The ward sister round presents an integral part of the nursing profession. The ward sister round comprises a regular visit of the nurse directly at the patient´s bed. Its objective consists in determining and satisfying the unsaturated needs of patients, further in ensuring and providing a high quality and efficiency nursing care in a close link with medical care. Nursing handover can be divided into two main sections: written and oral handover. The oral handover takes place directly in the patients´/clients´ room under the use of nursing documentation. Its advantage consists in the direct involvement of the patient/client in the handover process. The written handover is then entered by the nurses into the Handover Book. The significance of my diploma work consists in increasing the nurses´ standard of knowledge related to the modernization of ward sister rounds and nursing handover as an integral part of the nursing profession.

No momento em que a creche integrou o sistema educativo brasileiro, o Estado depara-se com o desafio de estabelecer parâmetros de qualidade e critérios de avaliação do atendimento oferecido às crianças de 0-6 anos. Desta maneira, uma avaliação instrumentalizada da qualidade de ambientes de creches poderia auxiliar nesta tarefa. Dada a inexistência de instrumentos brasileiros, esta pesquisa objetivou verificar a adequabilidade para o nosso contexto da versão traduzida da escala norte-americana Infant/Toddler Environment Rating Scale Revised Edition, utilizada internacionalmente para avaliar a qualidade do atendimento oferecido para crianças de 0-30 meses. Essa escala é composta por 39 itens agrupados em sete subescalas, que contemplam diversas dimensões do ambiente de creches: Espaço e mobiliário (5 itens); Rotinas de cuidado pessoal (6); Falar e compreender (3); Atividades (10); Interação (4); Estrutura do programa (4); Pais e equipe (7). Tais itens servem de guia para observações feitas nas várias áreas da creche, durante atividades rotineiras de uma turma de crianças e sua(s) educadora(s); com base nas condições observadas e nas descrições dos indicadores de qualidade da escala, o avaliador atribui pontuação de 1 (inadequado) a 7 (excelente) para cada item. Esta pesquisa englobou quatro etapas: (1)análise semântica; (2)treinamento e familiarização com a escala; (3)verificação da discriminabilidade; (4)verificação da concordância entre aplicadores treinados. Na Etapa 1, seis participantes avaliaram se as sentenças escritas nos indicadores de qualidade da escala expressavam claramente o que deveria ser observado. Dos 466 indicadores, 80% foram considerados compreensíveis por todas as participantes; os 93 indicadores considerados com dificuldades de compreensão semântica passaram por revisão e 57% foram reescritos. Na Etapa 2 (treino através de vídeo e aplicação da escala em três turmas, uma de creche universitária e duas de creche filantrópica), o índice de acordo obtido entre dois aplicadores na terceira turma (82%) permitiu encerrar o treinamento. Na Etapa 3, a escala foi aplicada em quatro turmas de creches com tipos diferentes de gestão (universitária, municipal, filantrópica e particular) a escala discriminou níveis diferentes de qualidade, conforme o escore total obtido (E.T.): as turmas Universitária (E.T.=4,97) e Municipal (E.T.=3,33) apresentaram nível de qualidade suficiente e as turmas Filantrópica (E.T.=2,7) e Particular (E.T.=1,57), nível de má qualidade. Na Etapa 4, dois aplicadores treinados avaliaram, simultânea e independentemente, duas turmas, uma de creche municipal e outra universitária; o Coeficiente de Correlação Intraclasse indicou uma concordância quase perfeita (0,83) e substancial (0,66), respectivamente para cada turma; a análise de concordância sugeriu um nível satisfatório de precisão da escala. As avaliações realizadas identificaram, em cada turma, aspectos positivos da qualidade do atendimento e aspectos que necessitam de melhorias, os quais foram apresentados às coordenadoras das creches, favorecendo reflexões/discussões sobre qualidade do atendimento e oferecendo a elas subsídios para trabalhar com as educadoras; pois, para promover um ambiente institucional de qualidade é importante que a equipe discuta e reflita sobre aspectos positivos já presentes e aqueles que necessitam de planejamento para serem implantados. Desta maneira, a escala pode ser um instrumento útil na promoção de qualidade do atendimento infantil em creches brasileiras. / At the moment that day care center was incorporated to Brazilian educational system, the State come across with the challenge of establishing quality parameters and criteria for evaluation of services provided to children of 0-6 years. Thus, assessment the environmental quality of day care center by an instrument could help in this task. Because of the nonexistence of Brazilian instruments, this research aimed to verify the suitability for our context of translated version of the North American scale Infant/Toddler Environment Rating Scale - Revised Edition, used internationally to assess the quality of services offered for children of 0-30 months. This scale consists of 39 items grouped into seven subscales, which include various dimensions of day care center environment: Space and furnishings (5 items), Personal care routines (6); Speaking and understanding (3) Activities (10); Interaction (4) Program structure (4) Parents and staff (7). These items serve as a guide for observations made in various areas of day care center, during routine activities of a group of children and their teacher(s); based on observed conditions and descriptions of quality indicators of the scale, the evaluator assigns scores of 1 (inadequate) to 7 (excellent) for each item. This study included four phases: (1) semantic analysis, (2) training and familiarization with the scale, (3) verification of the scales discrimination, (4) verification of agreement between trained evaluators. In the Phase 1, six participants judged if the written phrases of quality indicators of the scale expressed clearly what should be observed. Of the 466 indicators, 80% were considered understandable by all participants, the 93 indicators considered not understandable underwent revision and 57% have been rewritten. In the Phase 2 (training through video and application of scale in three playrooms, a playroom of an university day care center and two playrooms of a philanthropic day care center), the agreement between two evaluators in the third playroom (82%) allowed finishing the training. In Phase 3, the scale was applied in four playrooms of day care centers with different types of management (university, public, private and philanthropic) - the scale discriminated different levels of quality, according to the total score obtained (T.S.): the playrooms University (T.S. = 4.97) and Public (T.S.= 3.33) had sufficient level of quality and the playrooms Philanthropic (T.S.= 2.7) and Private (T.S.= 1.57), level of poor quality. In Phase 4, two trained evaluators assessed, at the same time and independently, two playrooms, a playroom of a public day care center and another university; the intraclass correlation coefficient indicated an almost perfect correlation (0.83) and substantial agreement (0.66), respectively for each class, the analysis of agreement suggested a satisfactory level of accuracy of the scale. The evaluations identified, in each class, the positive aspects of quality of service and aspects that need improvement, which were presented to the day care centers coordinators, encouraging reflections and discussions about quality of service and offering them subsidies for working with educators; because, to promote the quality of institutional environments is important that the team discuss and reflect on positive aspects already present and those that require planning to be implemented. Thus, the scale may be a useful tool in promoting quality of service provided to children in Brazilians day care centers.

Living with inflammatory bowel disease (IBD) affects physical, psychological and social dimensions, limiting the ability to engage in daily activities. Persons with IBD may need frequent and lifelong contacts with the healthcare (HC), highlighting the importance of quality care. High quality HC for persons with IBD involves a partnership between the HC professionals and the person living with the disease. Information is essential, the more a person knows about their disease, the more concordant and satisfied with their treatment they are likely to be. The overall aim of this thesis was to describe the knowledge need, life situation and perception of HC among persons living with IBD, in order to develop a questionnaire to evaluate the quality of HC. This thesis is based on three studies that are presented in four papers. Qualitative methods were used to describe aspects of life situation in relation to the disease, whereas quantitative method was used to develop a questionnaire measuring quality of care. Study I and II have an inductive qualitative design. In study I, qualitative interviews with 30 people were performed to describe the knowledge need and experience of critical incidents in daily life while living with IBD. The interviews in study I were analyzed using content analysis (results presented in Paper I) and critical incident technique (results presented in Paper II). In study II, the perceptions of HC among persons living with IBD was explored in five focus group interviews and two individual interviews, in total n=26. Study III aimed to develop and evaluate a questionnaire, measuring quality of care among persons with IBD, including 318 persons with IBD and 8 professionals. The knowledge need among persons with IBD focused on managing symptoms and course of the disease and learning to assimilate the information in order to manage everyday life. Losing bowel control was of great concern for most of the informants in the study. Many of the informants said that “the bowel ruled their life” and that it influenced them to a great extent in their daily lives. The perception of HC among persons with IBD meant being met with respect and mutual trust, receiving information at the right time, shared decision-making, competence and communication, access to care, accommodation, continuity of care and the pros and cons of specialized care. The quality of care questionnaire QoC-IBD was constructed in five dimensions, building on the results from Study I and II. The dimensions were trust and respect, decision-making, information, continuity of care and access to care consisting of 21 questions in total. QoC-IBD is a short, self-administrated questionnaire that measures experiences of healthcare among persons with IBD with promising validity and reliability. To improve quality of care, HC is recommended to consider individual care needs and take the person’s daily life and social context into account. The QoC-IBD questionnaire measures the subjective experience of quality of care. Further testing in clinical practice is necessary to evaluate if QoC-IBD can be used to evaluate the care given and areas of improvement in HC for persons living with IBD.

Magister Public Health - MPH / The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of 'acceptable' waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients' health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers' skills and clients' satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities. / South Africa

Magister Public Health - MPH / Introduction Mother to Child Transmission is a significant route of HIV infection in children and in South Africa (SA) the median HIV prevalence rate among pregnant women is 30, 2% and in the Western Cape Province (WCP) it is 18, 2%. lthough Prevention of Mother to Child Transmission (PMTCT) programmes are now available at 100% of all health care facilities and 95% of women attend antenatal care, these programmes are complex and outcome data reveals fluctuations in transmission rates as well as pockets of high transmission within well performing sub-districts. The careful management of programme processes thus requires more than coverage and outcome data. It also requires a clear picture of process indicators related to access to PMTCT services, the quality and continuity of care within the PMTCT programme and integration of PMTCT service into the comprehensive package of health care services. Aims and objectives To develop a tool that will measure the quality of care of HIV exposed infants in the PMTCT programme at primary care setting in Cape Town, by engaging local programme managers in a participatory process to develop a tool that is locally applicable and relevant, and captures local management expertise. To identify the evaluation omains, to develop a set of indicators for each domain and to pilot the tool to assess its feasibility and usefulness of the data generated.

Magister Public Health - MPH / Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of “acceptable” waiting time among the providers and clients.

This master thesis is focused on marketing of Santé, the private clinic. The first part is theoretical and has two main chapters. Marketing in the field of health care is the first chapter, including the differences between health care marketing and marketing in other fields and other characteristics of the medical system. Next a product is defined, in health care it is the provided service. Marketing mix is described not as 4P but as 4C. Then there is the practical point of view on the health care system. Very important is the patients' satisfaction, which is measured by many different surveys, such as the best hospital, or quality perceived by the patients. The other chapter discusses used methods, defines marketing research and the S-T-P strategy. The practical part of thesis introduces the company Santé followed by the description of their clientele, which is differentiated as individual and companies' clientele. Marketing mix of the company consists of the 4 components already mentioned higher. Next is the SWOT analysis. Analysis of the competition focused on the main competitors of Santé. Very significant moment is the research project created to suit the needs of this thesis only. A complex questionnaire researching the privet clinic market as a whole was prepared. Analysis of the data was complex as well. Open questions were analyzed separately, closed questions were processed with the help of SPPS computer program. By the end of the thesis there are some recommendations for the company that originate in the research project and also from the confrontation of the theory and practice. Last is the conclusion, bibliography and the annex, where you can find already mentioned questionnaire.

The final thesis follows up the quality of health care. This topic has been nowadays much discussed and is very current. The aim of this work was to bring the issue of health care quality and analyze the quality of health care in the facility Dr. Pírko Clinic by using a questionnaire to research the satisfaction of it's patients.

La qualité des soins a progressivement été intégrée dans l’ordre juridique français. Elle est désormais reconnue de manière indirecte comme un droit du patient et un objectif à atteindre pour les professionnels et les établissements de santé.Toutefois, le champ de la qualité des soins ne bénéficie pas d’un cadre juridique propre. Un droit souple de la qualité des soins a parallèlement émergé pour répondre principalement à l’inadaptation du droit dur à ce domaine et plus largement à la pratique médicale au regard notamment de la rapidité de son évolution. Ces « instruments » de droit souple se distinguent des règles de droit dur, traditionnellement définies comme obligatoires et assorties d’un régime de sanctions de l’autorité publique.Le champ de la qualité des soins obéit ainsi à un régime normatif gradué s’étendant du droit dur au droit souple, ce qui implique désormais de définir l’articulation entre les différents dispositifs et leurs effets juridiques.En effet, l’amélioration de la qualité des soins est également freinée par la surproduction des dispositifs et la crainte des professionnels de voir leur responsabilité engagée à la suite de leur participation à ces démarches.Des évolutions réglementaires, organisationnelles et opérationnelles visant d’une part à élaborer un régime juridique dédié aux données issues de ces démarches et, d’autre part, à préciser les rôles et compétences de chaque acteur afin notamment de coordonner l’ensemble des dispositifs semblent indispensables. En revanche, une législation spécifique portant sur la protection des professionnels n’est pas souhaitable. / Quality of care has gradually been incorporated into French law. It is now recognized indirectly as a patient's right and a goal for professionals and health institutions to achieve.However, the quality of care domain does not have its own legal framework. Soft law concerning care quality has emerged in parallel as a principle response to the hard law’s inadequacy in this domain, and to a wider extent, with special regard to the fast evolution in medical practice. These « soft law » instruments are different from their hard law counterparts which are traditionally defined as mandatory and are accompanied by a regime of sanctions issued by public authority.In this way the care quality domain conforms to a graduated regulatory system which extends from hard law to soft law. This now entails defining the articulation between the different instruments and their legal effects.In fact, improvements to care quality are being slowed by the overproduction of measures and professionals’ fears of being held liable as a result of their participation in these processes.It seems indispensable that regulatory, organizational, and operational changes should both target the development of a legal regime dedicated to data from these approaches, as well as the clarification of the roles and skills of each player especially as concerns the entirety of the measures. In contrast, specific legislation targeting the protection of professionals is not desirable.