In order for computerised information systems (CIS) to be utilised to their full potential they must first be successfully implemented. The acquisition and implementation process continues to be an area which is reported by the media to present problems for both public and private sector organisations (Keen, 1994; Collins, 1996). The process was originally considered to be a technical process only, but more recently there has been acknowledgement that there are human implications. The process of acquisition and implementation of CIS in the NHS has, therefore, been studied in order to identify the barriers which might be present. The research commenced by conducting a comprehensive literature search which showed some of the barriers found by previous researchers. A number of theories were examined which it was thought would be helpful in approaching the subject. A change model was then identified (MIT9Os, Scott Morton, 1991) which was used to structure the study and as an aid to analysis. The model would be examined for its utility as a change model in the NHS setting. The research used both quantitative and qualitative methods of data collection. A macro view of the process was initially sought because this approach is seldom taken (Kwon & Zmud, 1987). The major part of the research consisted of 4 case studies and 2 survey questionnaires. One survey questionnaire was sent to IT/IS directors and managers about the process. It was sent to eight NHS Regions (359 questionnaires) and a response rate of 51.5% was attained. An additional questionnaire was sent out to human resource directors in the NHS. This was sent to 400 directors and the response rate was 48%. The study identified a number of barriers to implementation in different elements of the organisation, one of the most important barriers being related to politics/power. It was found that the reasons for acquiring new systems are not always articulated, and if these are not in the interests of powerful stakeholder groups, then implementation may be more difficult. Labour process theory was helpful in examining this aspect (Dent, 1996). Results show that existing models are inappropriate for the majority of CIS implementations. The MIT9Os Model (Scott Morton, 1991) was adapted, adding the element of politics/power, together with money and time as major constraining factors. The element of strategy was given a more prominent position, to indicate a pivotal role and it is argued that the model should not be an equilibrium model because of the constant change necessaiy in the modern business environment. The previous model was expanded to show some of the important issues and questions which need to be addressed by those approaching implementation. However, the research showed that the complexity of the process precluded any simple prescriptive answers to implementation problems being given. Models are little used by practitioners, but if they are used they need to carry a warning note that they are only an aid to preliminary thought, and much other background reading and analysis of the particular situation needs to accompany them.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 154-162). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Abstract The goals: The goal of the present thesis is to describe the principles of safe identification of patients by a nurse and the application of the medicines with higher risk rate. Another goal is to define procedures for prevention of a confusion of an intervention, a location or a patient at the operation theatre and to characterize the hand hygiene procedures in healthcare. The next goal was to describe a programme of prevention and reduction of falls and decubiti in hospitalized patients. The last goal focuses on the oral and telephonic prescription of medicines, on the reporting of patient examination results, and on the procedure of patient handover. Eight research questions were set in relation to these goals. Methodology: A qualitative research method based on in-depth interviews was chosen to reach the goals of the thesis. The intentional choice method was chosen for the selection of the communication partners. The research was performed in three selected hospitals of the South Bohemia Region. 20 communication partners participated in the anonymous questioning. The in-depth interviews were performed with a head nurse, with a quality manager, with perioperative nurses, with nurses from a neurology department and an after-care department. Scientific contributions of the thesis: The research deals with the current safety problems of hospitalized patients. The scientific results of the research are intended for both, specialist and the general public. The research study could serve to hospital managements as a stimulus for the improvement of the safety in the healthcare provision system. The achieved findings and conclusions: Hospitalization always brings some risk to a patient. From the point of view of the minimizing of adverse events and damage to a patient healthcare staff need to identify a patient safely, to apply risky medicines in safe manners, to prevent adverse events in operations, to adhere to the hand hygiene and the barrier nursing techniques. The healthcare staff also have to proceed correctly in the oral or telephonic prescription of medicines, in reporting of patient examination results, and in the patient handover procedures. It is in also the interest of the healthcare staff to minimize the risk of falls and to prevent the occurrence of decubiti in hospitalized patients.

Orientador: Ricardo Ribeiro / Banca: Tirsa Ragazzini Perez / Banca: Sebastião Sérgio da Silveira / Resumo: De abordagem qualitativa, a pesquisa realizada para fins desta dissertação caracteriza-se como descritiva, documental, numa dimensão histórica, jurídico-social e educacional. Trata-se de um trabalho fundamentado em textos legais com apoio bibliográfico, que reúne obras sobretudo de cunho jurídico. A exposição em apreço esclarece em que medida o Estatuto da Criança e do Adolescente - ECA, comprometido com a doutrina da proteção integral, constitui um desafio e uma conquista para a educação brasileira (Introdução). Traça o percurso dos direitos da criança e do adolescente no mundo (1), até que se chegasse a uma nova concepção dessa população infantojuvenil, abordando ainda a questão da inimputabilidade (2). Ao considerar a gestão da política de atendimento à criança e ao adolescente focaliza a descentralização político-administrativa e a participação da população por meio de organizações representativas, com ênfase nos Conselhos Federal, Estaduais e Municipais (3). Um rápido enfoque sobre prevenção, geral e especial, dá passagem ao estudo das medidas protetivas e socioeducativas, com seus desdobramentos. Nele, distingue-se a especificidade das respectivas aplicações: a) situação de risco pessoal e social; b) ato infracional praticado por menor de dezoito anos (4). No rol dos direitos assegurados pelo ECA, destacam-se os da educação e cultura, do esporte e lazer (5). Esperamos que o trabalho realizado seja, entre outras, uma contribuição prática principalmente para os educadores envolvidos na complexidade da trama social em que se movimentam crianças e adolescentes. / Abstract: As a qualitative approach this research can be characterized as descriptive, documental, and documental in an educational, socio-juridical and historical dimension. It is a work based on legal texts with bibliographical support, mainly putting together juridical works. The exposition being read, clarifies at what level the Adolescent and Children's Statute, compromised with integral protection, constitutes a challenge and conquer for the Brazilian education (Introduction). It traces the pathway of the adolescent and children's rights in the world (1), until a new conception of this infant-youth population was reached, also addressing the non-imputable question (2). By considering the political management of the adolescent and the children's care policy, it focuses the politics-administrative des-centralization and the participation of the population through representative organizations with emphasis on the federal, state and municipal councils (3). In studying the protective and socio-educative measures with their implications, it is distinguished the specificity of the respective applications as follows: a) social and personal risk situation; and b) infraction act practiced by youth less than 18 years old (4). In the role of the rights assured by the Adolescent and Children's Statute, the right to education and culture, sport and leisure are highlighted (5). We hope this work among others, to be a practical contribution for teachers involved in the complexity of the social context where children and adolescents move up. / Mestre

Current status: Safe process treatment should be provided to every patient in every hospital. Nurses should work to avoid security violation, especially in the surgical field, associated with irreversible changes in the treatment process. Perfect mastery of these measures assures patient safety. Risk prevention, safety of the patient and the medical personnel require the involvement of all members of the multidisciplinary team (Pokojová, 2011; Škrla and Škrlová, 2003). Objective of the research: to map the attributes of postoperative care in the safe treatment of patients. To determine whether nurses master preventive measures in safe patient care and whether they ensure compliance with the principles of safe care in practice. Methods: the research analysis was chosen to be based on qualitative research method. Data acquisition was performed in semi-structured interview with nurses, supplemented with hidden observation. The participation in the interviews was voluntary and anonymous. Audio data was recorded from the interviews and transcribed verbatim. The observation aimed to determine whether nurses respect the principles of safe care for patients in the postoperative care. Research cohort: consisted of general nurses who worked at the surgical wards and recovery room. The research was conducted in one of the hospitals of South Bohemia. Twelve nurses were interviewed. The interview and hidden observation were focused on patient safety in the postoperative period. The interviews were performed at nurse day-time rooms of individual surgical wards, some of them outside the hospital. All nurses met the criterion to be a provider of nursing care for post-operative patients at surgical wards and recovery rooms. The interviews were finished when reaching the theoretical saturation, when the answers and hidden observation of the respondents started to repeat the already acquired data, i.e. after twelve interviews and observations. Results: The nurses working in surgical wards and recovery rooms are exposed to a considerable mental and physical strain. This profession is very demanding and requires not only theoretical knowledge, but also manual dexterity in practice. Nurses are involved in the care process in a considerable extent. Therefore, it is important that the care was good and safe. In the treatment process, the nurses sometimes do not comply with relevant standards and the requirements for safe treatment. It is essential to follow the identification bracelets to avoid patient mismatch, thus endangering patients' health. Some nurses checked the identification bracelets thoroughly, but there were also nurses who ignored these rules too much and gamble with the patients' health. Medication errors are the most common cause of patient injury. The risk of medication errors increases also due to improper storage of hazardous drugs. In our investigation, the medication was repeatedly stored at a different place (not returned back to the original area), poorly stored or left freely available to anyone. If the physician records are illegible, the nurses solve the issue rather by guessing or asking an assistance from colleagues in the department. This area also includes replacement of medication by nurses if the prescribed product is not available at the ward, without consulting a physician first. The negligence in the use of protective equipment during dressing changes is alarming. Possible transmission of nosocomial infections. Poor or little use of disinfectants. Conclusions: Treatment of patients in the early and late postoperative care is one of the high risk parts of the hospitalization of patients at healthcare facilities. In this period, patient monitoring and risk prevention are essential. It includes pain control, the care for surgical wounds, safe patient identification, prevention of adverse events in both medication administration and patient falls, the compliance with hand hygiene ...

Objetivo: Este artigo tem como objetivo avaliar o impacto da implantação da estratégia de triagem com classificação de risco e da unidade vascular no processo assistencial dos pacientes atendidos no serviço de emergência do Hospital de Clínicas de Porto Alegre, HCPA. Método:Trata-se de um quasi-experimento em que 3.700 pacientes atendidos na emergência nos meses de março a maio de 2005 e 4.954 pacientes atendidos no mesmo período de 2007, após a implantação das novas tecnologias, tiveram seu processo de atendimento medidos e comparados.O impacto da reorganização do serviço com a implantação destas tecnologias foi avaliado através da comparação dos indicadores de “Tempo de Permanência”, “Tempo de espera para realização de Exames” e “Tempo de espera para realização Cirurgias e Procedimentos” de todos os pacientes atendidos e especificamente dos pacientes com doenças cardiovasculares. Resultados: O tempo mediano de triagem de todos os pacientes foi de 11,8 minutos (0-92,5) e de 6,3 minutos (0-53) dos pacientes com doenças cardiovasculares. Foi evidenciado aumento significativo da mediana de tempo de permanência: 2005: 12,3h (0-510,8) e 2007:15,5h.(0-388,9), P<0,001. O mesmo ocorreu com os pacientes cardiovasculares que passaram de uma mediana de tempo de permanência de 24,5h (0,5- 341) em 2005 para 74h (0,6 -287,h), P <0,001.O exame de tomografia de crânio apresentou redução significativa no tempo mediano de espera para todos os pacientes 2005: 4h (0,08-76,4), 2007: 3h (0,2-62,7), P =0,006,e para os pacientes com doenças cardiovasculares, 2005: 4,2h (0,5-15,9), 2007: 0,9h (0,5-7,9), P =0,001.O cateterismo cardíaco realizado pelos doentes cardiovasculares agudos apresentou uma redução significativa no tempo mediano de espera, 2005: 55,6h (31,2-90,4) e 2007 13,6h (0,6-97,6), P =0,025. Conclusão: Embora tenha havido aumento de 25,3% nos casos atendidos entre 2005 e 2007, acompanhado do aumento da mediana de idade, do escore de gravidade e de casos demandando procedimentos cirúrgicos, a implantação de estratégia de triagem com estratificação de risco e da unidade vascular em serviço de emergência de hospital universitário esteve associada à redução dos tempos de espera para procedimentos diagnósticos e terapêuticos considerados como essenciais em pacientes com síndrome vascular aguda. / Objective: This study assesses the impact of implementing a strategy of screening using risk rating and creating a vascular unit for patients admitted to the emergency department of Hospital de Clinicas de Porto Alegre. Method: This study describes a quasi-experiment in which 3700 patients treated at the emergency department from March to May 2005 (P1) and 4954 patients treated during the same months of 2007 (P2), after the introduction of new care technologies. The process of care was measured and compared. The impact of department reorganization with these technologies was evaluated comparing length of stay, length of stay to perform tests and length of stay to perform surgery or procedure, measured for all patients and specifically for cardiovascular disease patients. Results: Screening median time was 11.8 min (0-92.5) for all patients and 6.3 min (0- 53) for cardiovascular disease patients. Our results showed a significant increase in median length of stay from P1 to P2 for all patients, 12.3 min (0-510.8) and 15.5 hr (0-388.9) respectively, P < 0.001. Cardiovascular disease patients had a median length of stay of 24.5 min (0.5-341) and 74 hr (0.6-287) in 2005 and 2007 respectively. Cranial tomography scan had a significant time reduction for all patients from P1 to P2, 4 hr (0.08-76.4) and 3 hr (0.2-62.7) respectively, P = 0.006, and for cardiovascular disease patients 4.2 hr (0.5-15.9) and 0.9 hr (0.5-7.9) respectively, P = 0.001. Cardiac catheterization for acute cardiovascular disease patients showed a significant decrease in median waiting time, from 55.6 min (31.2- 90.4) in P1 to 13.6 min (0.6-97.6) in P2, P = 0.025. Conclusion: Although there was a 25.3 percent increase in admitted patients from 2005 to 2007 and an increase in age, severity score and surgical patients, the implementation of a screening strategy with risk stratification and creation of a vascular unit in the emergency department was associated with reduction of waiting times of diagnostic and therapeutic procedures for acute cardiovascular disease patients.

Objetivo: Este artigo tem como objetivo avaliar o impacto da implantação da estratégia de triagem com classificação de risco e da unidade vascular no processo assistencial dos pacientes atendidos no serviço de emergência do Hospital de Clínicas de Porto Alegre, HCPA. Método:Trata-se de um quasi-experimento em que 3.700 pacientes atendidos na emergência nos meses de março a maio de 2005 e 4.954 pacientes atendidos no mesmo período de 2007, após a implantação das novas tecnologias, tiveram seu processo de atendimento medidos e comparados.O impacto da reorganização do serviço com a implantação destas tecnologias foi avaliado através da comparação dos indicadores de “Tempo de Permanência”, “Tempo de espera para realização de Exames” e “Tempo de espera para realização Cirurgias e Procedimentos” de todos os pacientes atendidos e especificamente dos pacientes com doenças cardiovasculares. Resultados: O tempo mediano de triagem de todos os pacientes foi de 11,8 minutos (0-92,5) e de 6,3 minutos (0-53) dos pacientes com doenças cardiovasculares. Foi evidenciado aumento significativo da mediana de tempo de permanência: 2005: 12,3h (0-510,8) e 2007:15,5h.(0-388,9), P<0,001. O mesmo ocorreu com os pacientes cardiovasculares que passaram de uma mediana de tempo de permanência de 24,5h (0,5- 341) em 2005 para 74h (0,6 -287,h), P <0,001.O exame de tomografia de crânio apresentou redução significativa no tempo mediano de espera para todos os pacientes 2005: 4h (0,08-76,4), 2007: 3h (0,2-62,7), P =0,006,e para os pacientes com doenças cardiovasculares, 2005: 4,2h (0,5-15,9), 2007: 0,9h (0,5-7,9), P =0,001.O cateterismo cardíaco realizado pelos doentes cardiovasculares agudos apresentou uma redução significativa no tempo mediano de espera, 2005: 55,6h (31,2-90,4) e 2007 13,6h (0,6-97,6), P =0,025. Conclusão: Embora tenha havido aumento de 25,3% nos casos atendidos entre 2005 e 2007, acompanhado do aumento da mediana de idade, do escore de gravidade e de casos demandando procedimentos cirúrgicos, a implantação de estratégia de triagem com estratificação de risco e da unidade vascular em serviço de emergência de hospital universitário esteve associada à redução dos tempos de espera para procedimentos diagnósticos e terapêuticos considerados como essenciais em pacientes com síndrome vascular aguda. / Objective: This study assesses the impact of implementing a strategy of screening using risk rating and creating a vascular unit for patients admitted to the emergency department of Hospital de Clinicas de Porto Alegre. Method: This study describes a quasi-experiment in which 3700 patients treated at the emergency department from March to May 2005 (P1) and 4954 patients treated during the same months of 2007 (P2), after the introduction of new care technologies. The process of care was measured and compared. The impact of department reorganization with these technologies was evaluated comparing length of stay, length of stay to perform tests and length of stay to perform surgery or procedure, measured for all patients and specifically for cardiovascular disease patients. Results: Screening median time was 11.8 min (0-92.5) for all patients and 6.3 min (0- 53) for cardiovascular disease patients. Our results showed a significant increase in median length of stay from P1 to P2 for all patients, 12.3 min (0-510.8) and 15.5 hr (0-388.9) respectively, P < 0.001. Cardiovascular disease patients had a median length of stay of 24.5 min (0.5-341) and 74 hr (0.6-287) in 2005 and 2007 respectively. Cranial tomography scan had a significant time reduction for all patients from P1 to P2, 4 hr (0.08-76.4) and 3 hr (0.2-62.7) respectively, P = 0.006, and for cardiovascular disease patients 4.2 hr (0.5-15.9) and 0.9 hr (0.5-7.9) respectively, P = 0.001. Cardiac catheterization for acute cardiovascular disease patients showed a significant decrease in median waiting time, from 55.6 min (31.2- 90.4) in P1 to 13.6 min (0.6-97.6) in P2, P = 0.025. Conclusion: Although there was a 25.3 percent increase in admitted patients from 2005 to 2007 and an increase in age, severity score and surgical patients, the implementation of a screening strategy with risk stratification and creation of a vascular unit in the emergency department was associated with reduction of waiting times of diagnostic and therapeutic procedures for acute cardiovascular disease patients.

Made available in DSpace on 2014-06-11T19:24:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-28Bitstream added on 2014-06-13T19:11:01Z : No. of bitstreams: 1 campos_msvo_me_arafcl.pdf: 372959 bytes, checksum: 5ffa5c74855210e9ea9d5f7d07a3efaa (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / De abordagem qualitativa, a pesquisa realizada para fins desta dissertação caracteriza-se como descritiva, documental, numa dimensão histórica, jurídico-social e educacional. Trata-se de um trabalho fundamentado em textos legais com apoio bibliográfico, que reúne obras sobretudo de cunho jurídico. A exposição em apreço esclarece em que medida o Estatuto da Criança e do Adolescente – ECA, comprometido com a doutrina da proteção integral, constitui um desafio e uma conquista para a educação brasileira (Introdução). Traça o percurso dos direitos da criança e do adolescente no mundo (1), até que se chegasse a uma nova concepção dessa população infantojuvenil, abordando ainda a questão da inimputabilidade (2). Ao considerar a gestão da política de atendimento à criança e ao adolescente focaliza a descentralização político-administrativa e a participação da população por meio de organizações representativas, com ênfase nos Conselhos Federal, Estaduais e Municipais (3). Um rápido enfoque sobre prevenção, geral e especial, dá passagem ao estudo das medidas protetivas e socioeducativas, com seus desdobramentos. Nele, distingue-se a especificidade das respectivas aplicações: a) situação de risco pessoal e social; b) ato infracional praticado por menor de dezoito anos (4). No rol dos direitos assegurados pelo ECA, destacam-se os da educação e cultura, do esporte e lazer (5). Esperamos que o trabalho realizado seja, entre outras, uma contribuição prática principalmente para os educadores envolvidos na complexidade da trama social em que se movimentam crianças e adolescentes. / As a qualitative approach this research can be characterized as descriptive, documental, and documental in an educational, socio-juridical and historical dimension. It is a work based on legal texts with bibliographical support, mainly putting together juridical works. The exposition being read, clarifies at what level the Adolescent and Children’s Statute, compromised with integral protection, constitutes a challenge and conquer for the Brazilian education (Introduction). It traces the pathway of the adolescent and children’s rights in the world (1), until a new conception of this infant-youth population was reached, also addressing the non-imputable question (2). By considering the political management of the adolescent and the children’s care policy, it focuses the politics-administrative des-centralization and the participation of the population through representative organizations with emphasis on the federal, state and municipal councils (3). In studying the protective and socio-educative measures with their implications, it is distinguished the specificity of the respective applications as follows: a) social and personal risk situation; and b) infraction act practiced by youth less than 18 years old (4). In the role of the rights assured by the Adolescent and Children’s Statute, the right to education and culture, sport and leisure are highlighted (5). We hope this work among others, to be a practical contribution for teachers involved in the complexity of the social context where children and adolescents move up.

The following Thesis deals with problems concerning human resources management in the area of Health Care and its failures. Furthemore, it seeks for the reasons for such failures, analyzes the legal background and compares it with the day-to-day life of hospitals. The goal of this Thesis is to reveal the real roots of the ongoing crisis, which was demonstrated e.g. by so called Děkujeme, odcházíme campaign, and to find out possible solutions to stabilize the Health Care system and minimaze the risk of lose of health care professionals.

Cooperation of nurses and physicians from the perspective of nursing management Master's thesis was focused on the cooperation of nurses and physicians from the perspective of nursing management. Nursing care and nursing management has an irreplaceable role in health care. The world of medicine, nursing care and health care is an extremely complex organizational system, which is not surely represented only by physicians and nurses, but these, however, are still the dominant persons on the scene. The first objective of this thesis was to make a survey of cooperation between nurses and physicians during the nursing process in the care of patients from the perspective of nursing management in departments of surgery and internal medicine. The second objective was to identify problem areas in cooperation between nurses and physicians from the perspective of nursing management in departments of surgery and internal medicine, and the third objective was to find out the way the nursing management tackles problem situations in cooperation between nurses and physicians in departments of surgery and internal medicine. To meet these objectives four research questions were stated: 1. In what areas do nurses and physicians cooperate during the nursing process while providing care for patients from the perspective of nursing management in their respective departments? 2. How do nurses assess and perceive cooperation with physicians from the perspective of nursing management in their respective departments? 3. Are there problem areas in cooperation of nurses and physicians from the perspective of nursing management in their respective departments? 4. How does nursing management tackle problem situations in cooperation between nurses and physicians in their respective departments? The research was conducted in the hospital, where I was given information under the condition of anonymity of the respondents interviewed. The responders were chief nurses and senior staff nurses working in departments of surgery and internal medicine. The investigation conducted is a qualitative research. Interviews with the structure of questions to non-standardized interviews were conducted with the respondents according to question structures of the non-standardized interview. Subsequently, transcripts of interviews and data categorization in tables according to the Ritchie and Spencer´s framework analysis were made. The survey suggests the following conclusions. Nurses and physicians cooperate within the nursing process in providing care for patients from the perspective of nursing management in departments of surgery and internal medicine at the stage of problem solving. Nurses appreciate cooperation with physicians on the basis of mutual respect, but they still feel the prevailing dominance of physicians. From the perspective of nursing management there are problematic areas in cooperation between nurses and physicians. Nursing management tackles problem situation in cooperation between nurses and physicians by seeking common solutions. It will be possible to provide the health care facilities, where the research was conducted, with the outcomes of the research. Thinking about the possible improvement in mutual cooperation as early as during physicians´ and nurses´ studies, to introduce various measures to improve cooperation between nurses and physicians by organizing joint seminars and cultural events could lead to meeting the purpose. It is necessary to raise physicians´ awareness of nursing process and to carry out further research on this topic.