A computerized data base system for managing clinical activity of faculty and residents has been developed and tested in The Department of Anesthesiology, University Medical Center, Tucson, AZ. Using d-Base III+ and an IBM PC AT the system provides the department residents with tabulated data on a monthly and year-to-date basis, which can be easily transposed onto annual clinical activity reports required by The American Board of Anesthesiology. The system maintains a clinical activity history for the faculty, which allows for equitable work scheduling. The system also tabulates anesthesia equipment usage and problems. The system has been in operation since October, 1987 with residents and faculty receiving clinical activity reports on a monthly basis. System operation requires 10 to 12 hours of secretarial time weekly.

D.Cur. (Nursing Management) / A health maintenance organisation (HMO) that implements managed care is the health care service provider for a mine group. Case management is an integral part of managed care. Case management in a managed care setting within this mine group should be to the holistic benefit of both the client/patient and the service provider. Within the case management environment, nurse case managers (CMs) and their counterparts (professional nurses) should provide and facilitate quality patient care. However, they face many challenges, such as working in isolation from one another. The purpose of the study was to develop a training programme for CMs and professional nurses (PNs) to facilitate quality patient care in a managed care environment for the health care service provider for a mine group. In this study a qualitative, exploratory, descriptive, and contextual design was followed. Purposive sampling was conducted from the populations of six CMs (N=6) and thirty PNs (N=30). Focus group discussions with twenty-eight (28) PNs and individual unstructured interviews with four (4) CMs were conducted to describe their experiences in the case management environment. Open coding followed, based on Tesch’s (1990) method of qualitative analysis (De Vos, 1998:343), and a conceptual framework emerged from the data analysis. A programme to facilitate quality patient care in a case management environment of the HMO was described for stakeholders (nurse case-managers and PNs). Recommendations for implementing the programme were described. Adapted phases of the programme development process of Meyer and van Niekerk (2008) were used in developing the programme. The survey list of the Practice Oriented Theory of Dickhoff, James and Wiedenbach (1968:434) formed the basis for developing a conceptual framework for the programme. Principles of case- and problem-based approaches (Scheider, 2010) served as a point of departure to develop the context-specific training programme. Trustworthiness was maintained by using Guba’s (De Vos, 2006:346; Babbie & Mouton, 2001: 276) model criteria, which are credibility, transferability, conformability and dependability. Ethical standards were adhered to throughout the study.

Since the deinstitutionalisation of chronic mentally ill patients, there has been an increase in the number of relapsed chronic mentally ill patients who become acutely mentally ill and need to be re-admitted for acute care in psychiatric institutions. Professional nurses working at rural primary healthcare clinics find it difficult to care for these individuals because they lack the necessary knowledge and skills. Chronic mentally ill patients who have been admitted to acute care facilities are stabilised by rendering care, treatment and rehabilitation and then released into the care of the professional nurses working at rural primary healthcare clinics. These patients live in the community and have to make use of the primary healthcare clinics nearest to their homes to provide them with their prescribed medication and care. Furthermore the patients’ mental conditions do not always remain stable, possibly because of a knowledge deficit, at times about their mental status. Patients may become non-compliant, resulting in the recurrence of symptoms, and thus need to be re-admitted to the acute care facility. However, the problem leading to re-admission is not clear for all admissions. It may be that patients do not make use of the primary healthcare clinics. It also seems that the professional nurses in the primary healthcare clinics are unfamiliar in dealing with chronic mentally ill patients living in rural communities. The aim of this study was therefore, to explore and describe the experiences of these professional nurses in caring for chronic mentally ill patients living in a rural community. The researcher used qualitative, explorative, descriptive, and contextual research design. The research population consisted of professional nurses working at primary healthcare clinics. Non-probability purposive sampling was used to identify participants for inclusion in the study. Data collection was conducted using one-on-one, semi structured interviews, observations and field notes and interviews were tape-recorded and transcribed. Data analysis was conducted using Tesh’s method of content analysis to identify themes and sub-themes. A literature control was done to compare the findings to the current published research. Trustworthiness was ensured by using Gubas’s model (1985) of trustworthiness. A pilot study, conducted by interviewing a small sample prior to the start of the main study, determined whether the sampling and interviewing techniques of the researcher as well as the research questions were adequate for data collection. The researcher ensured that the study was of a high ethical standard by taking into consideration values that guide the principles of autonomy, beneficence, non-maleficence and justice. The findings of the study was categorised into three main themes and 13 sub-themes. The main themes were as follow: Professional nurses experience problems when they have to take care of psychiatric patients attending rural primary healthcare clinics. This theme had six sub-themes which were discussed in details in chapter three. The second theme was that professional nurses experience that psychiatric patients in rural communities experience problems which affected their well-being. This second theme has got five sub-themes which were discussed further in chapter three. The last theme was that professional nurses have positive experiences when caring for psychiatric patients in rural communities. This theme has got two sub-themes as well discussed further in chapter three.

The Best PhD Thesis in the Faculties of Architecture, Arts, Business & Economics, Education, Law and Social Sciences (University of Hong Kong), Li Ka Shing Prize, 2003-2005. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

The purpose of this study was to determine case managers’ understanding of their role in a managed care organisation and to develop recommendations for the improvement of case management practice. Quantitative descriptive research was conducted to explore perceptions of case managers regarding their role. A self-administered questionnaire was used as a formal data collection instrument and 25 respondents participated in the study. The findings revealed that the majority of case managers know what is expected of them in their job but that they do experience some barriers. There appears to be uncertainty with quite a number of respondents regarding certain aspects of their role. Recommendations were made for improved case management practice.

The purpose of this study was to determine case managers’ understanding of their role in a managed care organisation and to develop recommendations for the improvement of case management practice. Quantitative descriptive research was conducted to explore perceptions of case managers regarding their role. A self-administered questionnaire was used as a formal data collection instrument and 25 respondents participated in the study. The findings revealed that the majority of case managers know what is expected of them in their job but that they do experience some barriers. There appears to be uncertainty with quite a number of respondents regarding certain aspects of their role. Recommendations were made for improved case management practice.