The aim of this research is to know the training of health professionals in health promotion and disease prevention, and to examine its manifestation among the actions and interventions for prevention of tobacco, alcohol or cannabis consumption. The sample includes 225 professionals. The study used a self-made design of quantitative methodology (survey study). The most important results are: the formative limitations in health education and prevention of substance use and the fact that professionals who have received specific training in substance use tap more health education as a prevention tool in their daily activities. It is also noted that 80% of professionals believe they should improve quality training, and 67% quantity, always in relation to the tobacco, alcohol and cannabis use. Generally, the overload care and the lack of time are cited as factors preventing the health education activities. Finally, the study also shows that secondary prevention activities are the most used, while community interventions are underutilized by professionals. / L’objectiu d’aquesta recerca és conèixer la formació dels professionals sanitaris en matèria de promoció de la salut i prevenció de la malaltia, i com es concreten les seves intervencions en la prevenció del consum de tabac, alcohol i cànnabis. La base del treball és una mostra de 225 professionals de la salut. S’ha utilitzat un disseny propi de la metodologia quantitativa (estudi d’enquesta). Entre els resultats obtinguts destaquem: les limitacions formatives en educació per a la salut i en prevenció del consum de substàncies, i el fet que els professionals que han rebut formació específica en consum de substàncies utilitzen més l’educació per a la salut com a eina de prevenció en la seva activitat diària. També s’observa que el 80% dels professionals considera que hauria de millorar la seva formació en qualitat, i un 67% en quantitat, sempre sobre el consum de tabac, alcohol i cànnabis. En general, la sobrecàrrega assistencial i la manca de temps són esmentats com a factors que obstaculitzen les activitats d’educació per a la salut. Finalment, l’estudi posa de manifest que les activitats de prevenció secundària són les més realitzades, mentre que les intervencions comunitàries són poc utilitzades pels professionals.

L'objectiu de la investigació ha estat conèixer perquè el col·lectiu d'infermeria no percep la seva professió al mateix nivell que unes altres acadèmicament similars i que es veu imbuït per una invisibilitat consentida pel mateix, per altres professionals de la salut, per les institucions i per la pròpia societat. Ens ha interessat esbrinar si això té a veure amb la presència majoritària de la dona en la infermeria. Estudi transversal quantitatiu i qualitatiu. Les estratègies utilitzades són la combinació i la triangulació.Els professionals de la infermeria la consideren vocacional, amb poca identitat professional, socialment secundària, amb responsabilitat, gran potencial de projecció i baixa consideració del propi professional respecte al rol autònom i la dependència mèdica. Important impregnació d'estereotips consentits pels mateixos professionals. La causalitat s'atribueix a la feminització.Els resultats de l'estudi comporten l'elaboració i implantació d'estratègies formatives en l'àmbit de la formació universitària i en el laboral. / The objective of the investigation has been to know because the nurses group does not perceive its profession at the same level that academically similar others and that is immersed by one invisibility allowed by the same one, by other professionals of the health, the institutions and the own society. It has interested to us to find out if this has to do with the majority presence of the woman in nursing. Quantitative and qualitative cross-sectional study. The used strategies are the combination and triangulation. The professionals of nursing consider vocational, with little professional identity, socially secondary, with responsibility, great potential of projection and low consideration of the own professional respect to the independent roll and the medical dependency. Important impregnating of stereotypes allowed by such professional. The causality is due to femininity. The results of the study tolerate the elaboration and implantation of educational strategies in the scope of the university formation and in the professional one.

This paper provides an analysis of Bradshaw and Colleagues' model of military healthcare professionals' moral distress experiences. Using novel interview data collected from Canadian Forces healthcare professionals, the steps of the model are validated or potential refinements are suggested. / Military healthcare professionals (HCPs) may experience moral distress during international deployment. Moral distress is experienced when a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it, or where all available courses of action require something of moral significance be given up. While the literature indicates that moral distress often negatively impacts the mental health of the individual and the effectiveness of the organization, limited research has examined moral distress amongst military HCP. Many similar stressors and psychological health problems are present for both civilian and military HCP; however, the unique context of deployment necessitates further examination. This thesis explores the military HCP experience with moral distress by using Bradshaw and colleague’s model of progression from the encounter with a moral dilemma to the impact on individuals and organizations. Through the analysis of novel interviews collected by the Ethics in Military Medicine Research Group (EMMRG), Bradshaw and colleague’s model of military moral distress is compared to participant’s experiences and qualitatively analysed, with the results outlining where the model is supported and where refinement is recommended. These challenges were then supported by a literature review from the disciplines of virtue and feminist ethics, moral psychology, bioethics, and civilian HCP moral distress research. Two novel and significant revisions to the model are suggested: representing and integrating the cumulative experience of moral distress, and re-conceptualizing the resolution process based on the consideration of contextual controllability on moral responsibility. / Thesis / Master of Science (MS) / This thesis examines the experience of moral distress in military healthcare professionals (HCPs) while working abroad, where a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it or it requires something of moral significance be given up. This thesis analyses the most recent model of military HCP moral distress (Bradshaw, et al., 2010) by comparing it to the experiences described by participants in the Ethics in Military Medicine Research Group (EMMRG) study. The results outline support for the model as well as novel suggestions for revision, which are supported by literature from a variety of disciplines. Two adjustments to Bradshaw and colleague’s model are suggested: clearer representation of the cumulative nature of moral distress as well as a reconceptualization of the resolution process to consider the influence of the immediate and extended environment on moral responsibility.

Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person‟s physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients‟ perceptions and experiences of treatment as being one of the most prominent themes influencing patients‟ overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals‟ perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals‟ perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population‟s diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were al seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients‟ experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person‟s physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients‟ perceptions and experiences of treatment as being one of the most prominent themes influencing patients‟ overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals‟ perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals‟ perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population‟s diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were al seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients‟ experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Mental health has issues globally and Sweden is one of the countries where this phenomenon occurs. In light of the swedish psychiatric reform and regarding to contemporary psychiatry this study has the purpose of examine the perspective in recovery process by healthcare professionals in this field. The theoretical tools for this are based on concepts by Tor Wennerberg and Jaakko Seikkula. The methodological tools are inspired by phenomenology and hermeneutics and the approach is qualitative interviews with healthcare professionals from the swedish psychiatric field. The results show that the operations partly has weight and structural issues. Long-term direction, social factors, follow-ups and work with relatives is an important factor in recovery process. Pharmaceuticals is used for large scale and this is a dilemma though it can be a supportive role in psychiatric treatment and recovery process. Conclusions is that outpatient swedish psychiatry field may have adversials in regard to the goals and purpose of the psychiatric reform twenty years ago. Further conclusion is that inter- and intrapersonal balance of autonomy versus dependence is a complex phenomena by reason of not necessarily being affected by if whether liberty and self-determination occurs or not. Another is that the patient initiative of discharge has some interesting aspects in regard to recovery process. Long-term perspective, an alliance and group-based solidarity based on some of the theoretical concepts is important in regard to recovery process. The last three factors show some interesting perspectives in regard to information and time. In regard to the limited materials of this study it is hard to draw any concrete conclusions about what long-term directions the swedish authorities can take to conduct good psychiatric care achieving a lower rate of mental illness but the field may have lack of a nuanced definition of not just recovery but recovery process and what it can contain.

Inledning: Studier påvisar att livsstilsrelaterade sjukdomar ständigt ökar och att fysisk inaktivitet bidrar till detta, likaså att FaR ej används i den utsträckning som det skulle behövas. Syfte: Att belysa för distriktssköterskor vilka underlättande och försvårande faktorer sjukvårdspersonal kan uppleva vid förskrivning av fysisk aktivitet på recept, FaR. Metod: En empirisk fenomenografisk intervjustudie med kvalitativ ansats. Fokusgruppsintervjuer med nio deltagare utfördes på tre vårdcentraler. Huvudresultat: Underlättande och försvårande faktorer framkom inom organisation samt i mötet mellan sjukvårdspersonal och patient, exempelvis stöd från cheferna, utbildning och motiverade patienter var underlättande faktorer. Försvårande faktorer var exempelvis tidsbrist, avsaknad av teamarbete samt negativ inställning till FaR. Konklusion: Chefernas engagemang samt patienternas inställning till fysisk aktivitet och FaR var områden som framkom vara av stor betydelse när sjukvårdspersonal skulle förskriva FaR. Att chefer gav sjukvårdspersonalen resurser för att möjliggöra arbetet med FaR, i form av tid, utbildning och teamarbete ansågs vara en grundläggande faktor. Hälsofrämjande synsätt och prioritering av FaR hos cheferna ger spridning och förankring hos sjukvårdspersonalen. Patienternas inställning till egenvård och fysisk aktivitet var en betydande faktor vid förskrivning av FaR. Där har distriktssköterskor en huvuduppgift i att motivera patienterna till livsstilsförändringar och egenvård samt informera om fysisk aktivitets inverkan på hälsan. / Introduction: Studies indicate that lifestyle-related diseases is constantly increasing and that physical inactivity contributes to this, likewise that PAP is not used to the extent necessary. Objective: To highlight for district nurses what facilitating and aggravating factors health care professionals can experience about prescribing physical activity on prescription, PAP. Method: An empirical phenomenographic interview study with qualitative approach. Focus group interviews with nine participants were conducted on three health centers. Main Results: Facilitating and aggravating factors emerged in the organization and in the meeting between health care professionals and patient, for example support from the manager’s, education and motivated patients were facilitators. Aggravating factors was for example lack of time, lack of team work and negative attitudes toward PAP. Conclusion: The manager's commitment as well as the patient’s motivation towards physical activity and PAP was the areas that appeared to be of great importance when health care professionals prescribe PAP. Having managers who gave health care professionals resources in terms of time, training and teamwork was considered to be a fundamental factor and made it possible to work with PAP. A health promotion approach and prioritization of PAP from the managers leads to a spread and transmits to health care professionals. The patient's attitude towards self-care and physical activity were also a significant factor when prescribing PAP. There, district nurses have a major task in trying to motivate patients to lifestyle changes and self-care and to inform them about physical activities impact on health.

This study aimed to identify the type, extent, and predictors of civic and political participation among addiction professionals. A sample of 633 addiction professionals participated in an online survey using the Citizen Participation Study’s survey instrument. Twenty-two political activities were measured as well as three predictors of political participation: resources, psychological engagement, and recruitment networks. Political participation and predictors of participation were analyzed for the full sample and compared among subgroups--social workers vs. those who were not social workers; those who reported they were recovering from alcohol and other drug (AOD) addiction vs. those who were not recovering; and those who held a professional addiction certification vs. those who were not certified and those who were certified plus held other professional credentials. The mean political participation index for participants who were not certified was significantly lower than for participants with a certification and those with a certification plus other professional credentials. No significant difference was noted in the mean political participation index for recovering participants and those not recovering from AOD addiction; and social workers and participants who were not social workers. Hierarchical multiple regression was used to assess the influence of resources, psychological engagement, and recruitment networks on political participation while controlling for recovery status, professional credentials, age, race, and gender. Resources, psychological engagement, and recruitment networks were all significant predictors of political participation. Recruitment networks was the strongest predictor for the full sample and for subgroups who were not social workers, certified, not certified, certified with other professional credentials, and not recovering from AOD addiction. Psychological engagement was the strongest predictor of political participation among individuals recovering from AOD addiction and social workers. However, the validation analysis did not replicate the findings for social workers, those not recovering from AOD addiction, and those who were certified. The significant role of recruitment networks in political participation has important implications for social workers and others interested in mobilizing addiction professionals for political participation. Recommendations for further research include the need to develop valid and reliable measures of political participation that capture civic activities and the use of technology. / text

This is a study of several contentious issues in Canadian health policy involving the interaction of public and private payers and for-profit (FP) and not-for-profit (NFP) providers; the influence of health professionals on market structure; and the role of foreign investment. A case study was used, the Ontario physiotherapy market in 2003-2005, with its complex mix of payers and providers and foreign investment opportunities. Key market features were: fragmented but substantial payer influence, effective though uncoordinated cost control across payers, constrained labour supply, and fragmented patient referral sources. These features increased the complexity of providers’ interactions with patients and payers, reducing standardization and therefore favouring local, professional-owned small business FP providers (FP/s) for ambulatory care. NFP Hospitals’ market share declined. The findings generally confirmed expected behavioural differences between FP and NFP providers but expected differences between investor-owned FP providers (FP/c) and FP/s providers were not generally found. FP/s dominated the market, and FP/c providers appeared to mimic FP/s market behaviours, competing in local sub-markets. With no single or dominant payer, cost control difficulties were expected, but all 11 payer categories (public and private) used various cost control mechanisms, resulting in significant collective but uncoordinated influence. Generally, no payer alone supported a provider’s operations. The dominant labour suppliers, regulated physiotherapists, were scarce and exerted significant pressure, affecting market structure by asserting individual preferences and professional interests. FP/s dominance resulted, supported by the traditional patient referral source, physicians in small practices. Very little foreign investment was found despite little protection for domestic providers under NAFTA. In sum, this study showed FP and NFP provider stereotypes are subject to payer pressure: FP/c organizations can adapt by mimicking FP/s, and payers can modify NFPs’ assumed community orientation. Labour shortages and historical referral patterns can make individual professionals and their preferences more influential than their collective profession without diminishing the importance of professional interests. The degree and structure of payer control can make a market unattractive to foreign investors. Finally, this market – neither a planned or standard market – had a service provision pattern more broadly influenced by professionalism and practitioner interests than policies or prices.

Pastarųjų metų Europos tyrimai rodo, kad psichologinis smurtas ir priekabiavimas sukelia didesnę grėsmę daugumai darbuotojų, nei fizinis smurtas. Priekabiavimas sukelia stresą, padidina psichologinę įtampą bei riziką darbe, įtakoja ligų atsiradimą. Darbo tikslas. Išanalizuot Kauno miesto sveikatos priežiūros įstaigos darbuotojų patiriamo priekabiavimo darbe paplitimą ir jų sąsajas su subjektyviu savo sveikatos vertinimu. Tyrimo metodika. Tyrime iš viso dalyvavo 226 sveikatos priežiūros įstaigų darbuotojai. Iš jų 176 Kauno miesto sveikatos priežiūros įstaigos darbuotojai ir palyginamosios grupės 130 sveikatos priežiūros specialistų. Tyrimas atliktas anoniminės apklausos būdu 2008-2009 m. rugsėjo - balandžio mėnesiais. Duomenų analizei naudotos programos SPSS 15,0 for Windows ir MS Excel. Rezultatai. Kauno miesto sveikatos priežiūros įstaigos darbuotojai statistiškai reikšmingai dažniau patyrė dažną priekabiavimą (5,8 proc.), nei palyginamoji grupė (3,8 proc.) (p=0,022). Pagal pareigas, dažną priekabiavimą patyrė 4,4 proc. slaugytojų ir 8,6 proc. kitas personalas. Gydytojai priekabiavimo darbe nepatyrė. Nustatytas ryšys tarp dažnai patiriamo priekabiavimo ir diagnozuotų sveikatos sutrikimų: kaklo/peties skausmų (p=0,047); traumų, lūžių, išnirimų, žaizdų, sužalojimų (p<0,000); plaštakos/rankos skausmų (p=0,028). 50 proc. slaugytojų, patyrusių dažną priekabiavimą, turėjo minimalių psichinės sveikatos sutrikimų (p=0,015). 28,6 proc. slaugytojų, dažnai patyrusių priekabiavimą... [toliau žr. visą tekstą] / Recent researches in Europe have shown that workplace bullying induces more intense threat in comparison with physical violence. Aim of the study. To make analysis of prevalence of undergoing bullying by the workers of Kaunas health care institutions and find out the links with self-reported health. Methods. The survey was conducted in one of the health care institutions in Kaunas and 96 workers of that institution were interviewed. Additionally, 130 nurses were randomly selected form the Kaunas district as control group. The questionnaire was composed of seven parts and 59 questions overall. The Negative Acts questionnaire, developed by S. Einarsen and H. Hoel, was used. The statistical software SPSS 15.0 for windows was used in the data analysis. Results. Less than one quarter of Kaunas health care institution workers admitted about undergoing bullying in the work place. Moreover, workers of Kaunas health care institution statistically significant more often have undergone bullying in workplace (5.8 %) in comparison with control group (3.8 %, p=0.022).Depending on position, repeated bullying have undergone 4.4% of nurses and 8.6% other staff. Occasional bullying have undergone 24.4% of nurses and 2.9% other staff. Medical doctors have not undergone any bullying in the workplace. Conclusions. Bullying in the workplace was common in both comparative groups of health care workers. Workers who have undergone repeated bullying in the workplace more often complained about... [to full text]