Class of 2007 Abstract / Objectives: To describe the after-hours medication needs in rural hospital pharmacies which are closed during the night. Methods: Entries in a night medication log from a 60 bed rural Arizona hospital that closed for 12 hours at night were collected. Complete entries were assigned a night of the week, a month of the year, and a two hour time period. Data was collected from April 1, 2005 to March 30, 2006. Entries were sorted into groups, counted, and ranked. Groups were compared using student’s t-test. The top 200 drug products ranked by quantity was recorded for a trial of fit into a night formulary. Results: The night medication log contained 4986 complete entries accounting for 669 individual drug products. Non-pharmacy staff entered the pharmacy after-hours 2070 times and removed 10449 drug dosage units. No significant difference in night medication need was found between summer and winter month or weeknight and weekend night. Early night need was significantly different than late night need (p = 0.01). The top 200 drug products covered 83.3% of the medication quantity need of the hospital. Conclusions: The study found that a large percentage (83.3%) of the night medication need could be accessible from a 200 item night formulary. Seasonal and weekend differences were non-significant with only time of night differences being significant. These results could justify the extending of current hours or establishment of a night formulary to decrease entrances into the pharmacy when a pharmacist is not on duty.

Background: South Africa is a diverse country in terms of its cultures, languages, socioeconomic variety and community beliefs and this is reflected in our health care setting. Communication is a critical feature of adequate medical care and an understanding of potential barriers to communication is important particularly in understanding under-resourced rural health care settings. The health community is comprised of different professionals who are required to communicate interdependently on a daily basis to ensure the best quality of care for their patients. Little research has been done on the role of interprofessional communication in a rural setting. Purpose: The aim of this research project is to describe and understand the influence of systemic and interpersonal factors on communication processes between health care professionals working in a rural hospital context. Method: The research study used a qualitative design and the application of social interaction theory, specifically Goffman’s framework was used to understand the phenomena studied. The study involved 52 health professionals and included: doctors, nurses, clinical associates, social workers, pharmacists, dieticians, physiotherapists, occupational therapists, speech and language therapists, audiologists and administrative staff. The data in this research were derived from ethnographic observations in the hospital, and focus groups and interviews with participants. Profession-specific vignettes were used during the focus groups to stimulate discussion. A SiSwati speaking research assistant helped with the collection of data and aided in translation and transcriptions. Data from the 52 interviews, 8 detailed xiv observations and 12 focus groups were analysed using thematic analysis. Findings: Numerous systemic and interpersonal themes were derived from the data. The study found that health care professionals felt isolation from both the wider medical community as well as the local community which influenced interprofessional communication. Systemic influences included the impact of the rural setting, changes in health systems (the proposed National Health Insurance scheme) and access to provincial support. Interpersonal themes included management, power, responsibility, handover, recognition of roles, blame, conflict and language issues. One of the most prominent interpersonal themes to emerge was the identity of the health care worker which was interlinked with their professional role, status, power, race, language and community identity. Participants’ thoughts about the way forward for the hospital also emerged. Conclusion & implications: Systemic and interpersonal factors do influence health care workers’ interprofessional communication. Social interaction theory explains some of the complex communication interactions but they do not account for important systemic influences. Goffman’s front and backstage is beneficial in identifying communication in a rural hospital however systemic and interpersonal categories were found to be more useful in this setting. The implications from this study are important for policy, theory and practice such as communication training programmes for rural healthcare teams as well as site specific models of training. Speech and language therapists are communication experts and therefore could be playing a greater role in the development of team communication.

This study examines the underutilization of rural hospitals in Kentucky. The authors study hospital and patient characteristics to determine why and how rural patients bypass local rural hospitals and how they make their decision in the hospital choice. A Health Care Service Survey conducted in rural Kentucky and hospital data drew from American Hospital Directory are used. A binary probit model and a conditional logit model are applied. The results suggest that the hospital quality, prior experiences and the satisfaction of the local hospital, along with patients’ value of hospital size, reputation and patients’ insurance coverage influence rural patients’ hospital choice. The study offers seven policy implications to better utilize rural health care institutions.

Healthcare professionals are expected to know their role in patient safety. In a rural hospital, they may have different roles along with their professional role. Staff and services are fewer and the community is often part of the hospital. This can influence patient safety culture. Researchers and governing bodies have focused on developing processes to assist healthcare leaders developing their patient safety culture. Researchers and governing bodies have tended to focus on urban hospitals and then implement the same processes in rural hospitals. This strategy has not always been successful. The purpose of this study is to explore the roles and responsibilities in patient safety culture of health care professionals in rural hospitals. A systematic review, using the Joanna Briggs Institute (JBI) review process, was completed to discover how patient safety culture and rural hospitals are described and measured. Some common elements in the literature were unique characteristics of rural hospitals, leadership, error reporting and the use of patient safety culture surveys. Ethnographic methods were used to explore healthcare professional’s roles in patient safety culture in a rural hospital. Healthcare professionals describe their roles differently than described in the literature. A patient safety culture model was developed from the literature and refined with the study findings. The affinity model was developed based on the study findings from the small rural hospital and the literature. Everything they do is how rural hospital practitioners described their role in patient safety. / Thesis (Ph.D, Nursing) -- Queen's University, 2014-02-20 09:15:25.007

MGS / Instittute of Gender and Youth Studies / In spite of the golden age of women which was ushered in by the Berlin Conference of 1995, women continue to be disadvantaged when it comes to public participation, both in the public and private sectors of the society. On a global scale even when they are well-qualified and in spite of the mainstreaming of more women into public life, women remain discriminated against in terms of accessing leadership positions. Despite their positive contribution, women continue to be significantly underrepresented in leadership positions. The aim of this study was to explore on the experiences and challenges of junior female managers at Tshilidzini Hospital in Vhembe District in Limpopo Province, South Africa. Qualitative method was used because it enabled the researcher to gain in-depth information about the challenges and experiences of junior female managers at Tshilidzini Hospital. This study is exploratory in nature. The population of this study consisted of junior female managers. Non-probability purposive sampling technique was used to select the research participants for this study. Ethical principles were considered, to ensure maximum protection of the research participants in this study. Face to face interviews were used to solicit information on the experiences and challenges of junior female managers at Tshilidzini Hospital. Thematic data analysis method was used in this study. The study found that gender discrimination is still widespread in South Africa, despite of the availability of many gender equality policies. The study recommends that policy makers, various government departments and law enforcement agencies makers should strengthen the gender machinery, to ensure that women are not denied an opportunity to take up leadership positions. / NRF

Indiana University-Purdue University Indianapolis (IUPUI) / Access to healthcare services is important for improving health outcomes, preventing and managing illness, and achieving health equity. The geographic maldistribution of physicians has a negative impact on rural areas compared to urban, particularly as it relates to access to healthcare. Rural hospitals have been closing or converting to another form of healthcare service at an increasing rate, adding another element to the existing complexities in rural access to care. Although a hospital closure in any location may have a considerable impact on the community, the closure of a rural hospital may have disproportionately more substantial implications for the economy and employment, health outcomes, and access to care. The contributing factors preceding rural hospital closures have been studied, but less is known about the full impact of rural hospital closures on the community. There is some evidence of shortages in healthcare providers and services, and therefore communities may employ multiple strategies to mitigate the shortages and provide services, including utilizing telehealth/virtual services. This dissertation proposes to examine the effects of rural hospital closures on the community, healthcare services, access to care, and provide a qualitative assessment of telehealth as a strategy to bridge gaps in provider access. This dissertation includes three studies: 1) a systematic review of the literature to examine the impact of rural hospital closures on the community; 2) an empirical study that utilizes a generalized difference in difference design with county and year fixed effects to estimate the relationship between rural hospital closures and nursing homes; and 3) a qualitative study exploring the perceptions and experiences of the nurses that piloted a virtual care support project, providing insights into crucial elements important to the implementation of similar models and the role of telehealth in bridging healthcare workforce gaps.

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital documentation and pertinent strategic information from their respective semistructured interviews. Sections of text signifying concepts from collected documentation and transcribed interviews were organized and coded according to research question and interview questions to explore strategies rural hospital leaders implemented to improve their hospital's financial performance. The methods triangulation process encompassed comparing findings from the interview themes and hospital strategic documentation analysis. The key themes that emerged from coded data were rural hospital leaders' decision-making when addressing rural hospital financial performance, developing synergies with external providers and hospitals, creating effective short-term and long-term strategies, and translating success to the entire organization. Implications for social change include the potential to prevent rural hospital closure and ensure access to healthcare services for the communities rural hospitals serve.

This study investigated the clinical accompaniment of nursing students in a rural hospital. Nursing students are allocated to clinical facilities for clinical exposure and learning opportunities; to integrate theoretical knowledge with practical skills and professional socialization under guidance and support from professional practitioners. Although the rural hospital, as context for this study, provides unique and challenging learning opportunities for clinical teaching and learning, the environment as such and the relationship between the stakeholders (nursing students and professional nurses) seem to be questionable and not conducive for learning. A qualitative, explorative, descriptive and contextual design served as framework for this study. Data was collected by means of semi–structured focus–group interviews with samples selected from two (2) populations of stakeholders with first hand experience of the clinical accompaniment of nursing students allocated to the rural hospital for clinical exposure and learning. The first sample consisted of thirteen (n=13) nursing students and the second sample consisted of professional nurses (n=6) directly involved in the clinical accompaniment of the nursing students. The focus of the interviews was the participants' experience of the clinical accompaniment in a specific rural hospital. Data was analyzed by means of the process of content analysis as described by Graneheim and Lundman (2004). Three (3) themes and eight (8) subthemes emerged from the data collected from the nursing students. The data collected from the professional nurses resulted in five (5) themes and eleven (11) subthemes. The collected data was integrated with relevant national and international literature to culminate in eight (8) conclusive statements. The conclusive statements served as basis for the proposal of guidelines to improve the clinical accompaniment of nursing students in a rural hospital and to enhance learning in the clinical practice area. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

This study investigated the clinical accompaniment of nursing students in a rural hospital. Nursing students are allocated to clinical facilities for clinical exposure and learning opportunities; to integrate theoretical knowledge with practical skills and professional socialization under guidance and support from professional practitioners. Although the rural hospital, as context for this study, provides unique and challenging learning opportunities for clinical teaching and learning, the environment as such and the relationship between the stakeholders (nursing students and professional nurses) seem to be questionable and not conducive for learning. A qualitative, explorative, descriptive and contextual design served as framework for this study. Data was collected by means of semi–structured focus–group interviews with samples selected from two (2) populations of stakeholders with first hand experience of the clinical accompaniment of nursing students allocated to the rural hospital for clinical exposure and learning. The first sample consisted of thirteen (n=13) nursing students and the second sample consisted of professional nurses (n=6) directly involved in the clinical accompaniment of the nursing students. The focus of the interviews was the participants' experience of the clinical accompaniment in a specific rural hospital. Data was analyzed by means of the process of content analysis as described by Graneheim and Lundman (2004). Three (3) themes and eight (8) subthemes emerged from the data collected from the nursing students. The data collected from the professional nurses resulted in five (5) themes and eleven (11) subthemes. The collected data was integrated with relevant national and international literature to culminate in eight (8) conclusive statements. The conclusive statements served as basis for the proposal of guidelines to improve the clinical accompaniment of nursing students in a rural hospital and to enhance learning in the clinical practice area. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

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