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

Nurses as professionals and front-liners in patient care should possess good knowledge about health research, as this is critical in improving patient outcomes. The purpose of this study was to determine the level of knowledge and attitudes that public health clinic nurses possess regarding health research in Botswana in order to make recommendations to enhance a research culture among nurses. A quantitative study with a cross-sectional study design was used. Twenty-six clinics in Gaborone were sampled and 168 nurses participated in the survey. Data was analysed using Stata version 15.1. Only 51% of the nurses demonstrated satisfactory knowledge of health research. Despite this limited knowledge, nurses had a good attitude towards health research (66%). Degree nurses were more likely to have satisfactory knowledge, as were those who reported research training and experience. Additionally, research training and experience were associated with a good attitude. Recommendations include provision of research training and practicums as part of the nursing education curriculum, as well as in-service training, in order to improve the levels of knowledge of health research among nurses. / Health Studies / M. P. H.

<p>Research has demonstrated repeatedly that income and income distribution are powerful determinants of health. While Ontario public health units are mandated to promote health and reduce health inequities, they have done little to help eliminate poverty, instead focusing on individual behaviours such as smoking, diet, and physical activity – an approach likely to worsen health inequities, rather than mend them. Public health nurses (PHNs) across Canada recognize poverty as a powerful determinant of health, yet have expressed challenges in their ability to take meaningful action to address it (Cohen, 2006b; Reutter & Ford, 1996). The study sought insight into how Ontario public health units can strengthen PHNs socio-political efforts to address the causes of poverty. A qualitative descriptive design was used to explore PHNs’ views, while an <em>Appreciative Inquiry</em> approach was used to draw on participants’ successful past experiences in addressing the causes of poverty and their thoughts for the future. Organizational factors thought to empower PHNs’ socio-political efforts to address the causes of poverty were identified using Kanter’s <em>Structural Theory of Power in Organizations</em> as a starting conceptual framework. Fifteen PHNs participated in face-to-face or telephone interviews. Qualitative content analysis was used to describe participants’ affirmative experiences, empowering organizational attributes, and desired actions and supports for the future. Three overall themes emerged with respect to empowering organizational attributes: authorities within the health unit ‘permit and provide’, active associates ‘help each other out’, and external allies ‘contribute and collaborate’. Factors beyond the health unit that would support anti-poverty work were also identified. Findings suggested that action to address the causes of poverty is within the reach of PHNs, and is consistent with their role and the public health mandate, but requires leadership support and political buy-in in order to maximize its effectiveness.</p> / Master of Science (MSc)

Two key policy documents are having an impact on health visiting practice in Scotland: Getting It Right for Every Child (GIRFEC) (2013), which seeks to promote all children’s wellbeing, and The Healthcare Quality Strategy for NHS Scotland (2010) which promotes person-centred care. ‘Shared decision making’ is integral to ‘person-centred care’; however no research studies to date have linked shared decision making with health visitor practice. This thesis reports on a descriptive, qualitative research study, which was conducted in two health board areas in Scotland, in order to explore the processes that support effective shared decision making in health visiting practice within the context of implementing GIRFEC. The design was in three phases and used Elwyn’s Framework, of ‘Choice, Options and Decision Talk’ as a structure (2012). Phase 1 consisted of audio recordings of 2 x health visitor: parent encounters when decisions were being made; Phase 2 consisted of semi-structured interviews with 9 x health visitors and 9 x parents who had made decisions within the last 6 months; Phase 3 involved 3 x focus groups reviewing the findings to date and reflecting on current issues when implementing GIRFEC. The framework method was used for analysis and two additional themes were identified: ‘Issues’ and ‘Relationships’. The health visitors demonstrated that they built up trusting relationships with parents; however there was lack of understanding and application of decision making theory which supports analysis, and an outcome focused approach to person-centred planning. This thesis identifies areas for health visitor practice development.

In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients’ Rights Charter. The quality of health care delivery has dropped drastically, and reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with thousands of patients being treated in condemned hospitals. Receiving and rendering health care in the face of such challenges, the question arose: “Are patients receiving patient-centred care in public hospitals?” The answer to this rhetorical inquiry appeared to be obvious, but this research study explored and described professional nurses’ perceptions of patient-centred care in public hospitals and their understanding of evidence-based practice and best practice guidelines. The proposed study followed a qualitative, exploratory, descriptive and contextual design. The research population included professional nurses who are employed in public hospitals in Nelson Mandela Bay, and consisted of nurse managers and nurses who work in the wards. The research study consisted of three phases. In Phase 1, semi-structured interviews and focus groups were conducted with nurse managers and professional nurses working in the wards in order to collect data about their perceptions of patient-centred care and their understanding of evidence-based practice and best practice guidelines. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four constructs: credibility, transferability, dependability and confirmability. An independent coder assisted with the coding process. In Phase 2, an integrative literature review was conducted in order to identify previous guidelines regarding best practice for patient-centred care. Relevant guidelines were selected, critically appraised, data was extracted and synthesised for the development of a best practice guideline for patient-centred care. An independent appraiser critically appraised the guidelines, thereby ensuring trustworthiness. In Phase 3, the data in Phase 1 and Phase 2 were integrated to formulate a draft best practice guideline for patient-centred care. The guideline was submitted to an expert panel for review and was modified according to the recommendations of the panel, whereby the best practice guideline for patient-centred care in public hospitals in Nelson Mandela Bay was finalized.

It is important for nurses to show acceptable behaviour when interacting with the patients. The purpose of this study was to explore and describe the factors that contribute to nurses’ negative behaviour when rendering patient care and to determine the effects of nurses’ behaviour on patient outcomes. The study used a non-experimental explorative and descriptive quantitative design. Data collection was done using a structured questionnaire. The sample comprised of 64 respondents which consisted of 25 registered nurses and 39 enrolled nurses. The study found that besides the known contributing factor, that is, the shortage of nurses, further identified contributing factors to nurses’ negative behaviour when rendering patient care are failure to retrain nurses identified with negative behaviours, poor condition of employment and patients’ behaviours and cultural beliefs. These results suggested a need to train more nurses, improve conditions of employment, as well as support and retrain nurses identified with negative behaviours. / Health Studies / M.A. (Public Health)