The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

Telecare and especially Mobile Care Systems are getting more and more popular. They have two major benefits: first, they drastically improve the living standards and even health outcomes for patients. In addition, they allow significant cost savings for adult care by reducing the needs for medical staff. A common drawback of current Mobile Care Systems is that they are rather stationary in most cases and firmly installed in patients’ houses or flats, which makes them stay very near to or even in their homes. There is also an upcoming second category of Mobile Care Systems which are portable without restricting the moving space of the patients, but with the major drawback that they have either very limited computational abilities and only a rather low classification quality or, which is most frequently, they only have a very short runtime on battery and therefore indirectly restrict the freedom of moving of the patients once again. These drawbacks are inherently caused by the restricted computational resources and mainly the limitations of battery based power supply of mobile computer systems. This research investigates the application of novel Artificial Intelligence (AI) and Machine Learning (ML) techniques to improve the operation of 2 Mobile Care Systems. As a result, based on the Evolving Connectionist Systems (ECoS) paradigm, an innovative approach for a highly efficient and self-optimising distributed online machine learning algorithm called MECoS - Moving ECoS - is presented. It balances the conflicting needs of providing a highly responsive complex and distributed online learning classification algorithm by requiring only limited resources in the form of computational power and energy. This approach overcomes the drawbacks of current mobile systems and combines them with the advantages of powerful stationary approaches. The research concludes that the practical application of the presented MECoS algorithm offers substantial improvements to the problems as highlighted within this thesis.

Human immunodeficiency virus (HIV) is a worldwide problem, with more than 34 million people infected with HIV/AIDS in 2011. At the end of 2011, in Nigeria, an estimated 3.7% of the adult population were living with HIV/AIDS. HIV services in Nigeria are secondary-care led, involving multidisciplinary teams and access to free antiretroviral. However, evaluations of service provision from both patient and healthcare professional perspectives, especially, pharmacists in Nigeria have never been conducted, and are the aims of this research. This study involved grounded theory methodology, using In-depth semi-structured interviews with adults infected with HIV, pharmacists, and administrators involved in the management and care of those patients at Maitama District Hospital in Abuja. HIV pharmacists working for the NHS in the UK were interviewed for comparative purposes. Thirty-five patients were interviewed. Five concepts were identified that influenced how they accessed hospital services after diagnosis. These include faith in God and antiretroviral, social issues with emphasis on HIV stigma and discrimination, patient journeys at the hospital with delays and repeat visits, obstacles such as ARV unavailability and their expectations. Also, five concepts were identified from the pharmacists’ interviews which include clinical service, impressions of service provided, social issues the patients encountered, the obstacles faced with clinical service provided and expectations for improvement. Ten patients were shadowed on their clinic days to observe the patient journey articulated. Furthermore, the administrators interviewed re-affirmed the opinions of the patients and pharmacists about many patients attending HIV clinic, few staff attending to patients, medicines unavailability, especially ARV drugs, and lack of working space for staff. Delays, few pharmacists/many patients and shortage of ART as barriers to service provision ii emerged as dominant themes across the three groups of interviewees in Nigeria. Also, it has been found that there is a wide gap between HIV patients’ hospital management in the UK and Nigeria as regards availability of antiretroviral, staff strength, number of patients in attendance on clinic days and weekly clinic days. Pharmacy was found to have a substantial role in the management of HIV/AID patients but it appears from this study that service improvements, both human and material resources are needed. Twenty three recommendations, which are further synthesised into six potential areas, are made, which, if implemented, would dramatically improve the service provision for HIV/AIDS patients at Maitama District Hospital.

Bakgrund: Patientnära rond är ett teamarbete mellan framförallt patient, sjuksköterska och läkare. Ett bra samarbete förbättrar relationen dem emellan. Dessutom har en framgångsrik rond mellan patient och sjukvårdspersonal stor betydelse för att patienten ska kunna få en säker och personcentrerad vård. Därför är det viktigt att få en djupare förståelse för hur patienter och sjukvårdpersonal upplever patientnära rond samt för betydelsen av teamarbetet vid patientnära rond. Syfte: Att belysa vilka effekter patientnära rond har på vårdteam samt att undersöka upplevelsen av patientnära rond utifrån perspektiven från både patienter och sjukvårdspersonal (sjuksköterskor, läkare och medicinstudenter). Metod: En litteraturstudie baserad på 14 vetenskapliga originalartiklar. Databaser som användes i studien var PubMed, Cochrane Library, Cinahl, SBU och SveMed. Resultat: Resultatet av denna studie indikerar att både patienter och sjukvårdspersonal upplever en ökad tillfredsställelse vid patientnära rond. Vidare visar resultatet att patientnära rond bidrar till att sjukvårdpersonal kan ge patienter en proaktiv omvårdnad, att samarbetet sjukvårdpersonal emellan blir mer effektivt och att patientnära rond gynnar medicinstudenters utveckling samt ökar studenters tillfredsställelse med sin utbildning. En utmaning som sjuksköterskor upplever i samband med patientnära rond är tidsbegränsning – framför allt upplever de att det tar tid för sjuksköterskor och läkare att synkronisera och koordinera mötet mellan patient och vårdpersonal samt att tid för dokumentation är bristande. Läkare upplever dessutom att deras autonomi minskas i samband med patientnära rond. Slutsats: Överlag kan patientnära rond vara ett effektivt sätt att främja personcentrerad vård. Patientnära rond har en positiv inverkan på teamarbete sjukvårdpersonal emellan samt bidrar till ökad tillfredsställelse hos både patienter och sjukvårdspersonal. Det finns dock behov av ytterligare forskning om patienters upplevelse av patientnära rond och vilka specifika åtgärder som kan vidtas för att sjukvårdpersonalen ska kunna samarbeta på ett mer effektivt sätt. / Background: The ward round is a team collaboration mainly between patient, nurse and physician. A good collaboration enhances the relationship between them. In addition, a successful round between the patient and the medical personnel is of great significance for the patient to have a safe and person-centered care. Therefore it is important to gain a deeper understanding of how patients and medical staff experience ward rounds, as well as of the importance of team work during the ward rounds. Aim: To shed light upon the effects of ward rounding on healthcare teams and to explore the experience of ward rounds from the perspectives of both patients and medical staff (nurses, physicians and medical students). Method: A literature study based on 14 scientific articles. Databases used in the study were PubMed, Cochrane Library, CINAHL, SBU and SveMed. Results: The results of this study indicate that both patients and medical personnel experience an increased satisfaction during ward rounds. Furthermore, the results show that ward rounds contribute in making medical personnel provide a proactive care to their patients, that cooperation between medical staff becomes more efficient, and that ward rounding benefits medical students’ development and increases students’ satisfaction with their education. A challenge that nurses experience during ward rounds is time limitation – mainly they experience that it takes time for nurses and physicians to synchronize and coordinate the meeting between patient and medical personnel, and also that the time for documentation is inadequate. Physicians also experience that their autonomy is reduced in relation to ward rounds. Conclusion: Overall, ward rounding can be an effective way to promote person-centered care. Ward rounds have a positive impact on teamwork between medical personnel and contribute to increased satisfaction among both patients and medical staff. However, there is need for further research on patients' perception of ward rounding and which specific measures that can be taken for the medical staff to be able to collaborate more efficiently.

This study examined emotional labor as a potential source of stress for nursing students, as nursing students' performance of emotional labor may impact their working lives in important ways. Participants were 107 undergraduate and graduate nursing students enrolled in a large southeastern university who completed the Discrete EmotionsEmotional Labor Scale (DEELS; Glomb & Tews, 20041, the Student Nurse Stress Index (SNSI; Jones & Johnston, 1999), the Job Descriptive Index (JDI; Balzer et al., 20001, and the Job in General (JIG; Balzer et al., 2000) scales. Two sub-samples of nursing students were identified, one of which held a registered nurse license (seasoned group; N = 54), and the other which had no previous clinical training in nursing (unseasoned group; N = 53). First, it was hypothesized that frequency of faking emotions and suppressingemotions would predict stress and satisfaction levels for the overall sample. A second hypothesis explored if seasoned nursing students engaged in higher frequencies of faking and suppression of emotion when performing clinical nursing work. Results indicated that frequency of faking emotion was negatively correlated with student nursing stress overall, and also nursing stress about interface worries. Hierarchical regression analyses revealed that faking emotion and suppression emotion while engaged in clinical nursing work were significant predictors of overall nursing student stress. In addition, faking and suppressing emotion were significant predictors of stress related to the balance of personal and professional life. However, use of emotional labor strategies did not predictstress related to personal problems, or satisfaction with either work or the job in general. Furthermore, no differences were found with regard to frequencies of faking and suppressing emotion when seasoned and unseasoned students were compared. Other findings included that clinical nursing experience was positively related to genuine expression of emotion. In addition, students reported both high levels of stress with school and high levels of satisfaction. Students suppressed emotion while engaged in clinical work more frequently than they faked emotion. Overall, results of the present study suggested a link between nursing student performance of emotional labor strategies and their stress levels.

This thesis is focused on the complex nursing care of patients colonized with the resistant microbial strains. In the theoretical section I describe the major events of the history, the current issue of the antibiotic treatment and the species of occurring resistant strains of microbes. It also deals with recommended procedures in the care for these patients, such as patient isolation, use of the protective equipment, handling of the biological material , individualization of the aids, handling of the linen and the principles of health care. It also includes preventing the spread of disease resistant strains of the microorganisms and patient recolonization. The empirical part consists of the quantitative research conducted at the University Hospital in Pilsen with the help of a questionnaire survey. The questionnaires will be distributed to the nurses in intensive care units without the single - patient box system. The aim of the research is to determine nurses' knowledge of the disease resistant microbial strains and the ways they create patient isolation. Evaluation questionnaires will provide the pieces of information to compare the individual practices and knowledge of nurses in intensive care units. Results of this work can be used as a source of information or the study material. The benefit...

This research of teleconsultation services aims to improve the quality of diagnosis and treatment for rural cardiovascular patients through utilizing distant medical expertise. Equitable access to expert healthcare as well as improved medical management for these patients can assist in modifying cardiovascular disease (CVD) risk and reduce morbidity and mortality in Saudi Arabia. The objectives were to design and develop a new care pathway for cardiovascular disease patients by utilizing teleconsultation technology, investigate factors and issues that might act as barriers to its adoption, and then evaluate the impact of this model on the stakeholders. A small scale pilot project was used to determine the issues of technology, processes and human resources required to deliver an effective service with the context of the research setting. Four primary healthcare centres, two regional hospitals, fifteen patients and sixty other participant stakeholders were included in this study. An approach using (PCP) patient care pathways was used to introduce the teleconsultation technology and integrate it within the healthcare delivery system. Compared to the traditional PCP, the modified PCP utilising teleconsultation technology improved the quality of healthcare through:  Improved access to medical care and quality of diagnosis by obtaining the expertise of a distant specialist.  More efficient medical evaluation and management.  Enhanced role of primary healthcare centres and participating hospitals by providing all levels of health services for patients.  Evidence-based referral (reduced waiting time, reduced burden on outpatient clinics). The telconsultation adoption barriers included:  Inadequacy of finance  Limited infrastructure  Legal and regularity difficulties.  Organization issues.  Literacy on technology. This study recommends the following for telemedicine implementation in the country:  Promote perception and readiness for ICT services with the healthcare community.  Enhance structural readiness including appropriate infrastructure and adequate funding, human resources and equipment.  Proactive policies to encourage growth of the telecommunication sector and to address concerns regarding privacy and security.

Introdução: Nos serviços de urgência e emergência hospitalares, a complexidade das necessidades de saúde exige cada vez mais o trabalho colaborativo em equipes interprofissionais, sendo necessária a identificação das ações para a construção das competências específicas, comuns e colaborativas. Essa identificação clarifica os papéis e fortalece o trabalho colaborativo nas equipes de urgência e emergência. Objetivos: identificar as ações específicas, comuns e colaborativas dos enfermeiros em urgência e emergência hospitalar de um hospital público do Estado de São Paulo. Método: Pesquisa descritiva, exploratória e de abordagem qualitativa, que utilizou como categorias conceituais as competências, conforme a definição de Zarifian (2003); as competências complementares, comuns e colaborativas de Barr (1998); as competências para a prática interprofissional colaborativa, propostas pelo Canadian Interprofessional Health Collaborative (CIHC) de 2010, e a definição de equipe de referência e apoio matricial segundo Campos & Domitti (2007). Para a coleta de dados foram realizadas entrevistas individuais e semiestruturadas com os enfermeiros que atuam no Pronto-Socorro de um hospital público do estado de São Paulo. Para a análise do material proveniente das entrevistas foi utilizada a técnica de análise temática de Bardin (2011). Os dados das entrevistas foram analisados para identificação do conjunto de ações específicas, comuns e colaborativas. Resultados: Os achados revelam que os enfermeiros desempenham mais ações voltadas para a gestão e articulação do cuidado, comparando-se à prática centrada na família e no paciente, que ainda é pouco realizada pelos enfermeiros. A clarificação dos papéis e a importância do saber comum destaca que o enfermeiro reconhece o seu próprio papel, porém tem dificuldade em reconhecer os papéis dos demais profissionais da equipe. A comunicação é a principal ferramenta utilizada pelo enfermeiro dentro das ações específicas, comuns e colaborativas, e está mais relacionada à comunicação instrumental e tecnicista, ou seja, à passagem de informação entre profissionais, o que mostra a necessidade de uma comunicação mais ampla, com a troca de experiências, compartilhamento de informações, entendimento mútuo e a confiança entre os profissionais. A dinâmica do setor de urgência e emergência dificulta a realização de reuniões e encontros de equipe interprofissional de urgência e emergência, portanto se faz necessária a implantação de protocolos e fluxos de atendimento para o entendimento mútuo dos processos estabelecidos, o que facilitaria o trabalho interprofissional em equipe e em colaboração dentro do Pronto-Socorro. Conclusões: Espera-se que a identificação das ações possa levar à construção de um quadro de competências específicas, comuns e colaborativas para o enfermeiro em urgência e emergência, e clarifique o papel do enfermeiro no contexto das equipes interprofissionais, fortalecendo a colaboração e contribuindo para o desenvolvimento de novas práticas de saúde neste cenário. / Introduction: In both urgent care and hospital emergency room services, the complexity of the health needs urges more collaborative work among interprofessional teams, which is necessary to identify the actions in order to build specific, common and collaborative skills. This identification clarifies the roles and strengthens the collaborative work in urgent and emergency teams. Objectives: Identify the specific, common and collaborative actions of nurses in hospital emergency care at a public hospital in the State of São Paulo. Method: Descriptive, exploratory and qualitative approach, which adopted as conceptual categories the competences, as defined by Zarifian (2003); the complementary, common and collaborative skills of Barr (1998); competencies for collaborative interprofessional practice, proposed by the Canadian Interprofessional Health Collaborative (CIHC) in 2010, and the definition of reference team and matrix support according to Campos and Domitti (2007). For data collection, individual and semi-structured interviews were conducted with nurses who work in the emergency room of a public hospital in the state of São Paulo. For the analysis of the material collected from the interviews, the technique of thematic analysis of Bardin (2011) was employed. The interview data were analyzed to identify the set of specific, common and collaborative actions. Results: The findings show that nurses perform more actions related to management and care coordination, rather than focus on family and patient issues, which are still not carried out by nurses. The clarification of roles and the importance of common knowledge highlight that nurses recognize their own role, but have difficulty in recognizing the roles of other members from the staff. Communication is the main tool used by the nurse among the specific, common and collaborative actions, and it is more related to the instrumental and technical communication, i.e. passage of information between professional, which shows the need of a broader communication, with exchange of experiences, information sharing, mutual understanding and trust among professionals. The dynamics of the urgent and emergency sectors make it difficult to hold meetings with the interprofessional teams, and those are necessary to implement protocols and service flows for the mutual understanding of established processes, which would facilitate the interprofessional work in team and in collaboration within the first-aid station. Conclusions: It is expected that the identification of actions can lead to the construction of a specific competency framework, common and collaborative, for nurses in emergency care, and also clarify the role of the nurse in the context of interprofessional teams, strengthening collaboration and contributing to the development of new health practices in this setting.

O presente estudo objetivou compreender o significado que os graduandos de enfermagem de uma Universidade Estadual Pública atribuem à Gerência da Assistência de Enfermagem. Para essa finalidade optou-se por uma abordagem qualitativa, na vertente da fenomenologia. Esse desenho metodológico contribui para iluminar a ideia de Gerência da Assistência para estudantes de graduação e procura tornar visível o que está oculto. Busca-se a essência dos significados atribuídos pelos sujeitos sobre o fenômeno investigado e procura compreender o homem segundo a realidade vivenciada por ele. Essa metodologia também possibilita desvendar os valores, as percepções e emoções dos sujeitos envolvidos. É uma filosofia que repõe as essências na existência e não compreende o homem e o mundo de outra maneira senão a partir da sua facticidade. A fim de compreender o fenômeno que este trabalho pretendeu desvelar, foi escolhido para o cenário do estudo os cursos de Graduação em Enfermagem de uma Universidade Pública, situada no Estado de São Paulo. A instituição congrega dois cursos de graduação em enfermagem. Foi realizada entrevista fenomenológica com 26 estudantes. Para o desenvolvimento da pesquisa a seguinte questão norteadora foi adotada: Qual a sua compreensão sobre Gerência da Assistência? Após as transcrições, os depoimentos foram primeiramente analisados individualmente e após globalmente, resgatando os temas: Significado da Gerência da Assistência; Exercício da Gerência da Assistência;Gerência da Assistência no campo de estágio; Gerência da Assistência e o papel do enfermeiro; Exercício Burocrático. Avaliou-se nos discursos apresentados que em diversos momentos a definição de gerência da assistência foi trazida como um processo de coordenação da unidade de trabalho, sendo que as articulações com o cuidado direto ao paciente foram poucas vezes manifestadas. Em relação à supervisão, os discursos revelam como atividade de fiscalização e controle do processo de trabalho e pouco como artifício de educação. Os discursos também apontam como uma das principais atividades da gerência da assistência o controle e organização de recursos humanos.Uma ferramenta da gerência da assistência citada pelos graduandos foi a Sistematização da Assistência de Enfermagem (SAE), destacando-a como importante instrumento para um atendimento integral e qualificado. Elucidaram que há enfermeiros que desenvolvem a SAE com a finalidade de atender às normas das instituições. Foi mencionada a dicotomia entre a teoria e a prática durante a formação; salientaram a importância do estágio e da contribuição da disciplina de gerenciamento (bloco teórico) para o entendimento da gerência da assistência. Ainda com relação ao processo formativo, referiram que durante toda a graduação o foco na abordagem gerencial acontece principalmente no último semestre de graduação. Os estudantes de enfermagem também trouxeram o conceito de atividades burocráticas. Muitos enfermeiros estão apenas cumprindo tarefas estabelecidas pela instituição e exercem atividades burocráticas; outros são tecnicistas e não desenvolvem a gerência de enfermagem. A ideia de compreender o significado da gerência da assistência para o graduando de enfermagem é um ato de repensar a prática de ensino e aprendizado. Faz-se importante expandir a população de estudo, incluindo outras instituições de ensino, sejam públicas ou privadas / The present study aimed to understand the meaning that the nursing students from a State Public University assign to the Management of Nursing Care. For this purpose, it was chosen a qualitative approach, based on phenomenology. This methodological design has helped to brighten the idea of Management Assistance for graduation students and seeks to make visible what is hidden. It is searched the essence of the meanings attributed by the subjects about the investigated phenomena and it is sought to understand the man according to the reality experienced by him. This methodology enables to unveil values, perceptions and feelings of the subject involved. It\'s a philosophy which replaces essence in existence and does not understand the man and the world in other way but from their facticity. In order to comprehend the phenomena that this work intended to unveil, nursing graduate courses from a public university located in the state of São Paulo were chosen for the study setting. The institution gathers two nursing graduate courses. A phenomenological interview was carried out with 26 students. The following guiding question was adopted for the research development: What is your comprehension about the management assistance? After transcriptions, the testimonials were analyzed individually and then globally, rescuing the theme: Meaning of Management Assistance; Exercise of Management Assistance; Management Assistance in the internship field; Management Assistance and the rule of nurses; Bureaucratic Exercise. It was evaluated that at several moments in the presented speeches, the definition of Management Assistance was translated as coordination process in the work unit, whereas the articulations with the patient direct care were only a few times expressed. Regarding the supervision, the speeches reveal as inspection and control of the work process and a little as artifice of education. The speeches also points out the human resources control and organization as one of the main activities of the Management Assistance. A tool of the Management Assistance mentioned by undergraduates was the Nursing Care Systematization (SAE), standing out itself as an important instrument for a whole and qualified care. They have elucidated that there are nurses who develop the SAE in order to suit the rules of the institution. The dichotomy between the theory and the practice on learning was mentioned; they pointed out the importance of the internship and the contribution of the administration subject (theoretical block) for the understanding of Management Assistance. Still concerning the formative process, they referred that in the whole graduation the focus on management approach happens in the last semester of graduation. The nursing students have also brought the concept of the bureaucratic activities. Many nurses are just complying with tasks established by the institution and exert bureaucratic activities; others are technicists and do not develop the nursing management. The idea of understanding the management assistance for the nursing student is an act to rethink the practice of teaching and learning. It is important to expand the study population, including educational institutions, whether public or private

by Chan Wai Kei Victoria. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 75-79). / ABSTRACT --- p.3 / Chapter CHAPTER I: --- INTRODUCTION --- p.4 / Chapter CHAPTER II: --- GLOBAL AND LOCAL HEALTHCARE REFORM --- p.7 / Chapter CHAPTER III: --- HEALTHCARE REFORM AND TEAMWORK --- p.12 / Chapter CHAPTER IV : --- LITERATURE REVIEW OF RESEARCH ON TEAMWORK --- p.15 / Chapter CHAPTER V : --- CONCEPTUAL FRAMEWORK OF THE STUDY --- p.24 / Chapter CHAPTER VI: --- METHODOLOGY --- p.32 / Chapter CHAPTER VII : --- INTERVIEW RESULTS --- p.37 / Chapter CHAPTER VIII : --- ANALYSIS --- p.53 / Chapter CHAPTER IX : --- RECOMMENDATION --- p.61 / Chapter CHAPTER X : --- CONCLUSION --- p.71 / APPENDIX : GUIDELINE FOR INTERVIEWING HEALTH PROFESSIONALS IN HEALTHCARE INSTITUTIONS IN HONG KONG --- p.72 / REFERENCES --- p.75