O presente trabalho descreve, inicialmente, o papel desempenhado pela Secretaria de Higiene e Saúde (SHS) do Município de São Paulo, no contexto da assistência a saúde e das políticas nacionais que orientam suas atividades. Historicamente, a SHS vem atuando em duas linhas bem definidas e independentes: o atendimento às urgências e, paralelamente, a assistência materno-infantil que, face às novas diretrizes políticas, tende a se transformar em assistência integral à saúde. Como consequência das novas orientações políticas, várias tentativas têm sido realizadas no sentido de integrar essas duas linhas de atuação. Para tanto, a presente pesquisa, realizada no Posto de Assistência Médica (PAM) e no Pronto Atendimento (PA) Jardim São Jorge, localizado na zona oeste do Município de São Paulo, apresenta como proposta de trabalho a integração das ações de assistência médica individual de caráter curativo com as ações de assistência médico-sanitária. Partindo-se do pressuposto de que qualquer ação no campo da saúde depende da participação da comunidade, busca-se a forma pela qual a população recebe e utiliza os serviços localmente integrados. Nesse sentido, foram coletadas junto à clientela de ambos os serviços, informações tais como: motivo de procura, resolutividade, satisfação e outras, obtidas por meio de formulários. A análise das características das queixas, da resolutividade e da satisfação referida pela clientela, do objetivo e do processo de trabalho desses serviços, leva a conclusão de que o PAM e o PA são utilizados de forma seletiva pela clientela, visando principalmente, ao atendimento de suas necessidades diretamente relacionadas à resolução das manifestações de doença. / The present study describes, initially, the role played by the Higiene and Health Secretariat (SHS) of the City of São Paulo (Brasil), in the context of health assistance and of the national policies which govern these activities. Historically the SHS has acted within two well - defined and independent fields: emergency treatment and, parallel to this, mother and child health care. The latter, considering the new political guide-lines, is tending to be transformed into general health assistance. As a result of these new political guide-lines, various attempts have been made to integrate these two fields of activities. With this in view, this research project was carried out at the Public Health Clinic (PAM) and the Emergency Medical Service (PA) in the Jardim São Jorge, situated in the western zone of São Paulo City, and presents a working proposal for the integration of the individual medical care of a curative type and the activities of public health assistance. Taking as a starting-point that all activity in the health sector depends on community participation, this study seeks to discover how the population has received and used the geographically integrated health services. For this purpose, information was collected, by means of a questionnaire, from the users of both of these services, on the motive for the recoursing to the service, the service\'s ability to meet the need, the degree of satisfaction of the user, etc. The analysis of the above information as well as of the objective and the working method of these services, has led to the conclusion that the PAM and the PA are used by the public in a selective way, aiming at satisfying those immediate needs related to some present illnesses.

Using grounded theory methodology this study examined the acquisition and exercise of nephrology nursing expertise, seeking to answer the following questions: what constitutes expertise and how it develops in nephrology nursing; and whether expert nephrology nurses practice differently from non-expert nephrology nurses and, if so, how. Sampling consisted of 6 non-expert and 11 expert nurses from a renal unit in New South Wales, and data were obtained from participant observation of the nurses and subsequent interviews. A substantive theory was generated utilising an orchestral metaphor to explain the skills-acquisitive/exercise process. Findings revealed a three stage skills-acquisitive process: non-expert, experienced non-expert and expert. Each stage was typified by four characteristics that altered during the acquisitive process: knowledge, experience, skills and focus. The findings also identified features of the skill-acquisitive/exercise process either not reported or left implicit in previous studies, including the centrality of recognition of expertise; blurring the boundaries to expert practice; and the role of motivation, enjoyment and commitment to the acquisition of / Doctor of Philosophy (PhD)

Objective: To describe the levels of ANC adequacy and factors related in 3 provinces of Vietnam: Long an, Ben tre and Quang ngai. Method: Data from three rural provinces of Vietnam collected by the Vietnam Australia Primary Health Care Project were analysed using descriptive and analytical statistical techniques including multivariate regression, multipart analysis and hierarchical techniques. A sample of 1335 eligible women was available for analysis. The Andersen Health Behaviour Model was utilised in analyses of ANC utilisation. The Donabedian Quality of Health Model was used in analyses of ANC content and overall adequacy. Results: ANC was inadequate with only 71% of women having some ANC, 51% having initial visits within the first four months, 41% having three or more visits, 35% having three or more visits with the initial visits within the first four months, 17% of women reported three quarter or more of recommended ANC procedures/advice, 12% of women had enough ANC utilisation and fair ANC content. Factors that existed prior to contact with health care providers such as external environment, predisposing and need were related to whether the women seek any ANC and to pregnancy duration at first visits. However, factors that resulted from initial contact with health care providers, such as satisfaction of women with ANC services and health care provider related characteristics, were important in the models examining total number of ANC visits, overall ANC utilisation, content of ANC reported and overall ANC adequacy. Province of residence related to all aspects of ANC adequacy. Different aspects of ANC adequacy were related to each other. Conclusion: ANC adequacy levels in Vietnam were low. To increase the proportions of women who use ANC services and attend ANC early, promotion of ANC should be targeted at women at risk. However, to improve continuation with ANC, ANC content, and overall ANC adequacy, the quality of services provided needs to be improved. To reduce the gap between provinces, priority should be given to less developed provinces. / PhD Doctorate

This thesis reports on an evaluation of an intervention to improve the quality of care for adults with epilepsy. The intervention comprised an epilepsy specialist nurse working in 14 general practices in north west Bristol, England. A multi-method approach was employed. As part of a quasi-experimental trial, baseline and two annual follow-up questionnaires were sent to all patients in the practices aged 16 years and over and currently on drugs for epilepsy. In addition, interviews were undertaken with those having seizures to explore further some questionnaire findings and to appraise the appropriateness, acceptability and accessibility of the nurse service. The epilepsy nurse was interviewed to assess the feasibility of providing the new service. Baseline results highlighted deficiencies in services for people with epilepsy and suggested the need for structured care and increased discussion. The main effects of the nurse service were improved communication about epilepsy between health care providers and patients and increased access, especially for those with the greatest needs. The nurse service had limited impact on patients’ health status. There were indications of a negative impact on the perceived effect of epilepsy on aspects of everyday life. After one year, an intention-to-treat analysis suggested improvements in satisfaction with care from GPs, but decreased adherence to medication. A comparison of nurse service users with non-users after two years showed a reduction in the use of polypharmacy in users, and an increased proportion who queried GPs’ knowledge about epilepsy. Users reported increased visits to their GP. Interview data showed that the decision to use the nurse service depended on factors other than the severity and frequency of seizures. The service was most appropriate for those who perceived themselves to need care or information. This method of delivering care was feasible, but several operational problems were identified. The study supports the use of specialist nurses in primary care. Impact is, however, limited. The greatest contribution to improving care is by supporting and advising patients with specific and defined needs.

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

Background: Although racial and ethnic differences in healthcare have been extensively documented in the United States, little attention has been paid to the quality of health care for the foreign-born population in the United States. Objectives: This study examines the association between patient perceptions of the patient-physician interaction and nativity status. Research Design: Cross-sectional telephone survey. Subjects: A total of 6674 individuals (US-born ≤ 5156; foreign-born ≤ 1518) 18 years of age and older. Measures: Seven questions measuring the quality of patient-physician interactions. Results: Of the 7 outcome variables examined in the unadjusted logistic regression model, only 2 remained statistically significant in the fully adjusted model. For both the total sample and for Asians only, compared with US-born, foreign-born individuals were at greater odds [total sample, odds ratio (OR) ≤ 1.43; 95% confidence interval (CI) ≤ 1. 01ĝ€"2.04; Asians, OR ≤ 3.25; 95% CI ≤ 1.18ĝ€"8.95] of reporting that their physician did not involve them in their care as much as they would have liked. Compared with US-born Asians, foreign-born Asians were at greater odds of reporting that their physician did not spend as much time with them as they would have liked (OR ≤ 4.19; 95% CI ≤ 1.68ĝ€"10.46). Discussion: Findings from our study suggest that we should not only track disparities by race and ethnicity but also by nativity status.

Due to an increasingly aging population and long-term care available, the number of older adults seeking long-term care facilities is growing. Resident satisfaction indicators have become essential measurements of service quality. However, few studies have investigated the evidence on prevalent resident satisfaction indicators and associated factors. In order to understand what are the types of resident satisfaction measurements utilized in long-term care facilities in the United States and how these types of care services influence resident satisfaction, the researcher conducted the first study, which consists of a systematic scoping review by summarizing the evidence on the types of resident satisfaction indicators utilized in long-term care settings in the United States. The second study completed a further systematic review to summarize how nursing assistants impact resident satisfaction in long-term care settings.The third study aims to translate and validate a Chinese version of the resident satisfaction assessment based on the Ohio Long-term Care Resident Satisfaction Survey (OLCRSS). The fourth study will apply hierarchical regression to predict older adults' satisfaction with individual factors and care services factors in long-term care settings. The dissertation provided a holistic solution to measure resident satisfaction in long-term care settings, assist health providers in meeting the resident`s needs and improve the quality of the care. These studies are significant because they provide fundamental data for using evidence-based indicators of resident satisfaction to enhance the residents' quality of life. Findings could also add to the existing literature regarding resident satisfaction indicators.

No description available.

Genom att ta reda på vad det är i sjuksköterskors arbetsmiljö som kan påverka omvårdnadskvalitén kan sjuksköterskor få större möjlighet att utforma sin ideala arbetssituation och i förlängningen ge den bästa tänkbara omvårdnaden. Syftet med litteraturstudien var därför att undersöka aspekter i sjuksköterskors arbetsmiljö som påverkar omvårdnadskvalitén. Resultatet är baserat på 20 vetenskapliga artiklar av både kvalitativ och kvantitativ design. Resultatet visar att om sjuksköterskor upplever en god arbetsmiljö förbättras både sjuksköterskors och patienters uppskattning av omvårdnadskvalitet. Arbetsbelastning har en kritisk påverkan på omvårdnadskvalitén. Sjuksköterskor tvingas göra prioriteringar på grund av tidsbrist och tung arbetsbörda som missgynnar patienter och medför ökade kostnader för sjukvården. En ledare behöver kunna ta sjuksköterskors åsikter på allvar och säkerställa tillräckligt med kompetent personal. Att ingå i ett välfungerande team med god kommunikation förbättrar sjuksköterskors arbetstillfredsställelse. Lönenivån, karriärmöjligheter, kompetensutvecklingen och att sjuksköterskor finns representerade på beslutsfattande nivåer ses som viktiga aspekter för att höja professionens status och arbetstillfredsställelse. Beslutsfattare, patienter och närståendes bedömningar av omvårdnadskvalitet relaterat till sjuksköterskors arbetsmiljö behövs för att kunna ge ytterligare bredd till forskningen. / By findingoutwhich aspectsofnurseworkenvironmentthatmayaffect the qualityofcarenursescanhavegreateropportunity to design their ideal work situation and ultimatelyprovide the best possiblecare. The aimofthisstudywas to investigateaspectsofnurses' workenvironmentthataffectcarequality. The result is based on 20 scientificarticles: bothqualitative and quantitative design. The results show thatifnursesexperience a goodworkingenvironmentthisimprovesnurses' and patients' assessmentofcarequality. Workload has a criticalimpact on the qualityofcare. Nursesareforced to set prioritiesdue to timeconstraints and a heavyworkload, thisnegativelyaffects patients and results in increasedcosts ofcare. Being part of a well-functioning team withgoodcommunicationimprovesnurses' jobsatisfaction. A leadershouldtakenurses' opinions seriously and ensureenoughqualifiedstaff. Salary, careeropportunities, skillsdevelopment, and nurse representation at decision-makinglevelsareseen as importantaspects to raise the profession's status and jobsatisfaction. Implication for further research on the subjectcould be interventional studies thatattempt to improve the revealedaspectsof the workenvironment. Decision-makers, patients and their relatives understandingof the qualityofcarerelated to nurses' workenvironmentare alsoneeded to clearlydescribe the subject.

In the planning and delivery of services the voice and choice of consumers have appeared as the foremost key factors. For a large number of organisations the received feedback from customers about the quality of services, which are the criteria and indication of their level of satisfaction play a crucial role in the improvement of quality. Although across developed western communities, the importance of customers’ views has gained acceptance, few studies have been dedicated to the exploration of the voice of the residents in care homes. The review of the literature regarding residents’ satisfaction and quality in care homes revealed that the voices of residents in care homes are usually not heard or are absent. Moreover, the adoption of quality improvement tools in health care has lagged behind that in other industries and there is generally a failure to use an appropriate methodology in care homes, one based on residents’ voice, for improving quality. As a result, the main aim of this research is to investigate residents’ voice regarding improving their satisfaction in care homes. Further, the researcher seeks to obtain data by using an appropriate methodology to assist care home managers in enhancing the quality of the services they offer by assigning weights to quality indicators pertaining to improving quality and residents’ levels of satisfaction. For this purpose, this research employs both qualitative and quantitative approaches to develop a research process entailing: (1) a comprehensive literature review to recognise the phenomenon; (2) interviews with fifteen older people who lived in three different care homes in order to discover the most important residents’ needs and requirements in such homes; (3) a resident survey with one hundred and two residents in thirty five care homes. These were conducted to assess their preferences for the importance of demanded qualities; their satisfaction with provided services and the attributes of each demanded quality based on the Kano model, in order to identify the priority of improvement. Next, (4) there was the development of the House of Quality (HoQ) to optimize quality to assure residents’ satisfaction; and finally, (5) an evaluation study was conducted with thirteen service providers, in order to assess the accuracy and appropriateness of the methodology. This research has contributed towards a better understanding of the residents’ voice, and applying it for enhancing quality and residents’ satisfaction in care homes. For the first time residents’ requirements are prioritised and classified in this context through accurate methods. Moreover, an understanding of the attributes of care home residents’ needs in relation to a Kano model has been elicited. The novelty of this proposed methodology is in utilising the Quality Function Deployment (QFD) in care homes to translate the voice of residents’ regarding their requirements into service planning. The research methodology and results facilitate care home managers with a hierarchy for improvement planning at both service and executive management levels.