Magister Scientiae (Physiotherapy) - MSc(Physio) / The increasing spread of non-communicable diseases (NCDs), especially in the lowand middle-income countries calls for a more holistic and cost-effective measure to reduce its impact on society. One of the methods advocated for achieving this is health promotion. The Zambian government has called for a shift from curative to preventive management of diseases, including NCDs. Therefore, health professionals are being called upon to redirect their health care management approaches towards preventative care, incorporating health promotion. The study aimed at examining the knowledge, attitudes, practices and perceptions of physiotherapy practitioners and general medical practitioners in Zambia regarding their role in health promotion for NCDs in the hospitals of the Southern Province, Zambia. A sequential explanatory mixed method approach was employed. The quantitative results revealed 98% knowledge of general medical practitioners compared to the 90.6% of the physiotherapists. For attitude, physiotherapists possessed a more positive attitude with 86% while general medical practitioners possessed 80%. Lastly, the study revealed that physiotherapists practise health promotion more than the general medical practitioners, with a 96.2% and 67.7% respectively. The logistic regression showed no significance between the knowledge and attitude scores of the two groups of health practitioners. However, the practice scores revealed that physiotherapists are four times more like to incorporate health promotion compared to the general medical doctors. Both types of health practitioners were of the view that health promotion is the way forward towards the fight against NCDs. However, a number of challenges were echoed that prevent the implementation of a holistic approach management in their practice. Most of the challenges prevalent in these hospitals are policy-based, hence the need for policy makers to intervene for the fight against NCDs.

Indiana University-Purdue University Indianapolis (IUPUI) / Between 1 million and 2.2 million nursing home residents are transferred to a hospital emergency department each year. These transfers are costly, have negative health outcomes, and can increase the morbidity and mortality of residents. Few studies, however, have provided in-depth descriptions of transfer experiences. The purpose of this study was to examine the transfer process between the nursing home and the hospital from the perspectives of nursing home residents and nurses, focusing on how decisions were made to transfer residents. Using a qualitative descriptive method, 22 participants (10 residents and 12 nurses) were recruited from four nursing homes located in rural Indiana. Purposive sampling, semi-structured interviews, and conventional content analysis were used to collect and analyze narratives obtained from residents and nurses about their experiences with a recent transfer and to develop four in-depth case descriptions of these transfers. The participants described four aspects of the transfer process: transfer decisions, transport experiences, hospital stays, and returns to the nursing home. The most common reason for transfers was an acute exacerbation of a chronic condition, and the decision to transfer was often made by a nurse. Most participants found aspects of the transfer, including their hospital stay, to be aversive or upsetting. The return to the nursing home was typically welcomed but often challenging due to problems with mobility, medication adjustments, and cognitive changes. Participants also provided several recommendations for avoiding potentially preventable transfers including adding “in-house” diagnostic testing and treatment equipment, improving staff competencies in managing acute exacerbations, increasing staffing, improving communication among staff, and increasing staff familiarity with resident histories and preferences. The findings have several clinical and policy implications for preventing or decreasing the negative effects of hospital transfers.

Many communicable diseases can be prevented with the use of immunizations. The issue this study addressed was the use of vaccinations and the rise of continued preventable communicable disease. Researchers have recommended that children be vaccinated, a recommendation that is bolstered by the readily available supply of vaccinations worldwide. However, even with vaccine promotions, availability, and education, children continue to be unvaccinated and outbreaks have continued to occur. For this study, data will be collected from the Iowa Registry of Immunization Records and a local community health center pediatric clinic. Examples of data that will be collected are vaccine records, race, and language spoken. Also, data from questionnaires given to parents, caregivers, and medical staff will be obtained to discover their beliefs, misconceptions, and thoughts on vaccines. The sample size will be 35, with recruitment occurring when the parent brings a child into the clinic for a well child or sick visit. The questionnaires will be collected and analyzed by totaling the responses from a pre-existing Likert scale questionnaire.The purposes of the project are to (a) discuss with health care providers a project, that consists of reasons children are not vaccinated; (b) develop a plan to determine those reasons and how to educate parents, the community being served by this health care facility and health care staff on the importance of immunizations; (c) and promote vaccinations for the this community.

Thesis advisor: Jane Flanagan / Background: Preventable adverse events are an unfortunately frequent occurrence of pediatric health care. Disclosure of preventable adverse events to patients is a vital aspect of ethical and just practice. Pediatric nurses’ have a unique role as part of the clinical care team. Despite the prevalence of preventable adverse events and the impact of nurses, best practice for pediatric nurses during disclosure is not specified. In addition, it is unclear how pediatric patient and their family. This work provides a foundation for future nursing research and the development and identification of best practice for pediatric preventable adverse event disclosure. Methods: First, thorough review of existing literature identified gaps and key themes. Secondly, a cross-sectional survey shared via social media provided insight into the current policy, education, and pediatric nurses’ involvement in PAE. Lastly, pediatric nurses’ perspectives were unveiled via narrative interviews, adding the voice of nurses into the dialogue. Results: Pediatric nurses in the U.S. want the option to be present during disclosure to patients and their families. Currently, nurses are seldom present during disclosure and do not routinely receive disclosure training, nor do they have a policy to guide them through the process. While there has been a trend towards the use of interdisciplinary disclosure teams, it is unclear what role a nurse has. Conclusions: This exploratory work is foundational to understanding pediatric nurses and PAE disclosure and future research exploring best practice for policy, education, and practice are needed. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

SAMMANFATTNING Sjuksköterskan tillämpar omvårdnadsprocessen genom att observera, värdera, prioritera, dokumentera och vid behov åtgärda och hantera förändringar i allmäntillståndet, samt motverka komplikationer i samband med sjukdom, vård och behandling. Andningsfrekvens (AF) är den vitalparameter som först förändras och signalerar en förändring i allmäntillståndet. Vid de flesta hjärtstopp på sjukhus finns tecken till försämring hos patienten redan några timmar eller upp till ett dygn före.  Syftet var att undersöka sjuksköterskans inställning och följsamhet till att mäta och bedöma AF hos akuta sjuka patienter, för att tidigt upptäcka en försämring i patientens hälsotillstånd. Genom en litteraturstudie framkom fyra teman. Rutiners betydelse, sjuksköterskans inställning till AF och varför den inte mättes, värdet av förändringsarbete samt möjliga arbetssätt för att undvika vårdskador. Rutiner för mätning av AF, olika poängsystem och mätmallar för bedömning av vitalparametrar, påverkade antalet mätningar och registreringar av AF. Den enskilda sjuksköterskans inställning inverkade på mätningen och bedömningen av AF. Flera anledningar till varför AF inte mättes fanns. Studier visade att förändringsarbete och implementering av nya arbetssätt var ett komplext område, insatser krävdes inom flera områden på olika nivåer. Vårdskador och plötslig oväntad död minskade när nya rutiner och arbetssätt kombinerades med utbildning, uppföljning och återkoppling till personalen. AF är en viktig vitalparameter. Används inte den kunskapen för att hitta patienter på väg att försämras, riskerar patienterna att drabbas av vårdskador. Ett utbildningsbehov finns, den senaste forskningen har påvisat att rätt genomförd implementering av övervakningsrutiner och förändrat arbetssätt kan ge ett bra utfall i minskat antal vårdskador och oförutsedd död. / ABSTRACT The nurse applies the nursing process by observing, evaluating, prioritising, documenting and when necessary manage changes in the condition of the patient, and to prevent complications associated with disease, care and treatment. Respiratory Rate (RR) is the vital sign that first changes and signals changes in a patient’s condition. In most cardiac arrests there are signs of deterioration of the patient a few hours up to a day before the event.    The aim of this study was to investigate the nurse´s attitude and adherence to measure and assess RR in acutely ill patients, for an early detection of deterioration in the patient's state of health. Through a literature study four themes were emerged. The importance of guidelines, the nurses' attitude and why the RR was not measured, the value of change of management and possible ways to avoid injuries. Guidelines for the measurement of RR, different scoring systems and observations charts for the assessment of vital signs all affected the measuring and scorings of RR. The individual nurse's attitude affected the measurement and assessment of RR. Several reasons why RR was not measured were found. The studies showed that the process of change and implementation of new ways of working is a complex, and efforts were needed in several areas and at different levels. Care injuries and sudden unexpected deaths decreased when new routines and working procedures were combined with training, monitoring and feedback to the staff.   Research shows that RR is an important vital sign. If this knowledge is not used to find patients about to deteriorate, these patients risk suffering from permanent health effects. There is a need for significant training in this area and recent research has shown that a correct implementation of the procedures provide a good outcome in a decreased number of medical injuries and unexpected death

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Carta al editor. / Revisión por pares

Health Risk Behavior (HRB) is defined as behavior that increases the likelihood of adverse outcomes: injury, morbidity, or mortality. University students are particularly susceptible to HRB due to their age, academic pressures, social environment, and newly unsupervised lifestyle. Despite major efforts by university campaigns to make students aware of the potential health risks of HRB, students continue to consistently engage in behavior that risks both their short-term and long-term health. Previous literature indicates the importance of self-esteem in positive decision-making and the inhibiting role of shame in increasing withdrawal and social isolation. Shame and guilt are distinct self-conscious emotions often evoked in similar circumstances: shame often debilitative, and guilt adaptive. This study utilizes a cross-sectional design to examine the associations between HRB and the affective emotions of shame, guilt, and self-esteem to better understand HRB determinants. Data was collected from students using a Qualtrics form containing demographic and HRB questions. The Personal Feelings Questionnaire-2 (PFQ2) and the Rosenberg Self-Esteem Scale (RSES) assessed shame and guilt proneness, and global self-esteem, respectively. Mean data analyses, frequency tests, and one-way ANOVA analyses revealed associations between HRB and the three tested affective emotions. Results of this study indicated HRB is associated with higher negative emotion: higher shame and guilt proneness and lower self-esteem. With further research, this information can guide more effective clinical and educational interventions in reducing HRB and subsequent preventable diseases by targeting emotional risk factors in the university population.

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

Objective¡G The purpose of this research is (1) to find out the overall trends of the common avoidable hospitalization diseases in Taiwan since the implementation of the National Health Insurance (NHI), (2) to compare the different distributions of the common avoidable hospitalization diseases across age groups, genders, regions, and the hospital¡¦s characters, (3) to make the related useful information and suggestions of improving avoidable hospitalizations to the policy makers, hospitals, and the general public. Method¡G Standardized rates of avoidable hospitalization from 1997 to 2004 were derived from the National Health Insurance database and the Taiwan census data. In this research, we focus on the four main diseases¡GAsthma, Pneumonia, Diabetes, Hypertension as the avoidable hospitalization diseases. Logistic regression and chi-squire tests are used to detect and describes trends in data. Results¡G During the 8-year research period, AHCs (Avoidable Hospitalization Conditions)of Asthma and Hypertension decline overall, conversely, AHCs of Pneumonia and Diabetes show increasing trends overall¡Fin the hospital characters aspects, AHCs are mostly occurred in the local hospitals¡Ffrom the viewpoint of the patients¡¦ characters, AHCs of Asthma and Pneumonia are always occurred in children male, on the other hand, AHCs of Diabetes and Hypertension are always occurred in female and above 65 years old¡Fin the regional aspect, the AHCs of Asthma and Pneumonia are comparatively higher in east Taiwan. Conclusion¡G According to the results of this research, we can find that the avoidable hospitalizations in Taiwan still need to be improved. We suggest the policy makers and the hospitals may use the ¡uavoidable hospitalization¡vas an indicator to monitor the quality of care and the outpatient care quality in Taiwan¡¦s healthcare system. Thus can not only reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.