Através da metodologia “Observação Estruturada” foram estudados 5 (cinco) adm inistradores hospitalares de hospitais filantrópicos gerais de grande porte no estado do Rio Grande do Sul, durante uma semana cada um, observando, minuto após minuto, dia após dia, como eles executam seus trabalhos. O estudo, que utilizou as mesmas categorizações de Mintzberg (1973), conclui no mesmo sentido de Mintzberg de que também o Administrador Hospitalar “não é um planejador sistemático e reflexivo, mas sim um profissional que executa suas atividades em ritmo intenso, com as características de brevidade, fragmentação e variedade. É firmemente orientado para a ação e vê-se constantemente bombardeado por telefonemas, correspondências e por pessoas que às vezes irrompem em sua sala para fornecer-lhe ou dele receber informações” (pág. 28-53, 1973). Utiliza-se intensamente da comunicação verbal e apóia-se em extensiva rede de contatos externos à organização hospitalar para a obtenção e troca de informações. A principal diferença entre os Administradores Hospitalares por mim pesquisados e os gerentes analisados por Mintzberg é que aqueles envolvem-se num número expressivamente maior de negociações do que estes. Enquanto que 10% (dez por cento) do total de contatos dos Administradores Hospitalares referem- se a negociações, apenas 1% (um por cento) do total de contatos dos gerentes estudados por Mintzberg refere-se a esse papel. A dinâmica e complexa interação dos quatro mundos do hospital (Mintzberg,1977): cura, cuidados, controle e comunidade são fontes de constante pressão em seu trabalho, desafiando suas habilidades (técnicas, humanas e conceituais) e exigindo-lhe elevada capacidade de observação, de negociação, de administração do tempo e de controle emocional, ao lado da competência em argumentar, em falar em público, em conhecer o sistema de saúde e em inter-relacionar-se com os demais profissionais da saúde.

Thesis (MSc ( Med In Pharmacy)) -- University of Limpopo (Medunsa / Summary Summary Summary The words “researcher” and “pharmacist” are used interchangeably. In the last two decades, the role of the pharmacist has been expanding beyond product orientated functions, such as procurement, stock control and dispensing, towards patient centered functions, in which the pharmacist assumes responsibility for treatment outcomes as part of the health care team. This research aimed to assess the need for the provision of pharmaceutical care from the pharmacist to the surgical wards of Steve Biko Academic Hospital. The objectives of the study were to determine the role of the pharmacist in the general surgical wards, to assist in the design of an antimicrobial ward protocol for the surgical wards, to record and assess antimicrobial patterns in the surgical wards, to describe and categorize the interventions performed by a pharmacist during the provision of pharmaceutical care, to identify factors which limited the provision of pharmaceutical care and provide recommendations for future undertakings, to calculate the cost implications of pharmaceutical care interventions made, to assess the time spent on interventions performed by a pharmacist during the provision of pharmaceutical care and to determine if the medical staff members in the surgical unit feel there is a need for the pharmacist providing pharmaceutical services to the wards. The study was conducted in the surgical wards of Steve Biko Academic Hospital. The study design was a cross-sectional operational study in which 62 patients were recruited over the eight week period. A pilot study was conducted to validate the data collection instruments. The data was analyzed with the assistance of a statistician using various statistical methods for the different variables in the study. ix Of the 62 study patients, 33 were female and 29 were male. The female-to-male ratio of the study patients was thus 1:0.88. The average age of the patient population, was 52.5 ± 17.2 years, with a range of 15 to 88 years. The mean duration of stay for the study patients was 8.9 days, with a range 1 to 111 days. A total of 120 diagnoses were made for the 62 study patients. Conditions diagnosed most frequently included conditions affecting the gastro-intestinal tract (38 patients), conditions affecting the cardiovascular system (28 patients), conditions affecting the endocrine system (14 patients) and infections (12 patients). The five medicines used most frequently in terms of numbers of patients and duration of therapy were paracetamol (53 patients, 277 patient-days), morphine/papaverine/codeine (41 patients, 155 patient-days), enoxaparin sodium (24 patients, 113 patient-days), co-amoxiclav (21 patients, 101 patient-days) and metoclopramide (22 patients, 90 patient-days). A total 188 interventions were made and documented during the study period and 153 (81.4%) interventions were accepted. The number of interventions suggested ranged from 0 to 10, with an average of three interventions per patient and a median of one intervention per patient. The most frequent interventions were made due to system error or non-compliance (29.3% of all interventions), on patient or nursing staffs’ knowledge of the medication (18.6%), untreated medical conditions (11.2%), therapeutic duplications (9.0%) and on prescribed doses and dosing frequency (5.9%). The total time spent providing pharmaceutical care services within the surgical wards over the study period was 32 days (227.9 hours) with an average time of 7.1 hours per day. Of the total time in the ward, 48% was spent on providing pharmaceutical care to the patients, 26% to record and access the total antibiotic usage in the ward, 9% on administration and 6% on meetings. Other functions comprising of 3% and less of the time was information to patients, x communication with doctors, educational sessions with nursing staff, communication with the pharmacy and stock control procedures. Questionnaires were completed by the doctors and nursing staff before and after the study period to determine if they felt there was a need for a pharmacist in the surgical ward. The doctors felt that there was a need for a pharmacist in the ward in terms of providing information and assisting in the rational use of medication. All of the nursing staff felt that there was a need for a pharmacist to visit the surgical ward and specifically to assist with the legal aspects of the prescriptions and with the education of the nursing staff. The pharmacist played an important role in the design of an antimicrobial ward protocol and in order to do so the pharmacist recorded and assessed the antimicrobial prescribing patterns of the surgical wards. In conclusion, the pharmacist present in the ward functioned as a gateway between the nursing staff and the doctors. The interventions that require the most attention was made due to system error and non-compliance. Important interventions were made on the patients’ and nursing staffs’ knowledge of the prescribed medication. The pharmacist played an important role in the education of nursing staff to discuss relevant topics and problems often encountered. Educational sessions with the patients involved giving them advice on home medication and the medication prescribed to them to take home. The amount of patients seen per week increased with time and the average time spent per patient consultation decreased with time. This is a clear indication that the researcher gained confidence and became more familiar with the pharmaceutical care process as the time passed. From the questionnaires completed by the doctors and nursing staff it was clear that they felt that there was a need for a pharmacist in the ward in terms of xi providing information, assisting in the rational use of medication, to assist with the legal aspects of the prescriptions and with the education of the nursing staff.

My thesis comprises a creative and a critical component. The creative component is a novel entitled Ambergris. Ambergris in both its synthetic and natural states is a fixative to contain the evanescence of scent; it is also a metaphor for my novel which is set against the background of perfume making and deals with expatriates and migrants. Through the formal structure of the novel I hope to make a contribution to literature and to engage with critical and social concerns of the expatriate condition such as the place of home, the experience of longing, and whether or not one can really ‘belong’. My critical essay is entitled "The Smell of Dislocation: Olfactory Imagery in Selected Works of Janette Turner Hospital". The words 'olfactory imagery' may seem to be a contradiction in terms due to the difficulty of containing scent and the paucity of olfactory language. Scent, however, has strong links to memory and place, and through its non-visual and associative qualities may bypass language. I argue that engagement with the representation of scent in fiction can expand the current categories of formalist criticism found in narrative theory and Creative Writing pedagogy. My essay examines how Janette Turner Hospital employs olfactory imagery in her ‘Australian’ stories and novels to represent the recurring themes of dislocation underscoring the lives of many of her characters. Despite the difficulty of representing smell in fiction, I explore possibilities for thematic considerations triggered by the percept of smell as experienced by Janette Turner Hospital's characters, narrators, and possibly readers. Such explorations deal with the links between scent and memory, the liminality of both scent and the expatriate condition, as well as a narrative methodology which considers psychological and cognitive reactions to scent and culminates in their 'mapping' and the 'slippage' of personal associations. Both thesis components examine expatriate identity and approach its fictional representation through the filter of expatriate perceptions. Awareness by readers of such perceptions may serve to amplify their own appreciation of the dislocation of such identities in fiction, and in our current world of growing and even shifting diasporas.

Background Violence in the emergency department (ED) is a significant problem and it is increasing. Several studies have shown that violence in the ED is more likely to occur within the first hour of a patient’s presentation. Therefore, it is possible that there are some indicators of violence observable during the initial nurse-patient/relative interaction at triage. Nevertheless the problem remains inadequately investigated as many incidents are not reported and most studies that have investigated this issue are descriptive in nature. Although these studies have provided important preliminary information, they fail to reveal the complexities of the problem, in particular the cultural aspects of violence which are crucial for the ED. Aims The main aims of this study were to explore the cultural aspects of violence in the ED and to determine the possible indicators of violence at triage. Methodology Contemporary ethnography based on interpretive and post-positive paradigms was adopted to frame the methodology of this study. Methods This study was carried out at a major metropolitan ED over three months. The data collection techniques included field observations, questionnaires and semi-structured interviews. The data analysis framework adopted for this study incorporated Spradley's (1980) and LeCompte and Schensul's (1999) approaches. Findings The study indicated that the cultural meanings of violence were complex and highly subjective with variations among nurses which in turn influenced their responses to violence (e.g. reporting or not reporting an incident). The cultural meanings were sometimes contradictory and confusing as violence could be seen as both a challenge and a threat or predictable and unpredictable. The same type of behaviour from one individual could be perceived as violent but not for another. Many nurses perceived that violence was unpredictable and inevitable but the study demonstrated that there were indicators of violence which could be used to predict and prevent the problem. Factors such as environment, conflicting messages regarding waiting time, and patients' expectations and needs played an important part in violence. Besides, there were immediate warning signs of violence such as the overt verbal (e.g. mumbling or shouting) and covert nonverbal signs (e.g. staring or agitation). This study showed that patients' behaviours for instance being unfriendly, not appreciative, inattentive and uncooperative were better predictors of violence in the ED than their traits or problems alone. However, nurse-patient/relative behaviours and the resulting reciprocal relationship were considered central in determining if violence would occur or be avoided. Nurses' efforts to establish rapport with patients was crucial in minimising violence and needed to occur early. There was usually a ‘turning point’ that provided an opportunity for the nurse to avoid violence. Nurses’ behaviours at the ‘turning point’ strongly influence the outcome. Nurses' awareness of their personal expectations, prejudices and ethnocentrisms were the pivotal points in preventing escalation of violence. Conclusion This study has provided a more comprehensive and sophisticated understanding of the cultural aspects of violence in the ED. While violence is a complex issue with many paradoxes, there are lessons to be learned. The study indicates that effective interpersonal empathetic communication has a significant role in reducing violence in the ED. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457967 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2009

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Health Administration. Bibliography: leaves 274-293.

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Allied Health Professions. Bibliography: leaves 114-123.

Background: Breastfeeding is a tremendously important public health topic. Breastfeeding is associated with a myriad of health benefits on nearly all levels within the social ecological model (infants, mothers, families, workplaces, communities and societies). Scientific evidence supports that breastfeeding is associated with decreased obesity and other very costly health conditions that occur across the lifespan. The World Health Organization published 10 guidelines that comprise the Baby Friendly Hospital Initiative [BFHI] standards—which identify birthing facility-level elements that are associated with enhanced breastfeeding adoption rates. Methods: The purpose of this study was to determine the extent to which birthing facilities in Atlanta incorporate BFHI elements. Lactation policies among hospitals in the City of Atlanta with maternity wards were solicited, reviewed, and rated by two independent reviewers. Additional observations about environmental supports for breastfeeding were also noted. Results: Four out of 5 eligible hospitals provided their lactation policies for review (80%). Eight of out 10 BFHI elements were present in the 4 hospital policies. One element not present was distribution of reinforcing/educational materials to new mothers—although it was evident in an appendix. Another element that was not clearly stated in one policy was which states that breastfeeding initiation should occur within the first half hour after birth. Observations by reviewers included that ¾ (75%) of study sample were in the midst of drafting new policies. Another note was that ¾ (75%) of study sample was supported by a Centers for Disease Control and Prevention (CDC)/National Initiative for Children’s Healthcare Quality (NICHQ) effort—Best Fed Beginnings. Conclusions: This study is important as it addresses an unexplored question. Establishing such a baseline reveals that while nearly all the BFHI elements are present within the participating City of Atlanta hospitals, the administrative barriers that pursuit of BFHI accreditation poses should be considered. Given the fact that no hospital in Georgia has BFHI accreditation underscores an important new direction for public health researchers’ attention.

The purpose of this study was to identify events that give a sense of control (decisional, behavioral, and cognitive) to clients during hospitalization, and to identify commonalities among patients related to the importance attached to selected hospitalization events and a sense of control. Bandura's social learning theory provided the conceptual framework for the study.A non probability convenience sampling of 45 adult patients hospitalized for the treatment of genitourinary, gastrointestinal, thyroid disease, or cancer of any origin, completed the instruments which measure client control: The Client Control Q Set (CCQS;) and, The Health Opinion Survey (HOS.) A semi-structured interview validated the CCQS and a background data form provided demographic information. Q factor analysis was used to identify factors of client control. The emerging factors were analyzed in relationship to the results of the HOS and patient demographic information. Subjects' human rights were protected.This study was a modified replication of Dennis' (1985) investigation to determine if a sense of control was important to hospitalized patients. The investigation supported Dennis' (1985) findings that cognitive control over diagnostic tests, surgery, treatment and illness care was important to hospitalized patients. Another important dimension of control was identified through behavioral means involving the environment. Health Opinion Survey scores identified a need to be actively involved in the health care process by patients who also desired cognitive control over diagnosis, surgery, and tests. Also, commonalities of occupation, sex, age, and diagnosis emerged among patients who identified a need for cognitive control. Likenesses emerged in nonprofessional females between the age of 21-40 receiving treatment for gastrointestinal disease.The study supported the assumption that patients do desire a senseof control during hospitalization and also supported the need to recognize other patients may not desire a sense of control. It is important to recognize the difference and respond appropriately to individual patients. The study revealed the need for nurses to facilitate a flow of information to patients regarding diagnosis, surgery and impending tests. / School of Nursing

No description available.

The Administration Yuan Department of Health revised the medical treatment method, the third reading to have already passed on April 28th in 93 years. Revise the point be increasing the medical juristical person particularly the chapter the part already the clear statement standard it to change the system and build up the system. This research is standard according to the latest medical treatment organization classification that announced, the current conditions that inquires into the medical treatment organization finance information to make public currently, and from the point of view of stackholders:Investors and donators, analyzing the reading of hospital¡¦s public information for different relation persons, the usage index sign of the financial report, relatively manage it with company mutually the congeniality, the aptness and urgency that makes public currently for the hospital finance information is the research point of this thesises. Hospital's user in the information is divided into the exterior inspector,investor and inner part the governor, the hospital and company are establishing the dissimilarity on the property, the index sign that make public is also different, ducting in to make public the feasibility of the information with the analytical hospital from here. The medical treatment juristical person for match with the ordinance provision and reach the society direct to carry out the information to make public, is an irresistible general trend. With Department of Health announce the corporate body hospital financial report and each hospital manages the data the finance that make public voluntarily on the website for sample carry on the discussion. Because the medical treatment juristical person organization belongs to the not-for-profit organization, making public in the finance information up is different from in appear on market the listed company generally, The purpose of this research is inquiring into the hospital in order to respond the all society to inspect the public wealth to fly to, it carries on the public finance clarity and importance's lying in through the public lesson responsibility to safeguard the public benefit and the others rights, by the publication and transparency of the finance information, the public-spirited service and the mission responsibility that let the people understand and recognizes the pure hospital to should have, makes public the index sign and the rating result to information, expect the idea that can build up inspecting the hospital information to make public, being the investor and donator contributing money the reference that the person carries on making policy. This research makes use of the domestic and international cultural heritage research through ising analytical than the research, letting the donator known the management information and funds that its organization should make public the hospital to fly to, making the hospital be able to participate the social salvage more physically, Letting the investor known to take hospital as to invest the object of information's making public should belong to which contents, making the funds of the capital market flowed into the medical treatment industry, reaching the correction lawmaking purpose of the medical treatment method. Carrying out the hospital manages the mechanism to mainly expect to lie in the trust that can raise to contribute money the person and investor to the medical treatment juristical person, Making the national health insurance resource ability reasonable assigned through the publicly transparent finance information, reducing the medical treatment juristical person organization and an output information dissymmetry of the National Health Insurance Bureau and the morals risk of the occurrence, Passing by the public finance information makes public, and combines the exterior resultant force direct, can make to contribute money the person,investor eventually, the public ,the medical treatment promoter and the health insurance bureau to all win.