Thesis (M.Sc.)--Memorial University of Newfoundland, 1998. / Typescript. Bibliography: leaves 97-106.

This study aimed to explore existing quality improvement activities in primary health care setting in South Africa. Two sets of questionnaires were used to collect data from both patients and nurse managers. Findings indicated that clinics were generally acceptable and affordable to patients, but should operate for longer time-periods, that sorting of patients and long waiting times, coupled with short consultation time-periods, warranted immediate remedial actions. Only five of the fourteen listed quality initiatives were satisfactorily practised. It was concluded that despite many obstacles and difficulties as mentioned by respondents, the issue of quality-improvement in primary health care is receiving attention, but should still be improved to a greater extent. / Health Studies / M.A. (Advanced Nursing Sciences)

The purpose of the study was to investigate the perception of given information at discharge from a urological ward at Akademiska sjukhuset, and to investigate whether the patients had searched for information themselves after discharge.   The study is an empirical cross -sectional study with descriptive design. All the patients inscribed as urologic patients, discharged to their home during month of March 2009, were asked to participate in the study (in total 82 patients), which led to 57 participants. The data collection method was an interview over the phone, with 20 structured questions. The interview form was sent by mail to the patients after the discharge from the ward, the authors thereafter called the participants at home and performed the interview within 10-20 days after discharge.   The most common concerns for surgical patients after discharge are wound care, pain management, daily activity, the detection of complications, handling symptoms, elimination and quality of life. This study shows that 72 % of the participants considered the given information as sufficient for handling their self-care at home. The lack of information experienced by the participants concerned daily activity, eventual complications that may occur and pain management. The majority of the discharge information was given in the patient room.   Postoperative complications that occur after discharge can be expensive for the society and is a cause of unnecessary suffering for the patient, therefore the patient need to understand what to be observant of after discharge. This requires that both doctors and nurses provide relevant information for each individual patient. / Syftet var att undersöka patienters uppfattning av information given vid utskrivning från en urologisk vårdavdelning på Akademiska sjukhuset samt att undersöka om patienterna själva sökt information efter utskrivningen.   Studien är en empirisk tvärsnittstudie med deskriptiv design. Alla patienter inskrivna som urologpatienter, som skrevs ut till hemmet från en urologisk vårdavdelning under mars månad 2009 tillfrågades att delta (sammanlagt 82 patienter), 57 patienter deltog. Som datainsamlingsmetod användes en telefonintervju med 20 strukturerade frågor. Frågorna skickades hem till patienterna efter hemgång och författarna ringde sedan upp patienterna i hemmet och genomförde intervjun.   De områden som kirurgiska patienter upplever störst bekymmer för efter utskrivning från sjukhuset är sårvård, smärthantering, daglig aktivitet, att upptäcka komplikationer, symtomhantering, elimination och livskvalitet. Studien visar att 72 % av deltagarna tyckte att den information de fått var tillräcklig för att sköta sin egenvård. Den information som saknats har varit inom områdena daglig aktivitet, eventuella komplikationer som kan uppstå och smärtlindring. Majoriteten av utskrivningssamtalen ägde rum på patientsalen.   Postoperativa komplikationer som uppträder efter utskrivning kan bli kostsamma för samhället och är källa till onödigt lidande för patienten, patienten behöver därför förstå vad denne skall vara uppmärksam på efter hemgång. Detta ställer krav på både läkare och sjuksköterskor att ge information som är relevant för varje individuell patient.

atisfaction with diabetes care, perceived feelings of empowerment to participate in self-care management, and glycemic control in a sample of older African American men and women with diabetes. A descriptive correlational quantitative design was used. The participants in this study were 73 men and women of African descent who were at least 50 years, English speaking, and diagnosed with diabetes for at least one year. The participants were asked to complete three survey instruments: the Patient Satisfaction Questionnaire-18 (PSQ-18), which measured how satisfied the participants were with their medical care; the Diabetes Empowerment Scale-Short Form (DES-SF), which measured attitudes towards diabetes and self-management of diabetes; and a demographic form, which collected data on the demographics of each participant. The most recent hemoglobin A1c (HbA1c) of each participant was obtained from the medical records. The correlations between HbA1c, DES, and the PSQ-18 subscales were exam ined. The study data indicated all correlations were statistically significant and negative with one exception. There was no correlation between HbA1c and time spent, a satisfaction subscale. Approximately half the participants were high school graduates, married, and reported being born in the Caribbean. Most had primary care physicians, but less than half reported attending a diabetes education program. The average BMI was 33.0. The findings of this study indicated older African adults who reported higher satisfaction with the care provided by their health care provider reported feeling more empowered to participate in diabetes self-care and reported lower HbA1c levels, suggesting better glycemic control (R2 = .39; P=<.001). / The implications of this study are that feeling empowered to participate in diabetes self-care management may result in improved glycemic control. Positive diabetes outcomes have been linked in the literature with persons feeling empowered to participate in diabetes self-care. The significance of the findings from this study is that given the relationship between empowerment and glycemic control, nurses should support the empowerment model of diabetes teaching. Diabetes education should provide written materials that are culturally sensitive for African American elders. / by Bridgette M. Johnson. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2012. Mode of access: World Wide Web.

Introdução: Um dos objetivos mundiais para a melhoria da qualidade de vida da população é a redução da mortalidade materna. Visto que esta expressa não só contextos relacionados à saúde, mas também, epidemiológico, social e econômico. Uma maneira de promover mudança nas taxas de mortalidade materna é por meio do enfrentamento de barreiras para a melhoria do cuidado obstétrico. Países que já superaram a falta de serviços e de acesso à assistência obstétrica enfrentam problemas relacionados à qualidade da atenção ao parto e nascimento. Como por exemplo, danos a saúde materna e neonatal decorrentes de intervenções desnecessárias ou até desaconselhadas. A utilização da tecnologia móvel por meio de mensagens enviadas às gestantes tem se mostrado eficaz, com melhorias no cuidado durante o pré-natal e pós-parto. Esta dissertação foi desenvolvida por acreditar que o uso de mensagens enviadas às gestantes no pré-natal poderia modificar fatores relacionados à assistência ao parto. Objetivo: Avaliar se mensagens enviadas por celular às gestantes produz efeito sobre a satisfação das mulheres com o atendimento ao parto, sobre o uso de boas práticas no parto e sobre a percepção delas sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Métodos: Esta é uma análise secundária de um ensaio aleatorizado por conglomerados em 20 unidades básicas de saúde (UBS) com maior número de seguimento pré-natal. As 20 UBS foram aleatorizadas (1:1) de forma balanceada, por meio de um software, formando um grupo Intervenção e um Controle, com dez UBS cada. Do grupo Intervenção origina o grupo que efetivamente recebeu a intervenção (grupo PRENACEL). A intervenção compreendeu o oferecimento de um pacote de mensagens enviadas para o celular das gestantes como um complemento ao pré-natal padrão da rede pública. Participaram do estudo mulheres com 18 anos ou mais, com até 20 semanas de gestação, que estavam em seguimento pré-natal nas UBS selecionadas. A coleta de dados foi realizada em quatro maternidades, e para o presente estudo, foram avaliadas mulheres que tiveram partos por via vaginal e sem gestações de alto risco. Os desfechos avaliados foram: a satisfação dasmulheres com o atendimento ao parto; o uso de boas práticas na assistência ao parto e a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos. Resultados: Esta pesquisa foi composta por 241 mulheres no grupo Controle e 427 no grupo Intervenção, sendo 63 pertencentes ao grupo PRENACEL. Não houve diferença estatística entre os grupos em relação à satisfação ou uso de boas práticas. Nem sobre a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Encontramos alta satisfação das mulheres com o atendimento e alta frequência de uso de boas práticas durante o parto comparado ao cenário nacional. Já a percepção delas sobre ocorrência de abuso, desrespeito e/ou maus-tratos foi baixa. Conclusão: O uso de mensagens enviadas a gestantes no pré-natal não demonstrou efeito sobre os desfechos avaliados. / Introduction: One of the world\'s goals for improving the population\'s quality of life is to reduce maternal mortality. This is because it expresses not only contexts related to health, but also epidemiological, social and economic. A way to promote change in maternal mortality rates it is by facing barriers to improve obstetric care. Countries that have overcome the lack of services and access to obstetric care face problems related to the quality of childbirth care. As for example, damage to maternal and neonatal health still occurs from unnecessary or non-advisable interventions. The use of mobile technology through messages sent to pregnant women has been shown to be effective, with improvements in antenatal and postpartum care. Objective: To evaluate whether messages sent by cell phones to pregnant women have an effect on women\'s satisfaction with delivery, on the use of good practices during childbirth and on their perception of abuse, disrespect and / or mistreatment during the delivery. Methods: This is a secondary analysis of a cluster-randomized trial in 20 Primary Health Care Units (PHCU) with a higher number of prenatal followup. The 20 PHCU were randomized (1:1) in a balanced manner, using software, forming an Intervention and a Control group, with ten UBS each. From the Intervention group, the group that actually received the intervention (PRENACEL group). The intervention included the provision of a package of messages sent to the pregnant women\'s cell phone as a complement to the prenatal standard of the public network. Participants were women 18 years of age or older, up to 20 weeks of gestation, who were undergoing prenatal follow-up at selected PHCU. Data were collected in four maternity hospitals, and for the present study, women who had deliveries vaginally and without high-risk pregnancies were evaluated. The outcomes evaluated were: the satisfaction of women with delivery; the use of good practices in childbirth care and women\'s perception of abuse, disrespect and / or mistreatment. Results: This study was composed of 241 women in the Control group and 427 in the Intervention group, of which 63 belonged to the PRENACEL group. There was no statistical difference between groups regarding satisfaction or use of good practices. Neither about the perception of women about the occurrence of abuse, disrespectand / or mistreatment during childbirth. We found high satisfaction of women with the attendance and high frequency of use of good practices during childbirth compared to the national scenario. Their perception of abuse, disrespect and / or mistreatment was low. Conclusion: The use of messages sent to pregnant women during prenatal care did not show any effect on the outcomes evaluated.

Introdução: Um dos objetivos mundiais para a melhoria da qualidade de vida da população é a redução da mortalidade materna. Visto que esta expressa não só contextos relacionados à saúde, mas também, epidemiológico, social e econômico. Uma maneira de promover mudança nas taxas de mortalidade materna é por meio do enfrentamento de barreiras para a melhoria do cuidado obstétrico. Países que já superaram a falta de serviços e de acesso à assistência obstétrica enfrentam problemas relacionados à qualidade da atenção ao parto e nascimento. Como por exemplo, danos a saúde materna e neonatal decorrentes de intervenções desnecessárias ou até desaconselhadas. A utilização da tecnologia móvel por meio de mensagens enviadas às gestantes tem se mostrado eficaz, com melhorias no cuidado durante o pré-natal e pós-parto. Esta dissertação foi desenvolvida por acreditar que o uso de mensagens enviadas às gestantes no pré-natal poderia modificar fatores relacionados à assistência ao parto. Objetivo: Avaliar se mensagens enviadas por celular às gestantes produz efeito sobre a satisfação das mulheres com o atendimento ao parto, sobre o uso de boas práticas no parto e sobre a percepção delas sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Métodos: Esta é uma análise secundária de um ensaio aleatorizado por conglomerados em 20 unidades básicas de saúde (UBS) com maior número de seguimento pré-natal. As 20 UBS foram aleatorizadas (1:1) de forma balanceada, por meio de um software, formando um grupo Intervenção e um Controle, com dez UBS cada. Do grupo Intervenção origina o grupo que efetivamente recebeu a intervenção (grupo PRENACEL). A intervenção compreendeu o oferecimento de um pacote de mensagens enviadas para o celular das gestantes como um complemento ao pré-natal padrão da rede pública. Participaram do estudo mulheres com 18 anos ou mais, com até 20 semanas de gestação, que estavam em seguimento pré-natal nas UBS selecionadas. A coleta de dados foi realizada em quatro maternidades, e para o presente estudo, foram avaliadas mulheres que tiveram partos por via vaginal e sem gestações de alto risco. Os desfechos avaliados foram: a satisfação dasmulheres com o atendimento ao parto; o uso de boas práticas na assistência ao parto e a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos. Resultados: Esta pesquisa foi composta por 241 mulheres no grupo Controle e 427 no grupo Intervenção, sendo 63 pertencentes ao grupo PRENACEL. Não houve diferença estatística entre os grupos em relação à satisfação ou uso de boas práticas. Nem sobre a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Encontramos alta satisfação das mulheres com o atendimento e alta frequência de uso de boas práticas durante o parto comparado ao cenário nacional. Já a percepção delas sobre ocorrência de abuso, desrespeito e/ou maus-tratos foi baixa. Conclusão: O uso de mensagens enviadas a gestantes no pré-natal não demonstrou efeito sobre os desfechos avaliados. / Introduction: One of the world\'s goals for improving the population\'s quality of life is to reduce maternal mortality. This is because it expresses not only contexts related to health, but also epidemiological, social and economic. A way to promote change in maternal mortality rates it is by facing barriers to improve obstetric care. Countries that have overcome the lack of services and access to obstetric care face problems related to the quality of childbirth care. As for example, damage to maternal and neonatal health still occurs from unnecessary or non-advisable interventions. The use of mobile technology through messages sent to pregnant women has been shown to be effective, with improvements in antenatal and postpartum care. Objective: To evaluate whether messages sent by cell phones to pregnant women have an effect on women\'s satisfaction with delivery, on the use of good practices during childbirth and on their perception of abuse, disrespect and / or mistreatment during the delivery. Methods: This is a secondary analysis of a cluster-randomized trial in 20 Primary Health Care Units (PHCU) with a higher number of prenatal followup. The 20 PHCU were randomized (1:1) in a balanced manner, using software, forming an Intervention and a Control group, with ten UBS each. From the Intervention group, the group that actually received the intervention (PRENACEL group). The intervention included the provision of a package of messages sent to the pregnant women\'s cell phone as a complement to the prenatal standard of the public network. Participants were women 18 years of age or older, up to 20 weeks of gestation, who were undergoing prenatal follow-up at selected PHCU. Data were collected in four maternity hospitals, and for the present study, women who had deliveries vaginally and without high-risk pregnancies were evaluated. The outcomes evaluated were: the satisfaction of women with delivery; the use of good practices in childbirth care and women\'s perception of abuse, disrespect and / or mistreatment. Results: This study was composed of 241 women in the Control group and 427 in the Intervention group, of which 63 belonged to the PRENACEL group. There was no statistical difference between groups regarding satisfaction or use of good practices. Neither about the perception of women about the occurrence of abuse, disrespectand / or mistreatment during childbirth. We found high satisfaction of women with the attendance and high frequency of use of good practices during childbirth compared to the national scenario. Their perception of abuse, disrespect and / or mistreatment was low. Conclusion: The use of messages sent to pregnant women during prenatal care did not show any effect on the outcomes evaluated.

Using mainly quantitative methods of evaluation, as well as patient comment assessment, this study evaluated whether changing the current informed consent process for labor epidural analgesia to a longer, more informational process resulted in a more satisfied patient. Satisfaction with the labor epidural informed consent process was evaluated using a questionnaire that was mailed and also available online. Half of the patient population was given a written labor epidural risk/benefit document at their 36-week obstetric check up. All patients received the standard informed consent. Survey responses were evaluated based on three independent variables dealing with the modality, timing, amount of informed consent information and one dependent variable, whether the patient's expectations of the epidural were met, which is equated with satisfaction. Patients in this study clearly indicated that they want detailed risk/benefit information on epidural analgesia earlier in their pregnancy. A meaningfully larger percentage of patients who received the written risk/benefit document were satisfied with the epidural process as compared to those who did not receive the document.

Aims The aims of this study were to increase community pharmacists’ willingness and confidence to provide consultations for people with depression, and to enhance patients’ awareness of the pharmacists’ developing role. Research Design To observe pharmacist-patient consultations, the researcher developed a patient scenario. Pharmacist knowledge and attitude questionnaires were adapted, and a skills observation checklist was developed. Assessments of patient satisfaction levels took place before and after pharmacist training, which included a simulated consultation and action planning. The consultations were both video recorded and observed. Participants undertook a short interview with the researcher and each pharmacist developed his/her own plan for continuing professional development (CPD). An exploration of the interview transcripts was undertaken qualitatively. A University Ethics Panel approved the project. Results There were twenty-two pharmacists who took part in the study, comprising eighteen males and four females. MPharm students comprised one female and two males, and community pharmacists made up three females and sixteen males. The quantitative results: It was found that pharmacists possessed appropriate knowledge (the mean score was 75%, which showed that the pharmacists were aware of the safety and action of anti-depressants). The mean score for attitude was 54%, which tends towards the positive. When observing the simulated consultations, the mean score for initiating a consultation session was recorded at 28%. This indicates that the pharmacists were not very interested in initiating rapport with patients. However, the highest mean score calculated was 61%, which corresponded with closing a consultation. For data collection and action, the mean scores were 42% and 35%, respectively, and this indicates the need for improvement in these areas. The qualitative findings: The pharmacists demonstrated good knowledge about anti-depressants and held positive attitudes towards people with depression. However, the pharmacists were not very willing to exercise the responsibilities of their extended role or provide additional services for patients. The pharmacists lacked certain skills and opportunities to be able to enhance the patients’ satisfaction. The pharmacists in this study needed to improve their soft skills in some areas and engage in mutual discussion with patients in order to enhance patients’ expectations with the service provided. Conclusion/discussion The knowledge and attitude of pharmacists were good, but their consultation skills could be improved. Although simulated consultation allowed pharmacists to review their skills and practice the apparent impact on patient care was limited. This study has enable greater understanding of pharmacist strategies when consulting people with depression, and the findings could be used by those developing training programmes for enhancing pharmacists skills.

Objetivos: Caracterizar o perfil audiológico dos indivíduos com malformações congênitas de orelha externa e/ou orelha média, na Divisão de Saúde Auditiva (DSA), do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), da Universidade de São Paulo (USP), campus Bauru e avaliar o benefício e a satisfação dos usuários de aparelhos de amplificação sonora individuais por condução óssea (AASI VO) retroauriculares. Modelo: Análise de prontuários, avaliação do benefício pelo teste de reconhecimento de sentenças com ruído competitivo e pelas medidas do ganho funcional e avaliação da satisfação pelo questionário internacional QI - AASI. Local: DSA, HRAC/USP, Bauru. Participantes: Foram analisados os prontuários de 170 indivíduos e, destes, selecionados 13, com malformações congênitas bilaterais de orelha externa e/ou orelha média, deficiência auditiva condutiva ou mista moderada ou severa e usuários de AASI VO retroauricular. Resultados: O perfil audiológico (n = 170) caracterizou-se pelo predomínio das malformações bilaterais (53%), das malformações no sexo masculino (61%), da deficiência auditiva condutiva moderada ou severa (80%) e da adaptação de AASI VO (56%). A orelha direita foi mais afetada (32%), quando consideradas apenas as malformações unilaterais. Na amostra selecionada (n = 13), o benefício foi comprovado pelo melhor desempenho obtido na avaliação proposta, na condição com AASI, quando comparada à condição sem AASI. A satisfação foi confirmada pelos escores elevados obtidos no QI-AASI. Conclusões: O uso do AASI VO retroauricular trouxe benefícios para o reconhecimento da fala no ruído e para a percepção do sinal acústico, além de satisfação aos indivíduos com malformações congênitas de orelha, portanto, esses dispositivos devem ser considerados como uma opção no tratamento dessa população. / Objectives: To characterize the audiological profile of the individuals with congenital malformations of the external and/or middle ear, in the Divisão de Saúde Auditiva (DSA) of the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) of Universidade de São Paulo (USP), in Bauru and to evaluate the benefits and satisfaction of patients fitted with bone conduction hearing aid (BCHA). Model: Analysis of files, evaluation of benefits by means of test of recognition of sentences with competitive noise and by the measures of the functional gain, and evaluation of satisfaction by International Outcome Inventory for Hearing Aids (IOI/HA). Participants: 170 patients? files were analyzed, from which 13 were selected with bilateral congenital malformations of the external and/or middle ear, moderate or severe conductive or mixed hearing loss, and patients fitted with BCHA. Results: The audiological profile (n=170) was characterized by the prevalence of bilateral malformations (53%), of malformations in males (61%), of the moderate or severe conductive hearing loss (80%) and of the fitting of BCHA (56%). The right ear was more affected (32%) when considered the unilateral malformations only. In the selected sample (n=13), the benefit was demonstrated by the best performance obtained in the proposed evaluation, in the condition with hearing aid, when compared to the condition without hearing aid. The satisfaction was confirmed by the high scores obtained in the IOI - HA. Conclusions: Fitting BCHA denoted improvement at speech perception in noise and sound detection. Individuals with congenital malformations of the ear were satisfied with this device, so that must be considered as an option to the treatment of this population.

Introduction: Nursing presence occurs when nurses expend themselves on the behalf of a unique patient. This phenomenon requires further research to develop instruments. The Presence of Nursing Scale (PONS) measures the patient’s perspective (Kostovich, 2012). Psychometric testing of PONS-Revised using exploratory factor analysis is warranted to further develop a reliable and valid measure of nursing presence. Contextual workplace variables need exploration in inpatient settings for correlation with nursing presence. Method(s): A convenience sample of 122 adult inpatients from ten acute-care nursing units in a Southeastern Magnet hospital were surveyed to conduct the first psychometric testing of this revised instrument using exploratory factor analyses. Seven research questions evaluated potential correlations between the PONS-R, patient satisfaction using nurse-sensitive measures of HCAHPS, nursing unit-specific workforce factors and patient demographic factors. Results: PONS-R demonstrated high internal consistency reliability (r = .974), test-retest reliability (statistically significant at the .01 level) and divergent validity (p=.002). PONS-R compared to nurse HCAHPS measures was statistically significant at the .01 level, (r = .736). EFA revealed one factor (eigenvalues over 1), with a weak secondary factor centered on intimacy factors suggesting addition of items and repeated study with a larger sample size to further psychometrically develop the instrument. Unexpected negative correlations were found with unit-workforce factors including average RN experience level (r= -.185, significant at the .05 level), and average RN age (r = - .218). An unexpected positive correlation was found - percentage of Associate degree nurses (r = .269, statistically significant at the .05 level. The Triangle region was correlated with a higher PONS-R score (p = .038; n=4), otherwise no statistically significant correlations were found for PONS-R and patient demographics nor patient-specific variables such as estimated number of RN providing care, nor length of stay on the unit. Discussion & Conclusions: Further psychometric testing is indicated with larger samples and perhaps with the inclusion of intimacy factor items. Additional correlational studies focused on other patient quality outcomes measures with expansion of nurse demographics is indicated to explore for confounding variables.