No description available.

No description available.

The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics. In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems. The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions. RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV). This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.

The purpose of this qualitative study is to understand how the professions within the human service organization experience and describe inter-professional collaboration. The questions that the study discusses is the negative versus positive aspects that inter-professional collaboration entails and what conditions that are necessary for such cooperation to work.   The results are analysed with the help of Blumers (1969) theory of symbolic interactionism and Goffmans (2014) theory of team and appearance. The empirical material for the study is collected from semi-structured interviews with eight informants: two counsellors from the neuropsychiatric unit, two counsellors from kids and youth psychiatry, one counsellor and one sexologist from the youth clinic and three school nurses from different schools. The studies informants find that the inter-professional collaboration is crucial for the care that is provided for the patients. The informants believe that the consequences of non-cooperation would be longer treatments, misconceptions among the professionals and reduced overall visibility of patients' needs. The difficulties that the studies informants find with the cooperation are mainly the cooperation between different organizations. The difficulties include the different routines, loyalties, laws and objectives that organizations have. The conditions that the studies informants think is needed for a working inter-professional collaboration are effective communication, knowledge about each others professions, the staff’s willingness to cooperate and to increase learning about inter-professional collaboration.

<p>School psychologists in South Africa are employed by the state to provide psychological services to schools. The role of school psychologists has been debated and contested nationally and internationally for many decades, with the need for a paradigm shift in school psychology practice and redefining the role of school psychologists being highlighted. In this study, the roles and practices of school psychologists are explored, with a focus on the nature of collaborative work engaged in when facilitating school development. In particular, challenges that emerge when school psychologists work with other sectors to facilitate school development are investigated. The overall research question was: What are the challenges that face school psychologists who facilitate school development through intersectoral collaboration and how can these challenges be addressed?</p>

<p>School psychologists in South Africa are employed by the state to provide psychological services to schools. The role of school psychologists has been debated and contested nationally and internationally for many decades, with the need for a paradigm shift in school psychology practice and redefining the role of school psychologists being highlighted. In this study, the roles and practices of school psychologists are explored, with a focus on the nature of collaborative work engaged in when facilitating school development. In particular, challenges that emerge when school psychologists work with other sectors to facilitate school development are investigated. The overall research question was: What are the challenges that face school psychologists who facilitate school development through intersectoral collaboration and how can these challenges be addressed?</p>

Aim: This study aimedto illuminateawareness of hygiene regimens andinfection control guidelines for cystic fibrosis (CF) care at Scandinavian cystic fibrosis centers (SCFCs)and Norwegian cystic fibrosis satellite teams (NCFSTs).Method: We modified a knowledge, attitudes and practices (KAP) surveyused earlier for CF and infection control care teams in the United States. Our modified questionnaire sought responses regarding sputum cultures, hand hygiene, education and infection control measures in hospital/at home. We distributed individual questionnaires to 8SCFCs and 10 NCFSTs. Awareness exceeding 75% per item was considered sufficient for clinical practice. Results: Respondents represented different disciplines atSCFCs with 61 (37%) and 30 (58%) at NCFSTs core team professionals (mainly doctors, nurses and physiotherapists).SCFC respondents demonstrated higher KAP (range 49-100%) than NCFST (range 23-100%). Both groups showed a high awareness of outcome expectancy for selected guideline components (80-100%), but only moderate awareness regarding familiarity. Additionally, both SCFC and NCFST respondents demonstrated greater awareness of items connected closely to practical care and medical treatment(73% and 80% versus 93% and 74% respectively). As opposed, SCFC and NCFST respondentsshowed lower awareness of guideline content(49% and 23% respectively).Conclusion: Becauseinfection control is a cornerstone in CF care, reducing the risk of cross infection among CF patients in health-and non-health caresettings requireshealth care professionals to maintain increased awareness of CF guidelines. This study revealed generally good knowledge of infection control measures. Importantly, bestcarerequires continious collaboration and educationfor health care professionals and patients regardingthe written guidelines for CF infection control. / Hensikt:Studiens hensikt var å belyse etterlevelse av regimer for hygiene og infeksjonskontroll innen cystisk fibrose (CF) omsorg ved de seks skandinaviske CF sentrene (SCFC) og ti norske CF satelitt team (NCFST). Metode:Individuelle spørreskjema ble distribuert til seks SCFC og ti NCFST. Spørreskjemaet var tilpasset fra en tidligere Knowledge, Attitude and Practice (KAP) spørreundersøkelse for helsepersonell innen CF og smittevern i USA med spørsmål angående ekspektoratprøver, håndhygiene, opplæring og tiltak for infeksjonskontroll i sykehus og hjemme. Etterlevelse &gt;75% for alle komponenter var vurdert som tilfredsstillende i klinisk praksis.Resultat: Det var 61 (37 %) respondenter fra SCFC, og 30 (58 %) fra NSCFT, hovedsakelig leger, sykepleiere og fysioterapeuter. SCFChar flere ulike profesjoner medulike erfaringer fra klinisk virksomhet, og respondentene viser et høyt KAP nivå på de fleste komponenter av undersøkelsen (100-49%). NCFST representerer kjerneteamprofesjoner, og respondentene viser moderat til høyt nivå av KAP på de fleste komponenter ved anbefalinger og undersøkelsen (100-23 %). Et nøkkelfunn var det høye nivå av forventet resultat hos begge studiegrupper for alle utvalgte komponenter av undersøkelsen (100-80%), i kontrast til et mer moderat nivå av kunnskap om anbefalingene. Tiltak med nær tilknytning til klinisk praksis og medisinsk behandling viste høyere grad av etterlevelse hos begge grupper (73 % og 80 %, 93 % og 74 %), mens kunnskap om innhold i skriftlige anbefalinger var lavere (49 % og 23 %). Konklusjon: Infeksjonskontroll er en hjørnestein i CF behandling, og betydningen av helsepersonells etterlevelse av anbefalinger for CF infeksjonskontroll er essensielt for å redusere risiko for kryssmitte mellom CF pasienter i og utenforsykehus. Studien har avdekket generelt god kunnskap om tiltak for infeksjonskontroll, men også et behov for kontinuerlig samarbeid og opplæringfor helsepersonell og pasienteri skriftlige anbefalinger for CF infeksjonskontroll. / <p>ISBN 978-91-86739-62-1</p>

Doctor Philosophiae / School psychologists in South Africa are employed by the state to provide psychological services to schools. The role of school psychologists has been debated and contested nationally and internationally for many decades, with the need for a paradigm shift in school psychology practice and redefining the role of school psychologists being highlighted. In this study, the roles and practices of school psychologists are explored, with a focus on the nature of collaborative work engaged in when facilitating school development. In particular, challenges that emerge when school psychologists work with other sectors to facilitate school development are investigated. The overall research question was: What are the challenges that face school psychologists who facilitate school development through intersectoral collaboration and how can these challenges be addressed? / South Africa

Magister Pharmaceuticae - MPharm / The global movement towards enhancing inter-professional collaboration in patient care is in light of the increasing potency of drugs and complexity of drug regimens, particularly in the chronically ill where poly-pharmacy is rife, collaborative patient management by general practitioners and community pharmacists, in particular, has the potential to enhance patient therapeutic outcomes in primary healthcare. Literature from other parts of the world has enumerated the advantages of collaboration. South Africa with its unusual quadruple burden of disease and human resource deficient public healthcare system would benefit from collaboration between general practitioners and community pharmacists through expanded roles for community pharmacists to enable them to make more meaningful contributions to primary healthcare regimens. Particularly with the introduction of the National Health Insurance (NHI) programme. This dissertation aims to assess from general practitioners‟ perspectives: the current level and stage of collaboration (using the collaborative working relationship (CWR) model proposed by McDonough and Doucette, 2001) between general practitioners and community pharmacists in patient care, if general practitioners‟ perceptions of the professional roles of community pharmacists in patients‟ care can influence desired collaboration (prospects of enhanced future collaboration) and how do general practitioners envision enhanced future collaboration between them and community pharmacists in patient care, possible barriers to the envisioned collaboration between the two practitioners, and how general practitioners‟ demographic characteristics influence inter-professional collaboration with community pharmacists. Sixty randomly selected consenting general practitioners in private practice participated in a cross-sectional, face- to-face questionnaire study. The questionnaire contained a range of statements with Likert scale response options. Data was initially entered into Epi Info (version 3.5.1., 2008) and then exported to IBM SPSS Statistical software for analysis (version19, 2010). Medians were used to summarize descriptive data and Spearman‟s correlation coefficient, Mann-Whitney U Test and Kruskal-Wallis Test was used for bivariate analysis. Ethical approval was granted by the Senate Research and International Relations Committee, University of the Western Cape (Ethical Clearance Number: 10/4/29). The results indicated low-levels of current collaboration at stage 0 of the CWR model between general practitioners and community pharmacists. A statistically significant correlation was observed between general practitioners‟ perceptions of the professional roles of community pharmacists and desired collaboration (prospects of enhanced future collaboration), [p=0.0005]. Good prospects of enhanced future collaboration between general practitioners and community pharmacists were observed. General practitioners identified barriers to collaboration to include: the lack of remuneration for collaboration, absence of a government mandate or policy supporting collaboration, inability of general practitioners to share patients‟ information with community pharmacists and questionable professional ethics exhibited by community pharmacists particularly over financial gains. Most general practitioners agreed that joint continuing professional education organized by pharmaceutical companies or other groups will increase interaction and enhance collaboration. Enhanced Inter-professional collaboration between general practitioners and community pharmacists‟ can be possible in the future but hindrances need to be eliminated for this to be achieved. Future research can be aimed at exploring the perspectives‟ of community pharmacists to inter-professional collaboration in South Africa and interventions that will enhance collaboration.