Made available in DSpace on 2014-06-11T19:28:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-04-02Bitstream added on 2014-06-13T20:58:53Z : No. of bitstreams: 1 moraes_app_me_bauru_prot.pdf: 1194953 bytes, checksum: 699451576632c3ffd7acc0acbfbd0d2d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O trabalho em hospitais tem caracterísicas particulares e abrange várias situações-limite que acabam influenciando no bem-estar da própria equipe de saúde, podendo gerar stress e adoecimento. Dessa forma, a pesquisa teve como objetivo principal identificar e descrever situações estressoras e estratégias de enfrentamento relacionadas à atuação profissional e sua relação com sintomas físicos e psicológicos decorrentes do stress. Participaram da pesquisa sessenta profissionais que atuam na áera da saúde, sendo eles psicológicos, enfermeiros e assistentes sociais. A coleta de dados foi realizada em cinco hospitais gerais do interior do estado de São Paulo. Os instrumentos utilizados para a coleta de dados foram o ISSL, e a versão adaptada para o português do Inventário de Estratégias de Coping de Folkman e Lezarus. Os resultados obtidos apontaram a presença de stress em 51,6% dos profissionais da amostra e prevalência de sintomas psicológicos do stress (46,7%). A estratégia de enfrentamento mais utilizada pelos profissionais das três profissões foi a de resolução de problemas e as menos utilizadas a de confronto e afastamento. A maioria dos profissionais apontou com situação estressora no local de trabalho a Comunicação e Relacionamento entre a equipe e outros profissionais, seguida de Problemas institucionais. Portanto, além da necessidade de um treino de controle de stress, nota-se a importância de programas que visem desenvolver habilidades sociais relacionadas à comunicação e competências de relacionamento interpessoal. Enfrentar de maneira adequada situações estressoras poderá impedir com que esta perdure enquanto durar o trabalho / The work in hospitals has particular features and covers many extreme situations that influence the well-being of the care team, and may cause stress and illness. Thus, this research aimed to identify and describe stressful situations and coping strategies related to professional practice and its relationship to physical and psychological symptoms resulting from stress. The participants were sixty professionals working in health area, like psychologists, nurses and social workers. The data was collected in five general hispitals in the state of São Paulo. The instruments used for data collection were the ISSL and adapted to Portuguese version of the coping strategies inventory of folkman and Lazarus. The results indicated the presence of stress in 51,6% of the professionals of the sample and the prevalence of psychological symptoms of stress (46.7%). The coping strategy most used by professionals of the three professions was the problem-solving and the less used was confront. Most professionals mentioned as stressful at work Communication and Relationship between staff and other professionals, followed by Institutional Problems. Therefore, besides the need for a stress management training, we note the importance of programs designed to develop social skills related to communication and interpersonal relationship skills. Cope adequately with stressful situations may prevent that it remain for the duration of the work

<p> The topic of the study was burnout amongst volunteer emergency service personnel in a Northeastern state. An understanding of the role burnout plays in emergency service professionals exists in the literature; however, the current research expanded the understanding by focusing on volunteers. Years of experience and resilience were studied to determine if a relationship exists with burnout. Data analysis consisted of multiple regression analyses conducted for each subscale of the Maslach Burnout Inventory &ndash; Human Services Survey (emotional exhaustion, depersonalization, and personal achievement) (Maslach, Jackson &amp; Leiter, 1996). Results concluded that resilience, as measured by the Resilience Scale (Wagnild &amp; Young, 1993), was found to be statistically significant in its ability to predict emotional exhaustion and personal achievement, at the p &lt; .05 significance level. Resilience significantly predicted emotional exhaustion subscale scores of the Maslach Burnout Inventory &ndash; Human Services Survey, &beta;= -.25, <i>t</i>(82) = -4.36, <i>p</i> &lt; .001. Resilience and length of service when considered together also explained a significant proportion of variance in emotional exhaustion scores <i>R</i>² = .92, <i> F</i>(2,82) = 9.65, <i>p</i> &lt; .001. Resilience significantly predicted the personal accomplishment subscale, &beta; = .21, <i>t</i>(82) = 5.19 <i>p</i> &lt; .001. Resilience and length of service when considered together also explained a significant portion of the variance in personal exhaustion scores, <i>R</i>² = .25, <i> F</i>(2,82) = 13.91, <i>p</i> &lt; .001. Results concluded that resilience was not a statistically significant predictor of the depersonalization subscale; &beta; = - .07, <i>t</i>(82) = -1.72, <i>p</i> = .090. Length of service was not considered to be a statistically significant predictor for the subscales (emotional exhaustion, depersonalization, and personal achievement) at the .05 alpha level. Resilience and length of service when considered together did not explain a significant portion of the variance in depersonalization scores; <i>R</i>² = .04, <i> F</i>(2, 82) =1.90, <i>p</i>=.157. The regression analysis demonstrated that there was a low correlation between predictor variables of resilience, as measured by The Resilience Scale and length of service, <i> r</i> = .123. A stepwise regression analysis was also conducted and confirmed that the predictor variable of resilience held a greater control over the outcome variables in each regression analysis with a significant outcome. Study implications centered around a recognition that volunteer emergency service personnel can be affected by the work they perform in many similar ways as their paid counterparts. Further research is recommended to increase understanding of the relationship that other demographics and factors may play in the depletion of resilience and development of burnout in related professionals.</p><p>

This was an investigation into the relationship between quality of care and staff views of, and responses to, challenging behaviour in adults with learning disabilities. Cognitive representations have been identified as a determinant of therapeutic outcomes in a variety of health care settings. There were two main aims of this study. First, to describe and measure the cognitive representations of challenging behaviour among staff working with adults with learning disabilities and second, to evaluate the effects of training on these views held by staff. Existing literature was reviewed. A Likert type questionnaire, the Challenging Behaviour Representation Questionnaire (CBRQ) was developed to record staff views. The CBRQ draws on two existing measures: the Illness Perception Questionnaire (IPQ) and the Challenging Behaviour Attributions Scale (CHABA). The CBRQ will give a new method of evaluating the staff views most often associated with evidence-based practice, helping behaviours and positive outcomes. Questionnaire items were generated from responses by 300 staff, to assess the applicability of Leventhal's Self Regulatory model in the context of challenging behaviour. The rating scales in the questionnaire were theoretically derived, based on the dimensions of Leventhal's model (identity, cause, consequences, treatment/control, time-line). An 'emotional-reaction' dimension was added, suggested by more recent research. The use of the Leventhal model was supported, with the exception of the 'time line' component. The questionnaire was tested for reliability and validity then administered before and after training to staff in three different groups. Targeted training changed cognitive representation of challenging behaviour overall, as measured by the CBRQ, and this change was statistically significantly in two of the five dimensions for the experimental group. Other results suggest that dimensions of cognitive representation are affected in different and complex ways by training. The statistical and the practical significance of the results are discussed in relation to staff training and therapeutic outcomes for people with learning disabilities. A 'staff-regulatory' model of cognitive representation is proposed linking cognitive representation and challenging behaviour.

Orientador: Tania Gracy Martins do Valle / Banca: Maria Cristina de Oliveira Santos Myazaki / Banca: Carmen Maria Bueno Neme / Resumo: O trabalho em hospitais tem caracterísicas particulares e abrange várias situações-limite que acabam influenciando no bem-estar da própria equipe de saúde, podendo gerar stress e adoecimento. Dessa forma, a pesquisa teve como objetivo principal identificar e descrever situações estressoras e estratégias de enfrentamento relacionadas à atuação profissional e sua relação com sintomas físicos e psicológicos decorrentes do stress. Participaram da pesquisa sessenta profissionais que atuam na áera da saúde, sendo eles psicológicos, enfermeiros e assistentes sociais. A coleta de dados foi realizada em cinco hospitais gerais do interior do estado de São Paulo. Os instrumentos utilizados para a coleta de dados foram o ISSL, e a versão adaptada para o português do Inventário de Estratégias de Coping de Folkman e Lezarus. Os resultados obtidos apontaram a presença de stress em 51,6% dos profissionais da amostra e prevalência de sintomas psicológicos do stress (46,7%). A estratégia de enfrentamento mais utilizada pelos profissionais das três profissões foi a de resolução de problemas e as menos utilizadas a de confronto e afastamento. A maioria dos profissionais apontou com situação estressora no local de trabalho a "Comunicação e Relacionamento entre a equipe e outros profissionais", seguida de "Problemas institucionais". Portanto, além da necessidade de um treino de controle de stress, nota-se a importância de programas que visem desenvolver habilidades sociais relacionadas à comunicação e competências de relacionamento interpessoal. Enfrentar de maneira adequada situações estressoras poderá impedir com que esta perdure enquanto durar o trabalho / Abstract: The work in hospitals has particular features and covers many extreme situations that influence the well-being of the care team, and may cause stress and illness. Thus, this research aimed to identify and describe stressful situations and coping strategies related to professional practice and its relationship to physical and psychological symptoms resulting from stress. The participants were sixty professionals working in health area, like psychologists, nurses and social workers. The data was collected in five general hispitals in the state of São Paulo. The instruments used for data collection were the ISSL and adapted to Portuguese version of the coping strategies inventory of folkman and Lazarus. The results indicated the presence of stress in 51,6% of the professionals of the sample and the prevalence of psychological symptoms of stress (46.7%). The coping strategy most used by professionals of the three professions was the problem-solving and the less used was confront. Most professionals mentioned as stressful at work "Communication and Relationship between staff and other professionals," followed by "Institutional Problems". Therefore, besides the need for a stress management training, we note the importance of programs designed to develop social skills related to communication and interpersonal relationship skills. Cope adequately with stressful situations may prevent that it remain for the duration of the work / Mestre

<p> With many organizations facing the challenge of helping their employees prepare for change, it is important to identify the psychological constructs of employees that positively relate to their readiness for organizational change. The purpose of this quantitative, correlational study was to assess the relationships between psychological capital and its four dimensions (self-efficacy, hope, optimism, and resilience) and readiness for organizational change among behavioral health professionals in one behavioral health organization in the southwestern United States. The theoretical foundation of the study was provided by the psychological capital theory and the readiness for organizational change theory. The researcher collected primary data via online survey from a convenience sample of 101 behavioral health professionals using the CPC-12 and Readiness for Organizational Change Measure (ROCM) instruments. The results of the nonparametric Kendall&rsquo;s tau-b correlation analysis identified statistically significant positive low to medium level correlations of readiness for organizational change with self-efficacy (&tau;<i>_b</i> = .217, <i> p</i> = .003), hope (&tau;<i>_b</i> = .355, <i> p</i> &lt; .001), and resilience (&tau;<i>_b</i> = .236, <i>p</i> = .001). Additional analysis showed a significant correlation between the compound construct of psychological capital and readiness for organizational change (&tau;<i>_b</i> = .271, <i> p</i> &lt; .001). The findings of this study are important to behavioral health and organizational change leadership interested in increasing employee readiness for organizational change through interventions aimed at enhancing employee&rsquo;s psychological capital and providing for their psychological well-being.</p><p>

The historical roots of traditional and modem Western medicine have been the same, but during the past century these systems have diverged modem medicine has became dominant, replacing traditional systems in much of the world and denigrating them as quackery. In recent years there has been a resurgence of interest in traditional systems, with a remarkable change in attitude among health care professionals in many parts of the world. There is an increasing emphasis upon the importance of health care providers familiarizing themselves with specific culture-bound syndromes and their manifestations, in order to provide quality care to culturally diverse clients seeking health care services. Thus, there is a need for a complementary relationship between traditional healing practices and modem medicine in the world, reflecting the importance of respect for cultural diversity in health planning. The research problem assumes a relation between three distinctive dimensions of reality, namely, the industrial mentality, culture, and education. These dimensions will be discussed - according to the relation-axes model introduced by Wielemans and Chan (1992:19), which investigates the complexity of relationships between man and himself, man and fellowmen, man and nature, and man and the transcendental. In Kuwait the traditional healing practices will be examined according to Islamic medicine and its contribution to health care. A comparison of modem and Islamic medicine is formulated and recommendations are made for the training health care professionals in Kuwait. / Educational Studies / D. Ed. (Comparative Education)

This critical realist thesis seeks to understand how student, graduate and professional identities emerge in Emergency Medical Science (EMS) students at a South African University of Technology (UoT) as well as in professional paramedics in the Emergency Medical Care Services (EMCS). It further considers the construct of graduate attributes (GAs) and its relationship to emergence of identity and influence on curriculum design. The research design is that of a case study. The theoretical framework is critical realism whose depth ontology posits three domains of reality. Causal powers and generative mechanisms exist in the Real domain which cause events or phenomena to emerge in the Actual domain that are experienced in the Empirical domain. Using retroduction one may come to explore some of the causes for the event. Using Bhaskar’s concepts of identity, the self, absence and emergence, ontology and four-planar social being, a Bhaskarian explanatory framework of identity to explore the emergence of identity has been created. In exploring graduate attributes, a critical realist question is posed: “What must the world be like for GAs to exist” to explore the possibilities of the existence of GAs. It was found that student identity emerges diachronically in three moments, while professional paramedic identity starts to emerge during the third year of study mainly through the structure, culture and agency of workplace-based learning. In answer to the critical realist question it was found that GAs emerge from the neoliberalist commodification of universities. In seeking an alternative to GAs, traits and attitudes were explored. It was found that these emerge from curriculum, interplay of departmental structure, culture and agency of and from students’ being which makes them ontologically radically different from GAs. This study concludes that student, graduate and professional identities emerge from a person’s core constellational identity diachronically within four-planar social being and the interplay of structure, culture and agency. GAs cannot be related to the emergence of identity and curriculum design because of their ontology; however, if traits and attitudes are substituted for GAs, a close relationship does exist between emergence of identity, traits and attitudes and curriculum design.

Healthcare is the main contributor to the well-being of the population and the country. Healthcare services ensure that the country has a healthy and productive workforce which influences economic growth. Self-employed healthcare practitioners are key role players in the healthcare system in South Africa. However they are faced with several challenges that affect their relationship with their employees and the service offered in their practises. A lack of leadership skills, professionalism, budget constraints, corruption, increased legislation, medical negligence, poor human resources and poor management are mentioned in this study as part of the challenges facing self-employed healthcare practitioners. Against this background, the primary objective of this study was to establish the level of Servant and Ethical leadership displayed by self-employed healthcare practitioners in both the Eastern Cape and Western Cape, and to investigate whether the dimensions of these leadership styles influence Job satisfaction and Perceived financial performance. In this study a quantitative approach was adopted. A form of purposive sampling called criterion sampling was used to draw the sample for this study. The sample consisted of self-employed healthcare practitioners and their employees in the Eastern and Western Cape Provinces. The survey methodology was implemented using self-administered structured questionnaires. A total of 241 questionnaires were deemed usable, and were subjected to statistical analysis. Factor analysis was used to assess the validity of the independent (dimensions of Servant and Ethical leadership) and dependent variables (Job satisfaction and Perceived financial performance). More specifically, factor analysis was utilised to conduct tests of uni-dimensionality and principal components were used as the extraction method to produce an unrotated factor matrix. Concerning validity assessments, only factors with two or more items loading on them were included for further analysis. Items that did not load were discarded and were subsequently excluded from further statistical analysis. In this study, four items intended to measure Job satisfaction all loaded together as expected. Of the six items intended to measure Perceived financial performance, five items loaded together. Only one item did not load onto this factor and was excluded from further analysis. The items measuring the dimensions of Servant leadership, namely Humility, Servanthood, Caring for others and Developing others, loaded onto the respective factors as expected. All items measuring the dimensions of Ethical leadership, namely Integrity, Ethical commitment, Ethical guidance, Fairness and Sustainability, also loaded as expected. The Cronbach‟s alpha coefficients for all variables were greater than 0.7 which provided sufficient evidence of reliability of the scales. Statistical techniques used to analyse the empirical data, which included the descriptive statistics, Pearson product moment correlations and multiple regression (MRA). T-tests were explained as the method used to determine whether significant differences existed in the mean scores of self-employed healthcare practitioners and their employees for the leadership styles (Servant and Ethical leadership) under investigation. The results of the study show that for the dimensions of Servant leadership, both the healthcare practitioners and their employees returned the highest mean for Caring for others. The majority of self-employed healthcare practitioners agreed that they adopted these dimensions. The majority of employees also agreed that the self-employed healthcare practitioners use these dimensions. Statistically significant differences were found in terms of the mean scores returned for the level of Humility and Caring for others displayed by the self-employed healthcare practitioners. No significant differences were found between the mean scores returned for Servanthood and Developing others for the two sample groups. A significant difference was reported for mean scores returned for the levels of Integrity, Ethical commitment, Ethical guidance, and Fairness. No, significant difference was reported for Sustainability for the two sample groups. The multiple regression analysis (MRA) shows that the dimensions of Servant leadership Developing others and Caring for others had a significant positive influence on Job satisfaction. The MRA results also show a significant positive influence between Fairness, Ethical guidance and Ethical commitment and Job satisfaction. Based on the findings of the study several recommendations were put forward to ensure a Servant and Ethical behaviour among self-employed healthcare practitioners.

Social health insurance is a form of health care financing that has gained increased attention in African countries in the past decade. Tanzania introduced social health insurance by the establishment of the National Health Insurance Fund (NHIF) in 1999 with, inter alia, the objective of improvement of the quality and availability of health services. The goal of this study was to determine the perceptions of services providers on the quality and accessibility of health services following the introduction of social health insurance. A qualitative approach was used to gain an insider's perspective from the service providers of how the services have changed following the introduction of the scheme. Individual interviews, observation and field notes were used to gather information on the quality and accessibility of health services under the policy of social health insurance. Data were analysed using Tesch's method of data analysis. The health workers generally perceived the fund as being beneficial to its members as it reduced the financial barriers to receiving health care. However, the objectives of the NHIF as a health financing mechanism were not adequately understood by the health workers. Although they perceived the quality of health services as having improved compared to previous years, they did not associate this improvement with the NHIF. The health workers also perceived accessibility of health services as having improved for insured patients but not for non-insured patients.

Many midwives throughout the world experienced high stress levels when they deal with emergency childbirths. Midwifery professionals experience certain unique stressors, such as midwives being responsible for the care of women when they are giving birth. Complications of childbirth may occur during labour leading to the life of the baby and the mother being threatened. Situations such as this leave midwives experiencing high levels of stress for which they often do not have effective coping mechanisms. When the stress is not managed, it may lead to burnout. When burnout occurs the midwives present with physical and psychological symptoms of stress, grief for the loss and lack of motivation, which results in staff turnover and a fear of working in a maternity ward. Consequently, patient care may be compromised as some midwives became apathetic and develop unacceptable attitudes toward their patients. Such behavior led to poor work performances, maternity services that are not woman-friendly and women seeing the maternity ward as a place where they are treated in rude and unfriendly manner which increased the chances of adverse childbirth outcomes. The aim of the study was to explore and describe the experiences of midwives who have to cope with stress associated with emergency childbirths. This information was used to develop the guidelines to help midwives to cope with the high stress associated with emergency childbirths. The researcher used a phenomenological, qualitative approach. The study was explorative, as little was known on this topic in the Namibian context and it was also descriptive and contextual. Purposive and convenient sampling was used to select the research sample. The research population was all the midwives working in the maternity ward of a Namibian regional hospital, who met the inclusion criteria. Data gathering was done using semi-structured interviews. Once data saturation occurred, interviewing stopped. The interviews were audio-taped and transcribed verbatim. Tesch’s eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. Literature control was done after data collection to support and strengthen the study’s findings. Trustworthiness, as suggested by using Lincoln & Guba’s model of trustworthiness, included truth-value/credibility, applicability/transferability, consistency/dependability and neutrality/conformability was implemented. Ethical principles of beneficence, non-maleficence, autonomy and justice were ensured by obtaining permission to conduct the research from relevant authorities and from University structures, obtaining consent from the participants before the interviews, voluntary participation and right to withdraw from the study, privacy, confidentiality and dissemination of the results. Three main themes and sub-themes were identified namely: Midwives experienced significant stressors associated with emergency childbirth situations. Midwives experienced mixed emotions about dealing with emergency childbirth situations Midwives shared their views regarding their support needs associated with emergency childbirth situations. Recommendations for nursing education, clinical midwifery and for further research were made. Four guidelines were developed based on the study findings as well as literature related to these findings, to help the midwives to cope with high stress levels associated with emergency childbirths.