Magister Curationis - MCur / Much evidence exists that nurses are leaving the public health sector for the private sector, or leaving the country to seek better working conditions and higher salaries. Studies conducted on the job satisfaction of nurses are proof that there is a need to know more about the factors that influence their sense of job satisfaction. Most of these studies focus on the general nursing context. Due to its unique circumstances, many studies abroad have identified the field of psychiatric mental health nursing to investigate job satisfaction of nurses. The minithesis is an attempt to fill the gap that exists in job satisfaction studies in South Africa of nurses in a provincial psychiatric hospital. The study was a cross sectional, correlational, survey design study. The instrument was a self-administered questionnaire, combining a quantitative questionnaire with one qualitative open-ended question. The study was conducted on nurses of all categories in a provincial psychiatric hospital in the Western Cape. Sixty- eight nurses participated in the study. The data was analyzed statistically using the SAS v9 statistical software and Statistical Package for Social Sciences (SPSS). The open-ended question was analyzed qualitatively. The results revealed that the participating nurses were dissatisfied with remuneration, recognition and appreciation, training and development, as well as benefits and incentives. Nurses were most satisfied with supervision and support, interpersonal relationships, and rendering patient care. The study identified the factors influencing job satisfaction and job dissatisfaction of nurses in a provincial psychiatric hospital. Recommendations were made based on the results of the research. / South Africa

299 f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-25T16:57:22Z No. of bitstreams: 1 Tese Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-05-17T13:43:51Z (GMT) No. of bitstreams: 1 Tese Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) / Made available in DSpace on 2013-05-17T13:43:51Z (GMT). No. of bitstreams: 1 Tese Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) Previous issue date: 2004 / O objetivo desta tese foi compreender a práxis pedagógica de professoras com crianças e adolescentes hospitalizados, através da análise do Projeto ?Vida e Saúde?, realizado no Hospital da Criança das Obras Sociais Irmã Dulce, em parceria com a prefeitura da Cidade de Salvador/Bahia. A pesquisa ocorreu no período de Agosto de 2002 a Agosto de 2003, através da observação das aulas das professoras da Educação Infantil e do Ensino Fundamental e Médio que atuavam no hospital. A etnopesquisa e a abordagem multirreferencial, foram os subsídios teóricos que fundamentaram este trabalho e possibilitaram compreender os etnométodos utilizados pelas professoras neste espaço, ainda pouco conhecido como local de práticas educacionais. A pesquisa configurou-se como um estudo de caso, com observação participante moderada. Vários instrumentos foram utilizados na pesquisa, como: observações registradas em diário de campo das aulas, observações gravadas em vídeo, análise de documentos, entrevistas realizadas com as professoras e idealizadoras do projeto, assim como depoimentos dos familiares e responsáveis pelas crianças e adolescentes. Os resultados apontaram que as práxis pedagógicas das professoras eram diversificadas e desafiadoras, pois os currículos eram construídos para crianças e adolescentes de idades, cidades, níveis de escolarização diversos. Neste cenário, a proposta multicultural implicada, mostrou-se apropriada ao contexto e permitiu aos alunos, expressarem suas idéias e percepções, não somente sobre a escola no hospital, mas sobre a sociedade em que vivem. Em suas ações, as professoras realizavam movimentos inclusivos, tanto para inserirem-se como profissionais na instituição hospitalar, assim como para incluir as crianças e os adolescentes neste contexto. As professoras procuravam romper com paradigma da criança doente, que espera pacientemente pela cura e buscavam construir um conceito de criança ativa e em desenvolvimento. As diferentes práxis pedagógicas tinham impactos variados na vida dos alunos e dos familiares, os quais mostravam-se, em sua maioria, interessados na participação nas aulas. O trabalho também identificou a necessidade do reconhecimento desta modalidade educativa como parte integrante do sistema oficial de ensino, bem como de um maior acompanhamento do projeto por parte das instituições responsáveis. A proposta é que este trabalho possa contribuir para um aprofundamento das teorias educacionais sobre a educação em contextos diversificados, buscando assegurar o direito à educação, nas mais diversas circunstâncias. / Salvador

299 f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-29T16:48:12Z No. of bitstreams: 1 Tese_Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-06-10T20:17:20Z (GMT) No. of bitstreams: 1 Tese_Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) / Made available in DSpace on 2013-06-10T20:17:20Z (GMT). No. of bitstreams: 1 Tese_Ercilia de Paula.pdf: 1597440 bytes, checksum: bf28d396d313742312c42db8df004c3c (MD5) Previous issue date: 2005 / O objetivo desta tese foi compreender a práxis pedagógica de professoras com crianças e adolescentes hospitalizados, através da análise do Projeto Vida e Saúde, realizado no Hospital da Criança das Obras Sociais Irmã Dulce, em parceria com a prefeitura da Cidade de Salvador/Bahia. A pesquisa ocorreu no período de Agosto de 2002 a Agosto de 2003, através da observação das aulas das professoras da Educação Infantil e do Ensino Fundamental e Médio que atuavam no hospital. A etnopesquisa e a abordagem multirreferencial, foram os subsídios teóricos que fundamentaram este trabalho e possibilitaram compreender os etnométodos utilizados pelas professoras neste espaço, ainda pouco conhecido como local de práticas educacionais. A pesquisa configurou-se como um estudo de caso, com observação participante moderada. Vários instrumentos foram utilizados na pesquisa, como: observações registradas em diário de campo das aulas, observações gravadas em vídeo, análise de documentos, entrevistas realizadas com as professoras e idealizadoras do projeto, assim como depoimentos dos familiares e responsáveis pelas crianças e adolescentes. Os resultados apontaram que as práxis pedagógicas das professoras eram diversificadas e desafiadoras, pois os currículos eram construídos para crianças e adolescentes de idades, cidades, níveis de escolarização diversos. Neste cenário, a proposta multicultural implicada, mostrou-se apropriada ao contexto e permitiu aos alunos, expressarem suas idéias e percepções, não somente sobre a escola no hospital, mas sobre a sociedade em que vivem. Em suas ações, as professoras realizavam movimentos inclusivos, tanto para inserirem-se como profissionais na instituição hospitalar, assim como para incluir as crianças e os adolescentes neste contexto. As professoras procuravam romper com paradigma da criança doente, que espera pacientemente pela cura e buscavam construir um conceito de criança ativa e em desenvolvimento. As diferentes práxis pedagógicas tinham impactos variados na vida dos alunos e dos familiares, os quais mostravam-se, em sua maioria, interessados na participação nas aulas. O trabalho também identificou a necessidade do reconhecimento desta modalidade educativa como parte integrante do sistema oficial de ensino, bem como de um maior acompanhamento do projeto por parte das instituições responsáveis. A proposta é que este trabalho possa contribuir para um aprofundamento das teorias educacionais sobre a educação em contextos diversificados, buscando assegurar o direito à educação, nas mais diversas circunstâncias. / Salvador

A presente pesquisa tem como objetivo investigar a contribuição que o serviço de capelania hospitalar pode proporcionar ao enfermo oncológico e aos seus familiares no ambiente hospitalar. Neste trabalho, busca-se resgatar a dimensão humana por meio da espiritualidade, ser um referencial de auxílio diante da dor e do sofrimento ao transmitir o amor, o consolo e a esperança existente em Deus, oferecer aos profissionais da saúde uma melhor compreensão da importância do serviço de capelania hospitalar para o auxílio na recuperação do enfermo. Sendo assim, no primeiro capítulo resgata-se de forma objetiva a origem, a trajetória e o desenvolvimento da capelania hospitalar até o contexto atual. Aborda a questão da fundamentação evangélica da capelania hospitalar, bem como o perfil do capelão hospitalar. A segunda parte discorre a priori sobre a questão do diálogo entre a teologia e as ciências. E a filosofia participa deste diálogo como mediadora entre esses saberes. Em um segundo momento o autor trata dos conceitos saúde integral e salvação e, por fim, apresenta vários estudos que comprovam os benefícios da fé para com a saúde. No terceiro capítulo, estabelece uma reflexão sobre a questão do drama vivenciado pelo paciente oncológico. Aborda de forma concisa a espiritualidade do paciente com câncer no contexto hospitalar. / This research aims to investigate the contribution that the service can provide pastoral care to the sick cancer and their families in the hospital. In this paper, we seek to recover the human dimension by means of spirituality, be a reference to aid in the face of pain and suffering to convey the love and consolation and hope in God exists, to offer health professionals a better understanding of the importance of hospital chaplaincy service to aid in the recovery of the patient. Thus, in the first chapter its indicated an objective way to its origin, history and development of pastoral care to the current context. Addresses the question of evangelical statement of pastoral care, as well as the profile of the hospital chaplain. The second part discusses a priori on the issue of dialogue between theology and science. And the philosophy part of this dialogue as a mediator between these knowledge. In a second step the author addresses the concepts integral health and salvation, and finally presents several studies showing the benefits of faith to health. In the third chapter, in turn provides a reflection on the question of the drama experienced by cancer patients. Addresses concisely spirituality of cancer patients in the hospital.

Made available in DSpace on 2014-07-29T15:04:41Z (GMT). No. of bitstreams: 1 dissertacao lilian.pdf: 281825 bytes, checksum: 488c9e5d58cb1a521b28a8592ee6de50 (MD5) Previous issue date: 2006-02-23 / According to the World Health Organization (WHO), an hundred million of individuals are infected by M. tuberculosis, annually. Health care workers play an important role to control of tuberculosis, but they are also at high risk for this infection. Then, the objectives of the present study were to evaluate the prevalence of M tuberculosis infection in nursing professionals from the Tropical Diseases Hospital in Goiânia City, State of Goiás, to analyze the factors associated to tuberculin skin test (TST) positivity and to determine the TB infection incidence density in susceptible professionals Initially, the prevalence and factors associated to TST were investigated in 128 eligible individuals. Further, susceptible professionals (n=32) were followed up during three years (2001-2004) to detect TST conversion. Of the total individuals investigated, 69.5% (IC 95%: 60.7-77.2) were positive to TST. Two occupational factors were independently associated to skin test positivity: duration of profissional activity longer than 5 years (Adjustd OR = 6.3; 95% CI: 1.5-26.2) and occupational contact with a person with pulmonary TB ≤ 2 years (Adjusted OR = 12.2; 95% CI: 1.2-106.3). Seven profissionals showed tuberculinic conversion during the three years of follow up, and an incidence density of 11.5 new conversions to 100 persons-year was detected. All of them had taken care of patients during the period of the study. Two individuals developed tuberculosis disease. The data of this study ratify the high risk of tuberculosis in nursing team, and highlight the importance of this infection as an occupational disease to nursing professionals of our region. / De acordo com a Organização Mundial de Saúde (OMS), cem milhões de pessoas são infectadas pelo M. tuberculosis, a cada ano. Os profissionais de saúde são importantes para o controle da tuberculose, mas também um grupo de risco elevado para esta infecção. Assim, o presente estudo teve como objetivos avaliar a prevalência da infecção causada pelo M. tuberculosis em profissionais de enfermagem de uma instituição especializada em doenças infecciosas, em Goiânia Go, analisar os fatores associados à positividade à prova tuberculínica nesta população e determinar a densidade de incidência da infecção pelo M. tuberculosis, nos profissionais susceptíveis. Inicialmente, verificou-se a prevalência e os fatores associados à positividade à PT. A seguir, os profissionais suscetíveis à infecção (n=32) foram acompanhados, por três anos (2001-2004), para detecção de conversão tuberculínica. Do total de profissionais investigados, 69,5% (IC 95%: 60,7- 77,2) foram positivos à PT. Dois fatores ocupacionais foram independentemente associados à positividade à PT: tempo de atividade profissional > 5 anos (OR ajustado = 6,3; IC 95%: 1,5-26,2) e último contato laboral com alguém com TB ≤ 2 anos (OR ajustado = 12,2; IC95%: 1,2-106,3). Sete profissionais apresentaram viragem tuberculínica, resultando em uma densidade de incidência de 11,5 novas conversões por 100 pessoas/ano. Todos desenvolviam atividades assistenciais, durante o período do estudo. Duas profissionais desenvolveram tuberculose doença. Os resultados, deste estudo, ratificam o elevado risco de tuberculose nos profissionais de enfermagem, e evidenciam a importância desta infecção como doença ocupacional para equipe de enfermagem de nossa região.

The primary motivation of this PhD by publication has been the apparent disconnect between the metrics of hospital quality of care at national and board level and patients’ experiences. Exploration of the gap led to the realisation of two key points. Firstly, the concept of healthcare quality continually evolves. Secondly, the NHS Scotland Measurement Framework does not include a measure of patient experience at the microsystem level (e.g. hospital ward). This is needed to counterbalance easier to obtain metrics of quality (e.g. waiting times). Resource tends to follow measurement. Papers 1 and 2 were exploratory, investigating theoretical and practical aspects of measuring quality of hospital care at the clinical microsystem level. With the associated Chapters, they highlighted both the necessity and the possibility of measuring the patient experience at the micro level of the healthcare system. They also drew attention to the inadequacy of “satisfaction” as a metric, leading to closer examination of “experience” as the decisive metric. This required the development of a systematic review protocol (Paper Three), then a systematic review (Paper Four). The review (Paper Four) examined the utility (validity, reliability, cost efficiency, acceptability and educational impact) of questionnaires to measure the patient experience of hospital quality of care, with a newly devised matrix tool. Findings highlighted a gap for an instrument with high utility for use at the clinical microsystem level of healthcare. Paper Five presents the development and preliminary psychometric testing of such an instrument; the Care Experience Feedback Improvement Tool (CEFIT). The thesis provides, as well as the matrix tool and CEFIT, theoretical and methodological contributions in the field of healthcare quality. It contributes to an aspiration that the patient’s voice can be heard and acknowledged, in order to direct improvements in the quality of hospital care.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23118号 / 社医博第114号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 森田 智視, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Competition among hospitals and managed care have forced hospital industry to be more efficient. With higher degrees of hospital competition and managed care penetration, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. This study found that the coefficients for CMIs in the third-party hospital revenue model were greater than those in the hospital cost model until 1995. Since 1995, however, the coefficients for CMIs in the third-party hospital revenue model have been less than those in hospital cost models. Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant.

Typescript. / Thesis (D.P.H.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 259-273) / Microfiche. / xvii, 273 leaves, bound ill. 29 cm

This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure. This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure.