The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

This study documented the history of the development and practice of the kinlein associate. Consumer dissatisfaction with health care, nursing unrest, and increased demand for long-term care-givers were the antecedents for a paradigm shift to "caring with" persons based upon the theory of esca developed by M. Lucille Kinlein. Interested people wanted to learn how to offer care from this perspective, and informal classes were held in several locations across the nation. The study focused on identifying the teaching methods used by the founder, Miss Kinlein. The methodology was deemed important in an attempt to assure that future kinlein associate teachers reflect the original educational processes and style when Miss Kinlein is no longer teaching. Her methods were considered important for kinlein associate teachers to prepare kinlein associates for practice. To determine Miss Kinlein's teaching methodology, qualitative research was conducted by observing her teaching, face to face interviews with students and kinleiners interested in teaching, and material gathered from the founder, Institute of Esca/Practice of Kinlein, and the Detente Homer, Alaska. Modeling, coaching, and directed inquiry were the primary methods used by Miss Kinlein and Mrs. Raymond, kinleiner of reference at the Homer Detente, in teaching kinlein associates. It was important to ground their teaching in educational theory and the contemporary interest in constructivism philosophy. Principles were extracted from several articles regarding constructivist philosophy/theory and were aligned with principles from the theory of esca used by Miss Kinlein. The parallels between the theory of esca and constructivism were striking. The study concluded by recommending Miss Kinlein and her student teachers examine the constructivism philosophy relative to the kinlein philosophy and theory of esca. The result of this examination may open kinleiner interest to explore similar, new ideas and serve as a spark for an intellectual/philosophical interchange among professional kinleiners and educators. Specific recommendations were given regarding immediate attention to kinlein associate curriculum, videotaping Miss Kinlein teaching various levels of courses, and developing a course on assisting students in moving in esca in learning. / Graduation date: 1998

Thesis (B.Sc. (Hons.)) - University of Queensland, 2006. / Includes bibliography.

Not available / text

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 x, 65 leaves, Annexures A-H / Patient satisfaction is an important, desired measure of quality of care and has a significant influence on the perceived quality of care and outcome of treatment, and for this reason, it holds great value to the treating clinician. Satisfied patients are more likely to comply with treatment instructions and advice, remain with their service provider and refer others. Dissatisfaction, in the event of an unfavourable outcome, can result in legal action and complaints to regulatory bodies. Studies have indicated a high level of satisfaction with chiropractic care; however, none have been in a student clinic setting even in view of the suggested importance in the literature. In view of this significance and lack of understanding of the patients’ satisfaction / dissatisfaction in the history of DIT’s clinic operation the question remains as to what extent the students at the DIT Chiropractic Day Clinic satisfy their patients. This study evaluated the patient satisfaction at the DIT Chiropractic Day Clinic in order to establish a baseline for future comparison. Cronbach’s alpha scores were used to determine questionnaire reliability in a South African student context.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objectives: The aim of this study was to determine the current role of the Chiropractor in the Patient-Centred Approach to Stress Management. Methods: Chiropractors were contacted telephonically in order to discuss a convenient time in which they are free to receive the questionnaire at their practice. The questionnaire was developed specifically for this particular research project and verified through the use of a focus group and pilot testing. The researcher waited outside the room whilst the Chiropractor completed the questionnaire. The questionnaire was then collected after completion prior the researcher leaving the practice, in order to improve the return of the questionnaires. Results: Seventy-five percent of chiropractors, in the study indicated that they took a psychosocial history which may indicate that they utilised the fundamental biopsychosocial theme of ‘patient-centeredness’. 68.9% of chiropractors who took a psychosocial history indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and 55.6% indicated that their patients responded ‘Very Positively’ to their stress management protocols. All the Chiropractors in the study indicated that they had consulted patients who had associated their main complaint with stress related issues. 38.3% of Chiropractors felt that their patients ‘Often’ associated their main complaint with stress-related issues whilst 35% felt that their patients ‘Very Often’ relate their main complaint with stress-related issues. Muscle spasm (85%) was the most common symptom or sign found or elicited in a patient suffering with chronic stress. Referral was the most common primary method of treatment with 36% of Chiropractors utilising this method in the clinical setting when dealing with a stressed patient. iii Conclusion: Chiropractors in the study indicated that they took a psychosocial history therefore they utilised the fundamental biopsychosocial theme of ‘patientcenteredness’ and that the majority indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and that patients responded positively to their stress management protocols.

Thesis (Ph. D.)--University of Toronto, 2005. / Includes bibliographical references (leaves 109-115).

Thesis (Ph. D.)--University of Hong Kong, 1998. / Vol. 1 in two parts. Includes bibliographical references.

The purposes of this investigation were (1) to determine if a systematic training program in communication skills could be used to improve written response levels of dental hygiene students, and (2) to determine if a systematic training program in communication skills could yield improved dental hygiene student-patient rapport. The experiment involved two groups of dental hygiene students that had previously been randomly selected and consisted of twelve junior and twelve senior students in each group. The entire population of dental hygiene students at Texas Woman's University participated in the study. Analysis of the data provided statistically significant findings on seven of the eight hypotheses. Those subjects in the systematic training program were able to demonstrate increased ability to write responses and, in addition, had higher patient rapport scores. The results were also statistically significant two weeks following the training period. It was, therefore, concluded that the systematic training program in communication skills was an effective teaching device for improving dental hygiene responses. The systematic training program also seemed to be an effective strategy for improving dental hygiene student-patient rapport formation.

This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.