Typescript (photocopy). / Digitized by Kansas Correctional Industries

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Medical practice entails lifelong learning of both the science and art of medicine. However, it is not easy to teach or observe what one has learned about the latter. Previous literature has found that learning during the clinical phase is influenced by both the macro, structural issues and micro, individual factors. This ethnographic study investigates the deliberate, systematic, and sustained effort of clinical education at a district hospital in Taiwan in order to find out how medical educators can train and retain caring and competent physicians. It focuses on the students’ experiences during their clerkship, formal and informal teachings such as ward rounds, teachings at the operating room, and fortnightly medical humanities discussions, as well as what the hospital has done to create a conducive environment for teaching and learning. Using a grounded theory approach, it uncovers the problems novices face in clinical practice and learning and effective techniques expert clinicians use in teaching. It concludes that the most effective and efficient education happens when learning is made explicit and visible, when teachers actively engage students in legitimate peripheral participation, when learners become self-directed in their endeavors, and when there is a community of reflective practitioners.

Radiography is a constantly changing environment that is continuously evolving with new technology and new techniques on how to image human anatomy. This has led to cheaper and easier ways of imaging that present an opportunity for radiographers to practice independently from radiologists. The increase in the number of radiographers going into private practice since 2006 has led to a number of private radiography practices failing due to competition and other management and financial factors. This study seeks to provide insight into the changing environment of private radiographic practice and the level of success it can bring to radiographers. This will enable radiographers to better determine their personal and professional development needs, which will effectively improve their ability to manage and sustain private radiographic practices. This approach stems from the researcher’s belief that with the right skill and knowledge radiographers can run successful private practices and in so doing be able to empower others to do the same. The researcher has chosen to carry out a qualitative, exploratory, descriptive and contextual research design in order to explore and describe the detailed recommendations and views of private radiographic practice owners and how they manage their practices. The chosen method of data collection for this study is individual one-on-one interviews supported by a literature control. The one-on-one interview was used to collect the data from participants who meet the inclusion criteria. The researcher purposively selected participants to ensure that their ideas and opinions will benefit the study. The chosen method of data analysis is Tesch’s data analysis approach as it follows the qualitative way of data analysis which occurs in three phases: description, analysis, and interpretation. This research made use of Guba’s trustworthiness model to establish the validity and reliability of the qualitative research. The four criteria in this model for trustworthiness are truth-value by using the qualitative approach of credibility; applicability determined by using transferability; consistency determined by using the qualitative approach of dependability and, finally, neutrality determined by the qualitative approach to confirmability. The following six (6) ethical principles were followed to ensure no harm came to the participants: beneficence and non-maleficence, autonomy, justice, veracity, confidentiality and privacy. On completion of the study, the researcher made recommendations based on the findings for inclusion in basic radiographic training and continuous professional development. These recommendations are: Complete reviewing of the management training syllabus in radiography education. Compilation of literature that deals with private practice radiography. Inclusion of private practice radiographers in radiography societies. Further research into the subject of private practice radiography. This will allow for the knowledge contained in the study to be accessible to those who need it. It is also important to note that a study of this nature has never been conducted and therefore sharing of this information will allow for radiographers to know and understand what sustaining a private radiographic practice involves. The findings will be disseminated in seminars, conferences and publications.

With passage of the Patient Protection and Affordable Care Act (PPACA) and the publication of the Institute of Medicine’s report on the future of nursing, nurses are slated to take on an expanded role in primary healthcare delivery in the near future. Nurse practitioners, in particular, will be instrumental in filling the gap in primary care availability engendered by the increasing specialization of physician practice and increased access to healthcare made possible by the provisions of the PPACA. The need for this study was identified through gaps in the literature related to nurse practitioner practice; specifically, the paucity of quantitative research regarding patients’ perspectives of core holistic nursing values in nurse practitioner care, and, since nursing care is by definition and tradition holistic in nature, this inquiry attempted to quantify the degree to which nurse practitioner care upholds and preserves core holistic nursing values. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

The aim of this study was to document the safeguards inherent in the Mental Health Act (MHA) of 1973, and to examine the extent " to which these are observed in practice. The research was conducted at Lentegeur Hospital in Mitchells Plain, Cape Town. The population consisted of 726 certified patients who were admitted involuntarily (i.e. under sections 9 and 12 of the MHA) from 01 January 1990 to 31 December 1990. Data for each of these patients was collected from the admission register, clinical files, administrative files, and the certified post book. In addition, the official hospital statistics were examined. Measurements obtained included demographic data, the validity of the document contents, the validity of the certification process, and an overall measure of the validity of each of t he certifications taking into account both document contents and observance of the time strictures set out in the MHA. Twenty nine patients (4,0%) were admitted by Urgency (Section 12), and 697 (96,0%) on Reception Order (Section 9). The study focused mainly on the Section 9 patients, because of the small sample size for Urgency admissions. It was found that 609 (87,4%) of the 697 admissions were legally flawed in terms of document contents criteria and the time limits in the certification process. Document content criteria were not fulfilled in: 3,0% of the Applications for Reception Order; 32,1% of Medical Certificates; 20,1% of Reception Orders; and 3,6% of Reports to the Attorney-General. In 40,0% of certifications the Report to the Attorney-General (G2/28) could not be traced. Examination of temporal safeguards revealed that the least satisfactory aspect was the delay in the completion of the post-admission Report to the Attorney-General. It was found that 32,3% of these Reports were not submitted on time. Reasons for the discrepancy ("gap") between legal standards and actual practice are discussed. Recommendations are made which could help minimise or eradicate this "gap". These include suggestions for changes in the document format, for the use of a certification booklet, for stricter control of late and inadequate documentation, and for inservice training of all those involved in the certification process. / Thesis (M.Med.)-University of Natal, Durban, 1993.

Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.

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Healthcare-associated infections (HAIs) are among the most common and significant patient safety issues posing great threats to public health. One in every 25 inpatients in the United States experiences a HAI. Because they have continuously been a major reason for increased morbidity and mortality in healthcare facilities, increased attention to understanding the spread of HAIs is an urgently needed. Therefore, the purpose of this dissertation, was to examine the risk factors for two of the most common HAIs (surgical site infection [SSI] and Clostridioides difficile infection [CDI]), using multiple methodological approaches. Chapter 1 provides an overview of HAIs, the risk factors identified from the previous literature, and the necessity of different methodological approaches to identify the risk of HAIs. Chapter 2 is an integrative review synthesizing the findings from seven published studies examining the association between the development of pocket hematoma and the risk of wound infection in individuals with cardiovascular implantable electronic devices. Chapter 3 is a summary of a retrospective cohort study using machine learning techniques—logistic regression, decision tree, and support vector machine approaches—to build predictive models of SSI among individuals with permanent pacemakers, followed by a comparison of the predictive abilities of the three algorithms. Chapter 4 describes a retrospective matched case-control study to examine (1) temporal changes in the incidence of community or hospital-acquired CDI, (2) the risk factors for hospital-acquired CDI including individual-host factors and pharmacological-related factors, and (3) temporal changes in the risk factors for hospital-acquired CDI. Lastly, Chapter 5 summarizes and synthesizes the findings of the studies included in this dissertation, the strengths and limitations of the studies, implications for public health and clinical practice, advanced studies on methodology, and future research. In conclusion, this dissertation adds comprehensive knowledge regarding the associations between risk factors and HAIs by identifying reliable risk factors measured in various ways and applying various methodological approaches.