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<p>The practice of medicine has evolved from individual practice, mainly led by physicians, towards an interdisciplinary team-based activity that takes into consideration patients’ needs, preferences and values. This shift towards what is known as the patient-centered care (PCC) model requires better communication among medical staff and patients. Feedback is a key factor to improve team learning processes and also to understand patient perspectives. The objective of this thesis was to create a system to facilitate feedback processes within the Toronto General Hospital (TGH). To do so, a kiosk-based system was designed, allowing patients and health care providers to send feedback messages as well as positive recognition messages in appreciation of other people’s commitments and achievements. A pilot test was conducted by placing a kiosk in the General Internal Medicine unit at TGH for seven weeks. During this study, the application running the kiosk registered all user actions, with the objective of understanding how patients and staff interacted with the system. The kiosk was perceived as a positive, easy to use, and valuable tool by patients and providers. The different elements that need to be improved for future upgrades of the system are discussed. Overall, the use of kiosk-based systems to gather feedback should be considered when creating high performing teams in the health care domain.</p> / Master of Science (MSc)

<p>For more information contact: Susan Strong, <a href="mailto:sstrong@stjoes.ca">sstrong@stjoes.ca</a>; St Joseph's Healthcare Hamilton, West 5th Campus, Schizophrenia & Community Integration Service, 100 West 5th St., Hamilton, ON L8N3K7</p> / <p><strong>Introduction</strong></p> <p>Despite international pressure to implement self-management support for individuals living with chronic illnesses, little direction is available for integration into specialized mental health services. The premise of the dissertation is that self-management support can be provided and be beneficial within a recovery framework for individuals living with serious mental illnesses.</p> <p><strong>Methods</strong></p> <p>A large regional service was studied as an exemplar of specialized service delivery. Using a van Manen phenomenological study through an occupational therapist lens, the meaning of clients’ experiences with self-management learning events in a diverse sample was examined. Conditions shaping clinicians’ experiences and actions enabling self-management across eight varied settings were identified in a Yin case study with embedded units. Provider triads (occupational therapist-nurse-social worker) from each setting, allowed an examination of patterns by individual, discipline and practice environment. With an integrated knowledge translation approach, both studies informed the strategic creation of an innovation and implementation plan for organizational change.</p> <p><strong>Results</strong></p> <p>Findings created a rich picture of clients’ lifeworlds learning self-management and conditions and mechanisms influencing clinician self-management support practices. Client self-management needs were not routinely addressed by services. Clients experienced eight tasks shaped by contextual structures represented in a model of the work of learning self-management. Self-management was enmeshed in recovery and a personal resource for self-determination and living well. Another model illustrated the complex dynamic relationships underpinning clinicians’ intentions and actions, and key features of clinicians enabling client self-management. A structured approach to delivering self-management support and a learning and embedding initiative were generated.</p> <p><strong>Conclusions</strong></p> <p>The dominance of practice environments offers an opportunity for organizational change. Direction is given to customize self-management support in a conventional mental health service. The conceptualization of self-management support within a recovery framework may benefit all client groups with long-standing conditions.</p> / Doctor of Philosophy (PhD)

No / Measuring the quality of care for people using neuro-rehabilitation services is a complex area requiring reliable methods that account for variable communication abilities/cognitive functioning. Dementia Care Mapping (DCM) is an observational method widely used in dementia care to improve person-centred care, which may be usefully applied to neuro-rehabilitation settings. Evaluation is vital to determine the tool's acceptability in this setting. To explore the views of staff/patients regarding whether the use of DCM is acceptable in a neuro-rehabilitation setting. METHOD: DCM was conducted on an acute neuro-rehabilitation ward. Q-methodology, a technique for extracting subjective opinions, was used with 23 staff and 10 patients on the ward to evaluate the acceptability of DCM. RESULTS: Factor analysis was performed separately for staff and patient Q-sorts. Each found a "consensus" factor where all participants indicated positive acceptability for the use of DCM. Further exploratory factors indicated that some staff/patients had additional views/concerns that were not captured by the first consensus factor. CONCLUSIONS: The results from this preliminary study are promising and indicate that DCM is potentially an acceptable tool to use in acute neuro-rehabilitation. Further research is needed to explore the acceptability of this tool more widely across neuro-rehabilitation settings. IMPLICATIONS FOR REHABILITATION: Person-centred care is widely acknowledged as being important in all care settings, including neurorehabilitation. Dementia Care Mapping was deemed to be an acceptable approach for improving the quality of person-centred care on the basis of the views of staff and patients in a neurorehabilitation ward. Dementia Care Mapping, with adaptations for neurorehabilitation settings, successfully provides an acceptable framework for measuring and improving the quality of person-centred care in this setting.

No / Worldwide healthcare systems are facing immense changes in the demand of care with vast cost explosions caused by aging populations and the increase in chronic and mental diseases. The move towards patient-centered healthcare seems to be an ideal approach to meet future challenges but still clashes with reality. Patient Advice and Liaison Service (PALS) in the UK is one of the unique examples of patient empowerment to influence changes in healthcare systems like the National Health Service (NHS). The purpose of this paper is to look at user-driven organizational change management in PALS in retrospect to learn from its ‘best’ and ‘worst’ practices. In conclusion, patient-centered healthcare becomes more realistic if healthcare users and workers are empowered at the same time. The vision of patient, public, and staff involvement in the move towards patient-centered health needs to be backed up by adequate and secure resources as well as consistent organizational leadership and change management. Organizational change processes in general should be seen as biological continuous cycles with unpredictable evolutionary turning points rather than linear progressions. This helps to stay optimistic and embrace change as challenging, exciting, and difficult all the way through the change process.

No / It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over pound50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

The purpose of the study was to determine how professional nurses perceive their roles in patient centered care in various units, in three regional hospitals in Mpumalanga Province. The main objectives of this study were to determine * whether the working environment in provincial hospitals is supportive of patient centered care * what factors could hinder the provision of patient centered care * the extent to which patient centered care is provided to patients in provincial hospitals * professional nurses' perception of their role in patient-centered care The researcher used the descriptive exploratory method. A questionnaire with closed and open-ended questions was used to collect data from professional nurses in the three hospitals. Seventy- two (72) respondents returned the completed questionnaires. The findings indicated that the professional nurses perceived patients' and nurses' lack of knowledge as the biggest hindrance to patient centered care. Patients and relatives seemed to be less involved in their own care and the lack of information given to patients by professional nurses subsequently contributed to patients' inability to make / Health Studies / M.A. (Health Studies)

The purpose of the study was to determine how professional nurses perceive their roles in patient centered care in various units, in three regional hospitals in Mpumalanga Province. The main objectives of this study were to determine * whether the working environment in provincial hospitals is supportive of patient centered care * what factors could hinder the provision of patient centered care * the extent to which patient centered care is provided to patients in provincial hospitals * professional nurses' perception of their role in patient-centered care The researcher used the descriptive exploratory method. A questionnaire with closed and open-ended questions was used to collect data from professional nurses in the three hospitals. Seventy- two (72) respondents returned the completed questionnaires. The findings indicated that the professional nurses perceived patients' and nurses' lack of knowledge as the biggest hindrance to patient centered care. Patients and relatives seemed to be less involved in their own care and the lack of information given to patients by professional nurses subsequently contributed to patients' inability to make / Health Studies / M.A. (Health Studies)

No description available.

Aim: The aim of the study is to explore the perceptions of the nurses’ CPD and its contribution to quality patient care in the Gauteng province of the Republic of South Africa. Significance of the study: The significance of the study is to highlight the importance of CPD as one of the contributing factors to the quality of patient care through on-going competence. The researcher hopes the recommendations from the study may serve as a motivation to health institutions that are not actively involved in continuing professional development. Method and data analysis: Quantitative descriptive explorative design was used to achieve the objectives of the study. The study involved registered professional nurses (n =105) and enrolled nurses (n=56) employed in a state health institution. Data was collected by means of a structured questionnaire.A total of 200 questionnaire were distributed and 162 completed questionnaires were returned, giving a response rate of 162/200=81%. Statistical analysis was conducted using the SAS software version 9.3.The internal and external validity was enhanced by selecting a large homogenous sample. Ethical issues: An information leaflet indicating the key elements of the study such as the research title, the purpose of the study, voluntary participation and when to withdraw from the study was distributed to all the participants. Results: The study found that nurses participate in CPD activities to maintain their professional competence, thereby contributing to quality patient care. The findings are consistent with the findings from other studies / Health Studies / M.A. (Health Studies)