The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (MPhil)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Paarl, in the Western Cape, has been identified as one of the 15 national sites where antiretroviral treatment (ARVs) would be made available to people living with HIV/AIDS. Paarl Hospice initiated a support group for people to deal with this disease in 2003. Since February 2004 Paarl Hospice has been recruiting people from the surrounding informal settlements for ARVs. By means of participant observation I explored how HIV/AIDS-related disclosure experiences unfolded in places, spaces and events associated with the support group in the context of factors enabling and preventing people from accessing Hospice House. I did this by considering the insights drawn from an anthropological approach. I found the meanings of disclosure in the majority of studies to be limited and restricted. Available studies approached disclosure in a top-down fashion by regarding the definition of disclosure as the announcement of HIV-positivity at the time of diagnosis only. These studies have not considered social differences relating to disclosure neither did they focus on the actual process of disclosure. By means of a constructivist approach to grounded theory I seek to broaden the definition of disclosure to account for the range of ways in which disclosure practices take place. I found that disclosure could not be separated from the situational context in which it occurs and that it can only be understood in relation to the circumstances and relationships in which it takes place. In this study, disclosure was an ongoing process, situated somewhere between active, public announcement of an HIV-status and complete secrecy and somewhere between voluntary and involuntary revealing of the disease. / AFRIKAANSE OPSOMMING: Paarl in die Wes-Kaap is geïdentifiseer as een van die 15 nasionale areas waar antiretrovirale medikasie beskikbaar gestel sou word aan mense wat leef met MIV/VIGS. Paarl Hospice het gedurende 2003 ʼn ondersteuningsgroep geїnisieer om aan MIV/VIGS aandag te gee. Sedert Februarie 2004 is Paarl Hospice in die proses om mense te werf uit die omliggende informele behuisingsgebiede vir antiretrovirale behandeling. Met behulp van antropologiese insigte en deelnemende waarneming kon ek nagaan hoe verskillende maniere van MIV/VIGS-verwante bekendmaking ontvou in plekke, ruimtes en gebeurtenisse wat verband hou met die ondersteuningsgroep. MIV/VIGSverwante bekendmaking is ondersoek te midde van inhiberende en fasiliterende faktore wat mense verhoed of aanhelp om Paarl Hospice te besoek. Ek het bevind dat die definisie van bekendmaking in die meeste navorsing gebrekkig is. Beskikbare navorsing het bekendmaking volgens ‘n bo-na-onder-wyse benader as die openbare bekendmaking van ‘n MIV-status na afloop van diagnose alleenlik. Met behulp van ‘n konstruktiewe benadering van die begronde teorie het ek gepoog om die definisie van bekendmaking uit te bou om sodoende die verskeidenheid maniere waarop bekendmaking plaasvind te akkommodeer. Ek het vasgestel dat bekendmaking onlosmaakbaar deel is van die situasionele konteks waarin dit plaasvind en dat dit slegs begryp kan word in verband tot die verhoudings en omstandighede waarin dit plaasvind. In hierdie studie was bekendmaking ʼn voortdurende proses, gesitueer tussen aktiewe openbare bekendmaking en volledige geheimhouding van ʼn MIVstatus, asook tussen volkome vrywillige en onvrywillige bekendmaking van ʼn MIVstatus.

Made available in DSpace on 2016-04-04T18:29:53Z (GMT). No. of bitstreams: 1 Miriam Tachibana.pdf: 5134620 bytes, checksum: 556ff670c6db14ef3e3a558654201915 (MD5) Previous issue date: 2011-02-23 / Pontif?cia Universidade Cat?lica de Campinas / The occurrence of a pregnancy s interruption requires not only medical and hospital care, but also emotional support, aiming at the patient s welfare and her ability to welcome other babies that she may have in the future. During hospitalization, the patient is under the care of an obstetrical nursing staff and therefore her experiences are affected by the attitudes and behaviors of these professionals. Thus, our project has the objective of investigating the collective imaginary of the obstetrical nursing staff towards the patient who has miscarried. We conducted individual interviews with sixteen professionals from an obstetrics clinic of a university hospital, using the Procedure Drawings-Story with Theme as dialogue mediator. After each interview, psychoanalytic narratives were written and were considered psychoanalytically together with the drawings-stories of the participants, aiming to capture interpretive fields of affective-emotional sense. We captured patterns denominated "End of the World", "Eternal emptiness" and "Monstrosity", which allows the perception that, in the collective imaginary, the interrupted pregnancy is perceived as a phenomenon humanly unacceptable, that would present apocalyptic traits associated with the evil and harmful motivations towards the pregnant patient. The overall picture shows that the nursing staff, as a human collective, might face difficulties in adopting and sustaining supportive behavior to this type of patient. This situation may be overcome only if the instruction and enlightenment of these professionals is supplemented with clinic psychological care that will allow them to perform their tasks more calmly and maturely / A ocorr?ncia de interrup??o da gesta??o demanda n?o apenas atendimento m?dico - hospitalar, mas tamb?m sustenta??o emocional, tendo em vista tanto o bem estar imediato da mulher, como a possibilidade de acolhimento a outros beb?s que possa ter futuramente. Durante a interna??o, a mulher permanecer? sob cuidados da equipe de enfermagem obst?trica, de modo que suas viv?ncias ser?o, em certa medida, afetadas pelas atitudes e condutas destes profissionais. Assim, justifica-se a proposta de investigar o imagin?rio coletivo da equipe de enfermagem obst?trica sobre a mulher que sofreu interrup??o da gesta??o. Realizamos entrevistas individuais com dezesseis profissionais de um servi?o de Obstetr?cia de um hospital universit?rio, fazendo uso do Procedimento de Desenhos-Est?rias com Tema como recurso mediador-dial?gico. Ap?s cada entrevista, foram redigidas narrativas psicanal?ticas que, juntamente com os desenhos-est?rias das participantes, foram considerados psicanaliticamente, visando a capta??o interpretativa de campos de sentido afetivo-emocional. Foram captados campos denominados Fim do mundo , Vazio eterno e Monstruosidade , que permitem a percep??o da vig?ncia de um imagin?rio coletivo no qual a gravidez interrompida ? concebida como um fen?meno humanamente inaceit?vel, que apresentaria contornos apocal?pticos, associados ? atribui??o de motiva??es maldosas e nefastas ? pr?pria gestante. O quadro geral evidencia que a equipe de enfermagem, como coletivo humano, provavelmente enfrentar? dificuldades na ado??o de condutas solid?rias e sustentadoras diante deste tipo de paciente. Esta situa??o poder? ser superada apenas se a instru??o e o esclarecimento das profissionais puderem ser complementados com aten??o psicol?gica cl?nica, que lhes permita exercer suas tarefas de modo mais tranq?ilo e amadurecido.

Orientador: Vera Lúcia Pamplona Tonete / Coorientador: Regina Célia Popim / Banca: Heloísa Wey Berti / Banca: Regina Aparecida Garcia Lemos / Resumo: O objetivo geral dessa investigação foi apreender as concepções e experiências sobre cuidados paliativos, a partir de mães cujos filhos falecidos estiveram internados em um hospital oncológico de referência nacional, localizado no interior paulista. Trata-se de um estudo de abordagem qualitativa, do tipo descritivo que se baseou, também, em informações quantitativas para a caracterização dos participantes. Os dados colhidos se referem ao período de junho de 2007 a abril de 2010, sendo obtidos por meio de análise de documentos eletrônicos institucionais e prontuários das crianças inseridas no Programa de Cuidados Paliativos e, também, a partir de questionários e entrevistas realizadas nos domicílios de sete mães. Para análise dos dados, utilizou-se o Método de Análise de Conteúdo de Bardin, vertente temática. Foram detectadas 34 crianças que estiveram sob cuidados paliativos no referido período, em média, por 88,30 ± 66,83 dias, sendo a maioria do sexo masculino, de cor branca, católica, proveniente do estado de São Paulo e já falecida, com idade no óbito entre zero e seis anos, no hospital em foco. Quanto às mães entrevistadas, a maioria estava em fase de reação de luto adiado, era casada e com mais de um filho e idade entre 27 e 47 anos, sendo cinco católicas e duas evangélicas, com renda familiar mensal entre R$600,00 a R$8.000,00. Os depoimentos maternos colhidos foram sistematizados em cinco temas: Concepções sobre cuidados paliativos; Cuidados maternos após a comunicação sobre a impossibilidade de cura; Cuidados profissionais após a comunicação sobre a impossibilidade de cura; Sentimentos maternos sobre a fase de cuidados paliativos; Perspectivas maternas sobre os sentimentos dos filhos quando em cuidados paliativos. As concepções maternas sobre cuidados paliativos revelaram-se vagas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The overall goal of this research was to understand the concepts and experiences about palliative care from mothers whose children had been hospitalized in a national reference cancer hospital, located in the state of São Paulo. This is a qualitative study, descriptive in nature, which was also based on quantitative information for the characterization of participants. The collected data cover the period from June 2007 to April 2010, and were collected through review of electronic and institutional documents and records of children under a Program for Palliative Care and also from questionnaires and interviews in the homes of seven mothers. For data analysis, the method of content analysis of Bardin was used, thematic approach. It was identified 34 children who had been under hospice care in that period, on average, 88.30 ± 66.83 days, mostly male, white, Catholic, from the state of São Paulo and now deceased, with aging between zero and six years, at the hospital in focus. Most mothers in the interview were under delayed mourning, were married, had more than one child and aged between 27 and 47 years, five Catholic and two Protestant, with a monthly income ranging from R$ 600.00 to R $ 8,000.00. The maternal testimonies collected were organized into five themes: Conceptions about palliative care; Maternal care after the announcement of impossibility of healing; Professional care after the announcement of impossibility of healing; Maternal feelings about the stage of palliative care; Maternal perspectives on children's feelings when under palliative care. Maternal conceptions about palliative care proved to be vague, distorted or even nonexistent, showing a need for institutional investments to change this situation. As to the experiences reported by these women, those were permeated... (Complete abstract click electronic access below) / Mestre

Esta pesquisa propõe um instrumento para avaliação de serviços hospitalares com base em critérios de assistência, infraestrutura e práticas de gestão, como forma de contribuir para o gerenciamento dos negócios em saúde no Brasil. Desta forma, identificou-se que os planos/seguros de saúde e os hospitais brasileiros não possuem um instrumento abrangente e adequado para aferir a qualidade dos serviços hospitalares multiespecializados, disponibilizados aos seus clientes, nos três aspectos fundamentais citados acima. Consequentemente, não há diferenciação, nas tabelas de remuneração contratadas entre planos/seguros de saúde e hospitais, que seja fundamentada em critérios técnicos e que estimulem a concorrência entre os prestadores de serviços nos quesitos eficiência, qualidade e custos dos serviços prestados aos clientes/pacientes. Através da revisão bibliográfica, buscou-se compreender a dinâmica econômica do setor saúde no Brasil, o relacionamento comercial entre os participantes, os métodos de classificação hospitalar disponíveis no mercado brasileiro, os critérios legais e técnicos para avaliação da assistência médicohospitalar, da infraestrutura hospitalar e das práticas de administração hospitalar. Obteve-se, ao final desta pesquisa, uma ferramenta de diagnóstico precisa, do tipo check list, para mensurar as condições técnicas dos serviços hospitalares disponibilizados aos clientes das instituições avaliadas. / This research proposes a tool for evaluation of hospital services on the basis of assistance, infrastructure and management practices as a way to contribute to the health care management in Brazil. Thus, we identified that Brazilians prepaid health plans/health insurance and hospitals do not have a comprehensive and appropriate instrument for measuring the quality of multi-specialist hospital services, available to their customers for the three aspects above mentioned of this hospital services. Consequently, there is no differentiation in price scales between contracted prepaid health plans/health insurance and hospitals that are based on technical criteria and to encourage competition among service providers regarding to efficiency, quality and cost of services to clients/patients. Through literature review we sought to understand the economic dynamics of the health care management field in Brazil, the commercial relationship between participants, the methods of hospital classification available in Brazil, legal and technical criteria for evaluation of medical assistance, the hospital infrastructure and practices of hospital administration. It was obtained at the end of this research a diagnostic tool, of the check list type, for measuring the technical conditions of hospital services provided to clients by the evaluated institutions.

"October 2004" / Includes bibliographical references (leaves 313-337) / x, 337 leaves : ill. (col.), maps (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004

University of Macau / Institute of Chinese Medical Sciences

Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with  non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living alone and younger age were independently related to more depressive symptoms (Study I). Cardiac anxiety was reported by 42 % of the patients in study III and 67 % of the patients in study IV. Fear of body sensations was reported by 62 % of the patients in study III and 93 % of the patients in study IV. On average, patients with NCCP had 54 contacts with primary care or the outpatient clinic per patient during the two-year study period. This was comparable to the number of contacts among patients with AMI (50 contacts) and AP (65). Patients with NCCP had on average 2.6 hospital admissions during the two years, compared to 3.6 for patients with AMI and 3.9 for patients with AP (Study II). Four out of ten patients reported seeking healthcare at least twice during the last year due to chest pain (Study III). On average, 14 % of patients with NCCP were on sick-leave annually, compared to 18 % for patient with AMI and 25 % for patient with AP. About 11-12 % in each group received a disability pension. The mean annual societal costs for patients with NCCP, AMI and AP were €10,068, €15,989 and €14,737 (Study II). Depressive symptoms (Study I, III), cardiac anxiety (Study III) and fear of body sensations (Study III) were related to healthcare utilization. Cardiac anxiety was the only variable independently associated with healthcare utilization (Study III). In the intervention study (Study IV), almost all patients in both the intervention and control groups improved with regard to chest pain  frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. There was no significant difference between the groups. The intervention was perceived as feasible and easy to manage, with comprehensible language, adequate and varied content, and  manageable homework assignments. Conclusions: Patients with NCCP experienced recurrent and persistent chest pain and psychological distress in terms of depressive symptoms, cardiac anxiety and fear of body sensations. The prevalence and severity of depressive symptoms in patients with NCCP did not differ from patients with AMI and patients with AP. NCCP was significantly associated with healthcare utilization and patients had similar amount of primary care and outpatient clinic contacts as patients with AMI. The estimated cumulative annual national societal cost for patients with NCCP was more than double that of patients with AMI and patients with AP, due to a larger number of patients with NCCP. Depressive symptoms, cardiac anxiety and fear of body sensations were related to increased healthcare utilization, but cardiac anxiety was the only variable independently associated with healthcare utilization. These findings imply that screening and treatment of psychological distress should be considered for implementation in the care of patients with NCCP. By reducing cardiac anxiety, patients may be better prepared to handle chest pain. A short guided Internet-delivered CBT program seems to be feasible. In the pilot study, patients improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but this did not differ from the patients in the control group who received usual care. Larger studies with longer follow-up are needed to evaluate both the short and long- term effects of this intervention.

Family-centered care (FCC) is important within the practice of pediatric oncology nurses. Such nurses face challenges and barriers when attempting to provide FCC. The purpose of this study was to understand the experiences of pediatric oncology nurses in relation to FCC; identify how pediatric oncology nurses implemented FCC into their practice; identify what facilitated and enabled pediatric oncology nurses to implement FCC; and discern the barriers and challenges that were present in their setting when implementing FCC. A qualitative approach utilizing person-centered interviewing was used to collect data. Nurses (N=20) from the Alberta Children‟s Hospital were recruited through purposeful convenience sampling and were then interviewed. Five major themes were identified from the data set: ACH support f FCC, How participants defined FCC, Establishing FCC, Enhancing FCC, and Barriers and Challenges to providing FCC. Recommendations for future research and implications for practice and education are offered. / xii, 191 leaves ; 29 cm

This thesis explores the history of AIDS activism 'from both sides of the bed', by doctors and gay patients, in the 1980s and early 1990s. Such AIDS activism was formed in opposition to dominant racist and homophobic framings of the epidemic and the AIDS-related discrimination that these representations caused. Moreover, links between both groups of AIDS activists have their origins in this period. This history has emerged through oral interviews conducted with AIDS activists and an analysis of archival material held at the South African History Archive and the Centre for Health Policy at the University of the Witwatersrand. Evidence reveals that AIDS activism was politically overshadowed in the 1980s by the overwhelming need to respond to apartheid. Although the Gay Association of South Africa (GASA) resisted AIDS-related homophobia, it was politically conservative, which later led to its demise, and then the creation of new, more militant anti-apartheid gay AIDS activism. By contrast, the anti-apartheid doctor organisations such as the National Medical and Dental Association (NAMDA) and the National Progressive Primary Health Care Network (PPHC) were militantly anti-apartheid, but did not seriously address AIDS in the 1980s. In the early 1990s, in the new transitional context, AIDS activists framed the epidemic in terms of human rights to combat AIDS-related discrimination in AIDS policy. Simultaneously, doctor activists in NAMDA and PPHC mobilised around AIDS in the early 1990s, but both organisations disbanded after 1994. Meanwhile, gay AIDS activists remained prominent in AIDS activism, as some who were living with HIV adopted the strategy of openness about their HIV status. On the other hand, AIDS-related stigma remained widespread in the transition era with important implications for post-apartheid AIDS activism and policy-making. Ultimately, this history has significantly shaped post-apartheid, rights-based AIDS activism and its recent disputes with the government over AIDS policy. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.