Magister Public Health - MPH / Being healthy (‘feeling fine’) and health deterioration (‘getting sick’) were key health concerns among PLHIV prior to ART initiation. PLHIV often referred living with HIV as ‘being sick’ and experiencing poor health when already infected with HIV as ‘very sick’ and this perception about sickness and wellness partly determined the need and value placed on accessing HIV services. Motivations for starting treatment included needing to maintain or regain health, encouragement from HCWs, relatives and friends and believing in the effectiveness of ART to improve health. Prevention of HIV transmission to others was not cited to influence uptake. The majority of PLHIV reported stringent adherence to ART; even a half-hour delay in taking treatment was sometimes defined by participants as ‘non-adherence’. Initial reminders for taking ART (setting alarm, placing pills where visible) fell away as daily medication became routine. However, daily uptake of treatment had its own psychosocial and economic consequences which PLHIV had to navigate. With few exceptions, when taking the first line regimen, most PLHIV experienced both temporal (hallucinations, vomiting) and long-term (dizziness and irregular heartbeat) side-effects attributed to ART, which although not considered life threatening, could undermine ART adherence. HIV status disclosure was both limited and selective (mainly to spouses, close relatives, friends and co-workers) and deemed as promoting adherence to treatment and access to HIV services. HIV/AIDS stigma persisted even among relatively healthy PLHIV due to links with ‘promiscuity’, hampering disclosure and access to HIV services. Competing demands on participants’ time, especially livelihood activities, also disrupted accessing services. Good relationships between HCWs and PLHIV promoted access to services.

Thesis (M.H.A.)--University of Michigan, 1961.

Thesis (M.H.A.)--University of Michigan, 1961.

Orientador: Edineis de Brito Guirardello / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T00:18:04Z (GMT). No. of bitstreams: 1 Roscani_AlessandraNazarethCainePereira_M.pdf: 1574041 bytes, checksum: c6b1497cd99d0773b8f88e5448203228 (MD5) Previous issue date: 2009 / Resumo: A capacidade de direcionar atenção é essencial para o enfermeiro no ambiente de trabalho devido às múltiplas fontes de demanda de atenção que requerem alto nível de concentração para processar informações importantes no gerenciamento do cuidado ao paciente. Trata-se de um estudo descritivo e correlacional que tem por objetivos: avaliar como este profissional percebe o seu desempenho frente às situações cotidianas que requerem concentração e, verificar se existe associação entre as situações de demanda, percepção da adequação do ambiente e variáveis pessoais e profissionais. Para a coleta de dados utilizou-se os instrumentos: a) versão brasileira do Attentional Function Index (AFI) b) Demandas para Atenção Dirigida e, c) Percepção da adequação do ambiente de trabalho. Para análise dos dados utilizou-se o programa SPSS. Participaram do estudo 169 enfermeiros, sendo a maioria do sexo feminino. Verificou-se que a média de percepção de desempenho dos enfermeiros, avaliada pelo AFI foi de 60,43, considerada satisfatória, entretanto ao ser correlacionada com as situações de demanda para atenção, resultou em uma associação negativa de baixa magnitude (r = - 0,294; p < 0,0001) e positiva de baixa magnitude (r = 0,196; p-valor < 0,05) para a percepção da adequação do ambiente de trabalho. A percepção de desempenho difere entre os serviços (p = 0,013) no qual os enfermeiros da clínica médicocirúrgica II julgaram maiores médias de desempenho em relação aos da clínica médico-cirúrgica I e pediatria. Aqueles com jornada de trabalho inferior a 40 horas (p = 0,044) e com algum problema de saúde (p = 0,026) apresentaram menores médias de desempenho em relação aos demais. Dentre a maior demanda destaca-se as situações de demanda de atenção relacionadas ao domínio psicológico. Há diferenças estatisticamente significantes para as variáveis unidade de trabalho, número de pacientes por enfermeiro, presença de afecção psicológica. O ambiente de trabalho foi percebido como inadequado e como variável que interfere no esforço mental e na capacidade de direcionar atenção. Conclui-se que os enfermeiros julgaram um desempenho satisfatório na capacidade de direcionar atenção, sendo este associado às situações de demandas de atenção e a percepção da adequação do ambiente de trabalho. / Abstract: The capacity to direct attention is essential to nurses in the work environment due to multiple sources of attention demands that require higher level of concentration in order to process important information in the management of the patient care. This is a descriptive and correlational study that aims to evaluate: how nurses perceived their effectiveness in purposeful activity requiring direct attention and verify the relationships between the situations that require direct attention; the environment's adequacy and professional or personal variables. For the data collect were used the instruments: a) Attentional Function Index (AFI) - Brazilian version b) Direct Attention Demands and, c) Perception of Work Environment Adequacy. For data analyses was used the SPSS software. The sample was composed of 169 nurses, most of them women. The mean perception of the AFI was 60.43, considered satisfactory, but in correlating with attention demand situations resulted in low negative value (r = - 0.294; p < 0.0001) and low positive value (r = 0.196; p-valor < 0.05) for the work environment adequacy. The AFI showed differences between services (p = 0.013) in which nurses from medical surgical unit II judged higher mean values when compared to nurses from medical surgical unit I and pediatrics unit. The nurses who worked less than 40 hours a week (p = 0.044) and with some kind of health problem (p = 0.026) showed lower AFI in comparison with the others. The situations related to the psychological domain required higher level of directed attention in relation to the other domains. There was a statistical significance for the variables: work unit, number of patients usually assigned for care and psychological affection. The work environment was perceived as inadequate by nurses with can increased the need of mental effort or directed attention as well as the capacity to direction attention. As conclusion, the nurses judged a satisfactory AFI to do purposeful activity requiring direct attention= and it was associated to situations of attention demands and perception of work environment adequacy. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Magister Curationis - MCur / South Africa has a general shortage of most categories of health professionals, which include nurses, doctors, dentists and pharmacists. However, the problem is exacerbated by the fact that most of these professionals either work in the private health sector or have migrated to more affluent countries. Shortages of nurses in the rural setting continue to pose a problem for the Department of Health. The community service policy is stated in Section 40 of the Nursing Act, of 2005, and in the Regulations relating to Performance of Community Service published in the Government Notice No. 765 of 24 August 2005. In 2008, the first professional nurses started with their community service. Community service for health professionals is a policy proposal of the Department of Health that reacts to the lack of meeting the health requirements in poor communities, particularly in rural areas. It offers graduating health professionals with the prospect of gaining first-hand working experience in conditions of poverty and underdevelopment. South Africa is implementing community service for health professionals as a plan to manage the difficulties of human resources in the health sector. The transition period for community service practitioners in a rural setting is different, which implies that most support may need to be strengthened due to the remoteness of the rural setting. The purpose of this study was to describe the experiences of community service practitioners during their community service at a rural health facility. From the findings, guidelines were described for the operational managers who are responsible for supporting the community service practitioners at a health facility in a rural area. A qualitative, exploratory, and descriptive design was applied, using individual unstructured interviews and field notes. Each interview took around 30-45 minutes to complete. The purposively selected sample consisted of community service practitioners (n = 10) who were practicing at rural health facilities. The process of inductive coding of Thomas (2003:5) was used to analyse the data. The results of this study indicate that a process is needed for community service practitioners fresh from university and an urban environment to adapt to a remote rural health facility. Some of the participants did receive an orientation programme at the beginning of their community service year. However, most of the community service practitioners that took part in the study learned from their experience during the year of their placements. For some, the learning opportunities were more available in the rural setting than when they had worked as students at the urban hospital during their training.

Bakgrund Vårdmiljön har beskrivits ända sedan Florence Nightingales dagar. Sjukhusens utformning har följt samhällets utveckling och medicinska framsteg. Forskning om vårdmiljön började på allvar på 1980-talet. Forskning bedrivs både om patienters upplevelse och på hur arkitektur och design kan påverka läkning och återhämtning. Detta kan förstärka möjligheten för sjuksköterskan att ge personcentrerad vård.  Syfte Syftet var att beskriva patienters upplevelse av vårdmiljön. Metod En allmän litteraturöversikt gjordes och analyserades med innehållsanalys. Elva vetenskapliga artiklar ingick i översikten. Sju artiklar var kvalitativa och två artiklar var kvantitativa. Två artiklar var av blandad metod. Resultat Två huvudteman framkom vid analysen av de elva artiklarna gällande patienters upplevelse av vårdmiljö. Dessa teman var: Upplevelse av den fysiska vårdmiljön och Upplevelse av samhörighet och gemenskap. Resultatet visar att den fysiska vårdmiljön och den psykosociala miljön har en stor inverkan på patienters upplevelse. Likaså påverkar det om patienten hamnar i enkelrum eller flerbäddsrum samt om integritet, autonomi och sekretess kan upprätthållas. Sammanfattning Patienters upplevelse av vårdmiljön påverkas av ett flertal faktorer som framkom i resultatet såsom den fysiska vårdmiljön, den psykosociala vårdmiljön samt hur väl integritet och autonomi kan bevaras. Upplevelsen påverkas även av patientens livsvärld och kulturella kontext. Detta gör att sjuksköterskan måste se patientens omvårdnadsbehov kopplat till vårdmiljön i ett helhetsperspektiv. / Background The health facility environment has been described ever since the days of Florence Nightingale. The design of the hospitals has followed society’s development and medical progress. Research on the health facility environment began in earnest in the 1980s. Research is conducted both on the patients’ experience and on how architecture and design can affect healing and recovery. This can enhance the ability of the nurse to provide person-centered care. Aim The aim was to describe patients’ experience of the health facility environment. Method A general literature review was conducted and analyzed using content analysis. Eleven scientific articles were included in the review. Seven articles were qualitative and two articles were quantitative. Two articles were of mixed methods. Results Two main themes emerged from the analysis of the eleven articles regarding patients’ experience of the health facility environment. These themes were: Experience of the physical health facility environment and Experience of belonging and community. The results show that the physical health facility environment and the psychosocial environment have a major impact on patients’ experience. It also affects whether the patient ends up in a single room or multi-bed room and whether integrity, autonomy and confidentiality can be maintained. Summary Patients’ experience of the health facility environment is influenced by a number of factors that emerged in the results, such as the physical health facility environment, the psychosocial environment and how well integrity and autonomy can be preserved. The experience is also influenced by the patient’s life world and cultural context. This means that the nurse must see the patient’s nursing needs linked to the health facility environment in a holistic perspective.

Infant mortality (IM) incidence in health facility systems during or after infant delivery is substantially high in Nigeria. In this quantitative, cross-sectional study, the effects of skill birth attendants (SBAs), prenatal care, and providers of prenatal care on IM in health facility delivery centers were examined. The Mosley and Chen theoretical framework informed this study and was used to explain the relationship between SBAs, prenatal care, and providers of prenatal care and IM. One hundred and sixty infant deaths were examined among mothers who used an SBA versus those who did not, mothers who had prenatal care versus those without, and mothers who received prenatal care from a health facility versus traditional providers. The 2014 verbal and social autopsy secondary data set was analyzed using binary logistic regression technique. There was no significant difference in risk of IM between mothers who had SBA during infant delivery in health facility compared to those without SBA during delivery. Mothers who received prenatal care had a significant higher risk of infant death in a health facility compared to those that did not receive prenatal care. Mothers who received prenatal care from traditional providers did not have a statistically significant risk of IM compared to mothers who received prenatal care from a health facility. The findings could have positive social change implications by encouraging multilevel public health stakeholders to support and promote the use of health surveillance in understanding the barriers and challenges of health facility delivery practices, prenatal care, and use of SBA as it relates to IM to facilitate policy change in maternal and infant care practices in Nigeria.

Bakgrund: De medicinska insatser, omvårdnad och rehabilitering som erbjuds patienter i primärvård idag är vedertagna och vanligtvisevidensbaserade. Patienter kan få diagnos, behandling och ofta bot för många åkommor. En dimension som dock mindre ofta är tillvaratagen är effekterna av en genomtänkt fysisk miljö. Ett respektfullt bemötande i kombination med en genomtänkt vårdmiljö kan beskrivas som en god vårdatmosfär. Syftet med studien är att undersöka hur patienter upplever och uppfattar vårdatmosfären vid besök på en rehabiliteringsenhet i primärvård. Metod: Kvalitativaforskningsintervjuer och kvalitativ innehållsanalys Huvudresultat: En vårdatmosfär kan delas in i tre domäner: Fysisk miljö, Bemötande och Organisation. Inom domänerna finns ett antal kategoriermed variationer: Känsla av kontroll, Fysiska förutsättningar för att bli uppmärksammad, Subjektiva upplevelser av miljön, Kunskap om miljöns effekter, Uppmärksammar och bekräftar, Kommunicerar, Helhetssyn, Patienten i fokus, Delaktighet, Empati, Jämlikt möte, Att göradet ‖lilla extra‖, Innehåll och utbud, Tillgänglighet, Kontinuitet, Vårdkedjor och samverkan, Jämlik vård, Patientens rättigheter, Bemötandeandaoch förbättrings-och utvecklingsanda.Temat som framkommit är Att bli sedd, att vara värdefull. Slutsats: Till begreppet vårdatmosfär kan förutom vårdmiljö och bemötande, organisation läggastill. Organisationen ger förutsättningar eller kan försvåra. Ett tema håller samman alla kategorier och det är betydelsen av att bli sedd som ger budskap om att vara värdeful / Background: Medical treatment, care, and rehabilitation offered to patients in primary care settings are established and mostly evidence-based. Patients can receive diagnose, treatment and, quite often, cure. A dimension that receives less attention involves the effects of a carefully planned physical environment. Combined with a carefully planned environment, respectful interaction between patients and health professionals enhancesthe atmosphere of care settings. Aim: This study aimed to investigate how patients experience the atmosphere they encounter when visiting a rehabilitation unit within a primary care unit. Method: Qualitative research interviews and qualitative content analysisResults: The atmosphere in care settings encompasses three domains: physical environment, interaction between patients and health professionals, and the organization. Within these domains, categories include sense of control, physical conditionsfor to attract attention, subjective experience, knowledge of the effects of the environment, attention to and confirmation of the patient, communication, holistic view of the patient, patient in focus, participation, empathy, equality in the meeting, To do ―the little more‖, healthcare content, accessibility, continuity, cooperation, equal care, patient rights, spirit of interaction between patient and health professional, and spirit of improvement and development. The major themes that emerged were the patient’s need to be noticed and valued. Conclusion: Our results suggest that the organization should be added to the concepts of atmosphere in care settings. The organization can create and obstruct careconditions. The overarching theme of these categories is the patient’s need to be noticed and valued / <p>ISBN 978-91-86739-27-0</p>

Analysis of drug-related problems in a health facility I. Author: Michaela Bahnerová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Intoduction: Drug-related problems (DRPs) lower the quality of health care and present a risk factor in patient's safety. Objectives: The aim of this thesis is identification, classification and further analysis of DRPs in health care facility. Methods: Revision of pharmacotherapy was performed in health care facility in term 6. 8. - 10. 8. 2012. The pharmaceutical team which contained two pharmacists and diplomant examined health documentation of patients hospitalized in the facility. We collected information from personal, allergic, family, and labor-social anamnesis of patients. This data were noted into electronical database and after revision were DRPs classified and evaluated. The results of DRPs identification were evaluated by frequency analysis. In ten randomly selected patients was described DRPs resolution. Results: In total we noticed medical therapy in 175 patients (61 % women). Average patient's age was 58 years. 482 DRPs were identified. Of the patients, 84 % had DRPs and an average of 2,75 DRPs were recorded per patient. Conclusion: Appearance of DRPs is very frequent and...

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