Thesis (Ph.D.)--RAND Graduate School, 2006. / Includes bibliographical references.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006 / Includes bibliographical references (p. 125-129). Also available on the Internet.

Thesis (Ph. D.)--University of Washington, 2000. / Includes bibliographical references (leaves 100-121).

Adverse drug reactions (ADRs) are common and should be reported to the CSM, particularly for newly marketed drugs. There is under-reporting of ADRs by doctors. Involving the patient in self-reporting, particularly when initiated by pharmacists is feasible and could help to improve reporting rates. This study investigated a comprehensive checklist questionnaire listed symptoms in all body systems to facilitate patient self-reporting using both established and new 'black triangle' centrally-acting drugs. Symptoms reported were compared to their documentation in medical notes and for new drugs to reports from other sources. A novel classification system for ADRs was developed to take account of the minimal data available and used to evaluate the potential accuracy of symptom attribution by patients. An external comparison of a sample of symptom classifications by an ADR expert was also obtained. The questionnaire was sent to 464 patients prescribed carbamazepine, sodium valproate, trazodone, doxepin and co-proxamol from three participating medical practices in a pilot study. Subsequently, it was sent to all patients (n=2307) prescribed tramadol, fentanyl patch, venlafaxine, nefazodone, citalopram, moclobemide, gabapentin, lamotrigine and topiramate from 79 participating medical practices in Grampian during January-March 1997. The overall response rates were 44.6% (n=207) for the pilot study and 36.3% (n=837) for the main study. The most frequently reported symptoms were: drowsiness for carbamazepine, unusual tiredness for sodium valproate, constipation for co-proxamol, dry mouth for trazodone, doxepin, tramadol, venlafaxine, nefazodone, moclobemide and citalopram, weight gain for gabapentin, loss of memory for lamotrigine, weight loss for topiramate and constipation for fentanyl patch. Overall only 22.4% (522/2330) of symptoms reported by patients were recorded by GPs in the 310 medical notes accessed. In general, common symptoms were reported more frequently by patients than in CSM reports and PEM data. Patients tended to report minor and known ADRs which bothered them, while CSM and PEM reports received were of more severe ADRs. Respondents were more likely to report symptoms (6040/8630,70%) potentially caused by the study drugs than those not to be caused by the study drugs. Moderate agreement (Kappa = 0.4-0.5) was found between expert and researcher classifications of symptom causality. It is suggested that interpretation by pharmacists of patient self-reporting using the checklist questionnaire could result in much higher ADR reporting rates, in particular for new drugs.

The purpose of this study was to compare the perception of the nurse and the perception of the patient in identifying priorities for his learning needs with respect to the hospital environment and to his medical condition. A Q-sort of statements related to these two learning needs was developed and used to test the nurses' perception and the patients' perception of these learning needs. The diabetic patient was selected for study because his learning needs with respect to his condition are well documented, and the general staff nurse was selected because she is responsible for direct patient care. To test the hypotheses, the Q-sort was administered to 50 newly hospitalized diabetic patients, to 50 general staff nurses directly responsible for the care of these patients, and to 50 general staff nurses having no contact with a patient or no direct responsibility for his care. The study was conducted in a large hospital in Vancouver, British Columbia. The hypotheses assumed that the two groups of nurses and the patients would assign different priorities to the patients' learning needs. The .05 level of significance was used in this study. An analysis of selected personal characteristics of the patients provided a description of the patient population. The findings showed that all but one patient had been in hospital before, and that only three patients were newly diagnosed diabetics. An analysis of selected personal characteristics of the nurses indicated that there was no significant difference between the two groups. Thus, any differences in perception could not be attributed to these characteristics. The Q-sort scores of all three groups were examined for differences in perception and the selected personal characteristics were tested with respect to these scores. The results indicated that both groups of nurses and the patients assigned a greater degree of importance to the patient's learning needs related to his diabetic condition than those related to the hospital environment. Although the nurses attached a greater degree of importance to the former needs than did the patients, the difference was not significant. The results also indicated that a majority of nurses and patients, matched as pairs, perceived the patient's learning needs related to the diabetic condition as more important, and yet there was a significant difference in perception. Other results showed a high degree of correlation between both groups of nurses and the patients and the nurses responsible for their care, with respect to priorities assigned to statements within each of the two categories of learning needs. Although the selected personal characteristics of each group were tested with respect to their more important Q-sort scores, only a limited number of relationships were significant for the patients and the nurses directly responsible for their care and none for the other group of nurses. These significant relationships were age, marital status, duration of illness, and education of the patients, and additional education and experience of the nurses. The results of the study have demonstrated the value of the Q-sort technique as a procedure for acquiring data with respect to the learning needs of the patient. The analysis of the data of the nurses and the patients under their care provided a measurement of the quality of patient care. In addition, the analysis of the data of the patients provided a guide for the establishment of a desirable learning sequence for the individual patient. / Education, Faculty of / Graduate

An exploratory study was conducted on 25 male and female patients who were admitted to a 29-bed surgical unit of a 450-bed general hospital, for diagnostic testing. The purpose of the study was to answer the following questions: (1) What situations does the patient perceive as helping him feel comfortable while he is experiencing the diagnostic regime? (2) What situations does the patient perceive as making him feel uncomfortable while he is experiencing the diagnostic regime? (3) What coping responses does the patient utilize in adapting to discomfort promoting situations during the diagnostic regime? The data for the study were collected through the utilization of a structured questionnaire for the initial visit and taped interviews with the selected patients. During the interviews, particular emphasis was placed upon exploring the patients' concerns by the use of Orlando's Open-Ended Interview Technique and a modified version of the Critical Incident Technique. The results were then categorized into themes of patient responses, tabulated, and analyzed. The results of the study revealed that the situations the patient perceived as promoting comfort or discomfort were dependent upon two significant variables: (1) The degree to which the patient's personal value system needs were met during the diagnostic regime; (2) The patient's ability to mobilize adaptive coping responses to deal with the stresses created by the diagnostic regime. The coping responses utilized by the patients in adapting to discomfort promoting experiences in hospital were numerous and highly diversified. It was noted that the patients' ability to cope adaptively was primarily influenced by their evaluation of what was happening to them. In turn, this evaluation was affected by their past experience, their present biopsychosocial state, and the duration of the uncomfortable experience. / Applied Science, Faculty of / Nursing, School of / Graduate

The primary objective of this study was to analyze dyadic verbal interactions and to determine whether they were associated with the roles of the participants. These "interactions occurred in the chronic paediatric health care delivery system between parents of handicapped children and physicians and between those same parents and other members of the health team. Additional objectives of this research included testing of the reliability of the Sequential Analysis of Verbal Interaction (SAVI) instrument and its utility in the health care system. Clinical data were obtained during regularly scheduled appointments in the form of audio-taped interviews using 37 parent-professional 'and 37 parent-paraprofessional dyads. A six-minute sample was selected from each interview tape, coded at three-second intervals, transcribed into the class of communication behaviour and analyzed. Subsequent to data collection, reliability and utility of the SAVI instrument were examined and determined to be appropriate for this study. The major finding of the study was that parents of handicapped children used different verbal messages and behaviours than professionals and paraprofessionals. The communication pattern for all three groups, using Agazarian's (1968) model was cross-purpose. Under a proposed model, adapted from Agazarian's, the parents' pattern of communication was considered to approximate the problem-solving pattern more closely. The conclusion drawn from this exploratory study was that very little of a personal nature was occurring in interpersonal communication, which in turn hindered the development of a problem-solving pattern of communication. An important direction for further research would be the testing of the predominance of the cross-purpose pattern of communication using a larger and more homogenous sample of professionals and paraprofessionals. / Graduate and Postdoctoral Studies / Graduate

Forskning tyder på att 200 000 personer i Sverige drabbas av en ätstörning någon gång under livet. Studiens syfte var att utforska behandlingen mot ätstörningar och de erfarenheter som patienter och deras anhöriga upplevt genom bemötande och delaktighet i vården och den inverkan de fått på deras tillfrisknad. Semistrukturerade intervjuer genomfördes med fem tidigare ätstörningspatienter och två anhöriga. Data analyserades med hjälp av tematisk analys. Av resultatet framkom ett övergripande tema: Se hela mig - kropp och själ hör ihop samt sex underteman: styrande stereotypa föreställningar, den stereotypa bildens följder, tillit och misstro, kompetens påverkan relationella band, medbestämmande och samverkan, maktobalans. Deltagarna saknade behandling för de tankar och känslor som upprätthåller ätstörningen. Auktoritära tillvägagångsätt främjade inte arbetsallians eller delaktighet. Deltagarna upplevde att utebliven psykologisk behandling orsakat att de fortsatt levt med negativa tankar och beteenden som mer eller mindre vidmakthållit ätstörda beteenden. Utifrån deltagarnas önskemål och beskrivningar av brister förefaller det behövas kompetenshöjande insatser kring bemötande i behandlingen av ätstörningar.

This dissertation is an ethnographic exploration of gossip and rumour around the fear and distrust that surrounds a local hospital in KwaNdebele that has acquired a reputation as a slagpale (an Afrikaans term for slaughterhouse). Using ethnographic data gathered over an 18 month period, I examine how gossip (ukuhleba) and rumour (amahemuhemu) capture patient voices of discontent with hospital service while also being a means by which patients seek to discipline medical professionals and to warn others about possible abuse when visiting the hospital. The focus on gossip and rumour answers an often neglected question in scholarship, which is how patients respond to the widely reported power that medical professionals exercise over them? Furthermore, having broadly traced the uses of gossip and rumour in resistance to biomedical technologies to the 1800s, this dissertation moves beyond a focus on patient responses to examine the logic underpinning this resistance. To do this I compare three categories of traditional healers in KwaNdebele. I found that gossip and rumours also circulated about traditional healers although unequally among the three types. There is particular suspicion around non-initiating healers called amagedla who are thought to practice outside ancestral structures of control. I read the emphasis on ancestral regulation as a metaphor for communal control and accordingly conclude that biomedicine and its practitioners similarly meet with much resistance particularly because they are far removed and disempowering to what are often semi-literate and illiterate residents. Finally, the dissertation focuses on stories of hospital hauntings and deaths said to be connected with a diminishing traditional practice of ‘fetching’ the spirits of those who die at the hospital and shows that discourses around hospital deaths and burial rites are intimately connected to broader considerations that extend beyond the hospital setting to encompass socio-economic changes and resultant anxieties. These considerations are framed through an idiom of a call for a return to tradition and ultimately express a perceived crisis of social reproduction in post-apartheid KwaNdebele. / Dissertation (MSocSci)--University of Pretoria, 2018. / UP Postgraduate Merit Bursary / NRF Scarce Skills Master's Scholarship / Anthropology and Archaeology / MSocSci / Unrestricted

Bakgrund: Utifrån ett sjuksköterskeperspektiv är kommunikation, och därigenom skapande av förståelse och mening, en grundläggande del av omvårdnadsarbetet. Att som sjuksköterska utveckla en positiv sjuksköterska-patientrelation är av fundamental vikt för säkerställandet av god omvårdnad. Effektiv kommunikation leder till högre patienttillfredsställelse, högre patientdelaktighet och förbättrade hälsoresultat.  Kommunikationen mellan sjuksköterska och patient kan påverkas negativt av kommunikationsbarriärer. Sjuksköterskans roll är att minimera de negativa konsekvenserna av existerande kommunikationsbarriärer genom att använda de metoder som ger bäst förutsättningar för god kommunikation i den givna situationen. Det finns ett behov att identifiera vilka barriärer för kommunikation som sjuksköterskor upplever samt hur sjuksköterskor kan övervinna dessa problem.  Syfte: Syftet var att undersöka hur sjuksköterskan upplever kommunikationen mellan patient och sjuksköterska då det föreligger kommunikationsbarriärer samt vilka åtgärder för att överbrygga kommunikationsbarriärer sjuksköterskan har erfarenhet av. Metod: Litteraturstudie med deskriptiv design. Litteratursökningen innefattade databaserna Pubmed, Psycinfo och CINAHL. Resultatet baserades på tio originalartiklar med kvalitativ ansats som var publicerade mellan 2012 till 2019.  Resultat: Under resultatanalysen identifierades två teman: Kommunikationsbarriärer samt Åtgärder och/eller metoder att överbrygga kommunikationsbarriärer. Inom varje tema identifierades kategorier och/eller underkategorier. Tolv kategorier av kommunikationsbarriärer har identifierats och sjuksköterskans upplevelse av dessa har beskrivits. Fem olika strategier och metoder som etableras av sjuksköterskorna har identifierats, att spendera tid på kommunikation, att använda tolk, att kommunicera via närstående, kunskap och utveckling samt kommunikativa strategier.  Slutsats: Studien förser sjuksköterskan med kunskap om kommunikationsbarriärer och redskap för att motverka ineffektiv kommunikation. Samtidigt rekommenderas vidare forskning för att stärka klinisk omvårdnad. / Background: From a nursing perspective communication is an integral part of nursing. Nurses need to establish a positive nurse-patient relationship to ensure good nursing practice. Effective communication leads to higher patient satisfaction, higher patient participation and a better health outcome.  The communication between nurse and patient can be negatively impacted by communications barriers. The nurse’s role is to minimize the negative consequences of existing communication barriers by using methods best adapted for the specific situation. There is a need to identify the barriers for effective communication that nurses experience and methods to overcome these communication barriers.  Aim: The aim of this study was to investigate how nurses experience the communication between patients and nurses while communication barriers exist as well as to investigate how nurses experience efforts to overcome communication barriers.  Method: Literature review with a descriptive design. The literature search encompassed three databases: Pubmed, Psycinfo and CINAHL. The results were based on ten original articles using a qualitative approach, published between 2012 and 2019.  Results: During the data analysis two themes were identified: Communication barriers and Measures and methods to overcome communication barriers. These two subject categories were subsequently divided into categories and/or sub-categories. This study has identified twelve communication barriers faced by nurses in their daily work and the nurse’s perceptions in this context. Five different categories relating to strategies and methods to overcome communication barriers, as perceived by the nurses, were identified.  Conclusion: This study provides knowledge and tools for nurses to counteract ineffective communication. Further research is recommended to further strengthen clinical practice.