Type 2 diabetes mellitus is a chronic disease that is associated with substantial morbidity, mortality, and health care cost. All patients with diabetes require a high level of clinical care to prevent the development of diabetic complications. The aim of this study was to compare the impact of a pharmaceutical care diabetic clinic within a primary care setting to standard care on clinical, humanistic and process outcomes in Type 2 diabetes patients. A randomised controlled trial was conducted in 9 general practices in Greater Glasgow Health Board. All patients with Type 2 diabetes, aged 18 years or over, taking an oral antidiabetic drug were recruited and stratified by practice, age, and gender, and then randomised into an active or control group. The patients in both groups were invited to a pharmaceutical care diabetic clinic within their general practice for three visits at three-monthly intervals. Active patients received review and allocated intervention by the pharmacist while control patients received review only without intervention by the pharmacist. Allocation remained blind until after the first evaluation. The pharmacist evaluated the appropriateness of the medication for the individual and their overall diabetic care. The pharmacist prepared a list of drug-related problems and a referral where appropriate. GP referrals were actioned in the active group but held back until after the conclusion of the study in the control group. Patient outcome measures include changes in HbA 1 c value, systolic blood pressure, health related quality of life (HRQOL), and drug related problems (DRPs) from baseline to the end of the study for both groups.

No / This paper is a contribution to the developing understanding of social relationships in institutional care settings. It focuses on two areas that have been neglected in research: the reasons for and types of social interaction in institutional settings, and the ways in which the context of people's lives shapes social interaction. The paper draws on ethnographic observations conducted in four care settings in Scotland using a symbolic interactionist perspective. It finds that residents communicate and interact, and that the personal, cultural and structural contexts frame social interaction and influence the ways that residents use humour, express sexuality, and show hostility. The paper concludes that residents create social interactions in which action is embedded, but do so within specific structural and cultural contexts. These contexts `control¿ resident action by establishing frameworks for the interpretation of meaning. At the same time, each facet of context is `controlled¿ by the ways in which residents actively take on the `role¿ of others, and project `self¿ and a `label¿.

The presence of art and artists in health care settings raise many questions of an ethical nature. The presence of art in such milieux challenges the manner in which notions of art, persons, health, healing, community, ethics and aesthetics are presently conceptualized. This thesis will argue that art ought properly be considered an essential human need - integral to the health, flourishing and well-being of all persons - particularly those who are sick and suffering. An ethical care of sick persons would demand that both artistic practice and health care practice be revisioned in the light of this different understanding.

No description available.

The documented experiences and perceptions of lesbian, gay, bisexual, and transgender (LGBT) patients receiving hospice or palliative care gives merit to the need for the implementation of LGBT affirming environments in hospice care settings. The guidelines for creating these affirming environments are described in this paper. Applying the Donabedian (1988) model of structure, process, and outcome this thesis project analyzes identified interventions relevant to the implementation of LGBT affirming environments in hospice care settings. Utilizing a formal PICO questioning method, a search strategy was devised and studies were identified based on established criteria. The results suggest that there is a paucity of data in relation to the implementation of LGBT affirming environments in hospice care settings. In an effort to assist in identifying existing interventions that have not been studied this project also includes a recommended survey tool to measure the active efforts of hospice organizations to implement LGBT affirming environments.

This study describes the differences of parents’, teachers’, and the researcher’s assessment of quality of five different child care programs. This study focuses on infant and toddler classrooms or care settings. Parents, and teachers/providers completed the Infant/Toddler Environment Rating Scale and the Definition of Quality Questionnaire in order to rate the quality of infant and toddler child care programs. The findings from the questionnaires supported existing research that indicates a majority of child care programs in the United Stated range from poor to mediocre; and parents utilizing all types of cares, licensed/certified or otherwise, tended to overrate the quality of child care programs. In this study, the only exception to this tendency was the ratings of quality in the licensed and accredited center, where parents’, teachers’, and the researcher’s ratings were similar. This study provides a new contribution to the field of child care research in its finding that some of the teachers in all the different types of care settings investigated (with the exception of the licensed and accredited center) also tended to overrate the quality of infant and toddler child care programs. Follow up interviews were conducted with some of the parents and teachers, in order to explore the reasons behind their ratings of quality. The consensus was that parents and teachers identified characteristics of quality that were dissimilar to those identified by child care experts. There are many possible reasons for this result, including lack of adequate information to help them identify determinant characteristics of quality programs, that there was difficulty in assessing quality, and that there was a lack of demand for quality programs. / Master of Science

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA. / Health Studies

This session will describe research approaches that have led to innovations in pharmacy practice. Specifically, the program will identify effective strategies to assess the impact of academic partnerships on advancing practicebased research at professional practice sites. This session will utilize a roundtable format to foster discussion and engagement among participants.

Philosophiae Doctor - PhD / The mental health care environment is a stressful environment because of the environment, perceived unpreparedness of students and the emotional demands placed on the students which are inherent in the nature of the work. The use of the self as a therapeutic tool also presents challenges for students. Whilst researchers have identified supportive interventions and strategies to address students support needs in mental health care settings, these interventions/strategies focus on meeting clinical learning objectives with the assumption that if the student learning needs are met, they will feel emotionally supported. Literature and experience indicates that it is imperative that in this field of study, students should be prepared to cope emotionally with the demands of mental health work. The aim of this research was to develop a model of emotional support for student nurses working in mental health care settings. A theory-generating design based on a qualitative, explorative and descriptive research approach was used to achieve the aim of the study. Purposive sampling was employed to select participants namely: students, educators and clinical staff who met the eligibility criteria. A sample of 40 students, nine educators and nine clinical staff who worked in the four psychiatric hospitals and community mental health clinics in the Western Cape participated in the study. Data collection was by means of focus group interviews (students) and indepth individual interviews (educators and clinical staff). Data was analysed by means of Tesch’s method of content analysis. The model was developed by means of the four steps of the theory generation process. Step one was concept development which consisted of two sub-steps namely concept identification and concept definition. A total of 22 concepts were identified which was further synthesised into six main concepts. The main concepts which were used to develop the model were: positive self-concept; positive work environment; academic and professional development; effective communication; formal and informal supportive interventions and collaboration between the Higher Education Institution and the mental health care setting. Step two of the theory generating process was model development. These main concepts were placed in relation with each other which formed an emotional support model for students working in mental health care settings. Step three was model description. The model was described using the three phases of interpersonal communication namely orientation phase, working phase and the termination phase. A visual application of the model which depicts the main concepts, the process and the context was shown. Step four dealt with the development of the guidelines for the implementation of the emotional support model. A critical reflection of the model was done using five criteria for model evaluation according to Chinn & Kramer. Trustworthiness of the data was ensured by means of applying Guba’ model of truth value, applicability, consistency and neutrality. Reflexivity was used by the researcher to further enhance trustworthiness. Permission to conduct the study was obtained from the relevant authorities. The ethical principles of respect for human dignity, beneficence and justice were applied throughout the study. Limitations were identified and ecommendations for nursing practice, education concluded the study.

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.