It has consistently been documented in many countries and sectors that there are difficulties in implementing public policy effectively. A priori, the Australian health care system is no exception to this general proposition. While governments issue directives with particular goals in mind these goals are not always met, because of the modifications, interpretations or lack of uptake by targeted populations. However it is not clear the extent to which these difficulties occur in the public hospital sector, and we lack clear empirical data on this phenomenon. This thesis investigates the effects of a state government directive on the development and implementation of elective admission policies in New South Wales public hospitals. It did this by three separate but related studies that examined the impact of the directive at the hospitals??? management and staff levels. The first two studies were quantitative and qualitative surveys of hospital managers and admission staff. The management survey aimed to ascertain the extent to which managers responded to the directive in terms of developing and implementing hospital policies. The staff survey sought to investigate staff awareness and knowledge of the developed policies. The third study was a qualitative analysis of the policy contents to determine the extent to which they reflected the aims and objectives of the government directive guidelines. All three studies found a general lack of relevance and applicability of the government directive and its guidelines to individual hospital organisations. The manager survey showed a disconnection between the central government office responsible for implementing the directive and hospital managers??? perspectives. This was apparent by the lack of response to the directive by many hospitals and the fact that managers often passed on the task of implementing the directive and its guidelines to other hospital staff. The findings of the qualitative analysis of policies showed evidence of hospital strategies to manage pressures created by the directive. These difficulties were corroborated by the surveyed staff that reported difficulties in translating the directive???s requirements (as reflected by the hospital policy), into the reality of their daily work; a lack of organisational commitment to policy enforcement; and a suspicion regarding the directive???s political motives. The findings of this thesis show that, as with other public service sectors effective policy implementation in the public hospital arena is problematic, with government agendas frequently not aligned with the requirements of stakeholders, and inadequate understanding of implementation barriers. Recommendations are made regarding methods to improve the synchronicity of political directives with organisational realties in the public hospital sector.

It has consistently been documented in many countries and sectors that there are difficulties in implementing public policy effectively. A priori, the Australian health care system is no exception to this general proposition. While governments issue directives with particular goals in mind these goals are not always met, because of the modifications, interpretations or lack of uptake by targeted populations. However it is not clear the extent to which these difficulties occur in the public hospital sector, and we lack clear empirical data on this phenomenon. This thesis investigates the effects of a state government directive on the development and implementation of elective admission policies in New South Wales public hospitals. It did this by three separate but related studies that examined the impact of the directive at the hospitals??? management and staff levels. The first two studies were quantitative and qualitative surveys of hospital managers and admission staff. The management survey aimed to ascertain the extent to which managers responded to the directive in terms of developing and implementing hospital policies. The staff survey sought to investigate staff awareness and knowledge of the developed policies. The third study was a qualitative analysis of the policy contents to determine the extent to which they reflected the aims and objectives of the government directive guidelines. All three studies found a general lack of relevance and applicability of the government directive and its guidelines to individual hospital organisations. The manager survey showed a disconnection between the central government office responsible for implementing the directive and hospital managers??? perspectives. This was apparent by the lack of response to the directive by many hospitals and the fact that managers often passed on the task of implementing the directive and its guidelines to other hospital staff. The findings of the qualitative analysis of policies showed evidence of hospital strategies to manage pressures created by the directive. These difficulties were corroborated by the surveyed staff that reported difficulties in translating the directive???s requirements (as reflected by the hospital policy), into the reality of their daily work; a lack of organisational commitment to policy enforcement; and a suspicion regarding the directive???s political motives. The findings of this thesis show that, as with other public service sectors effective policy implementation in the public hospital arena is problematic, with government agendas frequently not aligned with the requirements of stakeholders, and inadequate understanding of implementation barriers. Recommendations are made regarding methods to improve the synchronicity of political directives with organisational realties in the public hospital sector.

No description available.

The purpose of this study was to explore the experiences and needs of families during the admission of a child to a paediatric ward in an acute care hospital. Qualitative research methods were used to access the caregivers' and professionals' perceptions of the culture that families experience in a paediatric in-patient setting. For this project, data collection methods included a review of the literature in the area, individual interviews with caregivers, and focus groups with paediatric health care professionals. / In the study, both parents and paediatric professionals described a multitude of experiences and needs of families during a child's admission to a paediatric ward in an acute care setting. Understanding the experiences and needs of families is important for professionals. The information collected in this study provides some insight into the culture that families experience when their child is admitted to a paediatric ward in an acute care hospital.

No description available.

This dissertation examines recurrent patterns in the interaction between psychiatric patients and the systems of knowledge and power that constitute them as patients. These patterns are traced both in the historical migmti::m of patients into and out of the asylum, and in the language used by doctors and patients to account for such migration. Transcripts of interviews with patients and case notes written by doctors are subjected to new forms of quantitative analysis and this is used together with qualitative interpretation to reveal the ways in which disciplinary power operates through confession and surveillance to constitute psychiatric subjects in the tension between freedom and incarceration. / Psychology / D.Litt. et Phil. (Psychology)

This dissertation examines recurrent patterns in the interaction between psychiatric patients and the systems of knowledge and power that constitute them as patients. These patterns are traced both in the historical migmti::m of patients into and out of the asylum, and in the language used by doctors and patients to account for such migration. Transcripts of interviews with patients and case notes written by doctors are subjected to new forms of quantitative analysis and this is used together with qualitative interpretation to reveal the ways in which disciplinary power operates through confession and surveillance to constitute psychiatric subjects in the tension between freedom and incarceration. / Psychology / D.Litt. et Phil. (Psychology)

Thesis (MSc) Stllenbosch University, 2001. / ENGLISH ABSTRACT: A prospective study was conducted in 1999 to establish the incidence and nature of acute poisonings in the Cape Town / Western Cape region. This study was based on an analysis of Poison Centre queries and acute poisoning admissions to Tygerberg Hospital over a period of 1 year (1999). Summary of findings for Hospital admissions (1010 cases): Acute poisonings were more common in adults (83%) than in children (17%) and drug overdose was by far the most common clinical entity in adult Hospital admissions (89% of cases). Most overdoses in adults were intentional (97%). Seventy five percent of these cases were female, predominantly in the 20-40 year age group. The incidence of non-drug chemical exposures in adults was relatively low (11%). In children, on the other hand, there was much less of a discrepancy between drug and non-drug chemical exposures (41% and 59% respectively). Paracetamol was the drug most commonly used in overdose in both adults and children. In adults ethanol featured in 17% of cases. Ingestion of paraffin and related volatile hydrocarbons were the most important cause of acute poisoning in children. Acute poisoning admissions due to drugs of abuse, excluding ethanol, were minimal in both age groups (1%). Toxic exposures to non-drug chemicals in the agricultural and industrial settings were low (3%). The number of exposures to biological toxins was also minimal (2%). Summary of findings for Poison Centre inqueries (3744 consultations): In 1999 the Tygerberg Poison Information Centre received 3744 calls, of which 2690 were related to acute human exposures to poisonous substances. The remainder of the calls (1054) was either about drug therapy, or general non-patient related toxicological matters. There were more calls regarding poisoning in adults (61%) than in children (39%). Most of the paediatric poisonings were accidental (97%), whereas in adults 55% were deliberate and 45% accidental. Forty four percent of the children and 52% of adults were female. In children, inqueries about exposures to potentially harmful non-drug household chemical products comprised 56% of poison calls, while drug overdose was 28% and exposures to biological toxins 16%. In adults 44% of inqueries were with regard to household products, 40% about drugs and 16% biological toxins. A comparison of Hospital admissions versus Poison Centre consultations: In order to make a valid comparison between Hospital admissions and Poison Centre consultations, acute poisoning cases originating from the same area were compared. Eight hundred and thirty four (90%) of patients admitted to Tygerberg Hospital and 592 (25%) of Poison Centre consultations originated from the same region, the Tygerberg catchment area. Several differences were noted when comparing poisoning cases reported to the Poison Centre and Hospital admissions. Six hundred and eighty eight (83%) adults and 145 (17%) children were admitted to Hospital in contrast to Poison Centre inqueries, where 322 (54%) were adults and 270 (46%) children. In adults, 99% of Hospital admissions versus 59% of Poison Centre consultations were regarded as self-inflicted. Ninety three percent of adults admitted to Hospital were drug overdoses, whereas only 48% of adult Poison Centre consultations involved ingestion of medicines. In adult overdoses with paracetamol and other analgesics, tricyclic antidepressants, antiepileptics, theophylline and ethanol were significantly higher in Hospital admissions than in Poison Centre consultations. In contrast, exposures to pesticides e.g. pyrethroids, misuse of recreational drugs e.g. cannabis and biological toxin exposures e.g. spider bites, were significantly higher in Poison Centre consultations than in Hospital admissions. In children, poisoning exposures to volatile hydrocarbons, especially paraffin, were significantly higher in Hospital admissions compared to Poison Centre enqueries. As is evident from the disparity in the results above, inqueries to the Tygerberg Poison Information Centre cannot be regarded as a reflection of the true incidence of acute poisonings in the community. Poison Information Centre statistics are distorted because of two factors: 1. Under-reporting to the Poison Information Centre. Healthcare providers are familiar with how to manage drugs commonly used in overdose (e.g. paracetamol) and certain household non-drug chemicals (e.g. paraffin), and often do not consult the Poison Centre for poison cases involving these substances. The number of inqueries received by the Poison Information Centre regarding these substances is, therefore, an under representation of actual incidence. 2. Over-reporting to the Poison Information Centre. The Tygerberg Poison Information Centre is well known for its expertise in biological toxins (e.g. spider and snake bites, scorpion stings, plant and mushroom ingestions, and marine toxins). Therefore, the number of inqueries received by the Centre with regard to these exposures is far higher than actual incidence of exposures. It is clear from this study that one cannot use data derived from a poison centre alone as an indicator of true incidence of poisoning in the community. A more accurate estimate of incidence of acute poisoning could be obtained by including data from hospital admissions, as well as those from primary health care facilities. Another prominent finding in this study was the high incidence of self-inflicted drug overdose in adult females, with paracetamol being the drug of choice. Poison prevention should therefore not be limited to children. Adult prevention programs need urgent attention. / AFRIKAANSE OPSOMMING: ‘n Prospektiewe studie om die insidensie en aard van akute vergigtigings in die Wes-Kaap vas te stel, is gedurende 1999 in Tygerberg Hospitaal uitgevoer. Die studie is gebaseer op ‘n analise van oproepe wat deur die Tygerbergse Vergifinligtingsentrum ontvang is en pasiente wat gedurende dieselfde tydperk met ‘n diagnose van akute vergiftiging by die Hospitaal toegelaat is. Qpsomming van Hospitaal toelatinqs (1010 qevalle): Toelatings van akute vergiftigings was meer algemeen by volwassenes (83%) as by kinders (17%). Die meeste hospitaal toelatings (83%) by volwassenes is a.g.v. geneesmiddeloordoseing. By 97% van volwassenes was gifstowwe doelbewus ingeneem, met vroue in die meerderheid (75%). Die insidensie van vergiftigings met nie-geneesmiddel verwante gifstowwe by volwassenes was laag (11%). By kinders was daar egter ‘n meer eweredige verspreiding tussen geneesmiddel (41%) en nie-geneesmiddel verwante (59%) gifstowwe. By beide volwassenes en kinders, was parasetamol die middel wat by die meeste oordoserings betrokke was. Alkohol was by 17% van vergiftigings by volwassenes betrokke. Paraffien en verwante vlugtige substanse was die belangrikste gifstowwe betrokke by akute vergiftigings by kinders. Akute vergiftigings as gevolg van die gebruik van dwelmmiddels was laag in alle ouderdomsgroepe (1%). Vergiftigings in die landbou en industriele sektore was laag (3%). Dit was ook die geval ten opsigte van blootstelling aan biologiese toksienes (2%). Opsomminq van Tyqerberq Verqifinliqtinqsentrum konsultasies (3744 qevalle): Gedurende 1999 het die Tygerberg Vergifinligtingsentrum 3744 oproepe ontvang waarvan 2690 as gevolg van akute vergiftigings was. Die ander 1054 oproepe het gehandel oor geneesmiddel terapie of algemene, nie-pasient verwante navrae. Daar is aangetoon dat oproepe ten opsigte van akute vergiftigings by volwassenes meer algemeen was as by kinders (61% en 39% respektiewelik). By kinders was die meeste vergiftigings per ongeluk (97%), terwyl by volwassenes die meeste doelbewus (55%) was. By kinders was 44% van die vroulike geslag teenoor 52% by volwassenes. By kinders was nie-geneesmiddel gifstowwe by 56% van akute vergiftigings betrokke en geneesmiddels by 44%. By volwassenes was dit 60% en 40%, respektiewelik. ‘n Verqelvkinq ten opsigte van Hospitaal toelatinqs en Verqifsentrum konsultasies: Om ‘n geldige vergelyking tussen Hospitaal toelatings en Vergifinligtingsentrum konsultasies te maak is gevalle van akute vergiftigings afkomstig uit dieselfde geografiese gebied.vergelyk. Toelatings tot Tygerberg Hospitaal 834 (90%) en 592 (25%) oproepe wat deur die Tygerbergse Vergifsentrum ontvang is, kom uit dieselfde opvangsgebied, naamlik die Tygerbergse substruktuur. Verskeie verskille tussen die twee instansies ten opsigte van die tipe vergiftigings is aangetoon. Volwassenes 688 (83%) en 145 (17%) kinders is met ‘n diagnose van akute vergiftiging by Tygerberg Hospitaal toegelaat in teenstelling met die Inligtingsentrum konsultasies waar 322 (54%) volwassenes en 270 (46%) kinders by betrokke was. By volwassenes was 99% van die toelatings die gevolg van doelbewuste vergiftiging (paraselfmoord), terwyl dit 59% van die Inligtingsentrum se navrae was. Drie en negentig persent van die volwassenes was in die Hospital toegelaat met geneesmiddel oordosering. Heelwat minder geneesmiddel oordosering (48%) was deur die Inligtingsentrum hanteer. Parasetamol en ander analgetika, trisikliese antidepressante, anti-epilepsie middels, alkohol en teofillien oordoserings by volwassenes was beduidend hoer by Hospitaal toelatings as by Vergifsentrum konsultasies. Akute vergiftiging deur paraffien en verwante vlugtige substanse by kinders was beduidend hoer by Hospitaal toelatings as wat gevind is by Inligtingsentrum navrae. Navrae ten opsigte van pestisied vergiftiging, gebruik van dwelmmiddels en blootstelling aan biologiese toksiene was beduidend hoer as by Hospitaal toelatings. Hierdie duidelike kontrasterende data dui daarop dat die tipe navrae wat deur die Tygerberg Vergifinligtingsentrum hanteer word nie noodwendig ‘n weerspieeling van die ware insidensie van akute vergiftiging in die gemeenskap is nie. Daar is 2 hoofredes hiervoor. 1. Onderrapportering by die Inligtingsentrum. Gesondheidverskaffers (dokters, verpleegsters, aptekers ens.) is vertroud met die behandeling van sekere algemene vergiftigings soos byvoorbeeld parasetamol oordosering en paraffien inname. Hulle ag dit derhalwe onnodig om die Sentrum hieroor te konsulteer. Dit lei dus tot onderrapportering. 2. Oorrapportering by die Inligtingsentrum. Die Tygerbergse Vergifinligtingsentrum is bekend vir sy vakkundigheid ten opsigte van blootstelling aan biologiese toksiene (spinnekopbyte, slangbyte, skerpioensteke, plante-en sampioen vergiftigings, ens). Dit is om hierdie rede dat vergiftigings deur biologiese agense, geraporteer aan die Sentrum, ‘n hoer syfer verteenwoordig as wat die werklike insidensie ten opsigte van die vergiftigings is. Hierdie studie toon dat vergifinligtingsentrum data nie noodwendig ‘n indikator van die ware insidensie van akute vergiftigings in die gemeenskap is nie. Dit is dus belangrik dat hospitaaltoelatingsdata asook data van primere gesondheidsklinieke ingesluit word om sodoende ‘n beter beeld te verkry van die ware insidensie van akute vergiftigings. ‘n Opmerklike bevinding tydens die studie was die hoe insidensie van doelbewuste geneesmiddel oordosering by volwasse vroue, met veral parasetamol as die middel van keuse. Programme wat fokus op die voorkoming van akute vergiftigings in volwassenes het dringende aandag nodig.

Since deinstitutionalization many patients, instead of remaining in the community, revolve through the doors of psychiatric facilities resulting in the "Revolving Door Syndrome". Hence a biopsychosocial evaluation of readmissions was undertaken to see what processes came into play once a patient was discharged from a mental hospital and subsequently readmitted. Seventy Indian patients admitted to the Midlands hospital complex, Pietermaritzburg were interviewed and the data was collected. This comprised 40 readmissions and a control group of 30 first admissions. The diagnosis was made according to DSM-III-R. The results obtained were statistically analyzed and a chi square analysis was done to ascertain if there were any significant differences between the 2 groups. The following were the major findings 1. Most of the patients were in age group 20-29 years. 2. There was a preponderance of males in both groups. 3. Most of the patients in the readmitted group were unemployed and were receiving a disability grant. 4. The majority of patients was single or separated. 5. Most of the patients were discharged on a combination of drug and depot preparation. 6. A large percentage had two and more previous admissions. 7. Length of stay was less than 1 month in a large number of patients. 8. Community tenure was less than 1 year in most of the patients. 9. Even though the majority of patients reported regular attendance, a fair percentage reported attendance at the community clinic. 10. The reason for readmission was mainly aggressive behaviour and aggressive behaviour associated with substance abuse. 11. The discharge diagnosis was schizophrenia in a large number of patients. This study has several important implications for the community care of the patient and various recommendations are made to curtail the revolving door, as follows : 1. There is an urgent need for community based resources. eg. sheltered workshops, supervised housing, industrial and occupational therapy, halfway houses and day hospitals, which would help the chronically mentally ill patients lead more meaningful lives following discharge. 2. The family of the chronically mentally ill patient needs to be actively involved in the management of these patients and mental health workers must solicit the family's support, by educating them about schizophrenia, helping them to increase coping mechanisms and to decrease stress. It is recommended that support groups be held in the community for the families of patients. 3. The patient's family needs to be advised that when the patient show signs of decompensation, they should take the patient to the community clinic, rather than to the District Surgeon to avoid unnecessary rehospitalization. 4. The importance of maintenance medication cannot be overemphasised. There is a need to change the attitude of the patient and family with regard to their negative attitude about medication. 5. The high rate of readmission due to aggressive behaviour (which is aggravated by substance abuse) needs intervention. Substance abuse groups must be held in the community and the community needs to be educated about the consequences of substance abuse in the mentally ill. / Thesis (M.Med.)-University of Natal, 1993.

The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha. / School of Nursing