This dissertation offers an empirical examination of the relationship between community social capital and health care safety net capacity. The ability and willingness of federally qualified health centers (FQHCs) and private physicians to serve the uninsured is crucial to ensuring that all Americans have access to a basic level of health care. Among other factors, this ability and willingness has been found to be a consequence of unique community values and traditions. This dissertation examined the extent to which the level of community social capital (community rates of participation in club meetings, projects, volunteer and civic activities) was related to three health care provider outcomes; 1) the willingness of private physicians to deliver uncompensated care; 2) the financial capacity of FQHCs to provide uncompensated care; and 3) the amount of FQHC resources directed toward the provision of largely uncompensated community-oriented services.Community and health care provider data on 1,248 FQHCs across 183 U.S. counties and 12,406 private physicians across 1,029 U.S. counties were collected from multiple data sources. Comprehensive multivariate analyses including Canonical Correlation Analysis (CCA), Ordinary Least Square (OLS) and Hierarchical Linear Modeling (HLM), and a planned comparison was conducted on these data at the community ecological and individual provider levels of analysis.Based on a literature review and the theoretical components of social capital theory, I developed a conceptual framework that proposed a relationship among social context, institutional frameworks and organizational behavior. The dissertation research sought to determine the extent to which the social context in which the organization was embedded influenced organizational behavior.I found that the relationship between community social capital and health care safety net capacity was weak and the direction of the association mixed. Among the findings was a positive and significant relationship between civic participation and FQHC grant revenues. Unexpected findings included significant correlations between community social capital and Medicaid generosity, and social capital and uninsurance. Although the data analysis suggested that unmeasured factors were largely responsible for variation in safety net capacity, it raised interesting questions that provoke future study. Important implications for theory, policy and practice are discussed.

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Thesis (Ph.D. in Nursing) -- University of Colorado, 2005. / Typescript. Includes bibliographical references (leaves 198-212). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--Virginia Commonwealth University, 2005. / Prepared for: Dept. of Health Administration. Bibliography: leaves 202-251. Also available online.

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Health professionals have important roles to play in educating their clients about HIV prevention. However, research suggests that health professionals, including dental professionals, more often than not fail to provide any HIV education to their clients. This study employed Green and Kreuter's PRECEDE model to assess those factors that influence the provision of HIV education by dental hygienists in Virginia. A 22 item closed-ended questionnaire which addressed predisposing, enabling, and reinforcing factors was mailed to 649 randomly selected Virginia licensed dental hygienists. Fifty-five percent (360) of those contacted completed and returned the questionnaire. Key factors found to impact the provision of HIV education by dental hygienists were having received HIV education during formal training or continuing education courses, perceived self efficacy to deliver HIV education, and characteristics of the practice setting. Chi square analysis showed that dental hygienists with formal HIV education were more likely to educate their clients about HIV risk reduction than dental hygienists who had not received such education (p=.04). Dental hygienists who had received HIV education through continuing education were also more likely to provide HIV education to their clients than dental hygienists who had not (p=.05). / Master of Science

Creating a safety culture is the focus in the current healthcare environment. An inhouse, around-the-clock laborist service delivery model has been associated with positive outcomes, but little is known about the laborist structure’s contribution to the labor-anddelivery working environment. The purpose of this descriptive correlational study was to explore the effects of physician service delivery model on safety culture, nurse-physician collaboration, and nurses’ job satisfaction. An additional purpose was to examine associations between nurses’ perceptions of safety culture, nurse-physician collaboration, and job satisfaction. Ray’s (1981, 1989) Theory of Bureaucratic Caring and Homan’s (1974) Social Exchange Theory guided this study. A survey consisting of demographic questions, the Collaborative Practice Scale (Weiss & Davis, 1985), the Hospital Survey on Patient Safety Culture (Agency for Healthcare Research and Quality, 2015; HSOPSC), and the McCloskey and Mueller Satisfaction Scale (McCloskey & Mueller, 1990) was distributed to registered nurses (RNs) nationwide. The results indicated that nurses in facilities using the around-the-clock model had higher perceptions of nursephysician collaboration, but not of safety culture or job satisfaction in relation to the physician service-delivery model. Significant moderate-to-strong correlations between nurses’ perceptions of patient safety and job satisfaction, and a weak correlation between bedside nurses’ perceptions of nurse-physician collaboration and job satisfaction were demonstrated. Additional significant correlations were found between the instrument subscales. Control/responsibility in the MMSS scale was positively associated with both management support for patient safety, supervisors’ and managers’ expectations and actions promoting patient safety, and overall perceptions of safety in the HSOPSC scale. Praise and recognition in the MMSS scale were positively associated with supervisor/manager expectations and actions promoting patient safety in the HSOPSC scale. Further appraisal is needed to understand the mechanism by which the laborist model affects patient care and work environment. Recommendations for future research include replicating the study with a larger sample sizes in specific groups based on the role and scheduled shift, conducting the study in a single system or location to mitigate the effects of other variables; and exploring physicians’ perspectives on the variables being studied. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Despite a myriad of studies on fall prevention, patient falls continue to be a longterm problem experienced by health care organisations world-wide. Falls impose a heavy burden in terms of social, medical, and financial outcomes, and continue to pose a threat to patient safety. Because the potential for a fall is a constant clinical safety issue in every health care organisation, protecting the patient from falls and subsequent injuries, and ensuring that the patient care environment facilitates, are fundamental aspects in providing quality care. Moreover, the current international focus on creating a culture of quality care and patient safety requires the implementation of fall prevention programs that decrease the risk of falls. As with other international health care organisations, the National University Hospital (where the principal investigator is working), has been challenged with the issue of how to prioritise and implement quality initiatives across all disciplines. Faced with persistent patient falls that affect care outcomes, fall prevention has been a priority initiative at the hospital since 2003. In response, a nursing task force was established in an attempt to resolve this problem. A root cause analysis undertaken by this task force revealed that the hospital protocol on fall prevention was outdated and not evidence-based. Furthermore, many nurses did not understand the importance of fall prevention, while the administration of the fall prevention program was instituted on an ad hoc basis rather than as a standard of care for all patients. The challenge for this task force, as with other health care professionals, was not only in finding an intervention that was effective, but also identifying who would benefit from its implementation. Although the need to apply current best practices to reduce patient falls is clear from the task force results, evidence of the effectiveness of fall prevention interventions in acute care hospitals is lacking in literature. In addition, there are no published studies on fall prevention in Singapore to support changes in nursing practices. Thus, it becomes apparent that research on fall prevention is greatly needed in Singapore so that an evidence-based fall prevention program can be developed. This topic coincides with the Doctor of Nursing course, which requires the student to gain knowledge through scholarly research on contemporary issues in nursing by undertaking two separate projects related to a single area of interest. Undertaking the two research projects on fall prevention in an acute care inpatient hospital as part of the doctoral studies provided an opportunity to address this deficit in a way that could raise awareness of the importance of fall prevention in Singapore hospitals. This research also provides a platform for the first body of research into fall prevention to be conducted within the Singapore health care environment, which is essential, as international studies are not always necessarily applicable to the Singapore context due to differences in educational preparation, skills-mix, organisational culture and nursing practices. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321300 / Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.