Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Wu Yan Fei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 161-189). / Abstracts in English and Chinese. / Chapter 1. --- BACKGROUND --- p.1 / Chapter 1.1 --- Hong Kong health care system --- p.1 / Chapter 1.2 --- Medication compliance and treatment responses --- p.2 / Chapter 1.3 --- Definition of compliance --- p.5 / Chapter 1.3.1 --- Compliance --- p.5 / Chapter 1.3.2 --- Adherence --- p.6 / Chapter 1.3.3 --- Concordance --- p.7 / Chapter 1.4 --- Definitions of satisfactory compliance --- p.9 / Chapter 1.5 --- Importance of compliance --- p.10 / Chapter 1.6 --- Non-compliance as a behavioral disease --- p.12 / Chapter 1.6.1 --- Disease manifestation (Patterns of non-compliance) --- p.12 / Chapter 1.6.2 --- Prevalence/Epidemiology (Rate of non-compliance) --- p.14 / Chapter 1.6.3 --- Diagnosis (Detecting non-compliance) --- p.15 / Chapter 1.6.3.1 --- Direct methods --- p.16 / Chapter 1.6.3.1.1 --- Use of biological fluids --- p.17 / Chapter 1.6.3.1.2 --- Biological surrogate (Drug) markers --- p.18 / Chapter 1.6.3.1.3 --- Pharmacological indicators --- p.20 / Chapter 1.6.3.2 --- Indirect methods --- p.22 / Chapter 1.6.3.2.1 --- Self-report / Direct questioning --- p.24 / Chapter 1.6.3.2.2 --- Pill counts --- p.25 / Chapter 1.6.3.2.3 --- Diaries --- p.27 / Chapter 1.6.3.2.4 --- Electronic monitoring --- p.27 / Chapter 1.6.3.2.5 --- Physician estimates --- p.31 / Chapter 1.6.3.2.6 --- Outcome measurement and clinical judgment --- p.32 / Chapter 1.6.3.2.7 --- Presence of side effects --- p.33 / Chapter 1.6.3.2.8 --- Keeping of appointments --- p.34 / Chapter 1.6.3.2.9 --- Prescription refill rates --- p.34 / Chapter 1.6.3.3 --- Direct observation --- p.35 / Chapter 1.6.3.4 --- The ideal detection method --- p.36 / Chapter 1.6.4 --- Risk factors (Related factors of non-compliance) --- p.37 / Chapter 1 .6.4.1 --- Patient related factors --- p.37 / Chapter 1.6.4.1.1 --- Understanding and comprehension --- p.37 / Chapter 1.6.4.1.2 --- Health beliefs --- p.39 / Chapter 1.6.4.1.3 --- Socio-demographic factors --- p.44 / Chapter 1.6.4.1.4 --- Forgetfulness --- p.45 / Chapter 1.6.4.2 --- Illness --- p.46 / Chapter 1.6.4.3 --- Therapeutic regimen --- p.46 / Chapter 1 .6.4.4 --- Patient-practitioner relationship --- p.48 / Chapter 1.6.5 --- Treatment (Interventions) --- p.50 / Chapter 1.6.5.1 --- Education --- p.51 / Chapter 1.6.5.2 --- Dosing regimen planning --- p.55 / Chapter 1.6.5.3 --- Clinic scheduling --- p.57 / Chapter 1.6.5.4 --- Communication --- p.57 / Chapter 1.6.6 --- Intelligent non-compliance --- p.60 / Chapter 1.6.7 --- Overview of problems with compliance studies --- p.63 / Chapter 1.6.7.1 --- Complex and not effective --- p.64 / Chapter 1.6.7.2 --- Lack theoretical framework --- p.64 / Chapter 1.6.7.3 --- Fragmented studies --- p.65 / Chapter 1.6.7.4 --- Lack high quality compliance study --- p.66 / Chapter 1.6.7.5 --- Without long term follow up --- p.67 / Chapter 1.6.7.6 --- Correlation between compliance and desired therapeutic outcomes --- p.68 / Chapter 2 --- HYPOTHESIS AND OBJECTIVES --- p.71 / Chapter 3 --- METHODS --- p.75 / Chapter 3.1 --- Study design --- p.76 / Chapter 3.2 --- Outcome measures --- p.80 / Chapter 3.3 --- Statistical analysis --- p.81 / Chapter 3.4 --- Power analysis --- p.82 / Chapter 4. --- RESULTS --- p.85 / Chapter 4.1 --- Patient demographics --- p.85 / Chapter 4.2 --- Clinic attended and drug usage --- p.85 / Chapter 4.3 --- Non-compliant rates and its patterns --- p.86 / Chapter 4.4 --- Reasons for non-compliance --- p.86 / Chapter 4.5 --- Relationship between drug class and medication compliance --- p.86 / Chapter 4.6 --- Relationship between dosage frequency and medication compliance --- p.87 / Chapter 4.7 --- Clinical characteristics of compliant and non-compliant patients --- p.87 / Chapter 4.8 --- Comparison of non-compliant patients identified at baseline during the second reassessment --- p.88 / Chapter 4.9 --- Effects of pharmacist's telephone intervention on tertiary outcomes --- p.88 / Chapter 4.9.1 --- Medication compliance --- p.88 / Chapter 4.9.2 --- Blood pressure --- p.89 / Chapter 4.10 --- Effects of pharmacist's telephone intervention on secondary outcomes --- p.90 / Chapter 4.11 --- Primary end-points of compliant versus non-compliant patients --- p.91 / Chapter 4.12 --- Best predictors of mortality rate for the studied population --- p.92 / Chapter 4.13 --- Effects of pharmacist's telephone intervention on primary outcomes --- p.92 / Chapter 4.14 --- Clinical characteristics of non-compliant patients with / without second follow up --- p.93 / Chapter 4.15 --- Clinical outcomes of defaulted patients at the second visit --- p.93 / Chapter 5. --- DISCUSSION --- p.126 / Chapter 5.1 --- Study design --- p.126 / Chapter 5.2 --- Compliance assessment method --- p.126 / Chapter 5.3 --- Patient demographics and drug prescribing pattern --- p.128 / Chapter 5.4 --- Extent and pattern of non-compliance --- p.128 / Chapter 5.5 --- Reasons for non-compliance --- p.129 / Chapter 5.5.1 --- Lack of knowledge --- p.129 / Chapter 5.5.1.1 --- Dosing instructions --- p.129 / Chapter 5.5.1.2 --- Drug identification --- p.130 / Chapter 5.5.1.3 --- Storage --- p.131 / Chapter 5.5.2 --- Forgetfulness --- p.131 / Chapter 5.5.3 --- Problems with health beliefs --- p.132 / Chapter 5.5.3.1 --- Common myths or misconceptions --- p.132 / Chapter 5.5.4 --- Presence of side effects --- p.133 / Chapter 5.6 --- Predictability of non-compliance --- p.134 / Chapter 5.6.1 --- Socio-demographics --- p.134 / Chapter 5.6.2 --- Polypharmacy --- p.135 / Chapter 5.6.3 --- Dosing frequency --- p.137 / Chapter 5.6.3.1 --- "Little difference between daily, twice daily and thrice daily dosing." --- p.137 / Chapter 5.6.3.2 --- Importance of drug property in determining the impact of usual dosages --- p.138 / Chapter 5.6.3.3 --- The impact of missed dosage on clinical condition --- p.139 / Chapter 5.6.3.4 --- Practical issues regarding dosing frequency --- p.140 / Chapter 5.6.4 --- Drug Profiles --- p.141 / Chapter 5.7 --- Outcomes measure --- p.142 / Chapter 5.8 --- The role of pharmacist in chronic care --- p.147 / Chapter 5.9 --- The role of physician in chronic care --- p.155 / Chapter 5.10 --- Possible sources of bias and limitations --- p.156 / Chapter 5.11 --- Further studies --- p.156 / Chapter 5.12 --- Concluding remarks --- p.159 / Chapter 6. --- REFERENCES --- p.161 / Chapter 7. --- APPENDICES --- p.190

The patient portal, a Health Information Technology (HIT) tool, was created to help patients become engaged with their health and health information to improve health outcomes. The practice problem was the low patient portal use and lack of nurses' knowledge of patient HIT tools at an urban ambulatory clinic in the northeastern United States. The practice-focused question explored whether an educational intervention with the care coordination team (CCT) would increase prescription refill requests and facilitate patient-provider communications via the patient portal. The 2 frameworks used for the project were Knowles's adult learning theory and Lewin's theory of change. The preintervention data were collected from an electronic-medical-record-generated report that provided portal usage for the 6 months prior to the intervention. The CCT members were trained on teaching and modeling portal use from the perspective of the patients. A checklist of steps was created and given to the CCT to be used in patients' education. Postintervention reports showed that the patient portal usage for patient-provider communication increased by 165%. The prescription refill requests did not show an increase because medication used to treat chronic conditions were typically supplied for 6 months. The implications of this project for social change include the potential for providers to improve how they interact with their patients by incorporating patient portal education inpatient visits.

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In this study, I focus specifically on nurses’ actions related to pain. I establish how a different way of theorising ‘pain’ can assist in exploring how nurses’ subjectivity is constituted. I seek to open up possibilities for challenge and resistance by nurses to the dominant practices that influence how actions of nurses in relation to pain, come to exist. In challenging taken-for-granted representations of how pain is understood, I do not discount representations reported in literature, or as stated by people considered, for example, pain ‘experts’. Rather, I challenge how, these representations of pain and pain expertise, have come to exist as self-present truth, and seek to explore what other representations are marginalised as a consequence. I am aware that the interpretations of representations that I forward are open to this same critique. For my exploration of nurses’ actions related to pain for people having elective surgery, I undertook a poststructural analysis, informed by the works of Derrida, and Foucault. In particular, I constituted my thesis, in Derrida’s dictum ‘we are written as we write’, and Foucault’s analysis of three intersected topics: power, truth and the formation of selves. I analysed literature related to pain and management of that pain as text, and employed ethnographic techniques of observation, interviews and collection of documentary materials, to analyse nurses’ actions as text. I attempt to present a new text of nurses’ actions related to pain. I challenge the view that there is an essential true meaning that resides in pain, literature related to pain, or nurses’ actions aligned to that pain. Analysing how nurses’ subjectivity is written, in relation to pain, provides to nurses a means to read and write nurses’ actions in different ways. I reveal how a specific way of writing nurses’ actions, articulates a particular version of truth about pain, and how nurses are then positioned within this version of truth, and in turn, how nurses position people constituted as patients. I explore how, organisation as structure, is a way of thinking that continues to make invisible the power and politics dynamic in nurses’ actions related to pain. If the word ‘pain’ is taken as understood by nurses, that is, it is known what ‘pain’ means, this way of thinking will continue to privilege one meaning of pain in the hospital, and, maintain a traditional perspective of ‘organisation as structure’. In opening out alternate understandings of pain, and readings of nurses’ actions, the study allows for the possibility that pain, and the way that nurses act in relation to that pain, may indeed mean different things to different people. / thesis (PhD)--University of South Australia, 2000