Thesis (Ed. D.)--Duquesne University, 2004. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 77-95) and index.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1974. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis, PlanB (M.S.)--University of Wisconsin--Stout, 2006. / Includes bibliographical references.

Thesis (M.Nurs.)--Washington State University, December 2008. / Title from PDF title page (viewed on Mar. 2, 2009). "College of Nursing." Includes bibliographical references.

<p> Dramatic shifts in the way healthcare and related healthcare services are delivered and managed in the United States are unfolding at an unrelenting pace. Concurrent with ongoing changes in United States&rsquo; delivery of medicine, some argue that traditional notions of power are undergoing an equally transformative shift (Mintzberg, 2015; Na&iacute;m, 2013). The confluence of the emerging reconsideration of the role of power in our society and organizations along with the dramatic changes in the American healthcare system provides a fertile backdrop and context for this study of power. </p><p> At the center of this transformation, the physician maintains a unique and &ldquo;very special position&rdquo; in the hospital setting (Freidson, 1970). This grounded research study investigates the ways in which 24 physicians in modern hospital healthcare setting (MedHealth) conceptualize their exercise of power, autonomy, and control in their day-to-day interactions in the practice of medicine. </p><p> I find physicians at MedHealth chose to conceptualize their exercise of their power, autonomy and control unitarily. Physicians in all three participant groups at MedHealth (surgeons, pediatricians and others) conceptualized a significant loss of power, autonomy, and control, in the practice of medicine. Additionally, physician conceptualizations of their exercise of power, autonomy, and control in the practice of medicine are shaped and fashioned by micro, meso, and macro level interactions. </p><p> I present a theoretical model in an effort to gain a richer appreciation of how physicians at MedHealth conceptualize their power, autonomy, and control (PAC). I argue a reconceptualization of their PAC is necessary given the transformative changes to the US healthcare model. Last, I offer numerous implications for theory and practice, and recommendations for areas for future research that emerged from this research project.</p><p>

<p> Nationally, over 84 million Americans live in areas that do not have access to a sufficient number of primary care providers, with the majority being in low socioeconomic urban areas. Many physicians who are recruited or choose to practice in these areas leave after several years, while others remain. Limited empirical research has addressed the experiences of the physicians who choose to stay. </p><p> Choosing to maintain a career practice in these communities indicates a commitment. For this study, commitment is defined as the psychological force that binds an individual to a target or course of action of relevance to that target. There is limited understanding of physicians&rsquo; experiences that lead to and sustain their commitment to practice in underserved communities. </p><p> This hermeneutic phenomenological study explored the experience of physician commitment to practice long-term in an urban medically underserved community. It explored how this process developed in these physicians, as well as the influences that strengthened and/or weakened commitment. In-depth interviews of eleven primary care physicians who practice in underserved cities for seven years or greater were analyzed. </p><p> Four primary findings emerged from this study: </p><p> 1. The primary commitment of these physicians was to underserved communities in general and their specific community. The secondary commitment was to their practice clinic organization. </p><p> 2. The essence of the experience of physician commitment for practice in urban medically underserved communities involved: embracing satisfying activities; actualizing their individual values; enacting their identity; and facing/resolving challenges. </p><p> 3. Commitment developed over time through the merging of two prerequisite commitments: the commitment to be a physician and the commitment to the underserved. Family, religious upbringing, mentors, and the nontraditional educational route to and/or through medical school contribute to development of the commitment to practice. </p><p> 4. Commitment is sustained through embracing satisfying activities, actualizing values, enacting identity, and facing challenges. There is an intersection in all parts of the commitment experience that is reinforcing. </p><p> This study shows the complexity of the commitment of physicians practicing in underserved communities, broadens the view of commitment as it is applied to organizations, and has implications for policies for health professional retention.</p><p>

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Introduction: Amongst all public servants in Hong Kong, health care workers are one of the groups suffering from highest working pressure. They have long working hours and may have overnight shift duties, including Sundays or even public holidays. This may lead to poor job satisfaction, psychological stress and the recent high resignation rate in public hospitals. The aim of this study is to assess the prevalence of the psychological stress, psychological symptoms and job satisfaction of health care workers, the association between stress, psychological symptoms and job satisfaction; and also the factors associated with job satisfaction in a regional hospital in Hong Kong. Method: Health care workers in a large regional hospital of Hong Kong were surveyed by means of a questionnaire assessing basic demographic data, questions of the General Health Questionnaire (GHQ-12), Perceived Stress Scale (PSS), Warr-Cook and Wall job satisfaction scale (JSS). Four groups of health care workers (doctors, nurses, allied health workers and supporting staffs) were surveyed. Summary of descriptive statistics were calculated for each group to compare the prevalence of job dissatisfaction, perceived stress, and psychological symptoms. Two-stage analysis will be used. The first stage analysis will use ANOVA test to access the association between job satisfaction and different variables. The second stage analysis will use multivariate regression model to further assess the coefficient correlation of significant factors drawn from ANOVA test with job satisfaction. Results: There were 674 eligible questionnaires. About half (47%) of the health care workers reported having perceived stress and a third (33.8%) psychological symptoms. Doctors reported the (76.8%, 95% C.I = 69.43%, 84.17%) highest level of job satisfaction amongst all the health care workers surveyed. Among staff reporting a GHQ score equal to or more than three, supportive staff had significantly higher prevalence (38.7%, 95% C.I.=27.96%, 49.44%) and doctors the lowest prevalence (28.1%, 95% C.I.= 15.11%, 41.09%) of psychological symptom but proportions were compatible with their counterparts in other countries. The mean score for GHQ-12 was 2.41+/- S.D. 3.28. The overall mean perceived stress score was 18.14 with SD +/- 5.0. There was no significant difference when different subgroups were compared. The mean PSS scores of all subgroups were lower than their counterparts in other counties but were quite similar to the mean PSS reported during SARS period. Sixty eight percent of all health care workers surveyed were satisfied with their job (respondents indicating “moderately satisfied”, “very satisfied” and “extremely satisfied” on their overall job satisfaction). Values equal to or above 5 reflect being satisfied. The mean value for Job satisfaction was 4.58 +/-S.D. 1.21. The factors including shift duty, perceived stress, and psychological symptoms were negative correlated with job satisfaction. Factors such as clinical work, doctor and secondary school level were positive correlate with job satisfaction. Conclusion: Prevalence of perceived stress and psychological symptoms among health care workers were high when compared with the general population (14-17.6% for perceived stress and 28.1% for psychological symptom), but not as high as expected. In contrast to popular belief, doctors had the lowest perceived stress level, lowest prevalence of psychological symptom and the highest job satisfaction among different groups of health care workers. This may be related to higher income, social status and, education background that might help to protect them from depression and anxiety. Supportive staffs, who felt neglected by management, were found to have the highest prevalence of psychological symptom and higher stress levels. Nurses got highest prevalence of perceived stress. More attentions and resources should be devoted to these groups to cope with their psychological needs and stress. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing