Thesis (M.S.W.)--University of Hong Kong, 1981.

No description available.

Person-centered care (PCC) has been recognized by the Institute of Medicine as a critical element in the redesign of our nations healthcare system. Evidence suggests that the physical environment contributes to a more person-centered inpatient healthcare experience. This study explored the relationships among demographic characteristics of individuals receiving care in skilled nursing facilities, satisfaction with nursing care, perceived ambiance of the healthcare environment, and the perception of PCC. Descriptive statistics, Pearson’s correlation, Spearman’s rho, and hierarchical linear regression were used to analyze the data and answer the research questions. In addition, content analysis was used identify possible themes from the comments by the participants regarding the overall care experience. The sample consisted of 71 individuals (48 women) between the ages of 38 and 97 (M = 71.34, SD = 11.51) having received rehabilitation and/or nursing care in fourteen short-stay SNFs in Texas. A small positive significant relationship was found between the perception of personalized care and years of education (r = .27, p = .012). Moreover, a strong positive significant relationship was found between satisfaction with nursing care and PCC (r = .76, p <. 001), perceived ambiance and PCC (r = .57, p < .001), and satisfaction with nursing care and ambiance (r = .52, p < .001). Hierarchical linear regression only included years of education, satisfaction with nursing care, and ambiance since they were the only variables that had a significant relationship with the outcome variable. The analysis showed that satisfaction with nursing care was the strongest predictor of PCC accounting for 53% of the variance. In addition, ambiance was identified as a significant predictor of the perception of PCC after controlling for education and satisfaction with nursing care. Overall, the three variables accounted for 64% of the variance in the perception of PCC. This was the first study to explore the relationship between perceived ambiance of an inpatient healthcare setting and the perception of person centered care. These findings indicate that the physical environment is an important element that can influence the perception of personalized care in a short-stay SNF setting. / text

Skin is the major protective barrier in a human body. In premature infants, the immature skin barrier reduces the protection against germs. Emollient therapy is an effective prophylactic measure to improve premature infants’ skin condition so as to protect the premature infants against infection. A systematic review of studies shows that emollient therapy is a simple, safe and cost effective intervention for premature infants to improve skin condition. Evidence shows that emollient therapy can also decrease transdermal water loss, conserve heat and energy, stabilize fluid and electrolytes and prevent nosocomial sepsis. The potential of implementing the proposed evidence-based guideline is explored. It will be carried out in a clinical setting. The transferability of the findings, feasibility and cost-benefit ratio of the emollient therapy will be discussed. In order to ensure the evidence-based guideline will be carried out smoothly, a communication plan is necessary to be made in consultation with the stakeholders. A pilot study will also be conducted before the innovation is implemented to ensure frontline staff members to be familiar with the emollient therapy. At the end, the effectiveness of the emollient therapy will be evaluated in terms of skin score. Patients’ outcome and healthcare provider’s outcome will also be evaluated. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Physical inactivity has been widely regarded as a leading cause of non-communicable chronic diseases such as type 2 diabetes mellitus (T2DM) and hypertension. Physical activity (PA) has been shown to be the most effective self-care behaviour in alleviating T2DM, an incurable chronic disease. Previous behavioural modification programs intended to encourage and maintain PA behaviour among middle-aged and older patients with T2DM have had inconsistent results. PA has remained as a recommended diabetes self-care behaviour with the lowest compliance rate in many regions of the world. This thesis proposes a program focusing on health literacy (HL) as a means to nurture T2DM patients’ ability to navigate, read, understand, process, comprehend and act on health information, and thereby modify PA behaviour. This approach is proposed for three reasons: (1) the flood of available health information of varying quality affects patients’ decision making with regard to self-care behaviour; (2) the high prevalence of low HL in the US, Europe, and Asia affects the comprehension of self-care behaviour programs; (3) because 50% of older T2DM patients are impaired cognitively due to the impact of aging and hence have difficulty in carrying out suitable self-care behaviour without proper guidance. All of these factors can influence the effectiveness of PA behavioural modification programs designed to help middle-aged and older T2DM patients make self-care decisions based on sound health information according to their level of HL. This thesis reviews existing HL-oriented programs and models and validates the instrument used to examine the effects of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour among middle-aged and older patients with T2DM. In the study, 324 middle-aged and older Chinese T2DM patients recruited from two hospital diabetes centres in Hong Kong were divided randomly into intervention and control groups. The intervention group participated in an HL-oriented program on PA behaviour. The program significantly improved the mean of PA behaviour of patients in the intervention group from a sedentary level (under 1,000 average Metabolic Equivalents/minutes/week; 4463 mean number of steps per week) to an internationally acceptable standard (over 2,000 average METs-minutes/week; 7459 mean number of steps per week), and this improvement was maintained at three- and six-month follow-ups. The PA behaviour of the control group actually subsided. This study showed that a program addressing and nurturing patients’ ability to explore, understand and manage health information on T2DM and PA was effective in improving the PA behaviour of middle-aged and older adults with T2DM. This thesis is the first study to use objective measurements to evaluate the effect of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour. It extends the generalizability of culture and language-sensitive HL oriented programming from the United States (where previous HL studies were conducted) to China. The study can serve as a model for future investigations of self-care behaviour among patients with different chronic illnesses in various regions of China. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

This dissertation is about how knowledge is constructed in interactions and what knowledge entails in practical social work. It is about how a collective can provide a foundation for the construction and development of knowledge through the interactions contextualized in this study on Swedish elder care, organized by the municipality. This study follows a research tradition that recognizes knowledge as socially constructed, and focuses on the practice of knowledge within an organizational context of care. This is an ethnographic study. The empirical material consists primarily of field notes from participant observations at two elder care units in a midsized city in Sweden. Moreover, the collected materials include national and municipal policy documents, local policy documents and guidelines, and notes from observations in staff meetings and interviews with care workers and managers. This thesis uses Institutional Ethnography as a departure point for analyzing the contextual factors for workers in elder care, mainly women, and the situational factors for acquiring knowledge. The overall aim of this dissertation was to explore knowledge in elder care practice by analyzing the construction and application of knowledge for and by staff in elder care. This sheds light to the Mystery of Knowledge in Elder Care Practice: Locally Enabled and Disabled. In order to pursue this aim, two questions were addressed in the study: 1. How and what kind of knowledge is expressed and made visible in daily elder care practice? 2. How is knowledge shared interactively in the context of elder care? The findings shed light to the situation for care workers in elder care and the conditions for using and gaining knowledge. This situation is problematic as the local conditions both enables and disables knowledge use and sharing of knowledge. Contributing challenging factors are lack of recognition and equal valuing of various forms of knowledge; the organizational cultures and a limiting reflective work to the individual. The main findings in this thesis are presented in three areas: - a way of understanding tacit knowledge, which refers to knowledge gained by care workers through working in elder care; - the connection between an organizational culture and the knowledge shared within the organizational culture; - reflective practice in elder care work and the imbalance between individual and collective reflectivity. These findings have implications for specific knowledge in social work practice and the need for education linked to this knowledge. Formal knowledge alone is insufficient for effective elder care practice; however, informal knowledge is also insufficient alone. Both are needed, and they should be linked to create synergy between the two types of knowledge.

This study utilises a hermeneutical phenomenological framework to explore the lived experience of losing a child and how this experience may be understood theologically, with a view to exploring the delivery of spiritual care to the bereaved. This three dimensional approach takes seriously the voices of the bereaved as they influence the move towards a deeper understanding of theology, spiritual care and the unique role of the hospital chaplain. To explore the lived experience, unstructured interviews were carried out with parents and grandparents in five bereaved families following the death of a child. This included 5 mothers, 3 fathers, 5 grandmothers and 4 grandfathers. The participants were identified and recruited because of their experience of the death of a child in the family, had some concept of God and had used the chaplaincy service. They were interviewed as married couples or as individuals if there were no partners taking part. There were ten interviews conducted during the first 6 months of the research and contact approved for a 5 year period should this be necessary. Gadamer's philosophy of interpretation was essential to this process as the research involved an in-depth, thematic and hermeneutical analysis of the interviews. This analysis produced three key themes: hope and struggle with God, a new experience of community and a changed relationship with the child. The themes were then viewed from a theological perspective and the insights gained were the basis for exploring the delivery of spiritual care in NHS Scotland. The findings offer new insights into the delivery of spiritual care, key amongst the findings being: • Chaplains are not specialists in spiritual care when defined as separate from religious care. • Chaplains are specialists in theology and the language of faith where developing a ‘critical theological tool box' is essential. • Chaplains are specialists in supporting people to personally engage with the questio Chaplains are specialists in supporting people to personally engage with the question of life, giving them permission to move outside the ‘traditional box' of religion. The findings of this research will hopefully challenge and inspire chaplains to review the meaning of spiritual care and assert the unique and essential place they have within NHS Scotland.

published_or_final_version / Public Administration / Master / Master of Public Administration

No description available.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Since the Affordable Care Act (ACA) was signed into law in March of 2010, there have been multiple large survey studies focusing on physicians’ thoughts towards health care policy issues. 1‐6 Unfortunately, there has not been adequate attention paid to medical students’ feelings on reform in the literature. Today’s medical students will enter their practice at a vital time in the ACA’s implementation and will play an integral role in health care reform throughout their careers.7,8 This study is a national project that used a survey tool to demonstrate how well medical students know the details of the ACA and what their feelings are on the legislation. The survey was sent to eight different medical institutions across the country with ten total medical school campuses, using SurveyMonkey to collect results. The institutions were chosen based on their geographic location, mix between private and public institutions, and available investigators at each institution. The survey tool was developed by Tyler Winkelman, MD, from the University of Minnesota after a comprehensive literature review, adaptation of items from his previous survey of medical students in Minnesota performed in 2012, and consultation with physicians and policy experts.9 The survey focuses on student’s opinion of the ACA, knowledge of nine key provisions in the ACA, level of support of key health care policies, feelings towards health care policy education in medical schools, and socio‐demographic information, including political ideology, debt amount and intended specialty. Data analysis was performed using Pearson’s Chi‐square tests and multiple logistic regression models at The University of Minnesota to test for associations between students’ opinion of the ACA and five key predictors: debt, medical school year, political ideology, ACA knowledge, and intended specialty. A total of 2,761 out of 5,340 medical students (52%) responded to the survey, with 63% of students indicating support for the ACA, 75% agreeing that they understand the key ACA provisions, and 56% indicating professional obligation to assist in implementation of the ACA. Students intending to enter surgery or a surgical subspecialty and students who identified themselves as conservative were found to have less support and professional obligation of the ACA when compared to students entering primary care (Internal medicine, family medicine, pediatrics, internal medicine/pediatrics, or emergency medicine) or identifying themselves as liberal or moderate. Students that were most knowledgeable of the ACA were found to more likely support the ACA and indicate professional obligation towards the legislation. In conclusion, our study found that the majority of medical students indicate support for the ACA and feel they have a professional obligation in assisting implementation. The views of the ACA differ based on student’s political ideology, anticipated specialty, and knowledge of key ACA provisions, but overall, there is optimism that this high level of support can lead to advocacy and successful health care reform down the road.