Class of 2017 Abstract / Objectives: To facilitate a discussion among various healthcare professionals about the facets of interprofessionalism that occur, or do not occur, in a rural acute healthcare setting, and how interprofessionalism could be integrated into the facility’s current healthcare professional student programs. Methods: A focus group was conducted with 8 participants lasting about 45 minutes. Participants were one of three different professions (nurse, medical doctor, or pharmacist) and included administrators as well as staff employees. Six questions were discussed among participants and the answers from each participant were scripted onto a word document. This document was thematically analyzed and compared and contrasted to a previous study, which asked the same six questions in a different rural acute healthcare site. Results: The main findings of this study were that workforce shortage, lack of computerized physician order entry (CPOE), and lack of a uniformity throughout the hospital affected interprofessional practice, learning, and education. Conclusions: Perceived barriers of interprofessional practice at Canyon Vista Medical Center included: poor communication, understaffing, lack of a unified, computerized EHR throughout the hospital, and unclear policies. Some proposed ways to overcome these barriers include having a full staff, creating a unified electronic health record (EHR) system, offering interprofessional learning opportunities, and providing employees the opportunity to gain experience in departments other than their own.

Societal stigma surrounding mental health has adversely affected individuals with mental health concerns. Stigma often keeps persons with mental illness from seeking treatment from mental health professionals, bringing such issues to their primary care providers instead. This is problematic, as primary care providers have been shown to endorse mental health stigma toward patients with mental illness. Integrated healthcare, a system in which behavioral health services are integrated into primary care settings, has been hypothesized as a method for reducing mental health stigma among primary care providers and the general public. However, there has been little research examining the impact of integrated healthcare on primary care provider’s endorsement of mental health stigma. The present study was an effort to address this gap in the literature by examining the impact of working in integrated health care settings, personal and professional experience with mental health, and training in mental health and diversity on the endorsement of mental health stigma among primary care providers. The present study contributes to the understanding of the impact of factors in endorsement of mental health stigma among primary care providers in the United States. Contrary to my hypothesis that integrated healthcare reduces mental health stigma, the present study revealed that healthcare integration alone was not a significant predictor of lower endorsement of mental health stigma among primary care providers in the present sample. In contrast, training in mental health and diversity was found to be the most significant predictor of mental health stigma, with participants reporting more in-depth training in these areas endorsing lower levels of mental health stigma. Further research is needed to confirm this association and establish a clearer understanding of the role of integrated healthcare in reduction of mental health stigma. These results can be used to assist in improving training in research regarding mental health stigma and integrated healthcare.

Young men are at the greatest risk of contracting sexually transmitted infections (STIs) within the U.S. male populations, yet are the least likely to make a sexual and reproductive health (SRH) care visit. Clinical approaches in these areas that include the outreach to and the involvement of male partners of female patients can prove particularly useful in expanding SRH care to men and can also improve health outcomes for women who have sex with men. In this study I examined UCF's healthcare provider's approaches to educate and involve men (between the ages of 18 and 30) and male partners of female patients in their SRH needs. I conducted qualitative semi-structured interviews with 18 health care providers at the Student Health Center; including physicians, physician assistants, and registered nurses. This study found that there were significant differences in perception of men's SRH risk behaviors among the providers. In addition, this study revealed issues that might deter male students from accessing care, specifically how patients are required to state to the operator (who is also an undergraduate student) their name, PID and exactly why they are scheduling a visit to the clinic, thus many men say they have cold symptoms instead of issues with SRH. This study is significant because it can contribute to improvements in the delivery of SRH care to male students on campus.

Medical Assistance in Dying (MAiD) became legally accessible to Canadians in 2016, bringing with it significant changes to the Canadian health care landscape. With legalization of MAiD, physicians, nurses and allied health care workers had to consider their own systems of values, beliefs and their professional identity and decide whether or not they would be able to contribute to this practice or participate actively in this new medical procedure. I argue that health care professionals who participate in this practice create a professional identity that is intrinsically bound to the ethics and practice of MAiD, thus making it permissible for them to support and participate in the procedure actively. Moreover, I argue that this system of morals and beliefs has been accrued by these health care professionals across experiences and time that contribute to their capacity to participate in MAiD. Hamilton Health Sciences (HHS) was the locus for this research. HHS encompasses a network of five hospitals in the Hamilton, Ontario area. Each hospital region in Ontario has a unique staff and values, and HHS is no exception. HHS houses the Assisted Dying Resource and Assessment Service (ADRAS) group, a team of uniquely skilled MAiD providers, assessors and health professionals who service the HHS patient community. It is this group that is at the center of this research. Through interviews with members of ADRAS, I determined that values of altruism, belief in self-determination and deep respect for patients and families are central to the individual and collective identities of this group. In light of this ethical stance, members of ADRAS have crafted complex professional identities both individually and as a collective that enable them to participate in MAiD in a complete and meaningful way. / Thesis / Master of Arts (MA)

BAKGRUND: Självskadebeteende är ett impulsivt beteende där de drabbade medvetet tillfogar sig själva kroppsliga skador med motivet att lindra sin känslomässiga oro. Beteendet ses ofta hos unga vuxna och ger upphov till många känslor i samhället och är väldigt stigmatiserat. SYFTE: Syftet är att beskriva patienters upplevelser av vårdpersonalens bemötande vid självskadebeteende. METOD: En litteraturstudie baserad på självbiografier och biografier som analyserats med kvalitativ innehållsanalys. RESULTAT: Resultatet visar att patienter med självskadebeteende anser att vårdpersonalen saknar kunskap om självskadebeteende och hur det ska behandlas. Personalen är osäkra och nedlåtande i sitt förhållningssätt, tar inte patienterna på allvar och hela vårdprocessen tyngs av organisationen och dess regler vilket inskränker på patienternas rättigheter. Vårdrelationen har också stor betydelse för tillfrisknande. SLUTSATS: Patienter med självskadebeteende har många negativa upplevelser av bemötandet hos vårdpersonal och detta påverkar deras process mot ett tillfrisknande. För att kunna ge effektiv, kvalitativ och individanpassad vård som främjar tillfrisknande i helandeprocessen är det viktigt och meningsfullt att personalen skaffar sig tillräcklig kunskap om självskadebeteende. Genom detta kan de få bättre förståelse för beteendet och individen bakom ärren.

Bakgrund Forskning visar att hälso- och sjukvården har ett övervägande heteronormativt synsätt och brister i bemötandet av personer utsatta för samkönat partnervåld. Betydligt fler HBTQ-personer som utsatts för partnervåld skulle enligt forskning sökt vård om de kunde förvissas om att bli bemötta på ett adekvat sätt baserat på kunskap om deras livsvillkor. Därför är det av stor vikt att genom djupintervjuer av våldsutsatta HBTQ-personer belysa hur de upplever bemötandet och hur de själva velat bli bemötta av hälso- och sjukvårdspersonal. Syfte Syftet var att belysa HBTQ-personers upplevelser av hälso- och sjukvårdens bemötande när de sökt vård på grund av samkönat partnervåld. Metod Enfallsdesign (Single Case Study Design). En (1) semistrukturerad djupintervju genomfördes och intervjun analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultat Studien visar på åsidosättande av adekvat behandlings- och undersökningsmetodik och att råd och föreslagen behandling endast gavs i enlighet med den egna begränsade kompetensen. Studien visar även på bristande kunskaper om vad som särskiljer det samkönade partnervåldet gentemot heterosexuellt partnervåld hos hälso- och sjukvårdspersonalen. Vidare saknades anpassning av adekvata behandlingsåtgärder lämpade för situationen och okunskap kring remitteringsvägar. En osynlighet avseende hur initial och vidare kontakt upprättas framträdde och så även okunskap om vart personer utsatta för samkönat partnervåld kan vända sig för hjälp och stöd. Dessa brister i bemötandet ledde till personliga upplevelser av frustration, ambivalens, missförstånd, hopplöshet och osynlighet hos personer som söker vård på grund av samkönat partnervåld. Slutsats Det finns brister hos hälso- och sjukvården avseende bemötandet gentemot en person utsatt för samkönat partnervåld. Ökade kunskaper hos hälso- och sjukvårdspersonalen kring HBTQ-personers livsvillkor och det samkönade relationsvåldets praktik skulle förhoppningsvis leda till bättre bemötande och en personcentrerad vård och därmed ökad patientsäkerhet. / Background Previous research has shown that health care is permeated with heteronormative ideals resulting in sub optimal encounters with victims of same-sex domestic violence. According to previous studies, victims of same-sex domestic violence would be far more likely to approach health care services if they felt secure in health care service's knowledge and experience concerning LGBTQ-specific circumstances. It is therefore of upmost importance to highlight/report, through in-depth interviews, LGBTQ persons subjected to domestic violence, encounters with health care services.Aim The aim of this study was to highlight LGBTQ domestic violence victims’ experiences of encounters with health care services. Method Single Case Study Design. One semi structured in-depth interview was conducted with interviews analyzed through qualitative content analysis. Results Results of this study showed a lack of adequate treatment and examination methods as well. In addition, professional recommendations for treatment to the LGBTQ victims of domestic partner violence tended to be based primarily on the health care provider's own limited competence and knowledge of LGBTQ subject matter. Furthermore, health care providers' lack of knowledge concerning discrepancies between same-sex domestic violence and heterosexual domestic violence was identified. Additionally, there was an inability to adapt situation-appropriate treatment measures as well as a lack of knowledge concerning referral management. An apparent imperceptible lack of guidelines for facilitating initial and follow-up contact emerged as well as a lack of awareness concerning avenues of help and support for LGBTQ domestic violence victims. These shortcomings of professional treatment of LGBTQ persons resulted in feelings of frustration, ambivilance, confusion, despair, and a feeling of invisibility among LGBTQ persons seeking care for domestic violence. Conclusion There are deficiencies among health care personnel's ability to adequately treat a person subjected to same-sex domestic violence. Improved knowledge among health care providers concerning LGBTQ person's social determinants would hopefully lead to improved encounters and treatment with a person centered care, resulting in reinforced patient safety.

Background: Numerous studies demonstrate benefits of using advance care planning (ACP) in the general practice setting. Despite this, providers do not regularly initiate ACP and only one third of Americans have completed an advance directive (AD). This number is even lower among ethnic and minority groups. Community health center (CHC) providers have the opportunity to improve the quality of end-of-life (EOL) care and reduce healthcare disparities affecting medically underserved populations, yet no research has been conducted to identify CHC providers' practices, knowledge and attitudes towards ACP. Addressing this query may assist researchers in identifying optimal strategies for improving ACP delivery in this setting, ultimately leading to improved quality of EOL care for the populations served. Purpose: The study purpose was to assess Arizona CHC providers' practices, knowledge and attitudes towards ACP. Setting: The study setting was federally qualified community health centers located in urban and rural sites throughout Arizona. Participants: Study participants (N = 38) were predominantly middle-aged females practicing for an average of 13 years. 60% of providers were Master's or Doctor of Nursing Practice (DNP) prepared providers while 40% were Doctor of Medicine (MD) or Doctor of Osteopathy (MD). Methods: This study used a descriptive correlational quantitative research design. The "EOL Decision Making Survey" instrument was adapted into an electronic survey and distributed to 514 physician and non-physician CHC providers. Data analysis was performed using PASS and SPSS statistical software. Results: This sample of Arizona CHC providers was reasonably knowledgeable about Arizona state law and clinical application of ACP. Physician providers had greater knowledge and greater confidence in their answers related to Arizona state law compared to non-physician providers. Participants were largely comfortable with counseling patients in ACP and exhibited mostly positive attitudes toward ACP. Older respondents with greater years' experience tended to have greater knowledge of the clinical application of ACP as well as greater positive attitudes towards ACP. Providers with greater years' experience tended to have greater comfort in counseling patients in ACP. Despite these positive findings, routine initiation of ACP in this setting was low (44%). Conclusions: Though Arizona CHC providers have reasonable knowledge related to ACP, are comfortable with counseling patients in ACP and have positive attitudes towards ACP, less than half routinely initiate ACP conversations with their patients. Though more research is needed to validate these findings, targeted educational interventions and process changes may help improve ACP delivery rates in this setting.

Orientador: Ilda de Godoy / Banca: Paulo José Fortes Villas Boas / Banca: Ana Regina Borges Silva / Resumo: O objetivo deste estudo foi caracterizar a educação em saúde dos cuidadores formais em Instituições de Longa Permanência para Idosos (ILPIs) de Botucatu-SP. Trata-se de um estudo descritivo, quantitativo e transversal realizado em nove ILPIs cadastradas pela Vigilância Sanitária, sendo entrevistados 43 cuidadores, os responsáveis técnicos e coordenadores dessas instituições. Foram aplicadas questões técnicas para analisar o conhecimento dos cuidadores quanto à assistência ao idoso e também a Escala de Katz para avaliar o nível de dependência dos idosos abrigados para a realização das atividades da vida diária. A maioria dos cuidadores possuía o 2º grau completo, mas 34,9% apresentavam 1º grau incompleto. Além disso, 58,1% tinham formação na área da saúde e 9,3% realizaram cursos específicos na área de Saúde do Idoso. As principais dificuldades apontadas pelos cuidadores foram referentes às condições e organização de trabalho, sobretudo, a falta de recursos humanos e à habilidade técnica e/ou psicológica para lidar com o idoso com presença de estresse e deficiência de atividades de lazer. No entanto, a necessidade de capacitação não é percebida como prioridade. Os resultados revelaram desconhecimento de cuidados básicos, principalmente com relação à crença de mitos e estereótipos sobre o idoso e o processo de envelhecimento, sendo importante a expansão de conteúdos gerontológicos nos currículos de cursos especializados bem como o estabelecimento de critérios para a função de cuidador com seleção mais criteriosa no processo de contratação. Dificuldades quanto à referência e contrarreferência de idosos e a falta de rede de apoio social também foram referidas pelos responsáveis e/ou coordenadores, sugerindo a necessidade de melhor integração dos serviços com definição clara das responsabilidades. Problemas nas relações... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed at characterizing the health education of formal care providers in Long-Stay Institutions for Older Individuals (ILPIs) in Botucatu-SP, Brazil. It is a descriptive cross-sectional study performed in nine ILPIs registered by Health Surveillance, where forty-three care providers, technical supervisors and coordinators were interviewed. Technical questions were applied in order to evaluate the care providers' knowledge concerning care provision to older individuals, and the Katz scale was used to analyze the older sheltered individuals' level of dependence to perform activities of daily living. Most care providers were high-school graduates, but 34.9% had not completed elementary-school education. Additionally, 58.1% had health-care qualifications, and 9.3% had attended specific courses on older people's health. The major difficulties reported by the care providers were related to work conditions and organization, particularly to the lack of human resources and of technical and/or psychological skills to deal with the older individuals in the presence of stress and deficiency of leisure activities. However, the need for training is not perceived as a priority. Results showed lack of knowledge concerning basic care, particularly as regards the belief in myths and stereotypes regarding older persons and the ageing process, which shows the importance of the expansion of gerontological content in the curricula of specialized programs as well as the establishment of criteria for health care provider jobs with more strict criteria in hiring processes. Difficulties concerning the referral and counter-referral of older individuals and the lack of a social-support network were also reported by the professionals in charge or coordinators, suggesting the need for better integration of services with a clear definition of responsibilities. Problems related to relationships... (Complete abstract click electronic access below) / Mestre

This study aimed to provide an in-depth understanding of the way in which the macro, meso, and micro levels of the health care system affects nutrition care practices of family physicians (FPs) and nurse practitioners (NPs). It also examined how current practices compare to the clinical practice guidelines on the management and prevention of obesity. Three different types of team-based primary care settings were included: 2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic. Within each type of setting, six to eight FPs and NPs were interviewed (for a total n= 20). Site-specific documents and government reports were also analyzed. Findings suggest that the team-based nature improves nutrition care due to the accessibility to dietitians and cost-free service. Electronic Medical Records was an important enabler for chronic disease management. Duration of medical visits and increasing prevalence of complex patients were barriers for addressing nutrition and weight. Despite the importance of addressing obesity in primary care, the topic was approached in terms of chronic disease management rather than prevention. FPs and NPs spared the dietitian on site for patients who have more severe chronic conditions. Nevertheless, the presence of a dietitian on site increased the likelihood of primary care providers bringing up the topic of nutrition. Addressing site-specific barriers could improve nutrition care practices for weight management and chronic disease prevention in the primary care setting.

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