by Chow Wai-hung. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 56-57). / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF FIGURES --- p.vi / LIST OF TABLES --- p.vii / ACKNOWLEDGMENT --- p.viii / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Intensive Care Services --- p.1 / Clinician as an Information Processor --- p.2 / Executive Information System (EIS) for Intensive Care Services --- p.7 / Scope of the Study --- p.7 / The Organization of the Remaining Report --- p.8 / Chapter II. --- LITERATURE REVIEW --- p.9 / Sickness Scoring Systems --- p.9 / Executive Information Systems (EIS) --- p.15 / Information Requirements Determination for EIS --- p.17 / Future Direction of EIS in Intensive Care --- p.20 / Chapter III. --- RESEARCH METHODOLOGY --- p.22 / Survey by Mailed Questionnaire --- p.23 / Personal Interview --- p.24 / Subjects Selection --- p.26 / Analysis --- p.27 / Chapter IV. --- RESULTS AND FINDINGS --- p.28 / Part 1 - Questionnaires --- p.29 / Part 2 - Interviews --- p.31 / Chapter V. --- ANALYSIS AND DISCUSSION --- p.44 / Analysis of Results and Findings --- p.44 / Evaluation on Information Requirements Determination for an EIS --- p.50 / Chapter VI. --- CONCLUSION --- p.52 / Chapter VII. --- FUTURE DIRECTION OF DECISION SUPPORT IN CRITICAL CARE --- p.54 / REFERENCES --- p.56 / INTERVIEWS --- p.59 / APPENDIX --- p.60 / Chapter 1. --- A Sample of Hospital Information System Requirement Survey Questionnaire --- p.61 / Chapter 2. --- Samples of Visual Display --- p.67 / Chapter 3. --- A Sample of Format of a Structured Report --- p.70

Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

Bipolar disorder is the sixth leading cause of disability in the world among people aged 15-44. Bipolar disorder is a chronic psychiatric disorder with a significant impact on patients’ social, occupational, and general functioning well-being. Patients who are diagnosed with bipolar type 1 disorder are usually admitted to a psychiatric hospital as an involuntary patient which means that they will be cared for in a closed unit. In a critical analysis of the literature it was noted that not much is known of the experiences of patients in psychiatric wards. The researcher used a qualitative approach, with a phenomenological research strategy. An explorative, descriptive and contextual design was utilized to gain more insight into female patients’ lived experiences during their admission and stay in a tertiary level psychiatric institution. The research population was female patients who were diagnosed with bipolar disorder and who had recently experienced being admitted to and treated at a tertiary level psychiatric facility where they were treated for this condition. Purposive sampling was utilised to obtain the sample for the study. A pilot study was conducted before the study commenced to ensure the trustworthiness of the findings. The researcher obtained the data via semi-structured interviews as well as field notes and reflective journals. Data was analysed by using Tesch’s method as adopted by Creswell. Once the data had been analysed, a literature control was done in accordance with the findings. Guba’s model of trustworthiness was utilized to ensure that this study was trustworthy and credible. The researcher implemented ethical principles to ensure that no harm was done to the participants during the research study. Finally, guidelines were developed to assist professional nurses to manage patients optimally during their admission and stay in a closed unit of a tertiary psychiatric facility.

Background: A key innovation in the provision of inpatient services to facilitate the care and treatment of women with severe postnatal mental illness was the introduction of joint mother and baby psychiatric hospitalisations, where both the mother and baby are admitted to hospital together. This study examined the history of the practice of joint mother and baby admissions across the UK and critically explored the processes relevant to the diffusion of joint admissions and patterns of service development to identify the possible and probable causes for significant differences in service provision across the United Kingdom (UK). Aims: The study examined the documented history of the development of practice of joint mother and baby psychiatric hospital admissions across the UK and in doing so, a) Identified the pattern of service and practice development and the likely reasons for the pattern of the chronology. b) Identified the processes involved in the diffusion of joint mother and baby admissions in the UK, and explored why the practice was sustained (or not). c) Contributed new information to the continued development of innovation diffusion theory and research, and its application to health care service and practice development. Methods: A historical method was used in the study and was reported through the use of historical narrative and analysis. Data was collated from primary and secondary sources of documented evidence which was used to inform the history of joint mother and baby admissions across the UK. Data was analysed using the theoretical framework of diffusion of innovation (Rogers, 2003). Findings: Two versions of the same innovation were identified: joint admissions to side rooms of general adult psychiatric wards or annexed areas of the wards and joint admissions to specialist mother and baby units. Neither version of the practice followed the normal S-curve pattern of adoption in terms of frequency and rate of adoption. After a period of approximately 63 years there are 24 facilities for the provision of joint admissions in the NHS in the UK. The main influencers to the adoption of the practice was perception of risk, social networks internal and external to the NHS, the presence of clinical and political champions to drive the adoption and implementation of the innovation and policy entrepreneurship by clinicians working in the clinical field of perinatal mental health. The development of specific policy, guidelines and in Scotland, legislation, has resulted in a move during the last decade from joint admissions being diffused naturally to side room admissions being actively withdrawn and specialist psychiatric mother and baby units actively being disseminated. There is strong evidence that the diffusion process for specialist mother and baby units is still in motion at the time of reporting. Conclusion: Two competing versions of the same innovation had unusual patterns of diffusion. The influencers identified as relevant to the diffusion patterns of each version of the innovation were essentially the same influencers but they were used in different ways to affect change: rejection of one version of the innovation in favour of adoption of the other. The main influencers on the diffusion of joint admissions changed over the time line of the adoption pattern. Barriers to diffusion included the absence of evidence of effectiveness, the absence of economic evaluation, the position in service divisions of perinatal mental health as a field of practice and the absence of succession planning across professional groups. Recommendations are made for future research.

The mentally ill who have been found not guilty of a crime by reason of insanity (NGRI), appear to be at risk in several areas when confronted with the judicial system. The purpose of this study is to determine whether the factors which predict recidivism of NGRI patients in Community Out-patient Treatment (COT) also inhibit a patient's release into a conditional release program (CONREP).

In recognition of the inherently inflationary nature of retrospective reimbursement, the Reagan Administration enacted legislation that substantially changed Medicare's hospital reimbursement system. The Prospective Payment System (PPS) mandated paying hospitals a fixed payment, set in advance, based on the patient's diagnosis rather than retrospectively paying for all services delivered to a patient. Critics contend that PPS introduces incentives for hospitals to conserve resources during the hospital stay and to shift care to less costly settings, both potentially affecting quality of care to the elderly. The question addressed by this dissertation is whether there were changes in the discharge health status and post-hospital placement of Medicare beneficiaries as a result of the implementation of PPS. Using a quasi-experimental time-series PRE/POST design, data was collected from the medical records of 2,619 Medicare beneficiaries (1,258 in the PRE-PPS period; 1,361 in the POST-PPS period) hospitalized between 1981 and 1986. Two large (300+ beds) and two medium-sized (100-300 beds) hospitals, representative of hospitals in the Portland metropolitan area, served as data collection sites. Medical records were selected from five Diagnosis Related Groups (DRGs): three medical DRGs (stroke, heart failure, and pneumonia) and two surgical DRGs (hip replacement and major joint pinning). Analysis of the data show that overall length of stay declined from 11.3 days in the PRE-PPS period to 8.6 days in the POST-PPS period, a reduction of 2.7 days and significant at the p = $<$.001 level and a significant increase in Dependency between the PRE and POST periods for four of the five DRGs studies (Stroke, Pneumonia, Heart Failure, and Hip Replacement). Finally, an analysis of differences in post-hospital placements shows a significant increase in POST-PPS placements to home alone (p = $<$.05), home health (p =.01), and for hospital transfers (p = $<$.001). Though limited in its generalizability, the data presented in this dissertation support the contention that Medicare patients are leaving the hospital sooner, in more dependent states of health than before PPS, and that greater numbers of potentially high care patients are being discharged to home and to home health.

Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.

MCur / Department of Advanced Nursing Science