Obesity is a serious growing public health issue in the world, and it is increasing rapidly in Latin America. Obese people are an exposed group of patients that are stigmatized for various reasons. Negative attitudes and stigma against obese patients among healthcare personnel and within the healthcare environment can affect their care negatively. This study aims to see if nurses in Costa Rica view and experience the healthcare environment as a stigmatizing place for obese patients and if they experienced any negative attitudes that may affect the care of obese patients. The aim is to examine nurses attitudes and experiences with obese patients in the healthcare environment in Costa Rica. Semi-structured interviews were conducted with seven registered nurses (RN). The semi-structured interview guide contained 11 questions in four different areas based on a survey about healthcare professionals attitudes about obesity (Attitudes Toward Obese People). The registered nurses perceived obesity as a disease with uncontrollable causes as genetics and socioeconomic factors but also with self-inflicted factors as excessive eating of junk food and sedentary lifestyles. The lack of resources and time in the healthcare environment in general were major factors for the stigmatizing attitudes. Exhausted nurses could be more vulnerable for making mistakes and present bad attitudes. Despite the reported experiences of stigmatizing and negative attitudes in the healthcare environment none of the nurses felt that they had contributed to such attitudes. No particular differences between female and male attitudes were found through the interviews, but the female nurses pointed out that it is more difficult for a female to be obese in this superficial society.

Traditionally, the compliance rates with preventive care services for members in the Medicaid Program are significantly lower than their peers enrolled in a commercial health insurance plan even when there are no financial costs for those services to Medicaid members. Start of life services which include prenatal care for pregnant mothers and well-child visits for newborns and infants are used to focus the research. Non-compliance, defined as not receiving recommended preventive services within the timeframe expected, has large financial and societal costs. Women who receive only the minimal prenatal care are at high risk for developing pregnancy complications and having negative birth outcomes while those that failed to receive prenatal care were three times more likely to have a low-birth weight infant. Within the first 6 months of life, children with incomplete visits are 60 percent more likely to visit the emergency room. They may have untreated development delays and disabilities, which occur in approximately 13 percent of children and are estimated to cost $417,000 in direct medical costs and indirect lost productivity per child. This thesis looks at motivational theories and economic incentives in practice in the health care industry to address the lack of compliance of services. It will analyze the problem from the perspective of how does a business, the State Medicaid Program or Medicaid Managed Care Organization (MCO), get a customer, the Medicaid population, to perform a specific behavior, receive preventive care services using motivational theories. / text

Institutional theory is utilized to understand the role of the state in determining who among overlapping professions are allowed to compete in healthcare markets. Hypotheses are tested using a professional licensing policy innovation that influences the evolution of markets for healthcare services. This first paper demonstrates how the power of incumbent and challenging professional associations, the characteristics of a state's labor market, and previous adoptions by neighboring states affect a state's propensity to embrace or resist state legislation of professionally-contested healthcare licensing legislation over a 10-year observation period. The results of this research have implications for understanding state healthcare market innovations, the power of professional associations, and institutional theory. Two subsequent papers address the effects of this competition on training programs in the challenging profession.

Appointment scheduling involves picking a strategy for sequencing patient appointments such that the wait time per patient is minimized and the idle time and overtime for the doctor are minimized. The goal of this project is to increase the number of scans per day at the echocardiogram clinic in the Hospital for Sick Children. The objectives were realized by performing simulations of the workflow of the echo clinic using simulation software. The simulation model did not precisely reflect the echo clinic, and the disparity was attributed to limitations in the simulation model. Nevertheless, the user accepted the model and six different policy change scenarios were explored. All six scenarios yielded significant increases in average scans per day per sonographer. Scenario IV, which eliminated the use of sonographer schedules, was recommended to be implemented due to ease of implementation and lack of negative effect on patient wait time and sonographer overtime.

Cognitive behaviour therapy is a well-documented first-line treatment for mild to moderate depression. Primary healthcare providers have encountered several barriers when trying to provide CBT in an office-based setting and as such, adoption of this evidence-based treatment has been suboptimal. Primary healthcare nurse practitioners (PHC NPs) have an in-depth knowledge of advanced nursing practice, and are responsible for the assessment, diagnosis and management of patients with acute and chronic conditions, such as depression. PHC NPs are also ideally situated in the health care system to deliver CBT to their patients. The objectives of this project were to develop a format for the delivery of brief CBT methods that was feasible in the PHC setting, increase PHC providers’ confidence to implement CBT and ultimately increase their adoption of CBT

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

The existence of workplace violence in remote and isolated nursing station settings has been an area of limited knowledge to date. This descriptive study explored the phenomena of workplace and occupational aggression (WPOA), an operational definition of workplace violence created to capture all exposures to verbal and physical aggression in the 21 First Nations and Inuit Health (FNIH) managed Nursing Stations in Manitoba. Using the Manitoba Region Occurrence Reports from 2008, it was found that nurses in nursing stations experience a range of WPOA exposures with verbal incidents being more commonly reported than physical incidents. Quantitative findings related to patterns of reported WPOA with respect to timing, type, perpetrators and concurrent substance use. Themes related to the impact of WPOA on nursing staff and responses of managers to reported incidents were generated from the qualitative analysis. Recommendations for policy, administration, education and future research were generated.

The Winnipeg Children’s Hospital encounters delays within the surgical patient flow and cancellations due to a lack of available resources in the Pediatric Intensive Care Unit (PICU). Applying the concepts of lean thinking and the practices of simulation and statistical analysis, these problems were better understood and solutions were developed. Improvement projects were performed centralized on lean concepts and utilizing the tools of value-stream mapping and 7 forms of waste. Building and running a simulation model provided a capacity versus demand measure for the overall performance of the PICU. Simulation allowed for the study of hypothetical situations such as varying department resources and fluctuating patient levels. Statistical calculations were used to create a prediction tool to determine the probability of a PICU bed being available. This would enable a reduction in last-minute cancellations of surgical cases requiring a PICU bed.

In this thesis, we generalize a set of facility location models within a two-stage robust optimization framework by assuming each demand is only known to lie within a continuous and bounded uncertainty region. Our approach involves discretizing each uncertainty region into a set of finite scenarios, each of which represents a potential location where the demand may be realized. We show that the gap between the optimal values of the theorized continuous uncertainty problem and our discretized model can be bounded by a function of the granularity of the discretization. We then propose a solution technique based on row-and-column generation, and compare its performance with existing solution methods. Lastly, we apply our robust location models to the problem of ambulance positioning using cardiac arrest location data from the City of Toronto, and show that hedging against demand location uncertainty may help decrease EMS response times to cardiac arrest emergencies.

In this thesis, we generalize a set of facility location models within a two-stage robust optimization framework by assuming each demand is only known to lie within a continuous and bounded uncertainty region. Our approach involves discretizing each uncertainty region into a set of finite scenarios, each of which represents a potential location where the demand may be realized. We show that the gap between the optimal values of the theorized continuous uncertainty problem and our discretized model can be bounded by a function of the granularity of the discretization. We then propose a solution technique based on row-and-column generation, and compare its performance with existing solution methods. Lastly, we apply our robust location models to the problem of ambulance positioning using cardiac arrest location data from the City of Toronto, and show that hedging against demand location uncertainty may help decrease EMS response times to cardiac arrest emergencies.