Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

This study aims to identify conceptions of the body, as well as "rational" treatment among primary care practitioners (PCPs) and emergency medicine practitioners (EMPs) dealing with managed care plans. I conducted ethnographic study throughout 1996, and interviewed six PCPs and four EMPs. In the course of my interviews, I discovered that EMPs' and PCPs' perceived meaning and power in regards to treatment of their patients has been increasingly resituated by the power of scientific discourse as utilized by technocrats (such as consumer, provider, and insurance organizations who formulate managed care plans). Technocrats have developed scientific measurements to monitor physicians' performances, quantifiably or scientifically. Technocrats conceptualize ideal treatment as a cost effective care. They guide PCPs to supervise ideal treatment of the managed care delivery networks, providing care without referring patients to specialists and administrating to hospitals. Consequently, PCPs' power to pursue the newly conceptualized ideal treatment influences other arenas of specialty, such as EMPs. On the other hand, EMPs develop preferred treatment which is formulated through their medical school education and clinical experiences. The preferred treatment is associated with time because EMPs have to treat acute conditions of their patients within a limited amount of time. However, EMPs sometimes cannot complete their preferred treatment because they have to send their patient back to the patients' contracted PCPs in order to save health care expenditure. Technocrats implemented the engineering concept of quality control, and the concept is incorporated into the principle of managed care plans, and preventive medicine. As a result, the managed care plan networks become like production lines of large manufacturing factories, and PCPs work as laborers to maintain the bodies of enrollees in healthy conditions. / Graduation date: 1998

Thesis (Ph. D.)--University of Rhode Island, 2005. / Typescript. Includes bibliographical references (leaves 113-116).

THESIS (D.N.P. (Doctor of Nursing Practice))--School of Nursing, University of San Francisco, 2009. / Title from p. 42 ("Informed consent" page). Bibliography: leaves 30-36.

Thesis (MNurs)--University of South Australia, 1999

Techn. Univ., Diss.--Berlin, 2004.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 137-147). Available also in a digital version from Dissertation Abstracts.

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).   In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.   The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).   The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

Thesis (Ph. D.)--Florida State University, 2003. / Advisor: Dr. Wendy P. Crook, Florida State University, School of Social Work. Title and description from dissertation home page (viewed Oct. 6, 2003). Includes bibliographical references.

Thesis (Ph. D.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 204-215).