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. / 2031-01-01

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. / This study was underteken to determine if staff nurses in medical-surgical, public health end psychiatric nursing vary in their own practice of health measures. / 2031-01-01

Aim To study the conceptualization of mentors‘ behaviour and develop and validate a scale based on that to assess students‘ expectation and measure mentors‘ actual performance. Background In the field of clinical nursing education in China, mentors are struggling with student mentoring as no national guidelines exist and proper training is unavailable and nursing students are suffering from a low quality of learning and negative experiences. Design A mixed methods exploratory sequential design. Methods At the development and validation stage eleven steps were taken; mixed methodology was used, including focus group and cross-sectional survey with a large sample from China (n=669); in data analysis both classical test theory (exploratory and confirmatory factor analysis) and item response theory (Mokken scale analysis) were conducted. Results Mentorship in nursing was conceptualized as a model with three correlated factors, i.e. professional development, facilitating learning and psychosocial support, which was guided by the theoretical framework generated through 46 studies and supported by exploratory factor analysis, confirmatory factor analysis and Mokken scale analysis. Conclusion This new scale based on this conceptulization is reliable, valid and scalable, which is supported by a wide range of psychometrics. It has shown good content validity according to review by nine mentor experts from the UK, stability over time, homogeneity in content, differentiability between extreme groups and hierarchical properties of mentors‘ behaviour in importance and reliability and moderate precision of ordering students‘ expectation. Therefore the mentorship in clinical nursing education is conceptualized as a three–correlated factor model and it is hierarchical in importance. This scale could find utility in nurinsg education in China.

by Lo Po Hung, Gordon. / Thesis submitted in: December 1998. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 94-107). / Abstract and questionnaire also in Chinese. / ACKNOWLEDGMENTS / ABSTRACT (ENGLISH & CHINESE VERSION) --- p.ii / LIST OF TABLES --- p.vi / CHAPTER / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 2. --- LITERATURE REVIEW --- p.3 / Nursing Assessment --- p.3 / Purpose of Nursing Assessment --- p.4 / The Importance of Nursing Assessment --- p.5 / The Influence of the Concepts of Health and Holism on Comprehensive Nursing Assessment --- p.7 / Philosophical Perspectives on Nursing Assessment --- p.8 / The Incorporation of Nursing Theories or Models into Nursing Assessment --- p.10 / Implementation of Comprehensive Nursing Assessment --- p.12 / Areas Included in the Comprehensive Nursing Assessment --- p.13 / Biophysical Assessment --- p.14 / Psychological Assessment --- p.16 / Sociocultural Assessment --- p.19 / Spiritual Assessment --- p.21 / Summary --- p.24 / Chapter 3. --- METHOD --- p.25 / Design --- p.26 / Sampling --- p.28 / Data Collection Methods --- p.32 / Data Collection Procedure --- p.37 / Pilot study --- p.39 / Reliability --- p.41 / Ethical Considerations --- p.43 / Data Analysis --- p.44 / Chapter 4. --- RESULTS --- p.47 / Sample Characteristics --- p.47 / Mean Scores for Comprehensive Assessment --- p.50 / Items with Higher and Lower Scores in the Questionnaires and the Checklists of Nursing Records --- p.53 / Items with Higher and Lower Means in Each Category in Comprehensive Assessment Questionnaire --- p.57 / Differences in the Total and Category Assessment Mean Scores --- p.59 / Factors Affecting the Implementation Comprehensive Nursing Assessment --- p.64 / Suggested Interventions to Enable Nurses to Perform Comprehensive Nursing Assessment --- p.67 / Chapter 5. --- DISCUSSION AND CONCLUSION --- p.71 / The Performance of Comprehensive Nursing Assessment --- p.71 / The Focus of the Assessment within Each Component of Nursing Assessment --- p.74 / Factors Affecting the Implementation of Comprehensive Nursing Assessment --- p.81 / Limitations --- p.87 / Implications for Practice --- p.89 / Recommendations for Future Research --- p.91 / Conclusion --- p.92 / REFERENCES --- p.94

by Lee Yuet Ming, Isabella. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 85-92). / Abstract and questionnaire also in Chinese. / ACKNOWLEDGEMENTS --- p.i / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.vii / LIST OF APPENDICES --- p.viii / Chapter CHAPTER 1 --- INTRODUCTION / Background of the study --- p.1 / Purpose of the study --- p.2 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Concept of family as a system --- p.3 / Family as a supportive system to patients --- p.7 / Critical illness as a family crisis --- p.8 / Family needs of critically ill patients --- p.14 / Met and unmet needs --- p.21 / Person most suitable to meet the family needs --- p.24 / Summary --- p.26 / Chapter CHAPTER 3 --- METHOD OF THE STUDY / Aims and objectives --- p.28 / Operational definitions --- p.28 / Design --- p.29 / Sampling --- p.31 / Access --- p.32 / Data Collection --- p.33 / Ethical considerations --- p.42 / Data analysis --- p.43 / Chapter CHAPTER 4 --- RESULTS / Demographic data --- p.47 / Results from the questionnaire - CCFNI --- p.50 / Results from the interview --- p.56 / Summary --- p.63 / Chapter CHAPTER 5 --- DISCUSSION / Administration of the revised CCFNI --- p.65 / Critical illness threatened the stability of the family system --- p.65 / Relative importance of the family needs --- p.66 / "Additional cognitive, emotional and physical family needs" --- p.67 / Reactions to the patient's critical illness and hospitalization --- p.72 / Unmet needs of the family --- p.73 / Persons suitable to meet the important family needs --- p.75 / Relationship of family needs with demographic variables --- p.76 / Chapter CHAPTER 6 --- "LIMITATION, IMPLICATION & RECOMMENDATION" / Limitation of the study --- p.78 / Implication for nursing practice --- p.80 / Recommendations for further research --- p.83 / REFERENCES --- p.85

<p> Since 2009, the United States has experienced another wave of hospital mergers. Consequently, health systems are getting larger and increasing their market concentration. How patients benefit from hospital consolidation remains an open issue for policy-makers, economists, health care executives, community leaders, politicians, government agencies, and others. One measure of healthcare consolidation&rsquo;s impact, and its potential benefit/detriment, is how mergers affect patient experience, which, since 2007, has been measured by the standardized HCAHPS instrument. </p><p> Hundreds of studies conducted over the past 50 years have found mergers trigger an internal, socially-disruptive effect in the first 12 to 24 months following the event as the two merging organizations attempt to blend cultures, restructure job assignments, implement merger-related efficiencies, and achieve the overall strategic goals that brought about the merger. Consequently, organizational performance may decline in the short-term as the merger-related changes and accompanying upheaval move through the organization and get resolved. </p><p> Many researchers have evaluated the impact of hospital mergers on quality, safety, access, costs, pricing, and profits. However, no research study has examined the relationship between hospital mergers and patient satisfaction or patient experience. This research attempted to fill that gap with a quasi-experimental design using an interrupted time-series study. Cross-sectional, aggregate mean values of four different HCAHPS ratings (overall, physician communication, nurse communication, and staff responsiveness) of 99 merged/acquired hospitals were compared to that of 99 matched hospitals over a six-year time period (three year prior to the merger and three years post-merger). Fixed effects difference-in-differences testing was applied to evaluate and compare the post-merger rate of change in HCAHPS ratings between the two hospital groups. </p><p> This study revealed a negative relationship between some elements of a hospital&rsquo;s HCAHPS performance and merger status (i.e., completed a merger in the last 12 to 24 months or not). Specifically, a negative relationship was found between the merger group and two of the four HCAHPS domains (overall and nurse communications). Furthermore, a significant difference was found among the merged/acquired hospitals with respect to merger type. Hospitals that were acquired performed worse than hospitals that were part of a merger-of-equals. With the exception of the nurse domain, negative differences were resolved three years after the event. </p><p> Findings from this study will guide and inform hospital administrators, health system boards, state and federal government regulations and policies, and others across a wide spectrum of healthcare industry stakeholders.</p><p>

Early conceptualisations of Attachment Theory placed considerable emphasis on the importance of early experiences of relationships on development throughout life. Central to the theory is the notion that early experiences determine internalised representations of relationships and experience which subsequently affect the way individuals perceive themselves in relation to others. However, the evidence suggests that development is not so deterministic and that the impact of early adversity can be overcome through reparative experiences. The current study is part of a larger longitudinal investigation concerned with the impact of pure non attachment on development. The study reported in this thesis aims to consider the impact of early non attachment in adulthood, by exploring the sense that adults have made of their lives having been placed in institutionalised care in early childhood, with no opportunity to develop attachment, and who were then adopted or restored to biological parents. The meanings given to these experiences were explored by conducting a Interpretative Phenomenological Analysis of the accounts given by 15 participants using the Adult Attachment Interview. The results of the study suggest that the over all experience of non attachment did not prevent or severely inhibit development. However, six themes were identified in the study which highlight difficulties in people's ability to make sense of the pastJUld how they function in the present. The findings provide further insight into the impact of early non-attachment in adulthood and suggest that internalised representations of relationships may have a lasting influence, although alternative experience can ameliorate their impact.

Fewer patients are able to die at home than would wish to do so. A literature review showed that palliative home care patients are more likely to die at home than others. However, findings may be due to case mix differences, as variables which are positively associated with home death, are also positively associated with access to palliative home care. The thesis investigated the impact of a hospice at home (HAH) service on place of death. An observational, case control study compared 121 patients referred to HAH with 206 patients not referred. Multivariate logistic regression analysis showed that HAH care was strongly positively associated with home death. However, case mix effects could not be discounted. A randomised controlled trial (RCT) compared 186 patients allocated to HAH care with 43 controls. Analysis was intention to treat. Intervention patients were not significantly more likely to die at home than control patients (67% versus 58%). The RCT suffered loss of power and dilution of the treatment effect. Post hoc multivariate logistic regression analysis showed a positive association between actual HAH input and home death. However, this association was no stronger than that between less intensive home care services and home death. Concerns about case mix effects remained. Content analysis of professional and family carers' explanations of endstage inpatient admissions for RCT patients suggested such admissions were mainly perceived to result from factors unrelated to insufficient home care. While some patients may have benefited from added home support, this may not have affected place of death. Additional home care introduced on top of good existing provision, among patients who are already likely to die at home, may have little impact on home deaths. Careful consideration of service aims, target group, other health service context is required before introduction of further hospice at home services.

This PhD research investigated the effect of animal presence in long-term foster care through the lens of attachment theory. Previous research has supported the notion that animals may facilitate human-human relationships (Beck & Madresh, 2008; Bernstein et al, 2000; Fine, 2000; Kruger & Serpell, 2006; O’Haire, 2013; Olex, 2003; Sanders, 1999) and improve aspects of relational abilities such as care, empathy, and love (Plakcy & Sackson, 2006; Walsh, 2009a). Other research has suggested human-animal relationships may be beneficial to the facilitation of positive attachment representations and that insecure attachment patterns may be altered through the adjustment of individuals’ working models in relation to their animals (e.g. Kurdek, 2008; Kwong & Bartholomew, 2011; Parish-Plass, 2008, 2013; Sable, 1995; Zasloff, 1996). Empirical and theoretical research has also suggested that along with facilitating human-human relationships, animals may achieve attachment figure status in their own right and enter a human’s attachment hierarchical network (c.f. Beck & Madresh, 2008; Ferry, 2006; Kurdek, 2008; Carr & Rockett, 2013; Sable, 1995; Zilcha-Mano, Mikulincer & Shaver, 2011, 2012). Utilising a reworked version of West at al’s (1998) Adolescent Attachment Questionnaire (AAQ), longitudinal child-diaries and semi-structured interviews, results demonstrated that (a) children were able to form relationships with animals that satisfied the criteria for attachment bonds (Kwong & Bartholomew, 2011) and (b) that animal presence within the long-term foster environment assisted the development of more- secure relationships between the children and their carers through dual processes of softening the environment (Levinson, 1969) and attachment switching (priming attachment preparation through enhanced relational capabilities – Emmens, 2007). Findings suggest that children living in long-term foster care could benefit from being placed with animal companions and have implications for the attachment literature and foster care practitioners.

BACKGROUND. The United States healthcare system is one of the most expensive in the world, equaling approximately one trillion dollars. However, the quality of healthcare is low, as indicated by mortality rates, prevalence of diseases, rates of readmission to hospitals, dissatisfaction rates, and much more. One of the inefficiencies in the healthcare system that is causing errors and a decline in patient care to occur is the current paperwork system. Physicians and nurses spend much more time taking care of patient paperwork rather than giving direct treatment to patients themselves, and it's been shown that patient dissatisfaction levels rise and errors occur more frequently as a result of current physician/nurse workload. In order to change from paperwork to electronic files, hospitals must invest the time and money to look for alternative mechanisms that would decrease turn-around time of paperwork completion by leveraging digital solutions. A study was carried out to observe log back of paperwork by counting the amount of papers for each physician before and after an electronic email message intervention. RESULTS. The results were as expected: a simple email message did not drastically affect the amount of paperwork back log by residents, and numbers stayed consistent throughout. More than 50% of patient paperwork for residents in year 1 and 3 was more than 28 days old, which signifies the lack of paperwork availability and accessibility to the residents while off-site. CONCLUSION. Addressing the problem of paperwork burden to residents requires alternative solutions that include changing the entire paperwork system to a paperless, electronic system. Other solutions that require less effort, time and cost are possible, such as an email reminder as was done in this study, but will most likely not be as effective as switching to a paperless system that allows for physician-patient communication on a more consistent basis even though they may be off site. These changes would significantly improve quality of patient care as well as decrease administrative costs and waste.