Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Bakgrund: Sjuksköterskans kliniska arbete ska präglas av ett etiskt förhållningssätt som genomsyrar omvårdnadsarbetet i att skapa vårdrelationer och patientdelaktighet. God vård är allt mer jämställt med begreppet personcentrerad vård, att se människan och personen i patienten. Syfte: Att utforska hur personcentrerad vård kan utföras i sjuksköterskans kliniska arbete. Metod: En litteraturstudie av 20 artiklar har genomförts. Resultat: Analysen genererade ett antal strategier som presenterades i fem teman: Att se personen, Att lyssna, Att skapa relationer, Att visa respekt och empati, Att skapa stödjande miljö. Slutsats: Det är essentiellt att förstå att trots varierande strategier är det nödvändigt att flera strategier bör tillgås för att uppnå personcentrerad vård i alla situationer. Klinisk betydelse: Denna studie bidrar med kunskap om vad personcentrerad vård innebär och ger ökad insikt i hur det kan uppnås i det dagliga kliniska arbetet. / Background: The nurse work within an ethical framework that provides guidelines in the requirements of establishing nurse-patient relationships and in shared decision making. Good quality in nursing care depend on to what degree the nurse meet these requirements, which is equated to patient-centered care: to place the person of the patient in the center of care. Aim: To explore how patient-centered care may be performed in the nurse’s clinical setting. Methods: A literature review of 20 articles was performed. Results: The analysis resulted in various strategies. These strategies are presented in five main themes: To see the person, To listen, To create relationships, To show respect and empathy, To create healing environments. Conclusion: Despite the fact that there are various strategies, it is essential to understand that a combination of them is needed, in order to truly fulfil person-centered care. Clinical significance: This study may contribute to knowledge on how patient-centered care may be achieved in the everyday clinical setting.

Há anos a redução da taxa de mortalidade materna vem sendo discutida em todo mundo, sendo considerada um dos indicadores de qualidade à saúde. É consenso mundial que a presença de profissionais qualificados durante o ciclo gravídico-puerperal diminui o número das morbi-mortalidades de mulheres e recém-nascidos. Diante desta situação a Confederação Internacional das Parteiras (ICM) preconizou as competências essenciais que os profissionais devem possuir para realizar uma atenção qualificada em todas as fases do ciclo reprodutivo. Objetivo: descrever o perfil dos profissionais de enfermagem que atuam na assistência de enfermagem durante o trabalho de parto, parto e pós parto imediato no município de Piracicaba/SP e identificar os procedimentos que estes realizam segundo a preconização da ICM. Metodologia: estudo quantitativo de natureza descritivo-exploratória. Os dados foram coletados em duas instituições. Foram entrevistados através de questionário semi-estruturado 57 profissionais: 8 enfermeiros obstetras, 4 enfermeiros, 38 técnicos de enfermagem e 7 auxiliares de enfermagem. Através de observação não participativa foram acompanhados 24 acolhimentos para primeiro atendimento, 30 trabalhos de parto, 20 partos e pós partos imediato. Para análise dos dados foi utilizada a estatística descritiva. Resultados: Perfil da equipe de enfermagem: todos profissionais são do sexo feminino, com média de idade de 30 anos, 45,61% convivem com parceiro fixo, 57,89% não possuem filhos, média diária de trabalho de 7,42 horas, 77,19% destes participaram de eventos científicos após conclusão dos seus estudos, apenas profissionais com nível superior realizaram partos. Todos afirmaram gostar de trabalhar na assistência ao parto. Competências essenciais: em geral, as práticas obstétricas recomendadas pela Organização Mundial de Saúde (OMS) são adotadas, embora em muitas situações estas sejam realizadas de maneira incompleta em especial as que se referem à humanização da assistência. No entanto, notou-se que as atribuições são delegadas segundo categoria profissional e não em relação à competência profissional. Conclusão: o estudo demonstrou a necessidade de abolir a divisão das funções segundo formação profissional, permitindo que o atendimento seja realizado de acordo com a qualificação profissional em especial no que se refere ao atendimento a mulher durante o parto. Há necessidade de investimentos na reciclagem dos profissionais e na reorganização do modelo da assistência para contribuir com a melhoria da assistência durante o trabalho de parto, parto e pós-parto imediato no município de Piracicaba/SP. / For years, the reduction of maternal mortality has been globally discussed and is considered one of the indicators of quality of health. It is a global consensus that the presence of trained professionals during the pregnancy-puerperium cycle decreases the number of morbidities and mortalities of women and newborns. Thus, the International Confederation of Midwives (ICM) recommended the essential competences that professionals should have to provide quality care in all phases of the reproductive cycle. Objective: to describe the profile of nursing professionals who work in nursing care during labor, delivery and immediate postpartum in the city of Piracicaba-SP, and to identify the procedures they perform according to the recommendation of the ICM. Method: quantitative, descriptive and exploratory study. Data were collected in two institutions. Using a semi-structured questionnaire, 57 workers were interviewed: 8 nurse-midwives, 4 nurses, 38 nursing technicians and 7 nursing auxiliaries. Through non-participatory observation, 24 first welcomes, 30 labors, 20 deliveries and immediate postpartum were followed. Descriptive statistics was used for data analysis. Results: Nursing team profile: all workers are female, with average age of 30 years, 45.61% have fixed partners, 57.89% do not have children, the average daily workload is 7,42 hours, 77.19% of them participated in scientific events after finishing their studies, and only workers with higher education performed delivery care. All participants reported liking to work in delivery care. Essential competences: in general, the obstetric practices recommended by the World Health Organization (WHO) are adopted, although in several situations they are carried out incompletely, mainly the ones referring to the humanization of care. However, it was noticed that the attributions are delegated according to professional category and not in relation to professional competence. Conclusion: the study showed the need to extinguish the division of functions according to professional degree, permitting care to be delivered according to professional qualification, especially with regard to care to women in delivery. Investment in professional recycling and in the reorganization of the care model as to improve care during labor, delivery and immediate postpartum in the city of Piracicaba/SP is needed.

Assuring quality of care for patients who face the end of life has been a major concern for those in hospice settings. Limited research is available that has a focus on understanding what quality of care in a hospice setting looks like. This research is important to provide insight into hospice health care providers' perceptions of the quality of care in the hospice setting and on the indicators that influence care quality. A qualitative phenomenological approach was used to answer the research questions on the perspectives of the health care providers in the hospice care setting regarding the quality of care and the factors that health care providers perceive as important to the quality of care in the hospice setting. Kolcaba's comfort theory served as the theoretical framework that guided the preparation of the questions used for the interviews and for interpreting the findings. Data collection was conducted through structured interviews with a sample of 15 hospice health care providers. Interviews were held in a private office of the hospice setting. After Walden Institutional Review Board approval, participants consented and interviews commenced. Data were transcribed and Nvivo software was used to assist with identifying major themes. Recommendations from the study reflect Kolcaba's comfort theory providing patient-centered care and enhanced quality of care for patients in a hospice setting. The research findings and recommendations will help promote a positive social change by raising awareness for effective provider communication, staffing, education and adequacy of resources in the hospice setting.

This thesis focuses on the use of interpreters in Swedish healthcare. The overall aim was to explore how individuals, healthcare professionals and family members experience and perceive the use of interpreters in healthcare. The study design was explorative and descriptive. The thesis included Serbo-Croatian(Bosnian/Croatian/Serbian)speaking individuals(n=17), healthcare professionals(n=24), official documents(n=60)and family members(n=10)of individuals using interpreters in healthcare. Individual interviews, written descriptions, review of official documents in the form of incident reports from a single case study and focus group interviews were used to collect data. Data were analyzed using phenomenography, qualitative content analysis and qualitative data analysis of focus group interviews. The overall finding from all perspectives was the wish to have a qualified interpreter whose role was as a communication aid but also as a practical and informative guide in healthcare. The perception of a qualified interpreter was someone highly skilled in medical terminology, Swedish and individuals’ native language with ability to adapt to different dialects, wearing non-provocative and neutral clothes, of the same gender, with a professional attitude and preferably in personal contact through face-to-face interaction. Besides being a communication aid, the interpreter was perceived as having an important role in helping individuals to find the right way to and within the healthcare system because foreign-born individuals were unable to understand information in healthcare. Another aspect was to have a well-developed organization with good cooperation between the parties involved in the interpretation situation, such as patients, interpreter, interpreter agency, family members and healthcare professionals to offer a good interpretation situation. In conclusion, the use of an interpreter was determined by individual and healthcare situational factors. Individualized holistic healthcare can be achieved by offering and using high-quality interpreters and cooperation within a well-developed interpreter organization.   Keywords: communication, healthcare service, patient-safe quality care, qualitative data collection, qualitative data analysis, users’ perceptions/experiences, utilization of interpreters.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-10-03T18:51:28Z No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-10-03T18:52:11Z (GMT) No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) / Made available in DSpace on 2013-10-03T18:52:11Z (GMT). No. of bitstreams: 1 Diss MP. Adeanio Almeida 2013.pdf: 761576 bytes, checksum: e6fa6de40f4407eb0e64fad35f261cd6 (MD5) Previous issue date: 2013 / Na conjuntura atual, é perceptível o descompasso entre os conceitos de humanização e o processo de desenvolvimento tecnológico. A tecnologia, cada vez mais determinante para aumentar a sobrevida humana e diminuição do sofrimento, afasta os profissionais do contato mais próximo com o paciente. Ambientes com alta densidade tecnológica - que apresentam grande concentração de equipamentos e instrumentais médico-hospitalares (tecnologias duras) – trazem consigo desafios ligados à qualificação, modernização e à necessidade de refletir sobre as modificações que possam ocorrer para o cuidado de enfermagem. Neste trabalho interessa discutir este último aspecto, de forma a responder a seguinte questão: como se configura o cuidado de enfermagem, tendo em vista a perspectiva da humanização em saúde, em instituições com realidades distintas em termos de densidade tecnológica? A partir desta questão, o estudo teve como objetivo comparar percepções e práticas do cuidado de enfermagem, sob a perspectiva da humanização em saúde, em dois serviços hospitalares que se distinguem por apresentar, respectivamente a seguinte configuração: baixa e alta densidade tecnológica. Um critério básico para tipificar a densidade tecnológica foi a existência ou não de monitores multiparamétricos na unidade. Trata-se de uma pesquisa qualitativa, baseada no estudo de caso múltiplo, realizado em duas unidades hospitalares: Hospital Antônio Carlos Magalhães, em Inhambupe (BA) e Hospital do Subúrbio, em Salvador (BA). Os sujeitos foram cinquenta e um profissionais de enfermagem que atuam nas unidades assistenciais e de terapia intensiva. A coleta de dados foi realizada através de entrevista semiestruturada e observação direta. Os dados foram analisados e distribuídos em três categorias: percepções de enfermagem acerca do cuidado humanizado; práticas do cuidado e humanização da assistência e fatores que limitam ou que favorecem o cuidado humanizado de enfermagem. Não foram observadas, nos casos estudados, diferença significativa entre as percepções dos enfermeiros (as) e a prática, apenas mudanças de focos da dimensão ou ação do cuidado humanizado. Dentre os fatores limitantes, puderam ser notados o despreparo e insatisfação profissional, rotinas rígidas, sobrecarga de trabalho; tempo excessivo consumido em atividades gerencias e o constante barulho dos equipamentos médico hospitalares. Em contrapartida, fatores como ambientes silenciosos; melhor distribuição do tempo entre as atividades de enfermagem; estabelecimento de protocolos assistenciais; existência de programa de gratificação; adequação de horas de trabalho de enfermagem e, principalmente, programas de educação continuada são apontados como facilitadores da humanização do cuidado. Programas de educação continuada e o estabelecimento de ações gerenciais e institucionais que privilegiem a qualidade da assistência revelam-se essenciais para o incentivo à humanização, vez que o que o fator determinante para que a tecnologia desumanize o cuidado de enfermagem não é a tecnologia por si só, mas principalmente como esta opera nos contextos pessoais, institucionais e gerenciais. / Salvador

My master's thesis which topic is "Satisfaction of patients with the services provided. An important indicator of quality of medical equipment " is mainly focused on satisfaction of patients with the services provided in the Hospital České Budějovice, a.s. Furthermore, the mapping focused on overall satisfaction with care in the already mentioned Hospital České Budějovice and on exploring whether patients evaluate the quality of information provided by a medical doctor in this hospital affirmatively and whether they are satisfied with care of local nurses. The satisfaction of patients is an important indicator of the quality of care provided, which has an impact on their status of basic human needs. One main purpose was determined: Monitoring the satisfaction of patients with the services provided in the Hospital České Budějovice, a.s. and this purpose was fulfilled. Quantitative research was executed, to its realization the interview method was used. By means of the technique of standardized anonymous questionnaires on the basis of the above-mentioned purpose,the 3 following hypothesis were verified: 1) Patients are satisfied with the overall care in the Hospital České Budějovice, a.s. 2) Interviewed patients evaluate the quality of information provided by a medical doctor in the Hospital České Budějovice, a.s. affirmatively 3) Interviewed patients are satisfied with the care of nurses in the Hospital České Budějovice, a.s. I processed the data to confirm or refute the pre-established hypotheses. The evaluation of the data was carried out using statistical nonparametric methods, Chi-square test and the chosen level of significance of p=0.05. The results of the research have been clearly processed into the tables and graphs. The program Microsoft Office Excel 2010 was used to process the results.

The dissertation is divided into theoretical and practical parts. The theoretical part deals with the historical equipment of nursing and nursing education in the Czech Republic, further the legislation, the implementation of nursing education and a personality of a nurse. For the processing of the empirical part there was chosen the method of quantitative and qualitative research inquiry. For the quantitative inquiry there was chosen the method of asking by means the technique of a questionnaire and for the qualitative part of the research inquiry there was chosen the method of asking, namely the method of half-structured interview with opened questions. For the quantitative inquiry there were prepared two sorts of questionnaire, the first for the nurses, namely the universal nurses from experience and the second for patients, it means for the non ? professional public within the Southern Bohemia. There were set six surmises for this part of inquiry. The results of the inquiry were elaborated into diagrams and tables. In the quantitative part of the research inquiry were verified six hypothesis, that were set in advance: 1. The interest of nurses for the education follows more from the legislative aiming than from interest about more quality nursing care of a patient. The results show us that the need of credit is for the nurses more important than the need of more quality care for a patient. The first hypothesis was confirmed. 2. Choice of the courses of lifelong learning depends more on the amount of financial claims than on the orientation on care that provided. There follows from the research inquiry that for the nurses is more important the interestingness of an event than the amount of financial costs. The second hypothesis was disproved. 3. Motivation for the nurses for education is more the system of university education than the increasing of the quality of care. The results show that the nurses are more motivated by the need of a university education than by a better care of a patient. The third hypothesis was verified. 4. Implementation of an output of education isn´t incremental to its application in the real environment. The research inquiry showed us, there is no big possibility for the nurses to implement the results of their education in practice. The fourth hypothesis was verified. 5. The patient?s don´t distinguish, if the nursing care is provided by a qualified nurse or by another member of a nursing team. The fifth hypothesis was verified. 6. The patient?s don´t perceive nurses according to their education, but to a uniform. The results show, that the patients are not knowledgeable in the nursing staff neither according to their uniform nor their education. The sixth hypothesis was disproved. There were approached 12 respondents for the qualitative part of the research inquiry, within the Southern Bohemia again. The interviews were taken down, rewritten and analysed. The obtained data were categorized. There was set Research question for the qualitative part of the research inquiry: What is the meaning of nurses about the implementation of their education I the praxis? There was finding out by the research inquiry, that the nurses generally welcome the university education, mainly because of the reason, that the nurses come in praxis in a higher age. The lifelong learning should be also beneficial for them, but this has its shortcomings, namely in the financial part and it isn´t supported by the employers. They can also see the problem in implementation of their obtained knowledge from education in non ? interest of their employer and other members of nursing team.

As the United States' baby boom generation ages, the future of nursing home care becomes increasingly important. Through this study the researcher seeks to understand quality in nursing home care from the family's perspective. Surveys were collected at one North Texas nursing home, and data were analyzed to determine how gender and level of family involvement impact their concept of quality. Further, the information in this study is aimed at clarifying if interventions, specifically empowered CNA teams, have an impact on how family members view quality. Findings are identified and recommendations for future study are made.