Darbo tikslas: įvertinti slaugytojų ir šeimos gydytojų požiūrį į komandinį darbą ir jo skirtumus privačiose ir viešosiose asmens sveikatos priežiūros įstaigose. Tyrimo metodika: Tyrimo metu apklausta 342 Kauno PASP įstaigų šeimos gydytojai ir slaugytojai (atsako dažnis 76,0 proc.). Statistinė duomenų analizė atlikta naudojantis SPSS statistiniu paketu (20.0 versija). Hipotezės apie požymių priklausomybes buvo tikrinamos naudojant chi kvadrato (χ²) ir z kriterijus. Skirtumas laikytas reikšmingu, kai p < 0,05. Rezultatai: Dauguma apklaustųjų (77,7 proc.) pritaria komandiniam darbui. Dažniausiai respondentams komanda – tai bendras tikslas, pasitikėjimas vieni kitais, tiksliai atliekantys darbą nariai. Dauguma apklaustųjų nurodė, jog jų komandos veiklą inicijuoja organizacijos vadovas, o labiausiai reikalingu pirminės sveikatos priežiūros specialistų komandos nariu 96,4 proc. tyrimo dalyvių pasirinko šeimos gydytoją. Daugiau nei pusė apklaustųjų pažymėjo, jog didesnė atsakomybė gula gydytojų pečius. Dauguma respondentų žinojo efektyvaus komandinio darbo principus bei padedančius vystytis komandiniam darbui veiksnius, tačiau kaip trukdantį veiksnį nurodė, konkurenciją tarp kolegų. Respondentų nuomonė apie komandinį darbą skyrėsi priklausomai nuo socialinių demografinių veiksnių, pareigų, darbovietės, kurioje dirba rūšies. Nustatyta, jog šeimos gydytojams labiau nei slaugytojoms komandoje svarbūs maksimaliai geri rezultatai. Didesnė dalis šeimos gydytojų negu slaugytojų tik iš... [toliau žr. visą tekstą] / Aim of the study – to assess nurses and family physicians approach to teamwork and the differences between private and public health care institutions. Methods: The study involved 342 family physicians and nurses (response rate 76.0 percent) working in Kaunas city primary health care institution. Statistical data analysis has been done by SPSS 20.0 statistical package. Hypotheses about dependency of features were checked by calculation of χ2 criteria, z criteria. The difference was considered significant when p<0.05. Results: The majority of respondents (77.7 percent) agreed that teamwork is better than the individual. In most cases, respondents identified the team as a general purpose, trust of each other and as a team members precisely conducting the work. The majority of respondents indicated that their team activity is initiated by the head of the organization. 96.4 percent of research participants chose the family doctor as the most needed primary care team member. More than half of the respondents noted that the family doctors have the greater responsibility. The majority of respondents knew the principles of effective teamwork and factors of developing teamwork, but as an interfering factor indicated the competition between colleagues. Respondent’s opinion about teamwork differed depending on the socio-demographic factors, duties and working place. A statistically significantly greater proportion of family doctors than nurses said that maximum good results are... [to full text]

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

<p>This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners.</p>

Doctor of Philosophy(PhD) / The thesis explores the complexities of primary health care in a setting characterised as being both isolated and remote, and in the process identifies factors critical for developing successful PHC programs in such settings and more broadly. The four questions underpinning the study are 1) is a PHC approach relevant to the chosen small remote Australian community; 2) to what extent was a PHC approach being implemented; 3) what are the barriers and enablers to developing and implementing a PHC approach; and 4) what are the crucial factors for PHC programs in similar communities. The first chapter provides the background to the study, beginning with the range of descriptions of primary health care and the many themes needed to understand how it plays out in a small community. The Menindee community and some of the local health service players are introduced. Chapter Two explores complexity theory and complex adaptive systems and its relevance to organisations and managing change, particularly in complex environments. Chapter Three examines the evolution of primary health care, its philosophy, principles and elements as both a model of health care and of development. Chapter Four addresses social determinants, the life course and the long-term effects of inequity, before considering current factors that impact on health and health services. These include the beginning and end of the life course and those in the ‘middle’ where the effects of the obesity and diabetes epidemics are being played out at a younger age. The chapter concludes by noting common themes across the three chapters. Chapter Five describes the research design and methods. A case study using mixed methods was chosen and the theoretical framework provides an exploration of complexity and transdisciplinarity. What changed during the course of the study, questions of scope and its limitations are stated. Chapter Six is a quantitative analysis of the study community, which examines community demographics, the life course, a summary of adult and child health, and service use. These enable an understanding of the community profile, its uniqueness and its similarity to other communities that might benefit from a comprehensive PHC approach. The questions to be explored in the qualitative phase are identified. Chapter Seven is a qualitative study of the community in the midst of change. An individual interview guide approach was used and representatives from the community, local and regional health service providers were interviewed. Chapter Eight provides a synthesis of the two studies as they address themes from the complexity, PHC and social inequity literature. Five themes had particular significance to the study community: social determinants and Indigenous health; community size, resilience and change; chronic disease programs and prevention; vulnerable groups; and a complex adaptive systems perspective. The second section answers the four study questions. The thesis concludes with a discussion of PHC rhetoric and reality, the relevance of the study and its limitations, and issues requiring further research when considering primary health care in smaller communities.

Thirty years after the concept of primary health care (PHC) was declared the path to health for all, a crisis continues in human resources for health in Africa. This involves the low prioritisation of education and training for primary health care personnel (PHCP) which is crucial to effective practice in severely under-resourced settings. The curriculum required for this education, involving pictures and textual materials, must meet the needs and capacities of the learners so that learning transfer can occur and community health needs are met. This research set out to establish the basis upon which text and pictures should be incorporated into curriculum to address the requirements of community health nurses (CHNs) in The Gambia. A pragmatic, three phased, mixed methodological design was selected for this study. Curricula for African PHCP were first collected and examined using content analysis to determine the rationale for pictures and text. The second phase employed psychometric testing and statistical analysis to establish if learning style preferences for pictures and text were important in Gambian CHN learning. In the final phase, interviews with CHN students explored their preferences for pictures and text and how these preferences should be accommodated in curriculum. The research found that much of the PHCP curriculum analysed was generic, used traditional didactic approaches and focused on written knowledge-based assessment. Learning style preferences were not found to be a consideration and were unidentifiable in this context. Socio-cultural factors significantly impacted upon student CHN learning, but were not adequately addressed in the curriculum materials examined. In addition, CHNs preferred practical learning through primary, multi-sensory experiences. These findings support the conclusion that the localisation of CHN curriculum is required in order to provide a socio-cultural context for learning that is meaningful, rich, interactive and responsive to learner needs. This demands a reconnection with PHC principles of equity and participation which should underpin this curriculum. The thesis argues that an ecological framework better articulates the link between PHCP education and training, practice, and community needs, and should serve to guide curriculum design. Six strategies are identified that could be extended to African PHCP course design.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.