Magister Administrationis - MAdmin / HIV and TB are major problems in the South African context and the burden of these diseases is proving detrimental to the development of the country. These diseases have been evident in the country for many years and in recent times the infection rates of TB and HIV has been alarming. The World Health Organization (WHO) classified TB as a problem and the world was to actively implement strategies to combat this epidemic. The issue with TB control strategies is the emergence of HIV which has been the largest contributing factor to the increase in the TB burden in South Africa and many countries like it. South Africa has made great strides in the control of HIV in areas such as mother to child transmission, awareness programs, initiation of ARVs and medical male circumcision which have proven to be successful. In contrast, the TB burden does not share the same fate. The number of deaths caused by TB is continuously rising, as well as the number of new Multi-drug resistant TB cases. Furthermore the emergence of Extreme –drug resistant TB is seen as a sign of a failing health system. Policy makers are now faced with fact that the Directly Observed Therapy Short course (DOTS) program for the prevention of TB is inadequate in an area with a high HIV prevalence, which is what South Africa is faced with. The research objectives are therefore to identify if knowledge from South African TB policies are being disseminated to people who suffer from TB, also to measure if a lack of knowledge may have an impact on treatment success. A policy analysis was done of 5 South African TB policies to identify areas of the policies which are patient specific. The TB policies emphasized a patient-centred approach and the researcher used this concept to motivate that patient-specific areas must be known by the patients. The specific areas identified were: TB specific areas, Treatment specific areas, Adherence specific areas and information/education specific areas. Based on the policy analysis a case study was conducted at Brooklyn Chest Hospital to measure implementation of the policies on the ground. The study found that education was adequate in areas around TB diagnosis, treatment length, signs and symptoms, and family education. The participants lacked knowledge in areas such as TB contacts, monitoring of TB disease, education of TB prior to diagnosis and a high prevalence of non-adherence and multiple cases of TB were found among the participants. Also, the Chi-Square test found no statistical significance between the length of admission to hospital and treatment outcome. The result also shows that of the participants studied, over 30% of the study had not adhered to TB treatment after discharge. The study finds that there are significant shortfalls in the knowledge of participants based on South African TB policies, with a high non-adherence rate before and after discharge. The study shows a lack in the implementation of policy directives on education, following a patient-centred approach, which is evident in the lack of knowledge found in the participants in many facets of the TB disease and the processes to control TB.

Magister Commercii - MCom / The South African democratic government is mandated by the constitution to provide quality healthcare services to the citizens of the country. Therefore, healthcare in South Africa is considered as a basic human right. The existing healthcare system exhibits extreme inequality, which translates into inequity in health outcomes across different demographic factors. Even though quality healthcare is a basic human right, problems related to the quality of healthcare remain, which poses a major challenge for the South African government. This dissertation investigates patient perceptions of the quality of public healthcare in South Africa, using General Household Survey data (2009-2016), with the objective of determining the level and trends of patient satisfaction and complaints reported when accessing public healthcare services in South Africa and identifying the correlates of these perception. This study found that patient satisfaction with public healthcare services in South Africa has increased over time while complaints have decreased over time. This study refrains from drawing conclusion on these findings at face value, since they may be other factors that explain the observed trends. The most common complaint was long waiting time at public healthcare facilities. On average, White individuals, male household heads, individuals residing in rural areas and individuals from smaller household were more likely to report to being satisfied with healthcare services received at public healthcare facilities in South Africa. Therefore, patient satisfaction survey approach should be used in conjunction with other healthcare quality measures such as direct observation, vignettes and standardised or mystery patient.

Patients are the recipients of the provision of healthcare and an invaluable source when evaluating the quality of healthcare provided in our hospitals. There is limited research evaluating patient perceptions of overall quality of healthcare. A larger study Convergence and Divergence in Perspectives in Quality represented the first Saskatchewan effort to explore patient perceptions and what aspects patients indicate as important when evaluating the provision of quality of care. In the larger study, patients hospitalized with one of four tracer conditions (cerebral vascular accident, myocardial infarction, prostate disease and hysterectomy) were surveyed about their involvement in and satisfaction with the provision of healthcare. The present study, using a data subset of the larger study, specifically explored patients perceptions on their involvement in decision-making, feelings of being well informed of ones medical condition, and sources of health information. These perceptions were correlated with the overall ratings of quality of care. Findings indicated a moderately high overall rating of quality of care. Increased involvement in decision making regarding medical care and options for treatment, and the feelings of being fairly or well informed were associated with higher ratings of overall quality of care. While few of the correlations reached greater than moderate effect, it is still clear that opportunities for patients participation in decisions related to their medical care and patients feelings of being fairly or well informed contributed to overall perceptions of quality of care. The majority of patients preferred their doctor or nurse to provide information about their medical condition, thus indicating the human touch is still preferred. Nurses can use these results to advocate for time to ensure patients have access to correct information and are included in decisions about their care.

Patients are the recipients of the provision of healthcare and an invaluable source when evaluating the quality of healthcare provided in our hospitals. There is limited research evaluating patient perceptions of overall quality of healthcare. A larger study Convergence and Divergence in Perspectives in Quality represented the first Saskatchewan effort to explore patient perceptions and what aspects patients indicate as important when evaluating the provision of quality of care. In the larger study, patients hospitalized with one of four tracer conditions (cerebral vascular accident, myocardial infarction, prostate disease and hysterectomy) were surveyed about their involvement in and satisfaction with the provision of healthcare. The present study, using a data subset of the larger study, specifically explored patients perceptions on their involvement in decision-making, feelings of being well informed of ones medical condition, and sources of health information. These perceptions were correlated with the overall ratings of quality of care. Findings indicated a moderately high overall rating of quality of care. Increased involvement in decision making regarding medical care and options for treatment, and the feelings of being fairly or well informed were associated with higher ratings of overall quality of care. While few of the correlations reached greater than moderate effect, it is still clear that opportunities for patients participation in decisions related to their medical care and patients feelings of being fairly or well informed contributed to overall perceptions of quality of care. The majority of patients preferred their doctor or nurse to provide information about their medical condition, thus indicating the human touch is still preferred. Nurses can use these results to advocate for time to ensure patients have access to correct information and are included in decisions about their care.

Alla människor kan drabbas av en akut sjukdom eller skada. Hur de drabbade hanterar händelsen är mycket varierande. Känslor som rädsla, oro och smärta kan öka risken för mer eller mindre långdragna psykiska reaktioner. Om det akuta vårdteamet har kunskap om den intima kopplingen mellan människans kropp och psyke kan de ge ett korrekt stöd och bemötande redan i ett tidigt skede och därmed kanske minska patientens psykiska lidande. Trots att traumavården gör stora tekniska framsteg finns endast liten kunskap om hur det är att vara traumapatient. Syftet med studien är därför att belysa patienters upplevelse av det akuta omhändertagandet. Empirisk kvalitativ innehållsanalys användes som metod då författarna avsåg att undersöka patienters upplevelser i en specifik situation.Resultatet är en bearbetning av 10 vetenskapliga artiklar som belyser patienters upplevelser av akut omhändertagande på akutmottagningar och intensivvårdsavdelningar. Vid bearbetningen av artiklarna framkom flera områden som visar på patienternas upplevelser. Dessa har kategoriserats enligt följande: trygghet, professionalism, närhet, att ta kontroll samt kommunikation. Trygghet upplevdes som kärnan då övriga kategorier tycktes bidra till dess övergripande betydelse. Ett viktigt resultat som framkom var att vårdpersonalens tekniska kompetens upplevdes som viktigare än deras bemötande initialt i det akuta omhändertagandet. Förutom att patienterna hade ett behov av att få tydlig information så behövde de också känna att personal, familj och vänner fanns i deras närhet även om de inte kommunicerade med varandra. För att patienternas behov av trygghet skall tillgodoses vid det akuta omhändertagandet är det viktigt att vårdpersonalen ser till helheten och tar hänsyn till den enskilda individens psykiska status just i den aktuella situationen. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård</p><p>Uppsatsnivå: D</p>

Low back pain (LBP) has a global impact on health and is a substantial contributor to long term disability. The economic burden of LBP is immense and it is advancing annually. Costs attributing to LBP in the United States is about $84.1 to $624.8 billion. Physical therapy is commonly recommended for those with LBP since it is linked to improved clinical outcomes. However, patient perceptions can influence how this treatment approach is perceived. It is unclear if these perceptions can influence outcomes for patients suffering from LBP. Therefore, the purpose of this study is to identify the factors associated with positive or negative perceptions of physical therapy care in those with LBP. This was accomplished by developing and administering a comprehensive Qualtrics survey to participants in the Orlando area. Participants who took the survey were screened for eligibility requirements with exclusion criteria being those from vulnerable populations including pregnant women, minors, prisoners, and any person unable to provide informed consent. Screening, demographic, clinical, and perception questions were embedded within the online survey. Those who participated had to be 18 years or older, located within the Orlando area, able to provide informed consent, and speak English. Results from the data identified the five top key indicators which included clear explanation by the physical therapist on the treatment plan, how clear the physical therapist is in explaining the problem, friendliness of the physical therapist, patients perceive physical therapy is very effective in treatment of knee, and patients perceive physical therapy is very effective in treatment of lower back.

Bakgrund: Världens befolkning ökar och blir allt äldre. Med stigande ålder ökar risken att drabbas av sår, och följaktligen förväntas också en global ökning av antalet människor som lever med sår. Samtidigt förväntas mängden vårdpersonal minska. För att lösa hälso- och sjukvårdens utmaning att med minskande resurser ta hand en ökande och åldrande befolkning föreslås patienters egenvård ta större plats. Positiva effekter av egenvård har påvisats vid flera långvariga sjukdomstillstånd. Egenvård av sår är dock ett relativt outforskat ämne, och lite är känt om hur patienter uppfattar fenomenet. Patienters uppfattningar är värdefulla att undersöka eftersom de kan fungera vägledande vid framtida planering av egenvård av sår. Syfte: Syftet var att beskriva patienters uppfattningar om egenvård av sår. Metod: En litteraturöversikt i vilken artiklar analyserades med tematisk syntes enligt Thomas och Harden (2008). Resultat: Studiens resultat baserades på tolv artiklar med kvalitativ design. Patienter såg egenvård som en positiv möjlighet som gjorde det möjligt för dem att leva ett mer självständigt liv. Anhörigas stöd lyftes fram som särskilt viktigt för att egenvård ska vara möjligt. Vårdpersonalens kompetens uppfattades i vissa fall som bristfällig, vilket ansågs försvåra utförandet av egenvård. Patienterna efterfrågade bättre information och utbildning om sårbehandling. Slutsats: Patienter såg egenvård av sår som en tilltalande möjlighet som kan realiseras genom stöd från anhöriga, bättre information och utbildning, god kompetens hos vårdpersonalen, samt genom en tillitsfull relation mellan patienter och vårdpersonal. / Background: The world’s population is growing and getting older. At the same time, the number of healthcare workers is expected to decrease. To solve the healthcare challenge of taking care of a growing and aging population with diminishing resources, patients’ self-care is suggested to take a bigger place. Positive effects of self-care have been shown in several long-term medical conditions. However, self-care of wounds is a relatively unexplored topic, and little is known about how patients perceive the phenomenon. Patients’ perceptions are interesting to investigate because they can serve as a guide in future planning of self-care of wounds. Aim: The aim was to describe patients’ perceptions of self-care of wounds. Method: A literature review that analyzed articles using thematic synthesis according to Thomas and Harden (2008). Result: The study’s results were based on twelve articles with qualitative design. Patients saw self-care as a positive opportunity that enabled them to live a more independent life. The support of relatives was highlighted as important for self-care to be possible. The healthcare staff's competence was perceived as flawed, which was considered to make it difficult to perform self-care. Patients requested better information and wound care education. Conclusion: The patients saw self-care of wounds as a positive opportunity that can be realized through support from relatives, better information and education, good competence of the healthcare staff, and through a trusting relationship between patients and healthcare staff.

No description available.

With an increasing prevalence of osteoarthritis, total knee (TKA) and hip (THA) arthroplasty are the second-and third-most common surgeries in Canada. Although these procedures improve pain and function for a majority of patients, some patients report persistent postoperative pain. Opioids are conventionally used for these patients even though they are associated with addiction, falls, overdose, and death. Recently, many strategies have been proposed to decrease reliance on opioids after TKA and THA, including opioid-free and opioid-reduced multimodal protocols for pain management. Our findings demonstrate that Canadian patients’ receptivity to opioid-free or reduced postoperative protocols is associated with their perception of the efficacy and safety of opioids compared to non-opioid alternatives, and current opioid use. More patients are open to opioid-reduced postoperative care as they perceive that pain will be intolerable without opioids. This overlaps with many Canadian surgeons’ perception that opioids cannot be completely eliminated from postoperative pain management regimens and that patients expect an intolerable level of pain after surgery, warranting opioid use. This highlights a need for enhanced patient education on the safety and efficacy of opioids and alternatives, while managing patients’ expectations of postoperative pain control. Most Canadian and Dutch surgeons reported that they prescribe opioids to nearly all of their patients postoperatively. However, our cross-sectional study indicates that 40% of Canadian patients would be open to receiving no opioids postoperatively. In contrast, Japanese surgeons believed that opioids are unnecessary for managing postoperative pain. Variations observed among orthopaedic surgeons in Canada, the Netherlands, and Japan can be attributed to differences at the surgeon-level (individual practices and beliefs), patient-level (patient characteristics and preferences), and system-level (regulatory frameworks and healthcare systems). Further research is required on surgeon-centered approaches to mitigating opioid use, focusing on education and guidelines/policies for opioid prescribing. / Thesis / Master of Science (MSc) / Opioid analgesics are routinely prescribed to manage pain after total knee and hip replacement surgery. However, opioids are not typically more effective than alternatives and are associated with addiction, overdose, and death. This thesis aims to understand the perceptions of patients and orthopaedic surgeons on opioid use after total knee and hip replacement surgery. The findings demonstrate that more patients are open to receiving opioid-reduced surgery compared to opioid-free surgery, with receptivity being associated with patients’ perceptions of opioid efficacy and safety and current opioid use, highlighting a need for improved patient education. Additionally, orthopaedic surgeons identified challenges and facilitators to postoperative opioid reduction in six key areas: opioid prescribing practices, patient factors, collaborative care, policies/guidelines, surgeon education and training, and personal perceptions/beliefs. Compared to Canadian and Dutch surgeons, Japanese surgeons heavily relied on non-opioid medications as they believed that opioids are unnecessary for managing postoperative pain.

The general relationship between the physician and the patient is one where communication is used to establish and maintain what will likely become a long-term partnership. Health communication research indicates that physicians who have apt communication skills in the patient-physician relationship develop a platform of trust behaviors. The physician communication behaviors perceived to elicit trust reported by patients are; comfort/caring, agency, competence, compassion and honesty. The objective of the research project was to assess patient perceptions of previously determined physician communication behaviors that predict patient trust through individual surveys (N=162) between foreign-born international medical graduates and American-born non-IMG resident physicians. Patients reported finding a difference in the exhibited communication behaviors between non-IMG and IMG resident physicians, with the exception of comfort/caring. A modified Trust Model guided the research and supported certain prior findings, claiming that effective communication cannot exist in the absence of a solid, trusting physician-patient relationship.