MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand / The purpose of this study was to elicit and compare nurses’ and families’ perception of family needs in intensive care unit. A quantitative non-experimental, comparative and descriptive research design was used to achieve research objectives. Participants (nurses, n= 65; family members, n= 61) were drawn from three intensive care units. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory (CCFNI). Descriptive and inferential statistics were used to analyze the data. Majority (more than 50%) of both groups agreed with 42 out of 45 family need statements. All the nurses (100%, n=65) agreed with the need ‘to have explanations that are understandable’ while most family members (98%, n=58) agreed with the need ‘to feel that health care professionals care about the patient’. Seven out of ten statements agreed by majority of both groups were similar. Most of these statements were related to assurance and information need categories. In addition, both groups scored high on the two categories, assurance and information. However, family members scored higher than nurses in two categories, assurance and proximity with statistically significant difference (p-value < 0.05). Based on the research findings, it can therefore be concluded that generally there were similarities between nurses’ and families’ perception of family needs. These findings support evidence in literature resulting from previous studies.

The purpose of this study is to evaluate the satisfaction and performance indicators in discharge planning services at a regional hospital in Taiwan. A structured questionnaire incorporating client databases, services items, performance indicators and satisfaction surveys was employed. A self-constructed structural questionnaire, with content validity of 0.7 which was verified by five experts and examined with Cranbach £\, is employed as a key research tool. Data were collected from March 2007 to September 2007. In total, 321 clients accepted discharge planning services and gave their choices among the offered after-discharge caring services. Visit with the phone after coming out of hospital, nine people who is death, eight people who have not contact, total seventeen people was deletes. As a result, a total of 304 respondents or 94.7% response rate, responded their satisfaction levels via telephone interview thereafter. The results show that the respondents suffering from CVA (p<0.05) and head injury (p<0.01) accepted (statistically significantly) more medical transfer services than those with lung diseases; the respondents who were taken care by caring institutions after discharge accepted more nursing teaching services than those live with family members (p<0.01); the respondents living with family members after discharge received more medical transfer services than those staying with caring institutions (p<0.01); satisfaction levels reported higher in respondents living with family members than those with caring institutions (p<0.01); the more nursing teaching, medical transfer and social services are offered, the higher the satisfaction level is achieved (p<0.01); The results could provide the valuable information on the implementation of discharge planning. The study contributes to several significant results such as: (1) The more demand for tubes care, the more days in hospitalization ¡]r¡×0.28, p¡×0.00¡^and the more unexpected emergency care within two weeks¡]r¡×0.14, p¡×0.02¡^. (2) Significant difference ¡]F=5.13, p¡×0.02¡^was found between relocation and total days in hospitalization. Post hoc analysis shows clients who live with family had statistically significant less days in hospitalization than those who were relocated to other hospitals (p=0.008) and caring institutions (p=0.008). (3). Significant difference of satisfaction was found among different relocations¡]F¡×3.50, p¡×0.01¡^. Clients who live with family displayed statistically higher satisfaction than those who were relocated to caring institutions. (4). Significant difference of days in hospitalization was found between on nasal-gastric tube¡]F¡×9.64, p¡×0.000¡^and on tracheal tube¡]F¡×30.13¡Ap¡×0.000¡^ (5). Different departments show significant difference in unexpected emergency care within two weeks¡]F¡×20.12¡Ap¡×0.00¡^. The unexpected emergency care within two weeks in the Medical Department was statistically higher than the Surgical Department. (6). Positive correlations (p<0.05) were found between days in hospitalization and several satisfaction measurements, indicating the more days in hospitalization, the more time available to provide services and the higher client satisfaction can be achieved. Furthermore, clients with unexpected emergency care within three days displayed statistically low satisfaction. The results are capable of providing us information for improvement so as to ensure that clients can receive sustainable, effective and integrated care.

During the past 20 years, the number of children and youth with neurological disorders attending schools has increased dramatically. There are two reasons for this increase. First, medical advances have resulted in more children and youth with neurological disorders surviving. Second, in the past, children with disabilities and health care needs were cared for in hospitals and residential institutions. Since 1975, however, federal legislation has mandated that all children with disabilities be provided a free appropriate public education in the nation's schools and in general education classrooms whenever possible.Unfortunately, school administrators and classroom teachers are not trained in how to accommodate students with neurological disorders. The medical literature provides information regarding the medical aspects of neurological disorders. However, neither the medical literature nor the educational literature provides the specialized knowledge and skills administrators and teachers need to plan for and provide appropriate educational and health related services to children with neurological disorders. This dissertation addresses the need to provide teacher and administrators with practical information about accommodating students with neurological disorders in schools.The purpose of this project was to develop a resource manual which describes the impact of students' neurological disorders on their education. This "user-friendly" resource manual can be used by teachers, administrators, and support staff in developing individualized educational programs for children and youth with neurological disorders. The manual focuses on six neurological disorders about which school personnel have limited knowledge. Section One includes a historical overview of the education of children with neurological disorders and the legislation which mandates that schools must provide all children with disabilities an appropriate education. Section Two describes each neurological disorder by presenting the definition of the disorder and its associated physical and cognitive conditions. Section Three addresses accommodations teachers can use in classrooms to meet the individual physical, cognitive and health care needs of these children.

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Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.

published_or_final_version / Psychiatry / Master / Master of Philosophy

Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.

This thesis is comprised of three chapters that empirically examine two important areas in health economics: access to health care and health outcomes. The first chapter explores the impact of health care utilization on unmet health care needs (UHC) using four biennial confidential master files (2001-2010) of the Canadian Community Health Survey and applying an instrumental variables (IV) approach to deal with the endogeneity of health care utilization. The presence of drug insurance and the number of physicians in each health region are used to identify the causal effect. I find a clear and robustly negative relationship between health care use and unmet health care needs; individuals who are more likely to report unmet health care needs are those who use the health care system less frequently. One more visit to a family doctor, specialist or a medical doctor on average, decreases the probability of having unmet health care needs by 7.1, 4.6 and 2.8 percentage points, respectively. Further analysis by sub groups reveals that the impact of health care utilization on UHC is larger for females in comparison to males, rural residents in comparison to urban dwellers and those with low household income rather than high. The second chapter of this thesis examines whether the presence of the unmet health-care (UHC) needs has an adverse effect on health outcomes using the National Population Health Survey, a nationally representative longitudinal data set spanning 18 years. I pay close attention to the potential endogeneity of this problem. Five direct and indirect measures of health-related outcomes are examined. I find clear and robust evidence that the presence of UHC either two-years previously or anytime in the past, affects negatively the current health of the individual – controlling for a host of other influences. For instance, reporting UHC in the previous cycle reduces the probability of being in excellent or very good health and in good mental health, respectively by 8.1 and 1.2 percentage points; it reduces the HUI3 score by 2.9 percentage points and increases the expected number of medications used by 11%. Further analysis by looking at the effect of UHC when it was due to accessibility reasons, reveal that the effect of UHC because of accessibility reasons on health outcomes is larger than the one of the overall UHC, but the difference is small in general. Finally, the third chapter of this thesis examines the link between social networks and access to health care utilization, focusing particularly on the probability of having a regular family doctor. Unlike previous work that uses cross sectional data, I use panel data from the National Population Health survey to control for unobserved heterogeneity. Access to a regular family doctor is modeled using the dynamic random effects probit model, which makes it possible to explore the dynamics of access to a regular family doctor– for instance, the role played by past access status to a family doctor in predicting current access. In particular, I use the dynamic random effects probit model that controls for both unobserved heterogeneity and for initial conditions effects. I find robust evidence of a highly statistically significant relationship between social capital and the probability of having a regular family doctor. Although the marginal effects are modest, the results from all model specifications show that there is clear evidence that individuals with high levels of tangible, affection, emotional, social interaction, who live with spouse only or with spouse and children are more likely to have a regular family doctor, whereas those living alone are less likely to have a regular family doctor. The results also reveal that past access to a family doctor is an important determinant for both current and future access. The predicted probability of having a regular family doctor is about 18 percentage points (or 20%) higher for individuals who had a family doctor in the previous period, relative to those who did not. In addition, I find that unobserved heterogeneity accounts for about 25% of the variation in accessing a regular family doctor and is significantly correlated with the access to a family doctor over my long panel.