The dissertation discusses the provision and organization of mental health services through the operation of Community Mental Health Centres outside the Greater Vancouver area in the Province of B.C.. A derived organizational structure of a CMHC is presented permitting a generalizable discussion of inter- and intra-organizational features and their relationship to administration peculiar to this organization. A number of propositions are generated regarding CMHC organizational structure and process; these propositions are based on the dimensions identified in the areas of organizational technology, environment and goals. The propositions are applied to a model of management permitting an examination of general areas of management concern. Methods of optimizing these areas are discussed operationally with the intent of facilitating organizational effectiveness in a CMHC. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

A role description for a medical coordinator in extended and long term care facilities in British Columbia has been defined using a Delphi method. Also obtained during the study was a long term care philosophy. Three groups - nurses, administrators, and physicians took part in three rounds of the Delphi study. Thirty-five respondents were interviewed in the first round. During this interview the researcher obtained from the respondents the statements that they considered should be included in this role and philosophy description. During the second round the respondents rated the responses of the first round and in the third round those of the second round were revised after seeing the mean scores of the whole group and the three separate groups. The description of the role of a medical coordinator developed describes the role as it applies to: resident care; private physicians; planning, development and evalution of care; staffing of a facility; education; administration; and the training, experience, skills and attitude of a medical coordinator. When the description created was compared with that for the medical director in a long term care facility in the United States it was found that this study had described additional dimensions of the role, in particular the multi-disciplinary approach and the physician's knowledge, training, experience, skills and attitude. The results of the study show where there was agreement and where there were differences of opinion between the three professional groups. A long term care philosophy which was considered very important for a medical coordinator to promote, has been defined during the study. It focuses on the resident reaching his full potential, the creation of a special environment, as well as acceptance of disability, dying and death. Recommendations from the study are made for facilities which might be considering employing a medical coordinator, for planners deciding whether to provide funds for medical coordinators, for geriatric medical education and for the acceptance of a long term care philosophy in all parts of the health care system where there are long term care clients. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Background: The Alliance for Patient Medication Safety (APMS) helps community pharmacies comply with continuous quality improvement requirements of many states and third party payment contracts through use of their Pharmacy Quality Commitment (PQC) program. Aims: To assess changes in the incidence of prescription Quality Related Events (QREs) and adoption of patient safety culture attitudes after guided PQC implementation. Methods: Twenty-one pharmacies were randomized to standard PQC practices (control) or guided PQC implementation (treatment). Pharmacy staff completed retrospective pre and post safety culture questionnaires. Negative binomial mixed and linear regression analyses were employed to examine changes in QREs rates and attitudes, respectively. Rasch analysis was used to assess questionnaire validity and reliability. Results: During the 2-month study period 3,343 QREs were reported to the online PQC system. At baseline, no difference in the average QRE reporting rate was identified between groups. Treatment group QRE reporting rates differed in one category post treatment (more incorrect safety caps QREs reported in treatment group, p<0.034). Seventy-one employees completed the questionnaire (70% response). Attitude improvement in the treatment group was 36% greater than in control (p<0.0001). The questionnaire demonstrated acceptable reliability and validity evidence. Conclusions: Guided PQC implementation increased reporting of certain QREs and increased the adoption of patient safety culture attitudes among staff pharmacy.

This study is, in part, a product of the efforts of the Kitimat-Stikine Regional District Health Care Research Project (1975). During the course of this project interviews with representatives of local health care organizations were held in order to inventory the kinds and numbers of health care services in the Kitimat-Stikine Regional District. In assessing the roles of health care organizations in Kitimat and Terrace, British Columbia it became apparent that a number of community mental health organizations in these two centres were experiencing varying degrees of success and/or frustrations in attempting to meet their organizational goals. In attempting to analyse these experiences it became evident that they were frequently described in terms of the activities and decisions of other organizations. It was also considered that individual organizations had unique characteristics of an internal nature which were also seen to affect the relative success they had in meeting their goals. The question then arose as to the possibility of analysing community mental health services in Kitimat and Terrace in terms of the interrelationships of the organizations which were providing these services. This was seen to be a reasonable approach to the problem of analysis in that the specific intent of the research project from which this study emanated was to provide an inventory of local health care services. In considering the methodology for the analysis of these inter-organizational relationships a review of the literature showed that there had been three basic approaches to organizational research used to analyse organizational behaviour. These approaches were, in order of their development, analysis of an organization as a single unit in terms of its internal characteristics; analysis of an organization in terms of its relationships with other organizations and, analysis, as a unit, of a group of organizations which have recurrent interactions with one another. It was determined that each of these forms of analysis could be utilized in the context of the community mental health organizations located in Kitimat and Terrace. This approach has important implications from a planning point of view in that it affords analyses of benefit to planners and administrators of individual organizations within the context of their own organization's internal framework and within the context of the overall activities of other organizations with which they interact. Further more, it provides an advantageous perspective to authorities in central planning organizations as they attempt to coordinate activities of organizations under their jurisdiction. Five specific variables were selected to facilitate the analysis of inter-organizational relationships at each of the three levels. These variables were: resources; power, organizational autonomy; domain consensus; and inter-organizational coordination. The analyses showed that each of the three levels offer unique opportunities to view the interrelationships between and/or among organizations. It was also illustrated that the third level of analysis was an abstract concept that required further development before it could be clearly differentiated from the other levels. The five variables selected to analyse the interrelationships at each level exhibited varying degrees of relevance to the analysis. The main observation was that, although there was some overlap in their application to specific issues which were discussed, the five variables were able to satisfactorily address any factors which were seen to affect inter-organizational relationships at each of the three levels. Overall, the three level approach to analysis of organizational exchange relationships was suggested to be an appropriate method for central planning agencies to better coordinate the activities of organizations under their jurisdiction. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Unknown

No description available.

The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.

O objetivo deste estudo foi verificar a incidência das principais lesões esportivas comuns em atletas jovens de 16 a 19 anos de idade, que participaram de treinamento regular ou federado no ano de 2002, nas modalidades esportivas basquetebol, futsal e voleibol. Foram identificados, também, alguns aspectos de treinamento e estrutura médica. Para isso, aplicou-se um questionário para 323 atletas e entrevistas com 26 técnicos e 8 médicos, de 20 clubes esportivos de São Paulo. Os resultados do estudo indicaram um total de 343 lesões ou 1,7 lesão/atleta/ano. No basquetebol, as lesões mais comuns foram as entorses; a região corporal mais acometida de lesão foi a do tornozelo, seguida do joelho, coluna e dedos da mão; os armadores foram os mais afetados. No futsal, a lesão mais comum foi a entorse de tornozelo e houve ocorrência de lesão nas regiões da coxa e joelho; pivôs foram os mais afetados. No voleibol, a lesão mais comum foi a tendinite, principalmente na região do joelho, seguida das entorses e lesões musculares; a posição de meio de rede foi a mais afetada. As lesões ocorreram com uma maior freqüência em situações de treinamento. Dos 20 clubes avaliados, apenas oito possuem um médico especializado plantonista. Tal fato indica que alguns fatores de risco, como medidas preventivas em situações de treinamento, exame de pré-participação esportiva e acompanhamento médico especializado, não são devidamente organizados para os atletas jovens nos clubes avaliados / The objective of this study was to evaluate the incidence of the main sports injuries commonly found in young athletes in the 16-19 year age group who participated in regular or federate trainings during 2002 in sports modalities such as basketball, futsal and volleyball. Also identified were some aspects of training and clinical structure. To obtain these data, a questionnaire was applied to 323 athletes and surveys were performed among 26 coaches and 8 physicians from 20 sports clubs located in Sao Paulo (Brazil). The results of the study showed a total of 343 injuries or 1.7 injury/athlete/year. In basketball, the most common injuries were sprains, the most affected body regions in terms of injury being the ankles, followed by knees, backbones and fingers; point guards being the most affected athletes. In futsal, the most common injuries were ankle sprains, the thigh and knee regions being also affected by injuries; pivots were the most affected among the team. In volleyball, the most common injury was tendonitis, mainly in the knee region, followed by sprains and muscle injuries; the most affected position being the forward-center\'s. The frequency of injuries was higher during trainings. Only eight of the 20 sports clubs evaluated actually hire specialized emergency physicians. This fact indicates that some risk factors such as preventive measures during trainings, sports preparation evaluation, and specialized clinical monitoring are not appropriately organized for young athletes in the assessed sports clubs

Objetivo: Analisar a Implantação do Componente Hospitalar da Rede de Urgências e Emergências- RUE na Região de Ribeirão Preto do Estado de São Paulo e propor uma matriz avaliativa. Método: Trata-se de um estudo avaliativo de análise de implantação do tipo I com abordagem quantitativa e qualitativa, realizado na Regional de Ribeirão Preto do Estado de São Paulo. Os 7 hospitais pesquisados foram aqueles contemplados no Plano de Ação Regional da RUE - PAR daquela região. Para coleta e análise de dados, foram elaboradas a matriz avaliativa, a matriz SWOT e realizadas entrevistas semi-estruturadas em eixos temáticos. Resultados: O eixo das portas de entrada atingiu nível satisfatório (entre 70,8 e 83,8%) e os eixos de enfermaria clínica de retaguarda e de leitos de terapia intensiva atingiram grau pleno de implantação (>90%). Destaca-se que a classificação de risco não foi implantada satisfatoriamente, e que alguns conceitos e atribuições precisam ser melhor apresentados e fomentados, tais como o Núcleo Interno de Regulação, o Núcleo de Acesso a Qualidade Hospitalar e o kanban. Dentre os fatores contextuais que mais ameaçam a implantação da RUE estão as dificuldades de regulação assistencial e a insuficiência de leitos de retaguarda e longa permanência. Considerações Finais: Os principais aspectos observados foram a implantação do cuidado multiprofissional e a comunicação inter-hospitalar por meio do Núcleo Interno de Regulação, os quais, ainda que com limitações, contribuíram na integração em rede e 12 na integralidade da assistência, fundamentais ao enfrentamento da fragmentação do cuidado, desafio maior das urgências e emergências no SUS. / Objective: To analyze the implantation of the Hospital Component of the Emergency and Emergency Network - RUE in the Ribeirão Preto Region of the State of São Paulo and propose an evaluative matrix . Method: This is an evaluative study of type I implantation with quantitative and qualitative approach, carried out in the Ribeirão Preto Region of the State of São Paulo. The 7 hospitals surveyed were those included in the RUE - PAIR Regional Action Plan for that region. For data collection and analysis, the evaluation matrix, the SWOT matrix, and semi-structured interviews were elaborated in thematic axes. Results: The axis of the entrance doors reached a satisfactory level (between 70.8 and 83.8%) and the axes of the clinical ward of the ward and of beds of intensive care reached a full degree of implantation (> 90%). It should be emphasized that the risk classification was not satisfactorily implemented, and that some concepts and attributions need to be better presented and encouraged, such as the Internal Regulation Nucleus - NIR, the Hospital Quality Access Center - NAQH and KANBAN. Among the contextual factors that most threaten the implementation of RUE are the difficulties of care regulation and the lack of back beds and long stay. Final Considerations: The main aspects observed were the implementation of multi-professional care and inter-hospital communication through the Internal Regulation Nucleus, which, although with limitations, contributed to the network integration and integral care, fragmentation of care, greater challenge of urgencies and emergencies in the SUS.

Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 224 pages. Includes vita. Includes bibliographical references.

O objetivo deste estudo foi verificar a incidência das principais lesões esportivas comuns em atletas jovens de 16 a 19 anos de idade, que participaram de treinamento regular ou federado no ano de 2002, nas modalidades esportivas basquetebol, futsal e voleibol. Foram identificados, também, alguns aspectos de treinamento e estrutura médica. Para isso, aplicou-se um questionário para 323 atletas e entrevistas com 26 técnicos e 8 médicos, de 20 clubes esportivos de São Paulo. Os resultados do estudo indicaram um total de 343 lesões ou 1,7 lesão/atleta/ano. No basquetebol, as lesões mais comuns foram as entorses; a região corporal mais acometida de lesão foi a do tornozelo, seguida do joelho, coluna e dedos da mão; os armadores foram os mais afetados. No futsal, a lesão mais comum foi a entorse de tornozelo e houve ocorrência de lesão nas regiões da coxa e joelho; pivôs foram os mais afetados. No voleibol, a lesão mais comum foi a tendinite, principalmente na região do joelho, seguida das entorses e lesões musculares; a posição de meio de rede foi a mais afetada. As lesões ocorreram com uma maior freqüência em situações de treinamento. Dos 20 clubes avaliados, apenas oito possuem um médico especializado plantonista. Tal fato indica que alguns fatores de risco, como medidas preventivas em situações de treinamento, exame de pré-participação esportiva e acompanhamento médico especializado, não são devidamente organizados para os atletas jovens nos clubes avaliados / The objective of this study was to evaluate the incidence of the main sports injuries commonly found in young athletes in the 16-19 year age group who participated in regular or federate trainings during 2002 in sports modalities such as basketball, futsal and volleyball. Also identified were some aspects of training and clinical structure. To obtain these data, a questionnaire was applied to 323 athletes and surveys were performed among 26 coaches and 8 physicians from 20 sports clubs located in Sao Paulo (Brazil). The results of the study showed a total of 343 injuries or 1.7 injury/athlete/year. In basketball, the most common injuries were sprains, the most affected body regions in terms of injury being the ankles, followed by knees, backbones and fingers; point guards being the most affected athletes. In futsal, the most common injuries were ankle sprains, the thigh and knee regions being also affected by injuries; pivots were the most affected among the team. In volleyball, the most common injury was tendonitis, mainly in the knee region, followed by sprains and muscle injuries; the most affected position being the forward-center\'s. The frequency of injuries was higher during trainings. Only eight of the 20 sports clubs evaluated actually hire specialized emergency physicians. This fact indicates that some risk factors such as preventive measures during trainings, sports preparation evaluation, and specialized clinical monitoring are not appropriately organized for young athletes in the assessed sports clubs