This postmodern feminist ethnographies research aimed to explore the everyday meanings of primary health care (PHC) held by rural community nurses. Secondly, the research aimed to explore the everyday meanings of care held by the clients of the rural community nurses who participated in the study. The representation of this research is written in four voices which converse with each other to varying degrees in each chapter. This writing strategy is a deliberate one aimed at destabilising the usual approach to representation of research. It is also a strategy which seeks methodological coherence. The third aim therefore is to deliberately trouble the acceptable grounds concerning how nursing research is represented. The research utilised dialogical (conversational)and participant observation methods concerning the everyday meanings of nurses and their clients.The meanings I made of the information were created from a deconstruction of the texts. These texts included fieldnotes of participant observations and transcripts of conversations with nurses and their clients. The form of deconstruction utilised was informed from multiple sources and involved three levels of analysis. A realist interpretation was followed by an oppositional interpretation and then a reconstructive movement. The results revealed that rural community nurses practice is both spatio-temporally contextualised and metaphorically situated in an in-between space. This in-between space is situated between margin and the centre. Rural community nurses working on the margins traverse this space in order to overcome further marginalisation whilst working with Indigenous Australians and the aged. Moreover, the in-between space encompasses and creates opportunities to mutually exchange the gift of desire that being - empowering and compassionate relationships with clients and colleagues. Futhermore, whilst rural community nurses are strongly committed to the philosophy of PHC, their evryday working life is discursively constructed by powerful discourses which result in oppositional tensions. The tensions and the 'in-between' space allow the rhetoric of PHC to be resisted and reframed. Consequently, the oppositional constructs of their practice were displaced. Moreover, this necessitated the negotiation of space and place, and required the reconstruction of subjectivity, intersubjectivity and becoming / Doctor of Philosophy (PhD)

Thesis (M.A.(Applied))--Victoria University of Wellington, 2006. / Includes bibliographical references.

<p>The district nurses' duties with all organisational changes, above all during the last 20 years, have been changed. Economy and listing governs which visits that to be prioritized. The aim with this study was to examine what district nurses in the primary care in Uppsala län has for view about their occupational role. The method was qualitative and the selection comprized ten district nurses in Uppsala län that were interviewed individually on the basis of a semi structured interview guide that the authors the actual created. In the wide analysis of the results could a theme, <em>As a rubber screw in a shrinking hole</em> and three central categories be discerned, <em>Occupational role</em>, <em>Diversity</em> and <em>Organisation. </em>The district nurses enjoy with work and their choice of profession despite higher demand, stress and low staffing. They experience that the profession role have become unclear and others professions has poor knowledge about which competence they hold. They have an interest of working preventive and a holistic view when thinking about nursing care among children and adults. The feeling of not be needed as a profession, not to become seen with the competence that they possesses, is experienced very frustrating and the obvious role the district nurse earlier had in the primary health care and society seem to fade increasingly. The district nurses description of their profession role can compared as a rubber screw which reflects the flexibility but also the resistance against increasingly healthcare. The shrinking hole symbolize the majority organization changes as forced the district nurses to priority other duties than public health work and a decreased sphere of activity. <em> </em></p>

Neonatal mortality remains a problem worldwide, despite the existence of low-cost and evidence-based interventions. Unfortunately, the translation of these interventions into practice is deficient. The aim of this thesis was to study aspects of knowledge translation (KT) before and during the Neonatal Knowledge Into Practice (NeoKIP) trial in Quang Ninh, Vietnam. Over a period of three years, this trial evaluated the use of facilitators from the Women’s Union who supported maternal and newborn health groups (MNHG) comprised of eight local stakeholders, as an intervention for improved neonatal survival. In the first two studies (before intervention) we assessed primary health care staff’s knowledge and material preparedness regarding evidence-based neonatal care and explored how primary health care staff translated knowledge into practice. The last two studies (during intervention) were process evaluations aimed at describing the implementation, process and mechanism of the NeoKIP intervention. Primary health care workers achieved 60% of the maximum score in the knowledge survey. Two separate geographical areas were identified with differences in staff levels of knowledge and concurrent disparities in neonatal survival, antenatal care and post-natal home visits. Staff perceived formal training to be the best way to acquire knowledge but asked for more interaction between colleagues within the healthcare system. Traditional medicine, lack of resources, low workload and poorly paid staff constituted barriers for the development of staff knowledge and skills. Eleven facilitators were trained to cover eight facilitator positions. Of the 44 MNHGs, 43 completed their activities to the end of the study. In total, 95% of the monthly meetings with a MNHG and a facilitator were conducted with attendance at 86%. MNHGs identified 32 unique problems, mainly families’ knowledge/behavior, and implemented 39 unique actions, mostly regarding communication. MNHGs experienced that the group was strategically composed to influence change in the communes and facilitators were identified as being important to sustaining activities over time. The facilitators’ lack of health knowledge was regarded as a deficit in assisting the MNHGs, but their performance and skills increased over time. This low-cost model, building on local stakeholder involvement, has the capacity to be scaled up within existing healthcare structures.

Accessibility is a key tenet of the Canadian health care system. As many older persons, age 60 years and older, are managing ongoing chronic health conditions as part of their everyday lives, issues of access to health services are particularly important. Vancouver has a substantial number of older Korean immigrants, yet little is known about their experience and perceptions about accessing Primary Health Care (PHC) services. This study explored issues related to PHC access by older (aged 60 years and older) Korean immigrants. This qualitative study employed purposive sampling and interpretive description methodology. Open-ended interview data and field notes were gathered from 10 older Korean immigrants (five male and five female) recruited in Vancouver from mid-October 2006 to April 2007. The findings revealed that older Korean immigrants have had difficulty gaining access to appropriate PHC services because of the shifts in their social positioning and other barriers which contributed to an inappropriate use of PHC services, delays in care and lack of continuity in PHC. Also, the data revealed a number of ways the PHC system is unresponsive to the health care needs of older Korean immigrants. This study offers insights that may assist health care professionals to understand the nature of the challenges older Korean immigrants face when seeking health care and how they seek to resolve them. The analysis proposes a number of interventions that respect the older Korean immigrants’ values and interventions that may improve their access to PHC.

Over the past several years, both government and the profession of pharmacy have acknowledged that pharmacists are not being used to their full potential in our health care system. In order to advance the profession of pharmacy in this area, guidance on how pharmacists can be integrated need to be investigated.<p>The purpose of this study was to identify how to integrate a pharmacist into an already established primary health care team, at the Student Health Centre at the University of Saskatchewan. The project was divided into three phases: defining the role of the pharmacist, implementing the proposed role and then evaluating and prioritizing the role. Using action research, an expert panel consisting of established primary health/ambulatory care pharmacists from across Canada helped to identify possible clinical activities for a Student Health Centre pharmacist. The results were presented to the primary health care team, who then collaborated with the pharmacist and researchers to define the role of the pharmacist. Once an agreement was reached, a pharmacist provided eight weeks of full-time clinical services. Upon completion, focus groups with the primary health care team members were used to evaluate the pharmacists clinical services.<p>The role of the pharmacist was tailored specifically for the student health care centre selected for the study. However, the process of integrating and evaluating the role of the pharmacist, will serve as a template for other pharmacists desiring to be involved in any primary health care team interested in expanding their multidisciplinary service.

This dissertation is a study of the public policy-making process, the role of ideas and relationships in this process, and their effect on social economy enterprises, in particular co-operatives. It is concerned with a central problem in all social economy organizations today: understanding the impact of public policy on funding, decision-making and strategy. The relationship between Saskatchewans co-operative Community Clinics and the provincial government is of particular interest. In spite of a seeming congruence between the goals of the Community Clinics and the government, the Clinics have not been allowed to play a significant role in reforming the delivery of health care services in the province.<p> The dissertation draws on models and concepts from the literatures on businessgovernment relations, public policy and the policy-making process, the role of ideas and ideology in public policy, the social economy and public policy, and governmentco-operative relations. A case study of the Community Clinics is elaborated through key informant interviews and supported by examination of primary and secondary literature.<p> This research shows that the Community Clinics are unique organizations and that a new understanding can be developed if the Clinics are viewed as hybrids some combination of co-operative, public, and perhaps even private organizations. The ambiguity in the relationship arises at least in part from the differing and conflicting ways that the Community Clinics have been conceptualized by the politicians, government officials, the health regions, and even the Clinics themselves. The research also shows that the dominant idea at play in the health care policy domain in Saskatchewan remains that of private medical practice, with fee-for-service remuneration, and that the conditions necessary for a major policy change with respect to the role of the Community Clinics do not exist.

No description available.

Over the past several years, both government and the profession of pharmacy have acknowledged that pharmacists are not being used to their full potential in our health care system. In order to advance the profession of pharmacy in this area, guidance on how pharmacists can be integrated need to be investigated.<p>The purpose of this study was to identify how to integrate a pharmacist into an already established primary health care team, at the Student Health Centre at the University of Saskatchewan. The project was divided into three phases: defining the role of the pharmacist, implementing the proposed role and then evaluating and prioritizing the role. Using action research, an expert panel consisting of established primary health/ambulatory care pharmacists from across Canada helped to identify possible clinical activities for a Student Health Centre pharmacist. The results were presented to the primary health care team, who then collaborated with the pharmacist and researchers to define the role of the pharmacist. Once an agreement was reached, a pharmacist provided eight weeks of full-time clinical services. Upon completion, focus groups with the primary health care team members were used to evaluate the pharmacists clinical services.<p>The role of the pharmacist was tailored specifically for the student health care centre selected for the study. However, the process of integrating and evaluating the role of the pharmacist, will serve as a template for other pharmacists desiring to be involved in any primary health care team interested in expanding their multidisciplinary service.

This dissertation is a study of the public policy-making process, the role of ideas and relationships in this process, and their effect on social economy enterprises, in particular co-operatives. It is concerned with a central problem in all social economy organizations today: understanding the impact of public policy on funding, decision-making and strategy. The relationship between Saskatchewans co-operative Community Clinics and the provincial government is of particular interest. In spite of a seeming congruence between the goals of the Community Clinics and the government, the Clinics have not been allowed to play a significant role in reforming the delivery of health care services in the province.<p> The dissertation draws on models and concepts from the literatures on businessgovernment relations, public policy and the policy-making process, the role of ideas and ideology in public policy, the social economy and public policy, and governmentco-operative relations. A case study of the Community Clinics is elaborated through key informant interviews and supported by examination of primary and secondary literature.<p> This research shows that the Community Clinics are unique organizations and that a new understanding can be developed if the Clinics are viewed as hybrids some combination of co-operative, public, and perhaps even private organizations. The ambiguity in the relationship arises at least in part from the differing and conflicting ways that the Community Clinics have been conceptualized by the politicians, government officials, the health regions, and even the Clinics themselves. The research also shows that the dominant idea at play in the health care policy domain in Saskatchewan remains that of private medical practice, with fee-for-service remuneration, and that the conditions necessary for a major policy change with respect to the role of the Community Clinics do not exist.