La satisfaction du patient et du personnel sont considérés comme des indicateurs importants afin de mesurer la qualité dans le secteur hospitalier.<p>Dans les services de revalidation, les rencontres thérapeutes-patients présentent une valeur significative par le temps consacré, l'approche thérapeutique mais également la relation qui découle du processus de soin.<p>L'objectif de la recherche fut d'évaluer la satisfaction du personnel travaillant dans les services de revalidation physique (thérapeutes et techniciens ou assistants) et les différents variables démographiques ou liés à l'environnement du travail ainsi que la satisfaction des patients traités dans ces services.<p><p>Une analyse transversale par questionnaire a permis de mesurer la satisfaction au travail et les éléments de productivité dans les services de revalidation. Simultanément, une enquête concernant la satisfaction des patients a été réalisée dans ces mêmes départements. La recherche fut effectuée au sein de dix centres hospitaliers au moyen d'un questionnaire d'enquête commun basé sur le modèle " Effort- Reward Imbalance" ou “déséquilibre efforts-récompenses” et des informations complémentaires sur les conditions de travail ont étés collectées au moyen de questionnaires spécifiques. L’étude met en évidence des variables démographiques tells l'âge, la nationalité, le niveau d'éducation, ainsi que la charge travail et les types de cas traités comme facteurs significatifs influençant le stress au travail.<p>Les résultats confirment une corrélation positive entre le stress au travail par le déséquilibre Efforts-Récompenses et la performance quantitative (productivité) des thérapeutes en revalidation. Il est basé sur la satisfaction des thérapeutes en fonction des heures de travail, du nombre moyen de patients par jours ainsi que des mesures de productivité élevées du département. En ce qui concerne les récompenses perçues comme positives, le soutien du médecin et du superviseur apparaissent comme facteurs de motivation importants. Il a été également déterminé que les thérapeutes appréciaient la participation et l’expression de son opinion dans la gestion thérapeutique du patient. Bien qu’une corrélation entre la satisfaction des patients et le degré de stress au travail des thérapeutes n’ait pas été démontrée, ces deux mesures varient de manière significative en fonction des types d’hôpitaux et du degré de « Over-commitment » des thérapeutes dans leur travail.<p>Les déterminants essentiels de la satisfaction des patients en revalidation apparaissent toutefois liés à l’intervention du thérapeute tel que sa capacité à rassurer le patient ou la qualité de l’information liée au plan de traitement et doivent être considérés dans l’approche thérapeutique en revalidation.<p>Les résultats de l’étude ont permis de concevoir un modèle systémique de satisfaction et de stress au travail résumant les éléments liés de manière significative au déséquilibre des efforts et récompenses dans les services de revalidation physique et qui pourrait inspirer les directeurs ou gestionnaires hospitaliers a promouvoir une atmosphère de travail positive. <p><p>Patient and staff satisfaction are considered as important indicators to monitor quality in healthcare. In rehabilitation services the patient and therapist encounters are of significant value by the amount of time, the therapeutic approach but also the personal relations in the care process. The aim of the research was to evaluate the staff job satisfaction in physical rehabilitation services and the related variables as well as its correlations to patients’ satisfaction. <p><p>A cross sectional survey approach in the rehabilitation services has measured the job satisfaction and the related elements of productivity. Simultaneously a survey of the patients’ satisfaction was performed. As the research in the physical rehabilitation services was conducted in ten different health care facilities of the Jeddah region, a common assessment tool was utilized based on the Effort Reward Imbalance (ERI) model and complementary information were collected using specifically developed survey questionnaires. Socio-demographic variables such as age, nationality, work specialty, educational levels, as well as the caseload and workload appeared also as significantly influencing job satisfaction. <p>The findings confirmed a positive correlation between the Effort Reward Imbalance and the quantitative performance (productivity) of the rehabilitation staffs. It is supported by the level of job satisfaction of the therapists which is related to the number of patients per day, caseload, hours of work and high productivity measures. From the aspects of positive rewards, the role of the supervisor and doctors appear as important motivators. It was also found that therapists valued the fact of being given the opportunity to participate and discuss opinions in the patient management and quality improvement.<p>While no evidence confirmed a positive correlation between patients’ satisfaction about the rehabilitation treatments and the staff job satisfaction, both measured patients’ and staff satisfaction varied significantly according to the hospital type and the degree of Over-commitment. <p>Essential determinants of patients’ satisfaction appeared however related to the therapists' input, such as the ability to reassure or the quality of information given in the treatment plan and have to be taken into account when delivering the patients’ care.<p>All the results allowed the design of a systemic model of staff job satisfaction resuming the significant related elements of effort and reward in the rehabilitation services and could be utilized to inspire the hospital leaders, managers and executive directors to promote a healthy work life environment based on a valued human resources approach. <p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Cette étude s’appuie sur une recherche ethnographique commencée en octobre 2006, dans le cadre d’un doctorat en anthropologie. C’est une étude qui vise à comprendre la façon dont les relations sociales, qui articulent le continuum accueil-soins des malades, contribuent ou non à l’accès aux soins à l’hôpital Sendwe.<p><p>La plupart des études qui ont abordé la problématique de l’accès aux soins, et de l’utilisation des services de soins dans les hôpitaux publics des pays en développement, ont envisagé cette problématique davantage en termes de carence en matériel ;et réduit souvent l’essentiel des problèmes à une question financière.<p><p>Et pourtant, comme le témoignent des études récentes conduites dans les hôpitaux africains au cours de la dernière décennie, soutenues notamment par une méthodologie qualitative, alliant observations intensives et entretiens approfondis (cf. Jawkes & al. 1998 ;Gobbers, 2002 ;Jaffré & Olivier de Sardan, 2003 ;Vidal & al. 2005 ;Jaffré & al. 2009), l’accès ou non aux soins et l’utilisation des services hospitaliers recouvrent des champs plus vastes et plus complexes qui englobent à la fois des questions, bien sûr, économiques que des problèmes comportementaux d’exclusion, des violences, des humiliations… bref, des questions liées à la relation inégalitaire des pouvoirs due à la distance sociale qui s’observe entre soignant et soigné. Dans le cadre de l’hôpital Sendwe, cette inégalité de la relation soignant-soigné est particulièrement exacerbée par un contexte de misère sociale à laquelle se conjugue une bureaucratisation des tâches dont l’exécution vient ici redoubler au statut du fonctionnaire un pouvoir de soigner. C’est face à cette tension permanente entre partie en interaction favorisée par le décalage entre l’offre médicale et la demande des soins que je me suis interrogé comment les soins hospitaliers sont-ils négociés à l’hôpital Sendwe. Avec quelles ressources les parties s’engagent dans le processus d’accès aux soins ?Quelles sont les pratiques effectives qui s’observent dans les interactions avec le patient et ses proches ?Comment les patients catégorisent-ils le personnel médical, et vice-versa ?Quelles sont les règles, pratiques et morales, qui régissent leurs interactions ?C’est donc à toutes ces questions que cette étude tente de répondre. / Doctorat en Sciences politiques et sociales / info:eu-repo/semantics/nonPublished

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Practical Theology / M.Th. (Pastoral Therapy)

This phenomenological study examined the experiences of women in midlife. The primary purpose of the study was to develop and describe a model of health promotion that will facilitate self-care of women in midlife to support them in the attainment of wholeness. A theory-generative, qualitative, explorative, descriptive and contextual design was utilized to achieve the objectives of the study, namely to explore and describe women's experience of midlife transition; classify concepts of the model; describe the structure and process of a model for support of women during midlife transition, and develop guidelines for operationalization of the model. The study was undertaken in one of the northwest states of the United States of America. Purposive sampling of eight women included women between the ages of 40 and 55 years of age. Women who had undergone surgical menopause were excluded as the influence of prolonged hormone replacement therapy was seen as a bias. Data was collected by using an unstructured interview technique. Data was analyzed according to Tesch's protocol (in Cresswell, 1994:155). Guba's model (in Krefting 1991:215) was utilized to ensure the trustworthiness of the study. Ethical issues were considered throughout and these are reflected in chapter one of the thesis. The study identified two themes: (1) how the women experienced midlife and (2) how they managed it. The experiences of midlife were expressed in physical, psychosocial and spiritual changes while the management of the process was accomplished in two ways, namely self-care and the services of healthcare professionals. The researcher identified that health promotion was essential to facilitate the self-care practices of women in midlife. Essential and related attributes of health promotion were identified, analyzed and synthesized to define health promotion. The process of health promotion was then defined with a description of the structure and process of the model. Concepts identified were classified, defined and placed into relationship statements after which the model was described and evaluated. Guidelines to operationalize the model were then formulated to assist health professionals to support women in self-care for the attainment of wholeness. / Health Studies / D.Litt et Phil (Health Studies)

This phenomenological study examined the experiences of women in midlife. The primary purpose of the study was to develop and describe a model of health promotion that will facilitate self-care of women in midlife to support them in the attainment of wholeness. A theory-generative, qualitative, explorative, descriptive and contextual design was utilized to achieve the objectives of the study, namely to explore and describe women's experience of midlife transition; classify concepts of the model; describe the structure and process of a model for support of women during midlife transition, and develop guidelines for operationalization of the model. The study was undertaken in one of the northwest states of the United States of America. Purposive sampling of eight women included women between the ages of 40 and 55 years of age. Women who had undergone surgical menopause were excluded as the influence of prolonged hormone replacement therapy was seen as a bias. Data was collected by using an unstructured interview technique. Data was analyzed according to Tesch's protocol (in Cresswell, 1994:155). Guba's model (in Krefting 1991:215) was utilized to ensure the trustworthiness of the study. Ethical issues were considered throughout and these are reflected in chapter one of the thesis. The study identified two themes: (1) how the women experienced midlife and (2) how they managed it. The experiences of midlife were expressed in physical, psychosocial and spiritual changes while the management of the process was accomplished in two ways, namely self-care and the services of healthcare professionals. The researcher identified that health promotion was essential to facilitate the self-care practices of women in midlife. Essential and related attributes of health promotion were identified, analyzed and synthesized to define health promotion. The process of health promotion was then defined with a description of the structure and process of the model. Concepts identified were classified, defined and placed into relationship statements after which the model was described and evaluated. Guidelines to operationalize the model were then formulated to assist health professionals to support women in self-care for the attainment of wholeness. / Health Studies / D.Litt et Phil (Health Studies)

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Philosophy, Practical and Systematic Theology / M.Th. (Pastoral Therapy)