Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 risk-adjusted patient safety indicators (PSIs) as dependent variables. Random effects models were used in the analysis.It was found that the IQI and PSI models have different patterns. In the IQI models, CHS hospitals have lower AMI, CHF, Stroke, and Pneumonia mortality rates than hospitals in other system types. The PSI models did not indicate any systems' effects on adverse event rates. It was also found that system hospitals' compliance with the JCAHO performance area indicator for availability of patient specific information was associated with lower rates of CHF, Stroke, Pneumonia, and Infection due to medical care.The findings suggest that centralization of hospital structures may improve internal clinical processes by enhancing coordination of activities, communication between providers, timely adjustments of processes of care delivery and structures to external pressures. A lack of systems' effect on adverse events may be explained by a newness of the patient safety issues for hospitals and possible changes in reporting patterns of medical errors after the Institute of Medicine report of 1999. A system hospitals' compliance with the JCAHO performance area indicator may indicate improvements in information and clinical record systems.Hospital systems hold much potential for hospitals in improving patient quality of care and safety because they provide a laboratory for studying the health care process and sharing lessons across multiple institutions. Based on our findings, we recommend that future studies use a combination of IQIs and PSIs when examining institutional quality of care because both provide different and complementary information.

Workplace mistreatment (bullying, horizontal violence, and incivility) has been shown to impact nurses’ work satisfaction, job turnover, and physical and mental health. However, there are limited studies that examine its effect on patient outcomes. A correlational descriptive study of 79 acute care nurses was used to test a social justice model for examining the relationship between workplace mistreatment, quantified as threats to dimensions of nurses’ well-being (health, personal security, reasoning, respect, attachment, and self-determination), and nurses’ ability to provide quality patient care. In addition, this study considered the moderating effect of caring work environment among co-workers on nurses’ ability to provide quality patient care in the face of workplace mistreatment. Stories of workplace mistreatment were collected anonymously and analyzed for alignment with threats to six dimensions of well-being. Ability to provide patient care was measured using the Healthcare Productivity Survey and a caring work environment was measured via the Culture of Companionate Love scale. The results demonstrated that threats to all six dimensions of well-being described by Powers and Faden (2006) were expressed in nurses’ stories of workplace mistreatment. Furthermore, 87% reported a decrease in ability to provide patient care after an incident of workplace mistreatment. Yet frequency of threatened dimensions did not have a significant relationship with ability to provide patient care. Moreover, there was a significant moderator effect of the caring work environment on the relationship between number of threatened dimensions of well-being and ability to provide quality patient care. Nurses in high caring environments loss less ability to provide care than nurses in low caring environments when one to three dimensions of well-being were threatened. However, this relationship reversed when four or more dimensions were threatened. Implications include further research on the relationship between workplace mistreatment and nurse well-being and changing practice to include fostering a caring work environment in healthcare facilities. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

This study was designed to identify the spiritual needs of multicultural Australians with a health problem, in order to understand the educational implications for health care professionals. The rationale for the research was supported by the Australian Council for Health Service (1997) requirement that health care professionals meet the spiritual needs of their patients and clients'. At the commencement of this study, no research had been published on what these spiritual needs might be. To discover what health care professionals needed to be taught in order to meet the spiritual needs of their patients, I required a suitable group of patients. Then, after identify their spiritual needs, I wanted to explore ways in which these needs could be met. For this to occur, I also needed to identify factors that would fulfill patients' spiritual needs or prevent them from being met. This research proceeded in two stages. The first involved collecting data from all spiritual groups in Western Australia. The second involved the recruitment and interviewing a small number of ex-patients to gain their perspective of health care related spirituality and needs. To gain data about the various spiritual groups in Western Australia, I wrote to all organisations and associations, asking for information and reference material. This data was analysed using HyperResearch (1995), and themes common to all spiritual groups were developed. The inter-relationship between these themes provided the framework for an emergent model of spirituality. / For the second part of the research which involved a case study of health care patients, a qualitative methodology was used. This approach enabled me to explore the phenomenon of spirituality from the perspective of eight participants, which involved identifying their spiritual needs, the care they desired, and the rite of passage they underwent when receiving health care. The qualitative methodology enabled me to explore the subject from a sensitive holistic perspective, and to protect the integrity of the participants. I wanted to know what patients understood about their spirituality and how spiritual care could be implemented not only in clinical practice but also into health care education programs. The participants' detailed subjective experience was especially important, because I wanted to know how they identified their spiritual needs, how they had requested their needs be met by health care professionals, and the extent to which health care professionals had reacted to those cues. I formulated an 'interpretive phenomenology research' design based on the philosophical writings of Heidegger and Bakhtin. Heidegger argued that people gain knowledge of a subject from their own subjective experience, and of the person being in their world (simultaneous past, present and future thoughts). Bakhtin stated that to bring about social change, the researcher needed to understand the social context of the people's language including their culture, politics, government-provided amenities (such as education and health care), employment and social interaction, both within and outside their communities in which they live. The eight participants were interviewed a number of times in order to explore the phenomenon of spirituality beyond the notions already published in the literature (i.e. from multicultural Australian's perspective). / They told of hospital or health care experiences that included: health care for childbirth, mental and psychiatric illnesses (depression, manic-depression, and anxiety), immunology (lymphoma), stroke, detoxification of alcohol, arthritis, coronary occlusion, hypertension, and peritonitis; surgical procedured/s such as repair of hernia, bowel obstruction, eye surgery, orchiopexy (removal of testes from inguinal canal into the scrotal sac), caesarian birth, appendectomy, and oophorectomy (removal of ovaries); treatments such as radiotherapy, chemotherapy, and physiotherapy; and hospital experiences in both large and small public and private acute hospitals, private and public mental health/psychiatric hospitals, intensive care and coronary care units. These situations demonstrate the diversity of contexts which people want their spiritual needs met. The study revealed that it is not only dying patients who have spiritual need; spiritual needs exist in widespread ordinary conditions and across a wide range of health care services. The eight participants - Ann, Athika, Garry, Red, Rosie, Scarlet, Sophie, and Tom (pseudonyms) - were drawn from many of the multicultural groups resident in Western Australia including Aboriginal, Chinese, English, European, Indian, and Irish peoples. Their spiritualities encompassed Judeo-Christian, Buddhist, Hindu, Pagan Romany, Society of Friends (Quaker), Humanist, Socialist, and Communist values and beliefs. The results of the research give insight into the eight participants' perspectives on being a person, their understanding of spirituality, perceived spiritual needs, their desired levels of spiritual care, and the rite of passage they experienced when undergoing health care treatment in hospital. / The participants' spiritual needs comprised of four categories: 'mutual trust', 'hope', 'peace' and 'love'. The levels of spiritual care spoke of desiring were: 'acknowledgement', 'empathy', and 'valuing'. Recommendations are given for health care professionals to provide spiritual care for the eight participants, and implications are considered for the spiritual education of future health care professionals in order to sensitise them to the wide range of healthcare related spiritual needs they might encounter in local multicultural communities. It is recognised that the scope of the implications is contingent on further research establishing the incidence of health-care related spiritual needs among the broader population of multi-cultural Western Australians. The richness and depth of the data and the very sensitive nature of the material that came from the eight people who shared their experiences with me has rendered this thesis an important document. The nature of the various incidents and situations they shared with me, I believe, demonstrated their preparedness to tell their story so that health care can be improved. On many occasions, I felt honoured that they had sufficient trust in me to enable them to report such deep and personal suffering. For example, Rosie told me of her mental torment and of not knowing if she was alive or dead; of how she burnt her legs to try to feel pain in order to see if she was alive. It was stories such as this that gave me the passion to write this thesis well in order to do justice to all people who want spirituality included in health care treatment.

Hand hygiene compliance is one of the most important factors to prevent healtcare associated infections (HAI), which can cause unnessesary suffering, prelonged insitutional care, invalidity and higher mortality rate. It has been shown that despite regulations for hygiene compliances in healthcare, these are used unadequately. HAI affects 5-10 % of all patients in industrailized countries, in development countries the number is estimated to be up to 20 times higher. The aim of this study was to illustrate healthcareworkers hygiene compliances in patient care at a rural healthcarecentre in western India. Participant observation was used as a method, fieldnotes was taken for qualitative analysis. As a result of the analysis five fields emerged; use of handdesinfection and handwashing, complaince of gloves, the healthcareworkers clothing, use of jewlery and other hygienic aspects, which made the result. This study reveals that handhygiene complaince was poorly used by all informants, gloves was used only by one of the informants, and then only when bandaging wounds. The techniques used for both handwashing, handdesinfection and puttning on gloves was unadequate and therefor did not fullfil their purpose. Even though, the healthcare workers showed that they were aware of and thougt about hygiene in many ways. / Handhygien är en av de viktigaste faktorerna för att förhindra vårdrelaterade infektioner (VRI), vilket kan orsaka onödigt lidande, förlängd vårdtid, invaliditet och en högre mortalitet. Det har påvisats att trots att det finns riktlinjer för vårdhygien, används inte alltid dessa på rätt sätt. I industrialiserade länder beräknas 5-10 % av alla patienter att drabbas av VRI. I utvecklingsländer rapporteras siffran vara upp till 20 gånger högre. Syftet med studien var att belysa hur vårdarbetet bedrevs med avseende på vårdhygien på en vårdcentral på landsbygden i Indien. Deltagande observationer användes som metod, fältanteckningar fördes och analyserades sedan kvalitativt. Analysen utmynnade i fem områden; brukande av handdesinfektion och handtvätt, användandet av handskar, sjukvårdspersonalens klädsel, smyckeanvändning samt övriga hygienaspekter, vilka utgör resultatet. Studien visar att handhygien brukades sparsamt av samtliga informanter, handskar användes endast utav en av informanterna och då endast vid såromläggningar. Teknikerna som användes både för handtvätt, handdesinfektion samt att sätta på handskar var bristfälliga och uppfyllde därför inte sitt syfte. Trots detta visade vårdpersonalen att de var medvetna om och att de tänkte på hygien på många olika sätt.

Bakgrund: Vårdpersonal kan hjälpa patienter skapa motivation inför en beteendeförändring med motiverande samtal (motivational interviewing, MI). MI är en form av vägledning som hjälper patienter framkalla egna argument för en förändring. MI främjar även samarbetet mellan vårdpersonal och patient. Syfte: Att undersöka sjukgymnasters upplevelser av MI vid patientmöten.  Metod: Fyra sjukgymnaster som ansåg sig arbeta med MI intervjuades i en semistrukturerad intervju. Intervjumaterialet bearbetades sedan genom en kvalitativ innehållsanalys med en induktiv ansats. Resultat: Sjukgymnasterna hade övervägande positiva upplevelser av MI och upplevde att MI är bra då patienter ska genomgå en beteendeförändring. Sjukgymnasterna upplevde också att de får en bättre bild av patientens situation och ett bättre samarbete med patienten med hjälp av MI. Sjukgymnasterna upplevde att det förekommer vissa svårigheter med användandet av MI och att några patientkategorier kan försvåra arbetet. Dock upplevde de att deras arbete blivit bättre med MI och att patienten är mer delaktig i sin behandling. Slutsats: Sjukgymnasterna upplever att MI förändrat deras arbetssätt och förhållningssätt till det positiva. Författarna anser att det vore bra att göra större och kvantitativa studier för att kunna generalisera resultatet till en större population. / Background: Healthcare professionals can help patients create motivation for a behavioral change through motivational interviewing, MI. MI is a form of guidance to help patients develop their own arguments for a change. MI also promotes collaboration between healthcare professionals and patients. Objective: The purpose of this study was to study physiotherapist’s experiences of MI in patient care. Method: Four physiotherapists who considered themselves to work with MI were interviewed in a semi-structured interview. The interview material was analyzed through a qualitative content analysis with an inductive approach. Results: The physiotherapist’s experiences of MI were generally positive. The physiotherapists experienced that MI is good when patients are going to have a behavioral change. The physiotherapists also felt that they get a better picture of the patient´s perspective and better cooperation with the patient using MI. The physiotherapists felt that there are some difficulties with the use if MI as well as some categories of patients that can complicate the work. However, they feel that their own work has been improved with MI and that the patient is more involved in their treatment. Conclusion: The physiotherapists felt that MI changed their approach and attitude in a positive way. The authors think it would be good to do bigger and quantitative studies in order to generalize the results to a larger population.

Background: According to the Swedish Social Board induced abortions are increasing in the modern day society. Nurses who work with in the gynecological department can come across patients seeking care for an induced abortion. Theoretical framework: The findings of the study will be discussed in relation to Peplau's nursing theory, ethical concepts and nursing concepts. Aim: The aim of the literature review was to illuminate the experiences of nurses working with induced abortion. Method: A systematic literature review with an inductive approach was chosen. The findings are based on seven qualitative and two quantitative studies. The articles were assessed through two different modified templates based on qualitative or quantitative design. Findings: Nurses and midwives experienced their work with induced abortions as emotionally stressful. However, it was highlighted that all women have the right whether to choose abortion or to proceed with the pregnancy. Difficulties were identified in coping with abortion work. Such difficulties could easily occur when ethical dilemmas were caused by religion, personal values and experiences. Several coping strategies were identified. However, nurses and midwives aired their views concerning the need of more support from colleagues and the department head. Conclusion: It is clear that nurses are in need of assistance in various forms to ventilate and manage their emotions, in order to promote the professional approach and be able to offer a patient-centered care.

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that leads to respiratory compromise and eventually death within two to five years. Even though people with ALS must make many treatment decisions, none has such a significant impact on quality of life and survival as the one pertaining to assisted ventilation. A qualitative research study was undertaken to elicit factors that are pertinent to this decision-making process. Ten individual, semi-structured interviews were conducted with individuals with ALS. Six main themes emerged from the interviews. These are: meaning of the intervention, the importance of context, values, and fears in decision-making, the need for information, and adaptation/acceptance of the intervention. Based on these findings, it is argued that a pluralistic conception of autonomy as well as a shared decision-making model is better suited to give high priority to patient autonomy in this context. Some recommendations to improve clinical practice are proposed.

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