The main purpose of this study was to examine nurses' attitudes toward caring for patients with Acquired Immune Deficiency Syndrome (AIDS). The study also compared the attitudes of nurses who had cared for AIDS patients with the attitudes of nurses who had not cared for AIDS patients. Educational background was also examined to see if education influences attitudes. The Ajzen-Fishbein Model of Reasoned Action was the framework used for this study.A descriptive design was used for the purpose of gaining more information regarding nurses' attitudes toward caring for patients with AIDS. A random sample of all registered nurses in the state of Indiana was used for this study. The data obtained were analyzed using frequency distributions, independent t-tests, and analysis of variance.Nurses in general are sill uncomfortable with caring for AIDS patients. Between 40% and 50% of nurses are fearful of contracting the AIDS virus and fearful of putting their family at risk. On the other hand, approximately the same percentage are comfortable caring for AIDS patients. Furthermore, nurses believe that health care agencies should care for AIDS patients, but believe that nurses should have the right to refuse to care for AIDS patients.Results of this study indicated that educational background does not influence nurses' attitudes toward caring for patients with AIDS. However, as nurses have more experience caring for patients with AIDS, they appear to develop more positive attitudes. / School of Nursing

Purpose: Cardiac rehabilitation (CR) programs have been shown to promote numerous health benefits among patients with cardiovascular disease (CVD), but little is known about the characteristics of CR programs. Methods: A survey was developed and utilized to collect data on Early Outpatient Cardiac Rehabilitation programs (EOCR) in the USA. An email with a link to the survey was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) to their members. Program directors/administrators were recruited to provide information about their program in operation during 2009 in the United States. The CR survey contained 13 questions, some with multiple answers, regarding the utilization and patient demographics of an Early Outpatient Cardiac Rehabilitation (Phase II) program. Results: Responses were received from 138 programs in 44 states. Of the responses, 19,689 patients completed at least one EOCR exercise session. Of the responses, 68% of patients were men and 32% of patients were women. Patients enrolled in EOCR programs had a primary diagnosis of CABG 4,803 (30%); AVR/MVR 1,401(9%); MI 3,583 (22%); PCI/Stent 4,961 (31%); stable angina 965 (6%); heart/lung transplant 53 (0.33%); other 385 (2%). 8.4% complete 0-6 sessions of EOCR; 12% complete 7-12 sessions; 22% complete 13-18 sessions; and 58% complete 19-36 sessions. 35% of patients enrolled in EOCR programs are discharged early. 84% of programs offer an outpatient maintenance CR program. 96% of EOCR programs offer education classes; 89% offer resistance equipment; 72% are AACVPR certified; 62% also offer pulmonary rehabilitation; 23% utilize outcome measurements; 62% are in rural locations; and the average patient-to-staff ratio is 4.2:1. Conclusions: CR programs are used by a minority of eligible patients. There is marked variation in the structure and content of EOCR programs. Alternative strategies to improve standardization and outcomes should be implemented. / School of Physical Education, Sport, and Exercise Science

The purpose of this study was to ascertain the current status of healthcare delivery on American Indian reservations. In particular, the study sought to determine if the Indian Health Service was actually meeting its goals in delivering healthcare to American Indians, and if not, were there alternatives to public medicine for healthcare? The Indian Health Service has not met its own goals in delivering healthcare, and private medicine in the form of private practicing physicians and other medical personnel have filled the void left by the Indian Health Service. The study also discusses the possibility of private medicine being the only realistic alternative in the future for Indian healthcare delivery.

Cancer is devastating. Medical advances have resulted in the ability to diagnose cancer at its earliest stages and increase survivorship. Unfortunately, Black Americans possess a disproportionate cancer burden, with the highest mortality and lowest survival rate of any racial/ethnic group. Lung cancer is the most deadly, yet most treatable cancer. The purpose of this study was to determine the impact that the healthcare education program had on healthcare students’ level of cultural development and awareness of disparities regarding Black Americans and tobacco cessation. In light of the data substantiating that health disparities stem from a combination of racial and ethnic inequities in the access of the healthcare system, healthcare professionals’ low levels of cultural development, and the missed opportunities for promoting Black American tobacco cessation, the following questions were developed to frame the research: Research Question #1: How will the level of healthcare students’ cultural development change as a result of a healthcare education program? This question corresponds to the following hypotheses being tested in this study: Methods to answer this question included evaluation of findings from 1) comparison of pre and post-program Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals – Revised (IAPCC-R) mean scores by degree of study and by gender; and 3) comparison of pre and post-program Tobacco Cessation Assessment (TCA) mean scores by degree of study and by gender. Research Question #2: What is the relationship between cultural competence and increased awareness of disparities regarding Black Americans and tobacco cessation? Methods utilized to answer this question included evaluation of findings from comparison of results of knowledge gains in TCA vs. IAPCC-R mean scores, including using the Pearson’s correlation coefficient to determine existence and strength of the relationship. Findings were 1) level of cultural development increased; 2) awareness of disparities regarding Black Americans and tobacco cessation increased; and 3) weak, but statistically significant relationship between higher level of cultural development and increased awareness of disparities regarding Black Americans and tobacco cessation. This study could serve as a model for future partnerships with researchers, faculty, and healthcare professionals, linking pre-profession preparation with continuing professional education. / Department of Educational Studies

Bakgrund och syfte Inom hälso- och sjukvården har krav på ökad effektivitet, tillgänglighet och höjd kvalitet, samt en minskad ekonomisk ram, krävt förändringar i hälso- och sjukvårdssystemet. Ett syfte med denna avhandling är att utifrån professionellas upplevelser och erfarenheter belysa den praktiska innebörden av begreppet effektivitet i hälso- och sjukvården. Ett annat syfte är att utifrån olika perspektiv belysa ledarskap och medarbetarskap i samband med strukturella förändringar inom hälso- och sjukvården. Metod Avhandlingen bygger på fyra delstudier (I – IV) genomförda med hjälp av en kvalitativ forskningsansats. Delstudie I bygger på intervjuer kring begreppet effektivitet med strategiskt utvalda representanter för en organisations tre beslutsnivåer. Delstudie II och III bygger på intervjuer med medarbetare från olika professioner som deltagit i två olika sjukhussammanslagningar. I delstudie IV intervjuades medarbetare om sina upplevelser i anslutning till privatisering av en hälso- och sjukvårdsorganisation. Resultat Då en gemensam definition av begreppet effektivitet saknas i en Rorganisation ges olika aktörer utrymme att göra sin egen tolkning, vilket kan påverka måluppfyllelsen på ett negativt sätt. Vid strukturförändringar är det viktigt att medarbetare ges möjlighet till såväl delaktighet som att kunna balansera sina åtagande i processen. Det är även av vikt att medarbetare i en förändringsprocess har tillit till ledningen och organisationen. Strukturförändringar kan samtidigt innebära spännande utmaningar och nya möjligheter till utveckling. Slutsatser Strukturella förändringar inom hälso- och sjukvården, i syfte att effektivisera, är komplexa och mångfacetterade. Samtidigt är begreppet effektivitet mångtydigt och svårutvärderat. Det påverkas av såväl struktur och ledarskap som medarbetarskap. En förändringsprocess påverkar både ledarskap och medarbetarskap. Framgångsfaktorer är medarbetarnas möjlighet till delaktighet och balans, samt deras tillit till såväl struktur som ledarskap / Background and purpose Within health and medical care, demands on increased efficiency, availability and increased quality, as well as a reduced financial framework, have required changes in the health and medical care system. One aim of this thesis is to illustrate the practical significance of the concept of efficiency in health and medical care on the basis of the experience of professionals. Another aim, on the basis of different perspectives, is to illustrate leadership and employeeship in connection with structural changes within health and medical care. Method The thesis builds on four studies (I – IV) carried out with the help of a qualitative research approach. Study I builds upon interviews on the concept of efficiency with strategically selected representatives for an organisation’s three decision levels. Studies II and III builds upon interviews with employees from different professions who have participated in two different hospital mergers. In study IV employees were interviewed about their experiences in connection with the privatisation of a health and medical care organisation. Outcome When there is no definition of the concept of efficiency in an organisation, different players are allowed scope to make their own interpretation, which can negatively affect fulfilment of objectives. During structural changes it is important that employees are given the opportunity to participate and to be able to balance their commitments in the process. It is also important that employees, in a process of change, have trust in the management and organisation. At the same time, structural changes can involve exciting challenges and new possibilities for development. Conclusions Structural changes within health and medical care, with the purpose of streamlining, are complex and multifaceted. At the same time the concept of efficiency is ambiguous and difficult to evaluate. It is influenced by structure and leadership as well as employeeship. A process of change affects both leadership and employeeship. Success factors are the employees’ prospects for participation and balance, and their trust in both structure and leadership.

The General Medical Council has emphasised the importance of teaching communication skills to medical undergraduates. A two year follow-up study was undertaken, therefore, to assess the possible short-term and long-term benefits of the participation of cancer patients in communication skills training. Two hundred and forty nine third year students in the academic years 1992-1993 and 1993-94 received communication skills training (9 hours) in small groups: half the students were taught with patients who had cancer and the other half with patients who had another diagnosis. Each student was required to make a videotaped interview. These recorded interviews were evaluated by a trained rater. In addition, students completed a pre-course and post-course Attitude Questionnaire to assess their knowledge of and attitudes toward cancer and its management. Of the 1992-93 cohort of third year students, a sample of 54 students participated in the follow-up evaluation in fifth year. Fifty four Attitude Questionnaires were satisfactorily completed. All of the 54 students made a videotaped interview with a gynaecological cancer patient in a standardised setting. Each interview was rated independently by two raters. Analyses of the third year video recordings revealed differences in interview performance between the two groups. Following the course, between-group analyses and with-in group analyses identified various attitudinal differences. Analyses of the fifth year video recordings revealed that the interview performance of both groups had improved since their third year. However, those students originally taught with cancer patients were more likely to assess the impact of the symptoms on the patient's life. In addition, between-group and within-group analyses of the attitudinal data showed that both groups had retained positive attitudes with regard to the psychosocial aspects of cancer. These findings have implications for training medical undergraduates in communication skills.

This study by an expanded primary health care team suggests that as a method of needs assessment rapid appraisal has a number of benefits and constraints. Major benefits include that it brings a community orientation to primary care; it is community participative; it is multi-sectoral and promotes networking; it promotes equity; as an action research method it facilitates change and that it can be satisfying to carry out. Major constraints include the possibility of researcher bias; that training is necessary for interviewing and understanding the method; that the results are not generalisable; that little health service data is produced; that only "proportionate accuracy" is obtained and that it can only be applied to a "community" in some sense of that word. The other methods highlighted shortcomings of using rapid appraisal as a sole means of health needs assessment. Each method yielded particular insights into both health and health care needs. A method mix is likely to give the most comprehensive picture. Rapid appraisal offers a practical way of involving local people in decision making about their health services and as an action research method facilitates change. As a training process it promotes the attitudes and skills which professionals need to work effectively in the community. Its value will depend on whether the data it generates is seen to be of use for purposes of resource allocation and community participation. At worst it has the potential to be a misused tool to collect poor information for supporting poor decisions. At best, it has the potential to give substance to the rhetoric of community participation by providing tools, techniques and data useful to planners and the public to be co-producers of health.

No description available.

This dissertation project examines the effect of various state regulations such as Certificate-of-Need (CON) regulation, uncompensated care pools and community benefit requirement laws on hospital provision of uncompensated care and analyzes both for-profit and non-profit hospitals' responsiveness to the regulatory environment. The analysis of these regulations uses panel data econometric methods for a sample of hospitals in 17 states from 2002 to 2004. This study overcomes the limits of previous research that focused primarily on the effect of a single regulation in a given state. It uses three estimation methods: pooled Ordinary Least Squares (pooled OLS), random effects generalized least squares (GLS) and Hausman Taylor instrumental variable (HTIV) to obtain the parameter estimates. Weighing the advantages and disadvantages of each method, we interpret results based on the cross-validation of the GLS and HTIV estimates. Findings suggest that nonprofit and for-profit hospitals respond to some policy instruments similarly and others differently. For example, both nonprofit and for-profit hospitals respond to CON laws by increasing their uncompensated care provision. However, they respond to policy incentives such as community benefit requirement laws differently. Furthermore, regulatory interactions are found to significantly influence the uncompensated care provision by both nonprofit and for-profit hospitals. The dissertation helps policy makers formulate strategies to create incentives to enhance access to care for the economically disadvantaged. For example, implementing CON and providing public subsidies at the same time may offer better access to care for the uninsured than implementing either regulation alone. However, community benefit requirement laws do not appear to expand the amount of uncompensated care provided by nonprofit hospitals.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1982. / Bibliography: leaves 349-358. / Microfiche. / x, 358 leaves, bound ill., maps 29 cm