Family members of service personnel with polytraumatic injuries face a wide range of challenges. Research has shown that family member adaptation and adjustment to the caregiver role has a significant impact on the well-being of the person with the injuries. The Veterans Health Administration is rapidly developing services to meet the needs of severely injured service personnel and their family members. The purpose of the present study was to test the feasibility of a method of assessment to identify the needs of individual family members of service personnel and veterans receiving inpatient rehabilitation services at the Polytrauma Rehabilitation Center (PRC) located within the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia. Family member needs and emotional distress levels were quantitatively assessed. Qualitative data was collected with the intent of gaining a better understanding of the needs of families of individuals with severe injury from within a military cultural context. Results of this study suggest emotional distress levels of family members of persons receiving treatment on the PRC are not clinically significant. Study participants report overwhelming satisfaction with the program of care offered to patients and family members on the PRC. Furthermore, results of this study suggest that family members benefited from participating in the study. A strength-based family care pathway that utilizes an individual assessment of family needs is proposed and recommended for use with family members of individuals enrolled in the Veterans Health Administration polytrauma network services.

The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.

Bakgrund: Telefonrådgivning på vårdcentral utgör en stor del av distriktssköterskors arbete. När distriktssköterskor saknar visuell kontakt med vårdsökare i telefonen ställs andra krav på kommunikationen mellan distriktssköterskor och vårdsökande. I takt med den ökade invandringen i Sverige träffar distriktssköterskor på utlandsfödda vårdsökande med språkförbistring i allt större utsträckning. Det behövs därför mer forskning inom detta område. Syfte: Syftet med denna studie är att beskriva distriktssköterskors erfarenheter av telefonrådgivning på vårdcentral till vårdsökande som inte har svenska som modersmål. Metod: Designen på studien är en kvalitativ deskriptiv intervjustudie med induktiv ansats. Datamaterialet utgjordes av tio intervjuer med distriktssköterskor på vårdcentral. Analys gjordes med hjälp av kvalitativ innehållsanalys. Resultat: Ur analysen framträder fyra kategorier Att främja samspel i kommunikationen, Att träffa på svårigheter/ hinder i samtalet, Att använda organisatoriska strategier, Att använda sin kompetens. Slutsats: Att nå överensstämmelse i kommunikationen ansågs som något av det viktigaste i arbetet med telefonrådgivning.  Kulturella skillnader och språkförbistring gjorde telefonrådgivningen utmanande. Andrahandsinformation gjorde det svårt att veta att korrekt information gavs samt att sekretessen upprätthölls. Distriktssköterskorna beskrev oro för felbedömning vid samtal med uppringare med språkförbistring. Att förmedla trygghet ansågs viktigt vid telefonrådgivning till utlandsfödda vårdsökare. Distriktssköterskorna i studien eftersökte organisatoriskt stöd och utbildning för att lättare kunna arbeta med telefonrådgivning. / Background: Telephone advice and triage at health care centers constitutes a big part of the daily tasks a district nurse perform. As the tele nurses lacks visual contact with their patients, there are greater demands in the communication as opposed to face-to-face encounters. As the immigration increases in Sweden, the district nurse encounters an increasing amount of foreign born callers with language barriers. Therefore, more research in this area is necessary. Aim: The aim of this study is to describe distric nurses experiences of telephone nursing to healthcare seekers with other native language than Swedish. Method: The study design is a qualitative descriptive interview study with an inductive approach. Data was collected through ten individual interviews with district nurses in health center and the data was analyzed by content analysis. Results: Four categories emerged from the analysis: To encourage synergetic communication, To encounter obstacles in the conversation, To practice organizational strategies, To utilize one's competence. Conclusion: To pursue mutuality in communication and to conclude a common decision was seen among the most important aspects of the telephone nursing advisory. Cultural differences and language barriers caused the telephone nursing to become a challenging task for the nurses. Secondary information received through friends and relatives introduced an uncertainty to determine information correctness and whether the secrecy remained upheld. The district nurses expressed concern of misjudgment during conversations with callers who showed language inabilities. To bring security was noted as crucial in telephone nursing for foreign born callers. Furthermore, the district nurse needs to be confident in oneself. The district nurses in this study sought for organizational support and education.

Thesis (D. Min.)--Erskine Theological Seminary, 2008. / Abstract. Includes bibliographical references (leaves 131-134).

Thesis (D. Min.)--Erskine Theological Seminary, 2006. / Abstract. Includes bibliographical references (leaves 241-245).

Thesis (D. Min.)--Erskine Theological Seminary, 2008. / Abstract. Includes bibliographical references (leaves 131-134).

The purpose of this project is to develop a curriculum, which will examine the ethical methods or practices used by nurses in resolving ethical dilemmas in clinical practice utilizing the Moral Decision-Making Model for staff nurses at St.Bernardine Medical Center, Five Tower North.

The purpose of this project is to improve the existing version of the Sequential Alignment and Position Verification System (SAPVS) for functional proton radiosurgery and to evaluate its performance after improvement .

This thesis deals with the detailed documentation of the medical center . Estimated location of this building is on land No. 677/1 in Kutna Hora in the hospital Kutna Hora in the administrative area of Kutna Hora in Central Bohemia. Currently no land use. The land is owned by the investor , which is the Central Region. Newly built four-storey medical center will serve mainly for the provision of outpatient health care professional doctors and pharmacy , then there will be placed exit station emergency medical services and emergency medical call center services 155, 112 and emergency office space. The project was based on the layout of the study. The result of this work is to complete detailed documentation of the A building. Documentation includes drawings situation , surveying the situation , floor plans , sections, elevations , drawings, foundations , ceilings and details. Furthermore, a technical report , listing the elements of fire safety of the building , Thermal and acoustic assessment of the construction , specializing processed from concrete structures and building ventilation .

My thesis project is the newly built medical center. It is a detached building, which is situated on a slightly sloping terrain, which will be compensated. The building has a partial basement and two floors. In the basement there is technical support. On the first floor there is a reception, waiting room, nurses, clinic and pharmacy. On the second floor there are again waiting room, nurses, clinic and exercise room. The property is adjacent park. The building is brick ceramic blocks HELUZ is based on the footings. It has a ceiling of prestressed panels and flat roofs, one of which is designed as vegetation. The building is insulated contact system.