and intra cranial haemorrhage) and varied across geographical regions. These studies also showed that there was regional variation in the proportion of patients admitted to an ICU from another hospital, the proportion of such patients was increasing (particularly for sepsis) as well as patterns of variation based upon day of the week (highest occurrence Friday and Saturday) and moth of the year (mostly July to October). They also revealed that there is a negative correlation between the proportion of patients admitted to an ICU from another hospital with the proportion of elective and post operative admissions to the ICU. This information is important in regards to planning for the provision of acute care and emergency services resources. The interhospital transfer of critically ill patients has been previously documented to be associated with significant adverse patient events. However our understanding of these events in terms of contributing factors, preventability, potential for harm and minimizing factors has not been well documented. This body of work also showed that medical treatment may be altered based solely on the fact that a patient is undergoing retrieval. An example of this is the finding that such patients have a significantly greater likelihood of endotracheal intubation and mechanical ventilation that similar patients matched for demographics, severity of illness and diagnosis who have not undergone retrieval. Retrieval however can provide significant patient benefit, and this body of work illustrates that through the description of a number of unique and challenging cases and the retrieval specific factors that were associated with a good outcome for each of those cases. This information points to the importance of identifying quality in retrieval practice. This body of work outlines the original development of an incident monitoring tool for retrieval, based upon existing examples of use of the incident monitoring methodology within other medical and non medical domains. Following a retrospective review and analysis of comments from retrieval patient records and consultation a tool for Retrieval Incident Monitoring was developed. An investigation of the use of Retrieval Incident Monitoring across a number of retrieval organisations and pre hospital activities, including during deployment at a major public event (2000 Sydney Olympics) was undertaken. The findings of this study showed that the majority of incidents during retrieval are preventable (91%) and that most incidents were related to problems with equipment, then patient care, and transport operations, interpersonal communication, planning or preparation, retrieval staffing and tasking. Incidents were most likely to occur during patient transport to the receiving facility, at patient origin, during patient loading and at the retrieval service base. Contributing factors were almost equally spread between those that were system and human based. Patient harm was documented in 59% as well as a death. The importance of good crew skills/teamwork was highlighted as a minimising factor to incident occurrence. Subsequently this knowledge, experience and data was used to develop and validity a Retrieval and Ambulance Healthcare Incident Type within the generic and widely used Advanced Incident Management System (AIMS). Finally the occurrence of retrieval can be used as a quality measure for the wider health system. Ideally, because of the findings from this body of work of an associated greater than expected mortality and hospital stay of patients undergoing retrieval, particularly for certain diagnostic categories, then a measure of the occurrence of retrieval could be used as a quality indicator of health service provision across a region. As the need for retrieval will never be negated, outcomes associated with retrieval can be measured and benchmarked across a number of regions In summary, in its entirety, this work has added and tested new knowledge and methods as well as value added to existing knowledge for critical care delivery in the out of hospital environment, in particularly to medical retrieval of critically ill patients admitted to an Intensive Care Unit within Australia and New Zealand. It has developed and validated the efficacy of a new quality tool for retrieval and retrieval based quality measures. It has also pointed towards new areas of future investigation particularly in relation to factors that may favourably or adversely impact upon retrieval outcomes and outcomes of patients undergoing retrieval. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346925 / Thesis (M.D.) - University of Adelaide, School of Medicine, 2008.

In the past few years, many people with an Islamic background have settled in Australia. Within the health care context, this means that health care providers must modify the care provided to ensure it meets the needs of this culturally diverse population. Little nursing research has focused on understanding the perceptions and experiences of Muslim people within health care systems, particularly in Australia. This study provided an opportunity to explore, and document the experience of the hospitalisation for Islamic people and thereby advance the available information upon which important nursing care decisions that relate to this group can be more informatively made. This study aims to explore and interpret the lived experience of thirteen Muslim patients who had been hospitalised in an Australian hospital. The hermeneutic phenomenology of Heidegger (1967/1996), the philosophical hermeneutics of Gadamer (1989), and the ideas of van Manen (1990/1996) underpin this study. The meaning and understanding of the everyday experience of Muslim patient in a non-Islamic hospital is achieved through interpretation of the participants’ stories. Data were generated using unstructured audio-taped interviews from participants. The interviews were transcribed verbatim and analysed, then interpreted using phenomenological methods. The two themes to emerge from the participants’ experiences are: Being-thrown-into-an-un-everyday-world and living-Islam-in-the-un-everyday-world. The theme of Being-thrown-into-an-un-everyday-world arose from the sub-themes of the awareness of self and Being an outsider. The theme living-Islam-in-the-un-everyday-world was drawn from the three sub-themes of Being the same and different, hindrances to being Muslim, and adapting-to-the-un-everyday-world. The findings of this study provide an insight into the experience of Muslims being cared for in Australian hospitals. It is hoped that this interpretation will make a significant contribution to the care of Muslim patients by having health professionals consider how this group could be cared for in a culturally sensitive manner. It is not intended as a prescription for care but draws the reader to reflect on aspects of the Muslim faith and how this may impact on individuals experience when in hospital. The scope of this study and the dearth of available research in this area conclude that much more research needs to be undertaken. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1317115 / Thesis(Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.S.)--University of Michigan, 1982.