Dissertation submitted in fulfillment of the requirements for the Degree of Master in Technology: Emergency Medical Care, Durban University of Technology, 2011. / Background Information regarding pre-hospital emergency medical services is limited and it is therefore challenging to determine if there is delay in emergency transport of patients. This study aimed to provide such information specifically regarding the emergency transportation of obstetric patients. Purpose The purpose of the study was to describe the transport of obstetric patients within the Ugu Health District of KwaZulu Natal, in terms of patient profiles, the response time intervals and factors that affected response times. Objectives The objectives of the study were to:  determine response time intervals from the initial call to delivery of the patient to a public sector hospital;  describe the types of obstetric cases being transported;  describe factors that affect response times and;  make recommendations on policies and procedures governing emergency obstetric patient transportation Methodology All obstetric patients transported by Emergency Medical Rescue Service (EMRS) within a 2 month time frame within the Ugu District made up the study population. The study was conducted through prospective quantitative data collection using hospital records, the EMRS information system (communications centre data base records) and the EMRS patient return forms. The data was triangulated which established reliability before descriptive analysis was conducted. vi Findings The EMRS predominantly transports obstetric patients in labour with a gravidity of 1. The mean response interval (from receipt of the call to arrival at the patient) of 1h41minutes was a result of delays in the pre-response interval (pre-response waiting time). The mean pre-response interval of 1h07 minutes was a result of delays caused by ambulance unavailability. Pearson‟s correlation showed a significant relationship between the pre-response interval and response interval i.e. delays in the pre-response interval caused delays in the response interval. The EMRS lacks Standard operating procedures governing emergency transport and this was one of the main factors that contributed to some of the causes of ambulance unavailability. The lack of standard operating procedures is therefore also partly responsible for a delayed response interval. 64.5% of the incidents achieved response time intervals of more than 1hour and has therefore failed to achieve the predetermined Department of Health target for 70% of ambulances reaching the site of the patient within 1 hour. Other factors that affect the response time intervals were the poor road conditions, shift change delays and re-routing of ambulances. Conclusion EMRS predominantly transports obstetric patients in labour, including high risk patient groups that are arguably beyond the scope of care of the Basic and Intermediate qualified Emergency Care Practitioners. Standard operating procedures for governing emergency transport are lacking and have contributed to a number of factors affecting response time intervals. Standard operating procedures therefore need to be developed taking into consideration the findings of this study as well as previous recommendations by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD).

published_or_final_version / Social Work / Master / Master of Social Work

In British Columbia, individuals with a mental disorder can be hospitalised against their will under the Mental Health Act (1999), when a physician determines that "protection of the person or others" is an issue. Involuntary psychiatric hospitalisation involves a major infringement of an individual's civil liberty. When patients or their representatives disagree with the treatment teams about their involuntary hospitalisation, they can apply for an appeal hearing named the review panel under the Mental Health Act (1999). From a theoretical perspective, the traditional medical model and the social constructionist model, which offer different views concerning individuals with mental illness who are hospitalised against their will, are presented. This theoretical contrast underscores a major dilemma faced by mental health professionals in fostering client self-determination, while they are providing services on the principle of beneficent protection. An empowerment model of social work practice is then described to illustrate how services can be provided to help mental patients regain a sense of control over their lives. Concerns about the current legislation regarding involuntary hospitalisation are also discussed. To supplement the limited number of studies currently available on review panels, a quantitative descriptive study was conducted at Riverview Hospital, the only tertiary psychiatric hospital in British Columbia, surveying the experiences of 39 social workers and physicians with review panels. A questionnaire consisting of 22 Likerttype items was used. Four categories were identified: (a) patient-related issues, (b) effects of review panels on treatment teams, (c) role conflicts, and (d) operational issues. Despite the apparent lack of formal training, social workers and physicians generally reported having adequate knowledge of review panels. Social workers and physicians who were involved more frequently with review panels appeared to have more positive attitudes towards them. Their training pertaining to the Mental Health Act was also significantly related to their attitudes. Neither patients nor their families reportedly had adequate knowledge of the review panel process. Although some positive effects of review panels were acknowledged, staff generally had mixed attitudes about review panels. Guided by an empowerment model, these findings have important implications for social work practice. These include the need for further professional training, improved communication between health professionals and legal advocates, education for patients and families, and the support of patients' collective action, so that review panels can be a more empowering experience for mental patients.

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6595. Adviser: Arch I. Carson. Includes bibliographical references.

Thesis (Ed.D.)--Teachers College, Columbia University, 1996. / Typescript; issued also on microfilm. Sponsor: Susan W. Salmond. Dissertation Committee: Marvin Sontag. Includes bibliographical references (leaves 73-87).

M.A. (Social Work) / South Africa is a society undergoing major and rapid social change. An understanding of psychiatric services in the psychiatric hospital should also be identified within this context. The needs of the mentally ill and other interested parties will determine the extent of the services that need to be rendered. The social worker as part of the interdisciplinary team in the hospital, must have a clear perception of her professional role in order to render a relevant service. Social work must become more responsive to the consumers' needs and allow itself to be shaped by the context in which it is practised. In this study the role of the social worker in Weskoppies Hospital was identified by means of a descriptive research design with qualitative and quantitative methods of data collection. The qualitative research was done by means of in depth interviews and focus groups with interested parties. The quantitative research was done by means of questionnaires completed by patients of the hospital. A model for the role description of the social worker was derived from a literature study; the view of Lister, as described by the authors Hepworth & Larsen; the view of other authors and the results of the qualitative and quantitative research. The results of the research confirmed a need for social work services in Weskoppies Hospital. The greatest need expressed, was a need for help with material problems, followed by a need for help to be linked with other resources. Although community involvement was emphasised, there still was a need for individual counseling and support. Other important roles were also identified. The model serves as an integrated description of the role of the social worker in the hospital. From the results of the research it was thus possible to convey a clear picture of the role of the social worker in Weskoppies Hospital. Hopefully this will enable the social workers in the hospital to render a better and more understanding service to the patients, hospital and community.

In British Columbia, individuals with a mental disorder can be hospitalised against their will under the Mental Health Act (1999), when a physician determines that "protection of the person or others" is an issue. Involuntary psychiatric hospitalisation involves a major infringement of an individual's civil liberty. When patients or their representatives disagree with the treatment teams about their involuntary hospitalisation, they can apply for an appeal hearing named the review panel under the Mental Health Act (1999). From a theoretical perspective, the traditional medical model and the social constructionist model, which offer different views concerning individuals with mental illness who are hospitalised against their will, are presented. This theoretical contrast underscores a major dilemma faced by mental health professionals in fostering client self-determination, while they are providing services on the principle of beneficent protection. An empowerment model of social work practice is then described to illustrate how services can be provided to help mental patients regain a sense of control over their lives. Concerns about the current legislation regarding involuntary hospitalisation are also discussed. To supplement the limited number of studies currently available on review panels, a quantitative descriptive study was conducted at Riverview Hospital, the only tertiary psychiatric hospital in British Columbia, surveying the experiences of 39 social workers and physicians with review panels. A questionnaire consisting of 22 Likerttype items was used. Four categories were identified: (a) patient-related issues, (b) effects of review panels on treatment teams, (c) role conflicts, and (d) operational issues. Despite the apparent lack of formal training, social workers and physicians generally reported having adequate knowledge of review panels. Social workers and physicians who were involved more frequently with review panels appeared to have more positive attitudes towards them. Their training pertaining to the Mental Health Act was also significantly related to their attitudes. Neither patients nor their families reportedly had adequate knowledge of the review panel process. Although some positive effects of review panels were acknowledged, staff generally had mixed attitudes about review panels. Guided by an empowerment model, these findings have important implications for social work practice. These include the need for further professional training, improved communication between health professionals and legal advocates, education for patients and families, and the support of patients' collective action, so that review panels can be a more empowering experience for mental patients. / Arts, Faculty of / Social Work, School of / Graduate

No description available.

The abstract on the file is incorrect, use the the one in the system as it summerizes the full text. / This attempted to describe factors contributing to sleep deprivation in the a multidisciplinary intensive care unit in KwaZulu-Natal Province. A quantitative, descriptive research design was adopted and structured interviews were conducted with 34 adult patients. Most factors contributing to these patients' sleep deprivation are basic physiological needs. Much can be done to enhance patients' abilities to sleep if noise (from alarms, monitors, televisions, telephones and footsteps) could be controlled, patients' pain would be managed effectively, doctors would visit the patients regularly, doctors and nurses use lay terms when talking to patients. Visible clocks and windows will help patients to maintain time orientation. Friendly, approachable and respectful nurses who introduce themselves to the patients help' to reduce patients' stress levels and improve their abilities to sleep. / Health Sciences / M.A. (Health Studies)