Thesis (M.S.)--University of Michigan, 1982. / "A research report submitted in partial fulfillment of the requirements for the degree ..."--T.p.

Thesis (M.S.)--University of Michigan, 1982. / "A research report submitted in partial fulfillment of the requirements for the degree ..."--T.p.

Thesis (M.S.)--University of Michigan, 1989.

M.Cur. (Nursing Administration) / In this study the activities carried out by registered nurses working in family planning are assessed as well as the training nurses receive to equip them to function satisfactorily. Registered nurses are the main providers of family planning services in South Africa and function in an extended role to a far greater degree than nurses in most developed and developing countries. The study shows that registered nurses form a stable workforce. They perform a large number of family planning tasks but also spend a great deal of time on clerical and housekeeping tasks which limit the time available for quality client care. The need for more regular updating of clinical knowledge is evident as is the need for nurses to be kept informed on changes taking place in the Family Planning Programme. The study reveals that registered nurses are interested in and have a positive attitude towards family planning. If registered nurses are relieved of non-nursing tasks they will be able to meet the growing need for family planning services.

M.Cur. / The Government has committed itself to primary health care as the only way of providing an affordable health service to all the Inhabitants of the Republic of South Africa, namely by a partnership service between the State and the private sector. A team approach In the provision of primary health care is essential to ensure Its success. Eskom has a responsibility towards Its employees to ensure that the occupational health nurse receives the necessary training to enable her to provide an effective health service. Eskom has obtained permission to provide health services In accordance with Section 38A of the Nursing Act, 1978 (Act No 50 of 1978) and has committed Itself to give the occupational health nurse the necessary training for her extended role under Section 38A of the Nursing Act, 1978 (Act No 50 of 1978). Section 38A of the Nursing Act, 1978 (Act No 50 of 1978) authorises the occupational health nurse to do a physical examination, diagnose a physical defect and identify an illness in any person. The keeping of prescribed medicines and the supply and administering thereof by the occupational health nurse, subject to the prescribed conditions, as well as the promotion of family planning, are also authorised by the said Section 38A of the Nursing Act, 1978 (Act No 50 of 1978). An exploratory and descriptive study was done within a contextual framework, with the occupational health nurse, In-service training and the syllabus asthe maln concepts. The occurrence of health problems was thoroughly explored by means of statistics, a literature study and discussions with a panel of experts In Eskom. The learning needs of the occupational health nurses In Eskom were then investigated by means of a questionnaire. It was established that occupational health nurses In Eskom already possess sufficient knowledge In respect of certain health problems. Knowledge of these problems was made a prerequisite In the syllabus for In-service training for Section 38A of the Nursing Act, 1978 (Act No 50 of 1978). A syllabus was designed for the In-service training of the occupational health nurse in Eskom for Section 38A of the Nursing Act, 1978 (Act No 50 of 1978).

This study sought to better understand program evaluation capacity and competency amongst public health nurses. Program evaluation plays a vital role in public health and is an identified core competency for public health practice (Canadian Public Health Agency). In Part One, I conducted a scoping review to systematically map the current literature on this topic and to identify important areas for future research. Twenty-three articles were selected based on pre-established exclusion and inclusion criteria and the assistance of a secondary reviewer. The articles highlighted the value of program evaluation in public health and its importance as a nursing skill amidst the evolving health care sector. Themes identified included: a broader lack of public health competencies (including program evaluation) among all public health professionals; the complexities and challenges of evaluating public health interventions; and the uncertainty of what constitutes adequate evaluation competency in public health. Furthermore, my review noted inconsistent terminology to describe a public health nurse and the need for further exploration around the specific evaluation capacity of public health nurses. In Part Two, I explored the stated or expected evaluation competencies for public health nurses through a document review of relevant Canadian public health nursing core competencies, guidelines, and standards for practice. The identification of 52 stated evaluation competencies, demonstrates the assumption that public health nurses have competency and or capacity related to program evaluation and contrasts with the themes identified in my scoping review. Furthermore, the documents I reviewed included no specific reference to the Canadian Evaluation Society (CES), however some of the included content did align with the CES Program Evaluation Standards. This study demonstrates a misalignment between the discourse in the literature reviewed related to evaluation competency amongst public health nurses and the stated or assumed evaluation competencies put forth in leading public health nursing documentation. In the absence of any standardized evaluation training and preparation for public health nurses, further exploration is needed around what these broad evaluation competencies mean in practice and how they can be objectively assessed, exhibited, and better integrated into public health nursing education and evaluation capacity building activities. These questions warrant further investigation to ensure public health interventions are properly evaluated and that public health nurses have the competencies required for effective public health practice.

Introduction The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce "culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity. In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short, do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one. / 202 p. ; 29 cm.

Taiwanese health authorities are increasingly applying case management as a health care delivery strategy in the community. However, most Taiwanese public health nurses (PHNs) do not receive case management education because there are few education programs available. Several limitations in existing evaluative studies of case management continuing education programs were identified. These methodological weaknesses limit the conclusions that can be drawn about the effectiveness of these education programs. Hence, the purpose of this study was to develop, implement and evaluate a collaborative case management continuing education program for Taiwanese PHNs. The study was divided into three phases, with an expanded theoretical framework used to guide the program development, implementation and evaluation. Phase One conducted focus group discussions in order to assess the educational needs of Taiwanese PHNs. Phase Two developed a collaborative education program based on the findings of a literature review and the needs assessment. The initial program was evaluated by an expert panel and pilot testing was undertaken. Phase Three implemented and evaluated the program using an experimental research design and mixed evaluation methods. Three outcome levels were assessed, namely reaction, learning and performance by examining changes in PHNs' case management knowledge, skills and practice. The participants in the study were PHNs employed in health centres in Taipei City. The program itself involved 16 hours of workshops through four half-day sessions, conducted every two weeks during the participants' work time and at their workplace. Two types of data, focus group data and questionnaire data, were collected during the course of the study. The focus groups were conducted before and after the program delivery, for the needs assessment and program evaluation, using a subset of the participants. The focus groups were moderated by the researcher, who used a focus group discussion guide to collect data. The other data set was collected using self-report questionnaires. The participants were randomly allocated into two groups using cluster sampling, the experimental and comparison groups. Both groups were given questionnaires before the education program commenced, and then again eight weeks after the program was completed. For ethical considerations, PHNs in the comparison group also received the same program after data collection. The results revealed that the majority of participants were satisfied with the program. The education intervention significantly improved PHNs' case management knowledge, performance skills confidence, preparedness for case manager role activities, frequency of using case management skills, and frequency of using these role activities. A number of changes in case management practice were reported, in particular that the participants tended to follow the case management process more often and focus more on the quality of case management. This study was guided by an integrated theoretical framework, and used a clustered randomised controlled design to assess the effectiveness of the program across multiple levels of outcomes, hence addressing the design deficits identified in the prior evaluative studies. This study therefore provides an important contribution to the fields of nursing and case management by developing, implementing and evaluating a case management education program. Additionally, the program itself offers an evidence-based educational experience for PHNs and provides a new tool for nursing education in the context of Taiwan.

Thesis (Ed.D.)--Teachers College, Columbia University, 1992. / Includes tables. Typescript; issued also on microfilm. Sponsor: Elizabeth Tucker. Dissertation Committee: Douglas S. Sloan. Includes bibliographical references (leaves 157-175).

Thesis (M.S.)--University of Michigan, 1983.