Traditionally analgesics have been the main stay of postoperative pain management. Taught non-pharmacological strategies have also been used. The possibility that patients may have a repertoire of self-generated strategies has tended to be overlooked. The aim of this study was to identify whether patients possess and utilise self-generated strategies for acute pain, and if so, to ascertain the effect of engaging patients in their postoperative pain management by supporting their strategies. To empower nurses to deliver effective pain management, and to promote evidence based practice, a second aim was to actively engage nursing staff in the process. A collaborative action research design based on critical theory was used to facilitate practitioner participation, enable practice development and generate a theoretical understanding of the issues. Three action research cycles were identified, each containing various methods and involving both patients and staff. The first cycle, entitled “telling the situation as it is”, described current practice from the ward staff’s perspective and identified 10 strategy themes through an outpatient survey. Cycle two focused upon “testing the proposed changes”. In contrast to many action research studies, a randomised controlled trial was undertaken to test the effect of incorporating patients’ self-generated strategies into postoperative pain management. The nursing staff were pivotal in both the decision to undertake the trial and in its management. The results indicated that identifying and supporting patients’ self-generated strategies significantly reduced postoperative anxiety, pain intensity and distress. Fewer experimental subjects required opiates, although non-steroidal anti-inflammatory consumption was increased in this group. Staff understanding and awareness of pain and their ability and confidence to manage pain increased. Certain staff also gained research skills. The third and final cycle, “creating change in practice: implementation and implications”, is being led by the nurses. The potential of action research to engage nurses in practice developments related to patient-centred care has been demonstrated.

Thesis (M.S. or Ph. D.)--University of Florida, 2004. / Typescript. Vita. Includes bibliographical references (leaves 30-32).

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / Includes bibliographical references (p. 176-202). Also available on the Internet.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 176-202).

Purpose: The systematic review explored whether self-management interventions improve patient activation in long-term conditions, and if any improvements are greater than the amount of change experienced by patients in usual care or active control conditions. It also aimed to determine if positive effects on activation are maintained at follow-up. The empirical study sought to explore relationships between patient activation, psychological factors (depression and valued living), perceived clinician empathy, perceived symptom severity, self-management and demographic variables. It also examined whether depression, valued living and perceived clinician empathy are unique predictors of activation, and if activation is a unique predictor of self-management for MS, when relevant confounding variables are controlled for. Methods: For the systematic review, a comprehensive search of multiple electronic databases was conducted to identify intervention research reporting on patient activation outcomes, as measured by the short-form Patient Activation Measure (PAM-13), in people with long-term conditions. For the empirical study, a cross-sectional survey of 118 people with MS explored patient activation, MS symptom severity, valued living, depression, perceived clinician empathy, self-management for MS and demographic factors. Correlation and hierarchical regression analyses were employed to explore relationships between variables. Results: Twenty-five studies were eligible for inclusion in the systematic review, reporting a wide range of long-term conditions. Twenty-one studies (10 RCTs; 1 non-randomised study; and 10 uncontrolled studies) found an improvement in patient activation at post-intervention. Nine studies reported a significantly greater improvement in activation in self-management conditions compared with usual care or an active control at post-intervention. In six out of eight studies, gains in patient activation were maintained in the intervention group at follow-up. However, in four of these six studies, patient activation in the control group also improved over time. Findings from the empirical study suggested that only valued living was a significant predictor of patient activation after controlling for demographic variables and MS symptom severity. Neither depression nor perceived clinician empathy significantly predicted activation. After controlling for valued living, depression and perceived clinician empathy, patient activation independently predicted 5.5% of variance in self-management for MS. Both activation and perceived clinician empathy were significant predictors of self-management for MS. Conclusions: Self-management interventions improve patient activation in long-term conditions compared with usual care or active control. Patient activation gains appear to be maintained longer-term; however, the impact of self-management interventions on activation is unclear due to increases in activation in control groups over time. Valued living is associated with patient activation in MS, while patient activation and perceived clinician empathy are associated with MS self-management. Self-management interventions targeting valued living and the patient-clinician relationship may be effective for addressing low levels of activation in some patients with MS.

Thesis (M.H.A.)--University of Michigan, 1964.

Thesis (M.H.A.)--University of Michigan, 1964.

L'existence de mécanismes juridiques de protection de la vie privée en droit commun est irréfutable. Ceux dont le patient peut se prévaloir à l'occasion de la relation de soin demeurent nébuleux. La spécificité de cette relation, et des atteintes physiques et morales à la vie privée qui y sont consommées - regard, le toucher, nudité et échange d’informations privées - justifient un encadrement spécial et des protections spécifiques, existantes - mais à repenser - pour accompagner les enjeux posés par l'évolution et la modification de la relation de soin. L'émergence de nouveaux acteurs en santé, aux aspirations propres, modifie incontestablement l'objectif et les conséquences de cette relation. La donnée de santé, composante sous-estimée de la vie privée, en ce qu'elle ne transite plus uniquement du patient vers le professionnel de santé - et inversement - doit être encadrée, tant les enjeux économiques et politiques qui y sont afférents sont importants. La "valeur" de la vie privée doit être recentrée, à l’heure où la consommation, l’échange instantané d’informations et la publicité semblent avoir pris le pas sur elle. / The existence of legal mechanisms for the protection of privacy under common law is irrefutable. Those that the patient can claim during the care relationship remain unclear. The specific nature of this relationship, and the physical and moral impairments to privacy that are consumed in it - look, touch, nudity and the exchange of private information - justify a special framework and specific protections, existing but repensable, for accompany the stakes posed by the evolution and the modification of the care relationship. The emergence of new actors in health, with their own aspirations, undoubtedly modifies the objective and consequences of this relationship. Health data, an underestimated component of privacy, in that it n° longer passes only from the patient to the healthcare professional - and vice versa - must be framed, both the economic and political stakes associated with it . The "value" of privacy must be refocused, at a time when consumption, instantaneous exchange of information and “publicy” seem to have taken precedence over it.

The theoretical part of the diploma thesis explains terms as management, managers, managerial roles, process, costing method, process management, process analysis and its tools. In the practical part a chosen in-patient department and its surgical department are characterized. The general and the supportive processes are mapped and analyzed. In conclusion both economical and medical aspects of appendectomy carried out in classical and laparoscopic way are compared.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:08:35Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RoselainedosSantosFelix.pdf: 4923751 bytes, checksum: 97b12f80a780930245d6dbccffe6b309 (MD5) / Made available in DSpace on 2018-08-22T13:08:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RoselainedosSantosFelix.pdf: 4923751 bytes, checksum: 97b12f80a780930245d6dbccffe6b309 (MD5) Previous issue date: 2017-05-22 / In the effort to improve, the quality of health care with emphasis on patient safety and organizational culture assessments many efforts have been put forth worldwide. One of the groups to be investigated consists of the same maternal and childcare that for the sake of make part of a special population, which requires a general and specific care, with the necessity for a multi-professional team action. Therefore, this study had the objective to evaluate the safety culture of the patient in a maternity ward from the perspective of the users and from the multi-professional team. For this purpose, a cross-sectional study was carried out in which data gathering occurred between the months of May and June 2016 at the maternity hospital of a large teaching hospital in the interior of the Rio Grande do Sul state, Brazil. The sample was consisted of 352 users (101 pregnant women and 251 postpartum women) and 62 staff members (25 nursing assistants and technicians, 15 residents, 14 nurses and 8 other professionals). A questionnaire previously validated with socio-demographic, both clinical and patient safety already used with the users and the Brazilian version of the Survey Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality for professionals were the instruments utilized. All the work made in the elaboration of this essay followed all ethical aspects involving research with human beings. The data was analyzed through descriptive statistics (in absolute and relative frequencies) and also inferential, in which the chi-square test was applied to verify the associations between the patient's safety level, the events reported and the socio-demographic and clinical data that possessed the International goals of patient safety, respectively, in the category of health professionals and its users. It was considered a level of significance of α<0,05. The perception results of users about patient safety showed that the majority (60%) of the users were unaware of the issue, could not identify the risks related to care (82%), were satisfied with care (95%) and made suggestions in two categories: working processes (75%) and structure (10%). Among the associations performed, there was an association between age with the goal 4 of the correct procedures (p=0.03), number of pregnancies with the goals 2 of communication (p=0.03) and 3 related to medicine (p=0.01), type of delivery and Goal 2 (p=0.00), number of medical appointments and goal 1 of the correct identification of patients (p=0.01). With the basis on the evaluations of the dimensions from the instrument used with the professionals, no areas of positive force were identified, although organizational learning and continuous improvement; as well as expectations and actions of supervisors; openness to communication were located in the neutral area, and the others presented potential for improvement, with lower scores for management support dimensions and non-punishing responses to errors. The health team evaluated the degree of safety of the patient in the maternity ward as average (59.7%) and presented 15 suggestions to strengthen the safety culture of the patient in the maternity ward. The results suggest that users and health professionals identified week points of the patient safety culture in the maternity ward. To improve this scenario, some products were elaborated among those a folder and a Manual for the safety of the patient in the maternity ward with orientations for patients, relatives, companions and professionals. There are the necessity of changes to strengthen this culture and those are urgent and a priority, integrating a diversity of organizational actions that compromise managers, professionals and users in the promotion of a safe maternity ward. / Muitos esforços têm sido desenvolvidos em âmbito mundial para melhorar a qualidade da assistência à saúde com ênfase na segurança do paciente e em avaliações da cultura organizacional. Um dos grupos a serem investigados compreende o da atenção materno-infantil, por constituir uma população especial, que exige cuidados gerais e específicos, com a necessidade de uma atuação multiprofissional. Portanto, o presente estudo teve como objetivo avaliar a cultura de segurança do paciente em uma maternidade na perspectiva das usuárias e da equipe multiprofissional. Para isso, foi realizado um estudo transversal, com a coleta dos dados entre os meses de maio e junho de 2016, na maternidade de um hospital de ensino, de grande porte, do interior do estado do Rio Grande do Sul, Brasil. A amostra foi composta por 352 usuárias (101 gestantes e 251 puérperas) e 62 profissionais da equipe (25 auxiliares e técnicos de enfermagem, 15 residentes, 14 enfermeiros e, 8 outros profissionais de nível superior). Os instrumentos utilizados foram um questionário previamente validado com dados sociodemográficos, clínicos e de segurança do paciente utilizado com as usuárias e a versão brasileira do questionário Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality para os profissionais. O trabalho seguiu todos os aspectos éticos envolvendo pesquisa com seres humanos. Os dados foram analisados por meio de estatística descritiva (frequências absolutas e relativas) e inferencial, na qual o teste qui-quadrado foi aplicado para verificar as associações entre o grau de segurança do paciente, os eventos notificados e os dados sociodemográficos e clínicos com as metas internacionais de segurança do paciente, respectivamente, na categoria dos profissionais de saúde e usuárias. Considerou-se um nível de significância de α<0,05. Os resultados da percepção das usuárias sobre segurança do paciente apontaram que a maioria (60%) das usuárias desconhece o tema, não conseguem identificar os riscos relacionados à assistência (82%), estão satisfeitas com o atendimento (95%) e, realizaram sugestões em duas categorias: processos de trabalho (75%) e estrutura (10%). Dentre as associações realizadas, houve associação entre idade com a meta 4 dos procedimentos corretos (p=0,03), número de gestações com a meta 2 da comunicação (p=0,03) e 3 sobre medicamentos (p=0,01), tipo de parto e a meta 2 (p=0,00), número de consultas e a meta 1 da identificação correta dos pacientes (p=0,01). Com base nas avaliações das dimensões do instrumento utilizado com os profissionais não foram identificadas áreas de força positiva, mas o aprendizado organizacional e melhoria contínua; expectativa e ações dos supervisores e; abertura para comunicação localizaram-se na área neutra, sendo que as demais apresentaram potencial de melhoria, com menores escores para as dimensões apoio da gestão e respostas não punitivas aos erros. A equipe de saúde avaliou o grau de segurança do paciente na maternidade como regular (59,7%) e apresentou 15 sugestões para fortalecer a cultura de segurança do paciente na maternidade. Os resultados sugerem que usuárias e profissionais identificaram fragilidades da cultura de segurança do paciente na maternidade. Para melhorar este cenário, os produtos elaborados foram um folder e um Manual para a segurança do paciente na maternidade com orientações para pacientes, familiares, acompanhantes e profissionais. Mudanças para fortalecer esta cultura são inadiáveis e prioritárias, integrando uma diversidade de ações organizacionais que comprometam gestores, profissionais e usuárias na promoção da maternidade segura. Palavras-chave: Cultura