Psychology / M.A. (Clinical Psychology)

M.Cur. / Managed healthcare was introduced in South Africa largely in order to control the rampant increase of medical costs, more especially in the private healthcare industry. Managed healthcare is a system of healthcare delivery, which ensures that cost effective quality care is provided to patients without jeopardising the health of the patient. Positive working relationships are necessary among the role players in the provision of cost effective quality care within the managed healthcare context. Role players experience problems in the delivery of healthcare, affecting their working relationships, which in turn affects the quality of care provided to patients. Because managed healthcare is a new concept in South Africa, little is known about the problems. As a result, there are no guidelines for the formulation of a strategy to enhance positive working relationships among the role players within the context of managed healthcare. Understanding the problems experienced by the role players will provide guidelines to the researcher to formulate a strategy to enhance positive working relationships, hence the reseacher sought to explore and describe these problems in the study. The purpose of the study is to formulate a strategy to enhance positive working relationships among the role players within the managed healthcare context in Gauteng. The specific objective is to explore and describe the problems experienced by the role players, as well as the possible solutions within the managed healthcare context in Gauteng. The relevant research questions are: * What are the problems experienced by the role players within the managed healthcare context in Gauteng, and what are the recommended solutions to counteract these problems? * What strategy can be formulated to enhance positive working relationships among the role players within the managed healthcare context in Gauteng? A qualitative, exploratory, descriptive and contextual design was followed to answer the research questions. Focus group interviews and a workshop were conducted to collect data and a content analysis was conducted as described by Tesch (1990). The results were analysed in two phases: the problems experienced and the suggested solutions to counteract these problems. A strategy to enhance positive working realtionships was suggested. The strategy, which is based on role player empowerment, staff development, staff recruitment and selection, use of advanced information technology and standardisation of methods across managed healthcare industry, was derived from a synthesis of solutions suggested by the participants. Guba and Lincoln's (1983:290) principles of trustworthiness were employed by the researcher and the ethical standards as set by DENOSA (1998) were adhered to by the researcher to facilitate the quality of the study. It was recommended that the strategy be implemented and evaluated for its effectiveness by evaluating the quality of working relationships among the role players and that ethical standards be formulated in managed healthcare.

The rising costs of health care and burgeoning government deficits have prompted new ways to control costs, while continuing to provide necessary health care. One method increasingly chosen by states to achieve these objectives is managed health care. There are many forms of managed care organization today. There are HMOs that provide the financing and delivery systems under the control of a single for-profit or non-profit organization; preferred provider organizations consisting of providers that have a pre-negotiated and usually discounted rate for services; administration service organizations that provide claims adjudication; and managed indemnity services organizations that use case management to control costs, while providing beneficiary freedom of choice.

No description available.

Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

After cancer patients have completed active cancer treatment, they have specific follow-up care needs. These needs include ongoing surveillance for new and recurring cancers, managing the side effects of cancer treatment, and psychosocial concerns (Rushton et al., 2015). In the past, cancer centres and oncology specialists provided follow-up care; however, new models of care are needed because cancer centres can no longer provide treatment and follow-up care to all cancer survivors (Jefford et al., 2022). To allocate health care resources, low risk cancer survivors (i.e., breast and colorectal cancer survivors) are being discharged from cancer centres after primary treatment back to their primary care provider (PCP) for follow-up care. Survivorship care plans (SCPs) have been identified as a tool to help survivors and their PCPs with this transition (Rushton et al., 2015). SCPs generally consist of a treatment summary, a schedule for follow-up and surveillance tests, and general health recommendations (i.e., diet and exercise; Howell et al., 2011; Ruston et al., 2015). While SCPs are widely accepted, research on their effectiveness as transition tools has been inconclusive (Hill et al., 2019; Jacobsen et al., 2018). Some studies show positive, neutral, and negative impacts of SCP use, and there are three potential reasons for these mixed findings: 1) there is wide variety in the content, format, delivery, and timing of SCPs which adds considerable variance when studying the impact of SCPs; 2) the use of outcomes to measure the usefulness of SCPs as transition tools that are beyond the scope that information about treatment history and follow-up guidelines could impact and; 3) that SCPs are not effective as transition tools (Hill et al., 2019; Jacobsen et al., 2018). An important first step in clarifying whether SCPs are effective transition tools is to understand how SCPs are being used in real world practice (Hill et al., 2019; Jacobsen et al., 2018). The overall purpose of this study was to develop best practice recommendations for implementing SCPs. This was achieved through three study objectives: 1) to comprehensively identify barriers and facilitators perceived to influence SCP use among cancer survivors and primary care providers (PCPs); 2) to identify evidence-based approaches to address barriers and enhance facilitators of SCP use; and 3) to develop best practice recommendations that can be used by implementors of SCPs that are adaptable across different contexts. Article 1 presents the results of semi-structured interviews with breast and colorectal cancer survivors who had received a SCP at least 12 months prior to the interview. The interviews were based on the Theoretical Domains Framework, version two (TDF-2; Cane et al., 2012) and comprehensively identified barriers and facilitators of SCP use amongst breast and colorectal cancer survivors. Thirty cancer survivors (17 female, 13 male) participated in the 30–45-minute interviews, which were then analyzed using content and thematic analysis. Survivors who had received education about the purpose of SCPs and how to use them reported finding their SCP helpful and that they used it to schedule appointments and communicate with their healthcare providers. Barriers to SCP use that were reported by cancer survivors included having lost or not remembering receiving a SCP, not understanding the importance of their SCP, and wanting information about additional supports to be able to follow the SCP (e.g., regular contact from the cancer centre, avenues for peer support). Overall, study 1 found that in order to SCPs to be used as intended transition tools, survivors benefit from receiving education about how to use them and be informed of the expectation that they be actively involved in their follow-up care. Article 2 presents the TDF-based semi-structured interviews with primary care providers (PCPs). Thirteen PCPs completed 15-20 minute interviews, and content and thematic analysis was conducted. PCPs reported finding SCPs helpful and that they contained relevant information to provide follow-up care. A key facilitator of using the SCP was the table of follow-up tasks (e.g., mammography, colonoscopy) and their frequencies included in the SCP. Two significant barriers for PCPs using SCPs were: a) logistical issues with ordering follow-up tests and receiving results; and b) a lack of clear avenues to consult with oncology specialists (e.g., managing side effects of medications, actions that need to be taken when follow-up tests are abnormal). Overall, article 2 showed that PCPs appreciate and readily use SCPs, and contextual changes to facilitate clear avenues of communication between primary and tertiary care may be beneficial when implementing SCPs. Article 3 is a methodology article that presents a detailed explanation and rationale for the implementation science frameworks used and the data analysis chosen. The TDF-2 and Behaviour Change Techniques Taxonomy (BCTTv1; Michie, et al., 2008; Michie et al., 2013). The Human Behaviour Change Project researchers have empirically linked the 14 TDF domains to behaviour change techniques (BCTs), which allowed for multiple options to be developed to address barriers (and promote facilitators) of SCP use among breast and colorectal cancer survivors and PCPs (https://theoryandtechniquetool.humanbehaviourchange.org/tool; Michie et al., 2021). Using the TDF and BCTTv1 showed a dynamic between oncology specialists (e.g., oncologists, oncology nurses), cancer survivors, and PCPs that is involved in ensuring SCPs are implemented in an optimal way. A logic model was used to organize the barriers and enablers into different phases of SCP development, content, delivery, and use by PCPs and cancer survivors in their follow-up care (Mills et al., 2019). A flowchart organizing the recommendations of implementing SCPs was developed, and comprised 10 steps representing interrelationships between cancer centers, PCPs, and cancer survivors. The detailed methodology article also includes lessons learned and suggestions for implementation science researchers using the TDF and BCTTv1. Finally, article 4 is written for anyone looking for guidance implementing SCPs or improving upon how SCPs have been implemented already. It differs from article 3 in that it provides practical solutions for implementers. Because this work generated many recommendations, article 4 provides a worked example of how to use the results of this study. It is written in a way that outlines who would benefit from using the recommendations, and how to use the flow chart to narrow down the recommendation to those most relevant to implementors. The recommendations are organized into one of the 10 relationships in the flow chart, along with the purpose of the recommendations, how to implement it, to whom the recommendation targets, and those responsible for enacting the recommendations. The core factors associated with facilitating SCP use by PCPs and cancer survivors were: a) a treatment summary and follow-up guidelines included in the SCP; b) SCP provided to both cancer survivors and their PCP; and c) educating cancer survivors about their role as self-managers of their own care and the expectation that they participate in their follow-up cancer care. Future research on the usefulness of SCPs in follow-up care should include detailed information about the content, format, and receivers of SCPs and the outcomes most realistically influenced by the information included in SCPs. Before throwing the proverbial baby out with the bathwater, the implementation of SCPs requires additional standardization before meaningful investigation of their effectiveness as transition tools can be conducted.

The purpose of this study was to determine case managers’ understanding of their role in a managed care organisation and to develop recommendations for the improvement of case management practice. Quantitative descriptive research was conducted to explore perceptions of case managers regarding their role. A self-administered questionnaire was used as a formal data collection instrument and 25 respondents participated in the study. The findings revealed that the majority of case managers know what is expected of them in their job but that they do experience some barriers. There appears to be uncertainty with quite a number of respondents regarding certain aspects of their role. Recommendations were made for improved case management practice.

This study sought to investigate: •!• student nurses' perceived role of tutors, preceptors and professional nurses in fostering the development of interpersonal relationships of students nurses during training •!• student nurses' espousal of positive interpersonal relationships with colleagues, patients, friends and relatives of patients •!• Whether or not any significant differences existed between the first and fourth year students' perceptions and espousal of positive interpersonal relationships. First and fourth year student nurses in the Eastern Cape Province were studied. More first, than fourth, year respondents contended that tutors, preceptors and professional nurses facilitated the development of student nurses' interpersonal relationships with colleagues, patients, friends and relatives of patients. On the espousal of positive interpersonal relationships vis-a-vis patients, friends and relatives of patients and amongst themselves as colleagues, both groups of respondents provided similar response profiles. A posteriori "t" comparisons revealed no statistically significant differences in the response profiles between the first and fourth year respondents in their espousal of positive interpersonal relationships with colleagues, patients, friends and relatives of patients. The major inference drawn from this was that the four-year comprehensive course should place greater emphasis on the development of interpersonal relationships of student nurses in the Republic of South Africa. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)

Submitted in fulfillment of the requirements of the degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Aim The aim of this study was to evaluate the use of nursing care plans in the management of patient care and to recommend guidelines for improving the quality of planned nursing care at a level 3 hospital in the Umgungundlovu district of KwaZulu-Natal. Method The case study was based on the conceptual model of care planning and employed both quantitative and qualitative research designs. The quantitative phase involved a retrospective audit of charts, using an itemised checklist to determine whether items relating to the phases of the nursing process were in evidence within the charts. The qualitative phase consisted of face-to-face interviews with registered nurses, who were asked about their understanding and use of the nursing process. Data derived were analysed using Nvivo 10 and presented as graphs, tables and written text extracts. Results The results show that the use of the standardised care plans at the study hospital had an impact on the understanding of the importance of the nursing process and the successful implementation of the care plans. Factors that had an impact on this included the registered nurses who failed to nurture the junior nurses, lack of understanding of the care plans and what was expected of the staff, staff attitudes and the heavy workload. Conclusion It was suggested that nurse leaders support the implementation and continued use of individualised care plans in order to improve critical thinking skills of nurses by implementing teaching and in-service programs, employing knowledgeable registered nurses, by developing and enforcing adherence to policies that favour care planning and nursing documentation.

The main aim of this research study was to explore attraction factors pertaining to the literature and to the occupational context of nursing personnel who have exhibited employment interest in a managed care organisation. A qualitative research approach was adopted in which semi-structured interviews were held to collect rich exploratory data from the purposeful sample of nine applicants with nursing qualifications. Twenty-five themes were identified through interpretive data analysis as being important factors in the pre-interview attraction process. The highest ranking of these were identified to be opportunities for professional and personal growth and the relationship with the managed care client, followed by salary and working hours. This study contributes knowledge to Personnel and Career Psychology in the field of Industrial and Organisational Psychology and is pertinent to organisations recruiting nurses, advising them in the formulation of contextually appropriate attraction strategies that attend to the most notable attraction factors / Industrial & Organisational Psychology / M.Com. (Industrial and Organizational Psychology)