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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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

In the decade between 1974 and 1984, union certifications for service workers in the B.C. long term care industry increased from twenty-one to one hundred and fourteen. From 1976 to 1984 wages increased as much as two hundred percent in some facilities while the cost of living, went up by ninety percent. These substantial changes were due largely to the efforts of the Hospital Employees' Union (HEU). The HEU wanted to expand into long term care and attain for its long term care members the rates found in its acute care Master Agreement. This thesis analyzes the development of the HEU as the principal union representing service workers in long term care and the extent to which the Union was successful in achieving its goals. Previous to 1973 long term care unions had difficulty achieving first collective agreements due to employer intransigence. Invoking Section 73 of the provincial Labour Code, they could circumvent this problem through arbitrated settlements, thus removing one of the major impediments to union growth. The growth of non-profit facilities after 1978, brought about by public funding of the industry, acted as a catalyst to union growth. In non-profit facilities employer resistance to organizing was less than in proprietary facilities and bed capacities were generally larger, making organizing less costly for unions. In 1984 the HEU held more than two-thirds of all certifications in long term care. The Union was more willing to make use of Section 73 than the other long term care unions. It also had financial and organizational resources that contributed to its organizing success in the industry. There are two employers' associations in long term care, the Health Labour Relations Association (HLRA) and the Continuing Care Employee Relations Association (CCERA). CCERA will likely emerge as the dominant employers' association in the industry. CCERA's forerunner, the labour relations function of the Long Term Care Association, was set up by non-profit long term care employers with the help of the provincial government to provide an alternative to HLRA as HLRA mainly represents acute care employers. However, through arbitration the HEU has been able to establish its Master Agreement as the appropriate rate of remuneration for long term care employees. The greater consolidation of bargaining structure that has occurred and the creation of a separate long term care employers' association does not appear to have prevented this outcome. Through arbitrated and negotiated settlements, the HEU has achieved Master Agreement rates, or at least 95% of Master Agreement rates, in all of its long term care facilities except for those without first collective agreements, or those that achieved first collective agreements after the Compensation Stabilization Program was implemented. Arbitrators agreed with the HEU's position that its long term care members were entitled to the same rates of pay as its members in general hospitals, as the work performed was comparable. However, until the industry became publicly funded in 1978, they felt obliged to consider the employer's ability to pay an increase. From 1978 on arbitration awards more closely reflected Master Agreement rates. However, it was not until government officials publicly stated that the costs of arbitrated settlements would be covered by the Ministry of Health that arbitrators consistently began to award Master Agreement rates. The Compensation Stabilization Act, passed in 1982, has had the effect of preventing the attainment of Master Agreement rates in all HEU facilities. Although arbitrators have continued to award the Master Agreement, the Commissioner has rejected many of the resulting "compensation plans" stating that the proposed increases fall outside the Program's Guidelines. In April 1985 long term care workers represented approximately thirteen percent of the HEU's total membership. Expansion into this industry has increased significantly the Union's size. It is unlikely, however, that the HEU has yet benefited financially from this growth. Since there are five other unions in the industry, the HEU is unlikely to ever be the sole representative of long term care service workers. However, the HEU holds seventy-seven certifications in the industry while the union with the next largest membership holds only twelve certifications. The health care union clearly has come to dominate long term care. / Business, Sauder School of / Graduate

In its struggle to be recognized as a legitimate profession, nursing has proceeded in several directions, promoting diversity of professional views among its practitioners. The many changes taking place in nursing supported the need for a study determining exactly how staff nurses view the profession of nursing. The criteria of a profession as defined by Valiga (1982): the boundaries, goals, and scholarly component of the discipline, the recipient of the discipline's service, the relationship of the discipline to others, and the independence, responsibility, autonomy, commitment, and activities of the discipline's practitioners (pp. 126-127), were the basis of the study. The views of the profession as held by the staff nurses were related to the variables of age, preparatory and/or additional nursing education, number of years worked since graduation, length of time in present employment, and the agency of employment. The 600 subjects were randomly selected by computer at the Registered Nurses' Association of British Columbia (R.N.A.B.C.). The Views About Nursing Questionnaire, developed by Valiga (1982), along with a background information questionnaire were sent to the subjects by the R.N.A.B.C. A total of 262 usable questionnaires were the basis of data analysis. Pearson product-moment correlations and analysis of variance were performed as appropriate. These analyses revealed that there was an inverse, but not statistically significant, relationship between age and number of years worked and scores on the Views About Nursing Questionnaire. There was no relationship between the scores and education and the scores and length of time in present employment. Because a large majority of respondents were employed in acute care hospitals, no analysis of the relationship of agency of employment and the scores was undertaken. Conclusions and implications of this study are addressed and suggestions for further study are presented. / Applied Science, Faculty of / Nursing, School of / Graduate

This study involves an examination of hospital personnel's self-perceived ability to communicate with each other. In the process of pursuing this investigation, information on the perceived and observed ability to communicate was gathered to allow comparisons. The purpose of the study was to add to the existing body of knowledge regarding perception and communication in a hospital organization. The study was planned to test the following hypothesis: There is no significant difference between hospital personnel's self ratings of their communication effectiveness as measured by means of an Interstaff Communication Questionnaire, and their observed communication act scores which were obtained through Bales' Interaction Process Analysis. Data on the self-perception of hospital personnel's ability to communicate was secured by means of a questionnaire. Data on the observed effectiveness of communication came from another researcher, (McGill) who utilized Bales' Interaction Process Analysis. Both studies were conducted simultaneously on the same population. The study population included 165 members of different staff categories who were considered major communicators within the hospital organization. Analysis of data included frequency tables converted into relative values expressed in percentages. These results were depicted in bar graphs to facilitate comparison between the perceived and observed ability to communicate. The findings of the study showed that no hospital staff group is able to accurately access or evaluate its own communication effectiveness. Thus, the findings fail to support the hypothesis of the study. The study recommends that health team members progress in their understandings of what constitutes accurate perception and effective communication. Furthermore, since 40-50% of some categories of hospital staff think that no communication takes place, further investigation of this area of health team communication should be initiated. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this study was to investigate and describe actual and ideal activity profiles of inservice educators in hospitals, establishing time and frequency for each activity. The study also examined some socioeconomic factors that described the population in relation to activity time and frequency scores. The factors included characteristics of the educators and their job settings. The instrument developed for data collection was assessed by a panel of judges with expertise in health and education and then revised. Twenty-four inservice educators employed in acute care general hospitals of varying size in Greater Vancouver and Victoria were surveyed using the revised interview schedule. The data was analyzed and described using appropriate computer programs, non-parametric tests and other calculations. Socioeconomic data obtained described the population in terms of age, marital status and educational involvement. Most respondents were single and without dependents. Most had some formal training beyond a nursing diploma, many had a Bachelor's degree, and they were actively involved in their own continuing education. The actual activity profile for the group showed that instructional activities claimed the most hours in the educators' present jobs. Supervision took up the next highest number of hours, with program planning, miscellaneous and policy decision making activities ranking third to fifth. The ideal activity profile differed from the actual. Respondents wanted to spend the most amount of time in program planning activities, followed by instruction, supervision, policy decision making and miscellaneous activities. Comparison of actual and ideal profiles suggested that the educators felt some measure of dissatisfaction with their present activities. They wanted to spend a substantially greater number of hours per year involved in program planning than was possible under present circumstances. Conversely, they wanted a reduction of involvement in all other categories of activity. Socioeconomic data such as age, hospital size, amount of time employed in present job, and in involvement in continuing education were tested for correlation with activity scores. No strong relationships were found, although there were a few statistically significant correlations. Difficulties presented by the data, such broad ranges of responses and noticeable differences in mode and mean response, made it necessary to state conclusions in the study as suggestive rather than definitive. Nevertheless, it was felt that actual and ideal profiles could be at least indicated and then used as a starting point for more definitive studies of nursing inservice educators. It was pointed out that steps could be taken to clarify the inservice educator's role through standard job description and elimination of non-educational activities. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Call number: LD2668 .T4 1985 J66 / Master of Science

Tuberculosis is a disease of global importance and remains the leading cause of death in the developing world. In South Africa a weak notification system and poor occupational health services for health care workers has resulted in little information being available about the incidence of tuberculosis and the groups at highest risk of contracting tuberculosis amongst health care workers, the clinical presentation and management of workers infected with tuberculosis. The purpose of this study was to describe the incidence of tuberculosis, and the clinical and public health aspects of the management of tuberculosis among health care workers in eight public sector hospitals in the Ethekwini Municipality of KwaZulu-Natal. Data was collected through a retrospective review of hospital records for the study period January 1999 to June 2004. Study findings: Five hundred and eighty three (N=583) health care workers were diagnosed with tuberculosis for the period under review. The mean age of the HCWs was 38 years (95% Cl: 37-39). The mean cumulative incidence for the study period was 1040/100 000 HCW population (95% Cl: 838-1242). The mean cumulative incidence of TB was highest in males (1544/100 000 HCW population; 95% Cl 1228 -1859), the age group 25 to 34 years (1043/100 000 HCW population; 95% CI: 650 -1436) and in paramedical staff (1675/100 000 HCW population; 95%CI: 880-2470). The majority of health care workers presented with pulmonary tuberculosis (77%, n=322) and 3% (n=13) had multidrug resistant tuberculosis. Successful treatment outcomes were achieved in 63% (n=334) of health care workers. Only one hospital has a work place policy with regard tuberculosis in health care workers. Compensation for this occupational disease was sought as follows. Submissions of a first medical report were made in 107 (18%) of the 583 health care workers. In the 107 cases initially reported submission of progress reports (n=75; 70%) and final reports (n=60; 56%) decreased considerably. In conclusion, the incidence of tuberculosis in health care workers has increased annually since 1999 and the treatment outcomes among health care workers do not reach the targets set by the National Tuberculosis Control Programme. Recommendations based on the study findings include establishing a uniform provincial policy for the prevention and reduction of tuberculosis infections among health care workers for implementation in hospitals; the implementation of a medical surveillance system for health care workers with respect to tuberculosis and a provincial training programme for staff on the clinical and administrative management of TB in health care workers. / Thesis (M.Med.)-University of KwaZulu-Natal, 2006.