published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

No description available.

This study aimed to investigate and describe perceptions Fire Fighters and Platoon Commanders from Johannesburg Emergency Services have of educational offerings offered by and / or deemed applicable to the emergency service, with specific reference to their vocational applicability and value in relation to promotion. It is argued in this report that such perceptions may affect the motivation experienced by adult learners to engage in further study and thus may influence the learning process as a whole. An understanding of how emergency service workers feel about the various courses and or qualifications that are on offer becomes important for managers, trainers and educators not only within the Johannesburg Emergency Service but also within industry as they plan and structure future educational offerings and training programmes. To collect data on the perceptions described above in-depth face to face interviews were conducted with a purposefully selected sample of Fire Fighters and Platoon Commanders. During these interviews the participants were required to respond to questions which were specifically designed to elicit their views and perceptions on the vocational applicability of courses and qualifications relevant to their daily work within the emergency service and the value of further study for promotion. The interviews were audio recorded producing raw data, which could be later transcribed verbatim. Once sufficient data was collected, this data was analysed and interpreted. The analysis and interpretation yielded a number of significant findings relating to the participants’ perceptions of the vocational applicability of various courses and qualifications linked to the service as well as the perceived value or link between further study and promotion. The findings relating to vocational applicability emphasised that perceptions about which courses and / or qualifications had higher levels of vocational applicability were most often linked to the participant’s position within the service as well as their own personal preference for a particular specialist area or vocational discipline. In addition, the frequency with which the participants utilised a learning outcome or skill appeared to play a significant role in determining their perception regarding the vocational applicability of learning events. Although the courses currently on offer were largely seen as being vocationally applicable there was a perception that significant deficits existed in their levels of training and preparation for particular incidents and components of the participants’ vocational activities. The study also found a perception among the participants that they were not afforded an equal opportunity to study further in each of the three main vocational disciplines. Regarding further learning and promotion within the service, this study found that the participants did not perceive a clearly identifiable link between further study and promotion and that promotion was not the main driving force behind their desire to study further. There also appeared to be confusion and a lack of consensus about which courses are best for promotion. The rescue courses specifically receive little recognition from the service in terms of promotion. Based on these findings a number of recommendations were made. It was recommended that the service consider the introduction of new learning programmes to supplement the learning outcomes of existing qualifications and courses. The employer was also encouraged to provide better clarity and guidance for staff about how all the different courses and qualifications are to be recognised and managed within the service. In order to do this, the employer was encouraged to carefully reflect on the role of further study within the service as well as the envisaged linkages between particular courses and qualifications and the workers operational duties, promotion, specialisation and career development. / Dr. K. Steenekamp Prof. A. Swart

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Emergency department overcrowding is a growing problem worldwide including Rwanda. Literature shows that this problem has an impact on the functioning of the health care system and the quality of care provided. Research Methodology. This study aimed at exploring the phenomenon of overcrowding in ED/CHUK. Fifty one self-administered questionnaires were distributed to 40 ED nurses; these comprised three questions related to demographic data and 48 questions related to overcrowding. Correlation between overcrowding and causes and overcrowding with outcomes was explored and the pearson's test demonstrated that there is no linear correlation between these variables. Results. Findings from the demographic data demonstrated that the majority (92%) of ED nurse's were young (aged between 20 to 35 years). The majority (74%) of ED nurses had less than one to three years of experience in ED. With regard to overcrowding characteristics; nurses reported that the patient's waiting time for a physician varied between less than 30 min to more than 180 min; ED beds occupancy varied between 1 hour to more than 24 hours; patients were placed in the ED hallways for 1 hour to more than 24 hours; waiting room occupancy varied between less than 1 hour to more than 24 hours. Nurses attributed overcrowding to a variety of causes, including; a lack of inpatients beds (95%), large volume of trauma patients (87%), patients with no urgent condition (66), inappropriate referral of chronic cases (61 %), space limitation in emergency department (76%) and insufficient acuity ED beds (74%). Perceived outcomes (impact) were also multiples including, boarding patient in ED (92%), increased stress among nurses (79%), stress among physicians (60%), and risk of poor outcomes (60%), staff dissatisfaction (58%), violence between health care providers and patients (60%) and increased patient waiting time (58%). Regarding the undertaken interventions to reduce ED overcrowding, 100% of respondent asserted that there was some sporadic interventions, but not consistent. Recommendations: Like in other countries ED/CHUK overcrowding is a complex problem that needs to be addressed by all stakeholders: CHUK managers, hospital staff, ED staff, Rwandan district hospitals and Ministry of health. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.

Background Patient satisfaction is an important assessment of hospital’s service quality. Patients from emergency department (ED) usually have high expectation on receiving timely and high quality medical service. They generally have low patient satisfaction. Patient satisfaction has been identified to be associated with willingness to return and recommendation of the medical service to others. Therefore, to identify the factors associated with patient satisfaction in ED is important. Factors associated with patient satisfaction could vary by different ED systems. This project aimed at synthesizing factors associated with patient satisfaction in ED in Mainland China, Hong Kong and Taiwan, and comparing the different factors associated with patient satisfaction among the three areas and make recommendations on interventions to improve patient satisfaction in ED. Methods This review retrieved published literatures from PubMed, CNKI, and Taiwan electronic periodical services (TEPS). There is no restriction on study design, study population and measurements of patient satisfaction. Studies reporting factors associated with patient satisfaction in ED, and studies reporting effective interventions of improving patient satisfaction in ED were included. A total of 20 including 12 studies about Mainland China, two studies about Hong Kong and six studies about Taiwan were included. Results Common factors associated with patient satisfaction in emergency services have been identified in Mainland China, Hong Kong and Taiwan as well as other countries. These common factors included patients' characteristics, technical skills of medical staff, service attitudes, communication skills, professional ethics, provision of sufficient information, waiting time, allocation of resources and physical environment of ED. Different health systems can explain some unique factors identified in different areas. Satisfaction with medical expenses has been identified as a factor associated with overall patient satisfaction of ED in Mainland China, which could be due to that patients in Mainland have higher out-of-pocket share. Hong Kong has a gate keeper system which results in a large number of inappropriate ED users and thereby increases the waiting time and causes the ED crowding. Conclusion On the basis of the identified factors, potential interventions such as providing patients with sufficient information and improving medical staff’s technical skills, service attitude and communication skills can be implemented to increase patient satisfaction. Future studies should focus more on the evaluation of specific interventions. / published_or_final_version / Medicine / Master / Master of Public Health

Background: Individuals who make multiple visits to EDs for mental health complaints are a highly visible and challenging group. Recent healthcare priorities aimed at reducing inappropriate or unnecessary service use call for improved continuity of care. Implementing effective continuity interventions is contingent on sound foundational knowledge including population profiling and conceptual understanding. A deficit in these key elements is apparent in existing literature. These gaps in knowledge must be addressed to ensure quality continuity research targeting frequent presenters. Furthermore, there is a paucity of research available that implements evidence-informed methods and theory-driven measurement strategies. Objective: To strengthen the knowledge base on frequent mental health-related ED use and continuity in mental healthcare by addressing existing gaps in foundational knowledge and examining the phenomena at a regional tertiary healthcare centre. Method: This was a three-phase emergent study design using mixed methods. Phase 1 was an integrative study to synthesize research on frequent presenters to the ED for mental health complaints. Phase 2 was a theory analysis to explore the conceptual understanding of continuity in mental healthcare. Phase 3 was an observational case-control study of an exemplar population at a regional tertiary healthcare centre using the evidence-informed methods emerging from the first two phases. Results: From this enquiry, I proposed an evidence-informed profile for frequent presenters to the ED for mental health complaints, summarized parameters used to identify the frequent presenter population, highlighted existing areas of theoretical consensus not yet recognized in continuity research, and provided a global understanding of continuity in mental healthcare and an approach for selecting measurement strategies for continuity research. The observational study strengthened the emerging frequent presenter profile and explored CoC using a comprehensive tool. Conclusion: This doctoral thesis addresses important gaps in foundational knowledge by providing an evidence-informed frequent presenter population profile and global theoretical summary of continuity in mental healthcare. The observational study appears to be the first to use a theory-driven measurement tool and results differ from previous studies in which simple measurement approaches are used. Given this, new hypotheses/questions about the focus and role of CoC with frequent ED use need to be explored. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-04-26 10:47:19.626

Battery is a major health care issue that, despite increased recognition, fails to be detected in health care institutions. Without adequate detection, referral to social and community services are less likely to occur, rendering women victims vulnerable to continued risk physically, psychologically and medically. This study seeks to describe actual detection and referral practices in an emergency department at a large teaching hospital in Quebec, as well as explore health care professionals' knowledge about and practices regarding the detection and referral of battered women. Its aim is to better understand the pathways and barriers to detection and referral of abused women in order to enhance current practice responses in emergency departments. To examine detection and referral rates and predictors of battery, 200 medical charts from the emergency department were reviewed. Supplementing analyses of the charts were in depth interviews with ten health care professionals working in the emergency department. From these sources of data, it became apparent that neither detection nor referral occur in any systematic fashion. Whereas health care professionals seem to know a great deal about battery, their actual practice appears to be contradictory. Gynecological problems and woman's age were not found to be related to detail in charts but physical injuries were. Whereas a positive relationship was found between detection and referral in the chart reviews, everyday practice showed inadequacy in both areas. Implications for social work contributions to health care practice related to battery are offered.

This research portfolio examines the impact of trauma exposure in the emergency services. Emergency services represent a unique population in that they are frequently and repeatedly exposed to distressing and potentially traumatic situations. Firstly, a systematic review was conducted looking at factors that may potentially predict positive outcomes following trauma exposure in firefighters, namely the concept of posttraumatic growth (PTG). A review of the existing evidence was conducted across five databases. Studies were assessed against inclusion criteria and 12 studies were included. Results suggested that PTG was generally either not significantly or weakly related to other factors. Variables that were associated with PTG were aspects of the trauma exposure, post-traumatic stress severity and organisational and operational factors; however results were limited by methodological quality. Overall, the current evidence base has not identified strong predictors of PTG and associations appear multifactorial. Results indicate that PTG appears to have limited clinical utility in firefighters and that future research should improve upon the methodological limitations of the existing evidence base. The second part of the portfolio consists of an empirical study exploring the levels of post-traumatic stress symptom (PTSS) severity in ambulance clinicians and a cross-sectional analysis of factors relating to PTSS severity and psychological wellbeing in this population. A total of 508 ambulance clinicians (Paramedics and Ambulance Technicians) were recruited across Scotland. The relationships between PTSS severity, psychological wellbeing, self-compassion and psychological inflexibility were analysed using structural equation modelling. Results showed approximately 50% demonstrate clinically concerning levels of PTSS in the ambulance service and a strong positive relationship between psychological inflexibility and PTSS severity as well as with psychological wellbeing. Self-compassion had a small association with psychological wellbeing but was not significantly associated with PTSS severity. The potential impact of relying on post-traumatic stress disorder criteria of symptoms lasting for four weeks or more may mask the extent of PTSS experienced in this population. Findings indicate concerning levels of trauma symptomology within a representative ambulance service sample, and suggest the need for further investigation into potential causal relationships between psychological flexibility and PTSS in order to deliver effective interventions to reduce PTSS severity in this population.