This study reviews the growth and development of the Health Centre for Children, Vancouver General Hospital, which has offered, for the past four years, a diagnostic and treatment service to children in low-income families. The aim of the project is to determine to what extent the need in the community for a service of this kind is being met. The main research methods used to obtain the necessary information have been interviews and studies of medical and social case records. The medical structure is described in detail with suggestions for improvement of service in this area. The role which the social worker fulfills is outlined, and is compared with the role which the social worker would ideally assume in a setting of this type. Suggestions for improvement of service are made in this area also. Particular emphasis is placed upon the need for treatment of the "whole" individual, a factor which, because of concentration upon expansion of medical services, appears to have received too little attention in the Health Centre. Although there is still room for improvement in the programme, there is reason to believe that the need in the community for a service of this kind is being met to a great extent. The main indication of this is the comparatively large number of people who use the Health Centre facilities. This is particularly evident when attendances for the four-year period are compared with the numbers who used the only public medical services formerly available. Since the Health Centre will be moving into new and more spacious quarters in the course of the next few months and since, at this time, many major and minor changes will be instituted, this study is considered an interim one. It would be valuable to have a further study completed after four or five years of continued operation. / Arts, Faculty of / Social Work, School of / Graduate

Background: Due to the growing number of individuals suffering from dementia, many will require acute hospital care as other indirectly related conditions appear throughout the course of the disorder. Significant concerns have been raised about the provision of quality care. Understanding their experiences is essential. Method: Semi-structured interviews were conducted with caregivers and people with dementia after acute hospitalization. Data was analyzed using qualitative content analysis. Results: Twenty-nine participants experienced hospitalization and commented primarily on the negative experience. Despite the importance of caregiver involvement, and evidence of caregiver burden, they commented they were rarely included in care plans and lacked support. Continuity of care was said to be affected by absent communication amongst health care team members. The acute hospital process and environment was perceived as not supportive of dementia person-centred care principles, with reports of poor staff knowledge and recognition of the disorder. Conclusion: Reports of acute care hospital experiences of people with dementia and their caregivers provide insights for potential gaps in care delivery.

This descriptive study was designed to evaluate what modifications of an existing workload index staffing tool were necessary for practical application in an extended care hospital. Two activity studies were conducted concurrently in a 63 bed extended care unit. The Inroom Activity Study measured the amount and kind of care patients received on each shift. Patients were classified into two categories of nursing care needs - average and above average care. The Indirect Work Sampling Study identified how nursing staff spent their time during their eight hour tour of duty. A random selection of the days of the week and the shift to be observed was undertaken to select times that would be representative of the total week days. The data for the Inroom Activity Study was collected by continuous observations of nursing care given to patients during an eight hour period, and included 10 patients from each category on each shift. The data for the Indirect Care Study was collected by making fifteen minute spot checks on all nursing personnel throughout an eight hour tour of duty. Observations were made throughout 5 day shifts, 5 evening shifts, and 4 night shifts. Four questions were answered in this study. Data analysis of Question 1 revealed that there was a difference in the average amount of direct nursing care time that each category of patient received on days, and the average amount of time each category of patient received on evenings. There was no difference in the average amount of time each category of patient received on nights. Data analysis of Question 2 revealed that there was a direct ratio between the amount of care all patients received on days, the average amount of time all patients received on evenings, and the average amount of time all patients received on nights. Data analysis of Question 3 revealed that weighting factors could be established to determine the amount of care received by each category of patient on each shift. Data analysis of Question 4 showed the percentage of time nursing personnel were able to spend in giving direct patient care during an eight hour shift. The study concludes with consideration of the implications and recommendations for use of the workload index staffing tool, and suggests further research as to refinement of the tool. / Applied Science, Faculty of / Nursing, School of / Graduate

The aim of this work is a detailed analysis of the functioning and financing of medical equipment using standard methodologies type EBIT, BEP, ROA, ROE, etc., where more suitable design for this type of organization.

Class of 2006 Abstract / Objectives: To assess the accuracy of medication histories taken upon hospital admission. Methods: This study was a prospective chart review comparing the accuracy of hospital admission medication histories with outpatient pharmacy and physician records. Eleven hundred patients admitted to El Dorado Hospital were eligible for participation. Patients were excluded if they were: under 18 years old, non-English speaking, in a room with precautions, transferred from a hospital or skilled nursing facility, unable to give oral consent, or admitted to a geri-psychiatric unit. After verification of medication, dose, and schedule with outpatient pharmacy and physician records, the findings were documented as perfect agreement, error of omission, or error of commission. Results: One hundred and nineteen patient histories were analyzed. Forty three patients (36%) had at least one error in their medication history. Of the 582 medications verified for accuracy, 491 medications were accurate and 91 errors were identified. Of the errors identified, 64 were errors of commission and 27 were errors of omission. The average age of patients who had at least one error type was 74.9 years, and the average age of patients who did not have any errors was 68.3 years (p = 0.004). Medication histories with six or more medications were more commonly associated with errors (p = 0.001). There was no relationship between medication history errors and specific classes of medications such as cardiovascular, lipid-lowering, and antidiabetic agents. Conclusions: Medication histories for patients older than 75 years or those that contain six or more medications are more likely to contain an error. There appears to be no link between medication class and occurrence of error. While this study does not address methods to reduce error rates, verification of medication histories with outpatient pharmacies and physicians may help reduce hospital medication errors and promote positive health outcomes.

Class of 2008 Abstract / Objectives: To examine the utilization of the various laboratory tests in diagnosing iron deficiency anemia and determine the proportion of patients receiving unnecessary iron supplementation. Methods: Included in the descriptive study were 126 adult patients with a diagnosis of iron-deficiency anemia determined by ICD9 codes at the University Medical Center (UMC) in Tucson, AZ. Demographic and clinical characteristics were collected by chart review and analyzed by calculating means, standard deviation, and range for patient’s age, iron dose, and lab values. The study also examined the percentage of each lab value (serum iron, transferrin, transferrin saturation, serum ferritin, and/or hemoglobin/hematocrit) used to diagnosis iron deficiency anemia and the percentage of patients found below common references ranges for each serum iron laboratory test were calculated. Results: The average age of the iron deficiency patient was 55 with an average daily elemental iron dose of 108.1 mg with a standard deviation of 50.0. The majority of the laboratory tests were utilized over 50% of the time, with the exception of transferrin (49.6%), transferrin saturation (44.8%), and ferritin (46.4%). The laboratory test with results below the reference range the least percentage of the time was ferritin at 13.8%. The hematocrit (95.1%), hemoglobin (93.6%), serum iron (92.6%), and transferrin saturation (91.1 %) were below the reference range in a high proportion of the patients. Conclusions: It appears that physicians in a hospital setting are not obtaining or utilizing the correct iron laboratory tests in the diagnosis of iron deficiency anemia, resulting in unnecessary iron supplementation.

The purpose of this study was to compare a tour-based preadmission preparation programme for young children to a video-tape-based programme. Subjects were 30 English speaking children who were admitted to Surrey Memorial Hospital, a community general hospital in Surrey, B.C. The children were admitted for elective surgery which required an overnight stay. The children and their parents participated in the programmes three days to two weeks prior to the child's scheduled surgery. Half of the children and their parents were taken on a tour of the paediatric ward and laboratory. The other group was shown a video-tape made at the Surrey Memorial Hospital, which depicted the hospitalization of a boy and girl for tonsillectomy and adenoidectomy. Both treatments were followed by a discussion and play period. The two groups were not found to differ on sex, previous hospitalizations, types of surgical procedure, length of stay, length of anaesthesia, or prehospital personality as measured by a modification of the Post-hospital Behavior Questionnaire (Vernon, Schulman, & Foley, 1966). However, the tour group was found to contain more younger children (under 6 years of age) than the video group. No significant differences were found between the two groups on the self-report, behavioural, or physiological outcome measures, except for incidence of postoperative vomiting. The video group vomited less than the tour group. Questions concerning the validity of the Hospital Fears Rating Scale and the modified Posthospital Behavior Questionnaire for this age group are raised in the discussion. Complicating factors, such as small sample size, lack of a control group, and lack of control over physiological data collection are addressed in this chapter. Confounding factors, such as a preoperative teaching class and the discussion groups, are also addressed. Finally, the impact of Preadmission Programmes and practical considerations in choosing a programme are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This research examined how the needs of elderly women are being met in the hospital setting. Qualitative data were gathered through in-depth interviews with eleven women between the ages of 70 and 93 who had had a hospital stay in the previous year. Data analysis revealed that the system failed to attend to participants' age specific needs. This failure created gaps in care which were particularly troubling for elderly female patients whose frailty made them susceptible to additional health problems. Participants received inadequate care in such areas as bathing, walking assistance and help with eating. Hearing impairments and denture issues were at times overlooked. These gaps in care caused participants to view a hospital stay as a matter of survival. Participants developed strategies to cope with gaps in care which included lowering their expectations, developing support networks and relying on family members to meet their basic needs and advocate on their behalf. Recommendations for change include identifying elderly women as a vulnerable patient population and defining the problems they face as structural issues as opposed to individual problems. / Arts, Faculty of / Social Work, School of / Graduate

M.Cur. (Professional Nursing) / The shortage of professional nurses necessitates the optimal utilisation of the professional nurses and auxiliary staff available to unit managers in academic nursing units. The optimal utilisation of human resources, funds, stock and methods constitutes effective management. The unit manager is responsible for the achievement of objectives means of effective management enabling the optimal utilisation and productive functioning of her staff in the provision of quality nursing. Retaining auxiliary staff is often as difficult as retraining nurses and they will not be attracted to hospital work if there is no clear occupational structure. This study questions the expectations (knowledge and insight) of uni t managers as well as ward clerks regarding the duties and responsibilities of the ward clerk in an academic hospital nursing unit in Johannesburg. The value of a structured educational programme for ward clerks in order to improve their capabilities profile (knowledge and insight) was also examined. The objectives with this study were: to determine the expectations (insight and knowledge) of unit managers as well as ward clerks regarding the duties and responsibilities of the ward clerk (in an academic hospital nursing unit): to design, implement and evaluate an educational programme for ward clerks: and to determine the effect of that programme on the capabilities profile (knowledge and insight) of the ward clerk.

The purpose of this study is to investigate the relationships between ordinal birth position, family size, and psychiatric diagnosis, in patients at a state-mental hospital.