Global ETD Search

1	A grounded theory study of the clinical use of the nursing process within selected hospital settings. O'Connell, Beverly O. January 1997 (has links) The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++ / comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++ / process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
2	Looking beyond : the RNs' experience of caring for older hospitalized patients Molnar, Gaylene L 09 March 2005 Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population. searching knowing connecting dealing with complexity geriatric nursing hospitalized older patients acute care hospitals Elderly
3	Looking beyond : the RNs' experience of caring for older hospitalized patients Molnar, Gaylene L 09 March 2005 (has links) Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population. searching knowing connecting dealing with complexity geriatric nursing hospitalized older patients acute care hospitals Elderly
4	A mail survey to assess the incidence and impact of drug shortages within Texas Non - Government Acute Care Hospitals Rajab, Tawfik Rajab 25 March 2014 (has links) A Mail Survey to Assess the Incidence and Impact of Drug Shortages within Texas Non – Government Acute Care Hospitals Tawfik Rajab Rajab, M.S.Phr. The University of Texas at Austin, 2013 Supervisor: Marvin D. Shepherd The objective of this study was to explore the incidence and impact of drug shortages within Texas Non-Government Acute Care Hospitals. A self-administered mail survey instrument was used to collect data. A convenience sample of 321 pharmacy directors of non-government acute care hospitals in the state of Texas was selected from the Texas Department of State Health Services (DSHS) Hospital List for 2012. A total of 125 completed surveys were received by mail and 8 surveys were returned as undelivered, resulting in a response rate of 39.84% (125/313). A total of 56 (45.5%) respondents reported 11 or more drug shortages for the month of April 2013. There was a significant association between the number of drug shortages experienced and hospital size (p = 0.003), inpatient medication budget (p = 0.001) and hospital location (p=0.015). Of the 124 respondents, 78 (62.9%) spent four to 12 hours a week on managing drug shortage situations. There was a significant association between the number of hours spent per week by hospital pharmacy personnel when managing drug shortages controlling for hospital size (p < 0.001), number of drug shortages experienced (p < 0.001), number of pharmacist FTEs (p < 0.001), and number of pharmacy technician FTEs (p < 0.001). A total of 107 (85.6%) reported that grey market vendors have contacted hospital pharmacy personnel in the month of April, 2013. A total of 96 (76.8%) ‘strongly agreed’ that grey market vendors are more likely to contact health care facility when drug shortage exists, 110 (88%) ‘strongly agreed’ that grey market vendors sell drugs in short supply at inflated prices and 70 (56%) ‘strongly agreed’ that the practice of buying drug products from grey market vendors should be eliminated. In summary, all surveyed hospitals experienced at least one drug shortage for the month of April 2013, pharmacy personnel devoted a significant amount of time managing drug shortages and the majority of the hospitals were contacted by grey market vendors with the aim of selling drugs in short supply. / text Drug shortages Grey market vendor Mail survey
5	Effects Of Health Information Technology Adoption On Quality Of Care And Patient Safety In Us Acute Care Hospitals Seblega, Binyam 01 January 2010 (has links) The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitals' performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis Donabedian's structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT. health information technology HIT patient safety quality of care acute care hospitals
6	How privatization and corporatization affect healthcare employees’ work climate, work attitudes and ill-health : Implications of social status Falkenberg, Helena January 2010 (has links) Political liberalization and increased public costs have placed new demands on the Swedish public sector. Two ways of meeting these novel requirements have been to corporatize and privatize organizations. With these two organizational changes, however, comes a risk of increased insecurity and higher demands on employees; the ability to handle these changes is likely dependent on their social status within an organization. The general aim of the thesis is to contribute to the understanding of how corporatization and privatization might affect employees’ work climate, work attitudes and ill-health. Special importance is placed on whether outcomes may differ depending on the employees’ social status in the form of hierarchic level and gender. Questionnaire data from Swedish acute care hospitals were used in three empirical studies. Study I showed that physicians at corporatized and privatized hospitals reported more positive experiences of their work climate compared with physicians at a public administration hospital. Study II showed that privatization had more negative ramifications for a middle hierarchic level (i.e., registered nurses) who reported deterioration of work attitudes, while there were no major consequences for employees at high (physicians) or low (assistant nurses) hierarchic levels. Study III found that although the work situation for women and men physicians were somewhat comparable (i.e., the same occupation, the same organization), all of the differences that remained between the genders were to the detriment of women. The results of this thesis suggest that corporatizations and privatizations do not necessarily imply negative consequence for employees. However, the consequences appear to differ between groups with different social status. Employees whose immediate work situation is affected but who do not have sufficient resources to handle the requirements associated with an organizational change may perceive the most negative consequences. / At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Privatization corporatization organizational change ownership healthcare employees acute care hospitals physicians social status hierarchic level gender work climate work attitudes ill-health Psychology Psykologi
7	From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times MacLeod, Suzanne 26 March 2014 (has links) As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive. / Graduate / 0452 / 0680 / 0351 / macsuz@shaw.ca social determinants of health social exclusion crisis discourse Alzheimer's Alzheimer Society of Canada Suzanne MacLeod Susan Strega Donna Jeffery poststructural poststructuralism admission to long-term care funding for long-term care acute care aging demographic BC Psychogeriatric Association biomedical British Columbia Canada Health Act collective social responsibility competition corporate profit corporatization deresponsibilization elder friendly elderly citizens family caregivers Foucault found poetry genealogy of power knowledge incompetent Ministry of Health moral economics pharmaceutical bed blocker stigmatized tsunami absent-person action plan aging population alternative discourse apocalyptic demography appropriate archaeology archaeology of knowledge archaeological British Columbia burden Canada caregiver charity charitable collective collective car community community care condition of possibility conditions of possibility corporate counter-discourse dementia dementia care dementia policy dementia social policy dependent depoliticize discourse discourse analysis disruptive discourse economic burden economics economy elder emergency epidemic exclusion fear-monger Foucauldian found poem genealogy genealogical health authority health care health care staff health care system health policy document healthy lifestyle home and community care homogenization homogenize hospital imaginaries imaginary incapable individual responsibility individualism knowledge long-term care material effect materiality of discourse media moral panic national strategy neoliberal neoliberalism neoliberal rationality not prepared object objectification other person-centered people living with dementia person living with dementia persons living with dementia person with dementia poem poetic representation poetry policy policies political politics power power knowledge power relations private privatize privatization productivity of dominant discourse public health care residential care resistance responsibility responsibilization rising tide safety net shift costs to caregivers responsibility social policy imaginary social well-being social work social worker solidarity specialized stakeholder state stigma subject matter expert taxpayer threat unprepared unproductive voluntary volunteer wait time wave social policy
8	From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times MacLeod, Suzanne 26 March 2014 (has links) As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive. / Graduate / 0452 / 0680 / 0351 / macsuz@shaw.ca social determinants of health social exclusion crisis discourse Alzheimer's Alzheimer Society of Canada Suzanne MacLeod Susan Strega Donna Jeffery poststructural poststructuralism admission to long-term care funding for long-term care acute care aging demographic BC Psychogeriatric Association biomedical British Columbia Canada Health Act collective social responsibility competition corporate profit corporatization deresponsibilization elder friendly elderly citizens family caregivers Foucault found poetry genealogy of power knowledge incompetent Ministry of Health moral economics pharmaceutical bed blocker stigmatized tsunami absent-person action plan aging population alternative discourse apocalyptic demography appropriate archaeology archaeology of knowledge archaeological British Columbia burden Canada caregiver charity charitable collective collective car community community care condition of possibility conditions of possibility corporate counter-discourse dementia dementia care dementia policy dementia social policy dependent depoliticize discourse discourse analysis disruptive discourse economic burden economics economy elder emergency epidemic exclusion fear-monger Foucauldian found poem genealogy genealogical health authority health care health care staff health care system health policy document healthy lifestyle home and community care homogenization homogenize hospital imaginaries imaginary incapable individual responsibility individualism knowledge long-term care material effect materiality of discourse media moral panic national strategy neoliberal neoliberalism neoliberal rationality not prepared object objectification other person-centered people living with dementia person living with dementia persons living with dementia person with dementia poem poetic representation poetry policy policies political politics power power knowledge power relations private privatize privatization productivity of dominant discourse public health care residential care resistance responsibility responsibilization rising tide safety net shift costs to caregivers responsibility social policy imaginary social well-being social work social worker solidarity specialized stakeholder state stigma subject matter expert taxpayer threat unprepared unproductive voluntary volunteer wait time wave social policy

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