Work name: Mobbing in the health service Abstract: The work is focused on mobbing problems in the health service especially on an incidence of psychical violence encountered by registered nurses and management personnel (head nurses and senior nursing officers) in the Institute of Clinical and Experimental Medicine in Prague. Theoretical part deals with mobbing - with its occurence and registered nurses attitude towards a violence in the workplace. Further it deals with reasons of mobbing origin, its characteristical attributes and particular stages of a whole process. In that part a mobber personality and his strategy are also described, a personality of a victim is analysed, its reactions to mobbing and fatal impact on its organism. At the close a relation of management personnel to psychical violence in the workplace is described. In the practical part there are presented results of quantitative research. A questionnaire was completed by management personnel as well as by registered nurses. From the result it follows that mobbing is also a reality in the mentioned institute and though two thirds of nurses acquired knowledge in this matter (by means of training), the entire third is not teached in. Information on factors contributing to psychical violence progress was acquired, too. In most cases...

Motivated by the ongoing and widespread xenophobia in South Africa, this study explores the experiences of health access and the health sector by refugees and asylum seekers so as to understand intergroup relations, and more specifically the tensions between nationals and non-nationals. In achieving this, an ethnographic fieldwork was conducted in Cape Town, South Africa during Spring 2017; semi-structured interviews with refugees and asylum seekers provide the material for analysis to identify key perceptions on health and xenophobia to shed light on what possible peacebuilding initiatives should address. Key themes uncovered that intergroup violence based on nationality is prevailing in the areas and townships where refugees and asylum seekers live side by side with (black) South Africans. The presence of violence and the fear of risk of violence appear to fuel intergroup resentment and hostility. The lack of social well-being of the refugee became apparent in their frustrations in attaining safety in their everyday life. Moreover, it positions them so that they are unable to improve their own situation and attain health, health access, and health rights. Additionally, it found that a major obstacle to the realisation of health is connected to legal documentation as well as perceived competition for scarce health service. Specifically, it uncovered the perception of assumed hostile attitude (or fear hereof) by nationals among refugees and asylum seekers constitute both visible and invisible access barriers to the public health system and social integration. The application of the instrumental group conflict theory to the ethnographic interview material thus showed that to end what I term ‘norms of protracted social conflict rooted in xenophobia’, refugees and asylum seekers access to and treatment in the health sector is integral for their inclusion into society. It can simultaneously foster relations with the locals and, at the same time, allow for an everyday life wherein the individual can participate in and contribute to the South African society.

Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen's behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < .01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < .05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < .05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes.

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Barnhälsovårdssjuksköterskornas uppgift är att arbeta för att främja barns hälsa och utveckling. De ska identifiera och initiera lämpliga åtgärder vid problem i barns hälsa och utveckling. I deras uppdrag ingår även att vara ett stöd för barnet och föräldrarna. När Covid-19 pandemin spreds påverkades hela världens befolkning och även hälso- och sjukvården berördes av den uppkomna situationen. Syftet med studien var att beskriva barnhälsovårdssjuksköterskornas erfarenheter av att ge barn och deras föräldrar stöd under Covid-19 pandemin. En kvalitativ metod med en fenomenologisks ansats användes. Öppna intervjuer tillämpades för att besvara studiens syfte. Vid analysen av intervjuerna användes en kvalitativ beskrivande innebördsanalys. Resultatet visade att essensen av fenomenet som undersöktes var att förmågan att bibehålla stödet gav nöjdhet. Essensen av fenomenet byggs upp av två innebördsteman, Betydelsen av att vara flexibla och Möta ett behov av ökat stöd. Slutsatsen är att det är nödvändigt att vara flexibel vid en pandemi och att stöd behöver utökas och kunna ges i olika former till barn och föräldrar. / The task for specialist nurses in health care service for children is to promote children´s health and development. They must identify and initiate appropriate interventions when there is problem in children's health and development. Their mission also includes being a support for the child and the parents. When Covid-19 pandemic spreads, the entire world's population was effected and health care was also effected of the upcoming situation. The purpose of the study was to describe the child health care nurse's experiences of providing support to children and their parents during the Covid-19 pandemic. A qualitative method with a phenomenological approach was used. Open interviews were applied to preserve the purpose of the study. In the analysis of the interviews, a qualitative descriptive meaning analysis was used. The results showed that the essence of the phenomenon of study was that the ability to maintain support provided satisfaction. The essence of the phenomenon is built up by two main themes, The importance of being flexible and Meeting a need for increased support. The conclusion is that it is necessary to be flexible in the event of a pandemic and that support needs to be expanded and given in various forms to children and parents.

Preterm birth (< 37 weeks gestation) is a major health burden for affected children. Although the risk of health problems increases as the gestational age decreases, research in the last decades has revealed that even late preterm infants born at 34-36 weeks gestational age have higher mortality and morbidity than term infants. Because late preterm infants constitute three fourths of preterm infants, they are important from both public health and health policy perspectives. This doctoral thesis sought to answer important knowledge gaps in health service utilization of late preterm infants via three studies. Study A, a systematic review and meta-analysis comparing health service utilizations of late preterm infants with those of term infants, found that late preterm infants had increased hospitalization compared with term infants that persisted from the neonatal period through adolescence. Study B is a cohort study evaluating the re-admissions and emergency department visits by late preterm and term singletons and twins for the first 5 years after birth. Study B demonstrated that late preterm infants had higher re-admission rates than term infants although differences in twins were less pronounced than in singletons. Study C is a population-based cohort study with cost analyses assessing the health care costs and resource utilization related to three different discharge timings of late preterm and term singletons: early (< 48 hours), late (48-71 hours), and very-late (72-95 hours) discharge after birth. Study C found that early discharge was not associated with the reduction of health care cost in late preterm infants, and instead was associated with an increase in the cost in term infants over the first year after birth. These findings are useful for parents, care providers, health policy makers, and guideline developers to provide optimal care for late preterm infants. / Thesis / Doctor of Philosophy (PhD)

Background Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases. Methods We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians’ specialty, conservative treatments) and regional variables were analyzed. Results There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission. Conclusion This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians’ preferences.

No / Worldwide healthcare systems are facing immense changes in the demand of care with vast cost explosions caused by aging populations and the increase in chronic and mental diseases. The move towards patient-centered healthcare seems to be an ideal approach to meet future challenges but still clashes with reality. Patient Advice and Liaison Service (PALS) in the UK is one of the unique examples of patient empowerment to influence changes in healthcare systems like the National Health Service (NHS). The purpose of this paper is to look at user-driven organizational change management in PALS in retrospect to learn from its ‘best’ and ‘worst’ practices. In conclusion, patient-centered healthcare becomes more realistic if healthcare users and workers are empowered at the same time. The vision of patient, public, and staff involvement in the move towards patient-centered health needs to be backed up by adequate and secure resources as well as consistent organizational leadership and change management. Organizational change processes in general should be seen as biological continuous cycles with unpredictable evolutionary turning points rather than linear progressions. This helps to stay optimistic and embrace change as challenging, exciting, and difficult all the way through the change process.