Bakgrund: Sjuksköterskan i ambulansen har ett brett arbetsfält med stor variation på arbetsuppgifter. Sjuksköterskor inom prehospital vård utsätts för stress i sin arbetssituation. Vid obalans mellan arbetsförmågan och arbetsbelastningen kan stressen leda till ohälsa. Ohälsan kan leda till psykiska besvär som sömnstörningar och depression samt kan det leda till fysiska sjukdomar som hjärt- och kärlsjukdomar. Syfte: Att beskriva sjuksköterskor erfarenhet av stress vid prehospital vård. Metod: Den valda metoden för studien är en kvalitativ litteraturstudie med induktiv ansats. Resultat: Åtta artiklar ingick i resultatet. Sjuksköterskor inom den prehospitala vården upplever stress. Faktorer som utlöser stress är tidsbrist, bristande kunskap och erfarenhet av hot och våld, förlossningar, svårt sjuka eller skadade barn är stressutlösande faktorer. Resultatet visar på vikten av stöd i form av formellt stöd men också stöd av kollegor. Sjuksköterskor använder strategier för att hantera upplevd stress i sitt arbete. Konklusion: Stress ses som komplext och individuellt. Stressfaktorer kan bland annat vara svårt sjuka patienter, vård av barn, tidsbrist, bristande erfarenhet, förlossningar samt hot och våld. Genom denna uppsats skulle en ökad medvetenhet kunna leda till en godare upplevd hälsa och förebyggande av ohälsa för sjuksköterskor inom prehospital vård. / Background: The nurses in the ambulance has a wide field of work with a great variety of tasks. Nurses in pre-hospital healthcare are exposed to stress in their work situation. When there is an imbalance between the ability to work and the workload, this can lead to illness. This illnes can lead to psychological problems such as sleep disorders and depression, and it can lead to physical diseases such as cardiovascular diseases. Aim: To describe nurses' experience of stress in prehospital care. Method: The chosen method for the study is a qualitative literature study with an inductive approach. Findings: Eight articles were included in the result. Nurses in prehospital healthcare experience stress. Factors that trigger stress are lack of time, lack of knowledge and experience, threats and violence, caring for childbirth or seriously ill or injured children are stress-triggering factors. The result shows the importance of support in the form of formal support from the employer but also support from colleagues. Nurses use strategies to manage stress in their work. Conclusion: Stress is seen as complex and individual. Stress factors can include seriously ill patients, caring for children, lack of time, lack of experience, childbirth and threats and violence. Through this essay, an increased awareness could lead to a better perceived health and prevention of ill-health for nurses in pre-hospital care

This descriptive study examined the nursing and health care activities of Mormon women in the pre-depression period of 1914 through 1930 through analysis of the official voice of the Relief Society, the Relief Society Magazine. Entries from the Relief Society Magazine that dealt with any nursing or health care topic were coded according to the themes they addressed. Five themes emerged: Nursing, faith, healing, women's health, children's health, and public health.In each of the themes, the Relief Society Magazine showed that the members of the Relief Society recognized the health care problems of their communities and claimed responsibility for addressing those challenges. Mormon women developed programs and cooperated with existing government and private organizations to achieve their health care goals. The existence of the Relief Society Magazine gave Mormon women a vehicle for communicating their nursing and health care plans, goals, and successes with each other and provided an instrument for exploring the nursing and health work of Mormon women in the 1914 to 1930 period.

This is the history of those noble women who came into the territory, struggling to relieve the burden of poor medical service. This is an account of how well or how poorly they conducted the art of midwifery. From the first year the pioneers entered the region in 1847, down to 1896 when statehood was achieved, though there were male physicians in the field of medicine, Utah depended on its women. This is a study of their contribution.

The purpose of this research paper was to conduct a hospital management survey of the administration of medical services for prison inmates within the Texas Prison system. This type of survey has not been conducted within the medical services of the Texas Prison System in the past by any individual, or public or private group. Specific purposes were to appraise certain major areas in this system, to compare these findings with authoritative survey criteria, and to make recommendations based on the findings of the investigation.

This Applied Research Project (ARP) utilized qualitative research, specifically hermeneutic phenomenology, to investigate the vital roles of chaplains in healthcare during the COVID-19 pandemic. Chaplains played a significant role in providing spiritual care to patients, their families, and staff during the pandemic. Since there were limited studies about the role of chaplains during the pandemic, this research project adds to the knowledge and resources of what is known about the role of chaplains amid the pandemic. In this qualitative study, I convened and interviewed five Board Certified Chaplains (BCC) to identify their role during the height of the COVID-19 pandemic. This research shows the different roles of chaplains, the interventions they used, the challenges they experienced, and the changes in their roles because of the pandemic. The result of this study tells us that the chaplain's role did not change; chaplains continue to provide spiritual care. What changed was the implementation of the care they provided and the shifting of their priorities.

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care facilities. A cross-sectional study was conducted by using two main datasets, including Thailand's national HIV care performance results and an online survey of all public hospitals nationwide. A total of 382 hospitals responded to the survey, accounting for a response rate of 50%. A confirmatory factor analysis (CFA) method was performed to examine the validity of latent constructs developed from the diffusion of innovation theory. Structural equation modeling (SEM) approach was employed to investigate the relationship between the determinants of organizational decision-making and their contribution to organizational outcomes, under the context-design-performance framework. Furthermore, using a panel model of hospitals that reported performance results across a 3-year period, the improvement in HIV ambulatory services performance among the adopters was examined. The results indicated that two innovation attributes--relative advantage and simplicity perceived by HIV care practitioners in hospitals--were found to be positively associated with the level of the HIVQUAL-T model implementation. Two structural characteristics--interconnectedness and organizational slack--appeared to be positively associated with the level of model implementation, while rate of adoption in the region also had significant positive contribution. Ultimately, the extensiveness of the HIVQUAL-T model implementation demonstrated a proportionate impact on the variation in hospitals' HIV ambulatory services performance. It was noted that the implementers considerably improved their performance within two years of implementing the model. The study findings imply that adoption is more likely when individual practitioners assess the innovation and find it to be easy to comprehend and operate and also worthwhile to implement. Furthermore, hospitals' decision making is likely influenced by their relations to external environment. The findings suggest more emphasis on individual and hospital-level capacity building for meaningful use of this quality management initiative, accompanied by an adjustment of performance measurement software with valid, reliable, and interpretable indicators.

Patient safety climate is defined as a holistic snapshot of enacted work environment practices and procedures related to patient safety, derived from shared perceptions of social and environmental work characteristics. While patient safety climate has been touted as a critical factor underlying safe patient care, our understanding of input factors influencing shared climate perceptions and, in turn, the effects of climate as a collective, group-level construct on important outcomes remains underdeveloped, both theoretically and empirically. Therefore, the current study examines (1) the antecedents that impact individual patient safety climate perceptions and (2) the relationships between hospital unit patient safety climate and two important unit level outcomes: patient willingness to recommend a facility to others and patient safety. This study also examines climate strength--the degree to which climate perceptions are shared--as a moderator of these relationships. While climate is conceptualized as a holistic description of the working environment, existing evidence has focused on relationships between the independent dimensions of patient safety climate and patient safety. No study to date has examined the configurations (i.e. patterns or profiles) among the multiple dimensions of patient safety climate or how these configurations are related to important employee and patient outcomes. This gap is redressed in the current study by examining patient safety climate in terms of three profile characteristics: (1) climate elevation (i.e., mean positive or negative valence across all dimensions), (2) climate variability (i.e., variance among dimensions), and (3) climate shape (i.e., the pattern of peaks and valleys among climate dimensions). Evidence from studies of general organizational climate suggests that the shape of the pattern among climate dimensions, the overall mean score across dimensions, and the degree to which dimension scores vary are predictive of employee attitudes, customer satisfaction, and organizational financial performance (Dickson et al., 2006; Joyce & Slocum, 1984; Jackofsky & Slocum, 1988; Gonzalez-Roma, Peiro, & Zornoza, 1999; Litwin & Stringer, 1968; Schulte et al., 2009). The current study, then, tests a theoretical model of patient safety climate examining the configural nature of the construct. An archival dataset collected from seven hospitals located in a metropolitan area of the southeastern United States was utilized to test study hypotheses. Data was collected from 3,149 individuals nested within 84 hospital units using the Hospital Survey on Patient Safety Culture (Sorra & Nieva, 2004). Unit level patient safety and patient willingness to recommend was collected by the hospital risk management and nursing administration departments. Hierarchical linear modeling (HLM7; Raudenbush, Bryk, Cheong, Congdon, & du Toit, 2011) was utilized to test hypotheses regarding antecedents of individual level perceptions of patient safety climate to account for the fact that individuals were nested within hospital units. Traditional multiple regression analyses were utilized to test unit level hypotheses examining the relationships between unit level patient safety climate and patient outcomes. Results indicated that unit membership was significantly related to individual climate perceptions--specifically, individual-level climate profile elevation. In turn, individual climate profile elevation and profile variability were related to employee willingness to recommend their organization to family and friends in need of care. At the unit level of analysis, climate profile variability was significantly related to patient willingness to recommend the organization to others, and climate shape was found to be related to patient safety. Furthermore, these results were not dependent on climate strength. The current study meaningfully contributes to the conceptual understanding of the patient safety climate construct by examining the degree to which configural aspects of the construct are predictive of important outcomes across multiple levels of analysis. In this way, it extends beyond existing studies of climate configurations to examine relationships at multiple levels of analysis and to also examine the moderating effects of climate strength. Practically, results provide insight into how the construct of patient safety climate can be used diagnostically and prescriptively to improve patient care and the working environment for providers. In addition to contributing to the theoretical understanding of the patient safety climate construct, this study also augments the evidence-base available to administrators, front-line providers, and regulators regarding how patient safety climate can be used to guide and align quality improvement efforts for greatest impact.

Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.

The transgender and gender diverse (TGD) patient population consists of a diverse group of people with unique needs who have, unfortunately, been underserved by the medical community. These individuals share a disproportionate burden of discrimination and disease when compared to cisgender persons. However, despite this, they continue to receive inequitable treatment, and transgender health topics still comprise just a small portion of medical education training. While efforts to improve awareness and training regarding transgender health care needs are underway, these take time to gain traction. It also relies heavily on changing medical providers’ own biases. Telemedicine has been proposed as a way to potentially bridge the gap and increase the access and availability of quality, informed medical care to this community. Although telemedicine has demonstrated its ability to do this in other areas of medicine, the existing research on whether it has the capacity to do so for transgender health care delivery is scant. The majority of the existing literature on the topic consists of retrospective qualitative feedback provided during a time where telemedicine was still emerging as a commonplace medium through which medical care is provided. Therefore, this thesis proposes to perform a randomized controlled trial investigating whether instituting a hybrid telemedicine approach has the capability to expand the accessibility of specialty transgender health care services as compared to fully in person medical care while maintaining a high standard of health care quality and patient satisfaction. This study would have the capacity to help inform future health care policy and provide support for continued telemedicine offerings and reimbursement moving forward.

This dissertation investigates the pressing issue of education in cardiac arrest during pregnancy, an emergency of life-threatening significance that necessitates a coordinated response from maternal and neonatal healthcare teams. The study encompasses three primary chapters, each addressing a crucial facet of this intricate scenario. In the chapter titled "Cardiac Arrest in Pregnancy: A Scoping Review on Knowledge and Confidence in a Maternal & Neonatal Response," an extensive examination of existing literature illuminated substantial knowledge gaps in the resuscitation of pregnant individuals, a concern that has persisted for over a decade. These gaps encompass critical domains, including a dearth of high-quality research with a heavy reliance on limited experimental designs, small sample sizes that curtail the generalizability of findings, a lack of comprehensive comparisons among various teaching strategies for enhancing knowledge and confidence, an emphasis on short-term outcomes without adequate longitudinal assessments of knowledge retention and clinical impact, a need for tailored education programs catering to diverse healthcare professionals, and a scarcity of research on collaborative learning experiences, particularly concerning neonatology teams. These identified gaps offer valuable opportunities for future research aimed at fortifying the evidence base, refining educational approaches, and ultimately enhancing the management of cardiac arrest during pregnancy and neonatal resuscitation. This manuscript underscores the pressing need to expand educational initiatives beyond obstetrical units and to foster interdisciplinary collaboration among healthcare teams. The chapter titled, "Escaping PowerPoint: Enhancing Knowledge, Satisfaction, and Self-Confidence in Cardiac Arrest in Pregnancy," introduces an innovative teaching strategy known as the Virtual Escape Room (VER). The randomized controlled study compares the effectiveness of this virtual gamified approach with a traditional online PowerPoint method in improving knowledge acquisition, learner satisfaction, and self-confidence. The findings demonstrate the statistically significant superiority of the VER in enhancing these critical outcomes, highlighting the potential of immersive learning experiences in healthcare education. Notably, the data reveal a substantial increase in mean scores from the knowledge pre-test (M = 59.58, SD = 16.30) to the knowledge post-test (M = 68.24, SD = 17.42), t(64) = 5.635, p < .001 . The assessment tools employed included a knowledge quiz and The National League for Nursing (NLN) Student Satisfaction and Self-Confidence instruments. The chapter titled "Puzzling Out the Correlates of Learner Engagement and Exploring Motivational States within a Virtual Escape Room," delves into the intricate aspects of learner engagement within the gamified learning environment of the VER. It uncovers the relationships between engagement, learner satisfaction, and specific engagement components such as enjoyment, creative thinking, and dominance. This manuscript underscores the multifaceted nature of engagement and highlights the imperative need for further research to achieve a more profound comprehension of its role in shaping learning outcomes. The study employed the Gameful Experience Scale (GAMEX) and the Telic/Paratelic State Measure (TPSI) instrument. Notably, statistically significant positive correlations were observed, including r = 0.346 (p = 0.005) between the Enjoyment Score and knowledge post-test, r = 0.305 (p = 0.013) between the Creative Thinking Score and knowledge post-test, and r = 0.255 (p = 0.04) between the Dominance Score and knowledge post-test. Additionally, a significant interaction effect emerged between the T/PSI score (pre vs. post) and the educational intervention (VER vs. control group). T/PSI score increased from 35.83 (SD = 8.67) before the intervention to 38.86 (SD = 9.91) after the intervention, indicating a substantial change. In contrast, there was no statistically significant difference in T/PSI scores before and after the traditional PowerPoint intervention for the control group, where the mean scores changed from 35.89 (SD = 7.02) to 35.57 (SD = 7.94). These findings strongly suggest that the VER condition contributes to a paratelic state among participants when compared to the control condition. This dissertation underscores the paramount importance of effective education in managing cardiac arrest during pregnancy, given the persistent knowledge gaps among resuscitation teams. The introduction of the VER as an innovative educational strategy represents a significant advancement in addressing these deficits. Furthermore, the exploration of engagement and motivational states within the gamified learning environment offers valuable insights into the complexities of learner engagement, paving the way for more effective educational strategies in healthcare settings. Ultimately, these findings have the potential to empower healthcare teams, potentially reducing maternal mortality rates and improving neonatal outcomes in the face of this critical emergency.