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.

Osteossarcoma é o tumor ósseo maligno primário mais comum, com uma taxa de incidência nos adolescentes de 8 a 11 casos/milhão entre 15 e 19 anos. No Brasil, estima-se 350 casos/ano até 20 anos. A sobrevida é de até 70% em cinco anos para os não metastáticos e 80% de sobrevida global. Quando recaem, essa sobrevida atinge 20% em um ano. Pacientes com Osteossarcoma devem ser acompanhados frequentemente com estudos radiológicos para investigação de metástases, por pelo menos 5 anos após término do tratamento , sendo mais intensivo nos dois primeiros anos, onde ocorrem a maioria das recaídas. Objetivo: Avaliar o acompanhamento do pós tratamento nos pacientes portadores de osteossarcoma. Casuística e Métodos: Estudo retrospectivo realizado na Fundação Pio XII Hospital de Câncer de Barretos, com 52 pacientes tratados de Osteossarcoma pelo Departamento de Pediatria, no período de janeiro de 2000 a julho de 2006. Os dados foram coletados através de uma ficha clínica, que constava registros sócios demográficos e clínicos. Foi realizada a análise descritiva dos dados. Para a associação das variáveis independentes ao comparecimento à consulta, utilizou-se o teste qui-quadrado. Resultados: Dos 52 pacientes analisados, 61,5 % eram do sexo masculino, com mediana de idade de 15 anos e 48,1% procedentes do Estado de São Paulo. Em relação às variáveis clínicas, 59,6% recidivaram e desses recidivados, 58% foram pulmonar. Desses com recidiva pulmonar, 44,4% no momento da recaída apresentavam queixa e não adiantaram a consulta. Não houve associação estatisticamente significativa entre as características demográficas com o comparecimento adiantado à consulta, sendo que os residentes a menos de duas horas do hospital representaram 33,3% e os que residiam há mais de 21horas de viagem 30,8% (p=0,073). Nas consultas em que ocorreram atrasos, 54,5% dos pacientes estavam hospedados em alojamento (p=0, 010). Entre os pacientes, 81,3% dos que adiantaram a consulta apresentavam queixas quando comparados com os que não adiantaram (p=0,005). Dos pacientes que recidivaram, 12,9% compareceram atrasados em alguma consulta, enquanto que os não recidivados,47,6% atrasaram em alguma consulta (p=0,006).Nas consultas em que houve atrasos, 54,5% estavam hospedados em alojamento(p=0,010). Conclusão: Em nossa experiência podemos inferir que a distância não foi fator preponderante para o comparecimento atrasado às consultas e que a maioria dos pacientes que compareceram atrasados à consulta dependiam do alojamento para hospedagem. Verificou-se que os pacientes que adiantaram a consulta apresentavam mais queixas, e estas estavam associadas ao resultado positivo dos exames realizados. Além disso, nos pacientes que recidivaram, aqueles que adiantaram a consulta não apresentaram diferença estatisticamente significativa na sobrevida livre de recidiva / Osteosarcoma, the most common malignant primary bone tumor, with incidence rates, for adolescents between 15 to 19 years old, of 8-11 cases/ million. In Brazil, it is estimated 350 cases/ year until 20 years of age. It has a survival of up to 70% in five years for the non-metastatic ones and a global survival of up to 80%. When they relapse, this survival reaches 20% in one year, and it might reach 40 % in five years. Osteosarcoma patients should be followed up, frequently, with radiologic studies to investigate metastases, for at least five years after the end of treatment, which should be more intensive in the two first years, where most of the relapses occur. Aim: To evaluate the post-treatment follow-up in osteosarcoma patients. Material and methods: A retrospective study carried out at Fundação PioXII Hospital de Câncer de Barretos evaluated 52 osteosarcoma patients who were treated by the Pediatrics Department, between January, 2000 and June, 2006. Data were collected using a clinical file which comprised socio-demographic and clinical data. Results: 52 patients were analyzed, 61,5% were male, the mean age was 15 years old, and 48,1% were from São Paulo State. In regard to the clinical variables, 59,6% of patients relapsed, and from those, 58% have lung relapses. 44,4%of the patients who had lung relapses, presented some kind of complain and did not move up their visits. There was no statistically significant difference between the demographic features and the early attendance to visits, and people who lived less than a two-hour-trip from the hospital represented 33,3% of patients whereas people who lived more than a 21-hour-trip, represented 30,8% (p=0,073). The relapse showed association with late attendance to visit, because 12,9% of relapse patients were late (p=0,006). Among the late patients, 54,5% of them were in housing(p=0,005). Conclusion: In our study, we could infer that distance was not an important factor to late attendance to visits, and most late patients depended on housing to have a place to stay. During follow-up, it was verified that early patients presented more complaints, and those were related to the positive results of the exams. Besides, in relapse patients, those who have moved up their visits, did not present statistically significant difference in the relapse-free survival

Orientadores: Maria Cecília Marconi Pinheiro Lima, Maria de Fátima de Campos Françozo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T01:04:00Z (GMT). No. of bitstreams: 1 ArdinghiBrollo_MariaLuiza_M.pdf: 3510871 bytes, checksum: 5b33da3ad30af3f705aead6a6043024c (MD5) Previous issue date: 2014 / Resumo: Vários aspectos da estrutura social estão envolvidos com a construção das políticas de saúde. As tensões decorrentes de olhares distintos para problemas comuns, a organização das ações e a escolha das prioridades, o exercício continuado das relações de poder. Estudar as políticas de saúde e a organização dos serviços não é tarefa pouco complexa. No caso das políticas de saúde voltadas às pessoas com deficiência, uma diretriz importante é um maior grau de equidade no acesso desta população às ofertas de saúde para satisfazer suas necessidades na busca de bem estar físico e psíquico. Este trabalho se propôs a analisar a implantação da Câmara Técnica de Reabilitação da Secretaria Municipal de Saúde de Campinas, como um instrumento de gestão pública. Para tanto, foi realizado um estudo qualitativo, por meio de pesquisa de fontes documentais relacionadas com a atenção à pessoa com deficiência desta secretaria. Dentre os documentos estudados, encontravam-se prospectos, atas de reuniões, relatórios e manuais, buscando-se neles os fatos e acontecimentos relacionados com a implantação da Câmara Técnica. Além disso, foram analisados questionários aplicados pelo gestor da área de reabilitação aos trabalhadores do Centro de Referência em Reabilitação, cuja finalidade era, na época, avaliar o trabalho realizado pelo grupo e planejar futuras ações. Os resultados permitiram a elaboração de um breve histórico da reabilitação no município de Campinas, contextualizando a concepção da Câmara Técnica; evidenciaram a área de reabilitação se organizando e adquirindo visibilidade na estrutura da Secretaria Municipal de Saúde; destacaram o estudo de um manual que evidenciou a organização de uma rede de atenção pautada na colaboração entre seus serviços; permitiram, na leitura das atas das reuniões da Câmara Técnica, a correlação das propostas apresentadas com fatos descritos na época. A análise dos conteúdos dos questionários ressaltou três eixos principais: a percepção de uma rede de serviços voltada à reabilitação; a constatação de mudanças internas, subjetivas nos trabalhadores que participaram da Câmara Técnica e a compreensão da interdisciplinaridade e intersetorialidade pelos mesmos. Nas falas dos trabalhadores foi possível evidenciar a autonomia do grupo técnico e de seus usuários na medida em que conheceram seus pares e se organizaram numa rede de ações e saberes. Nas falas desses trabalhadores percebemos a figura do trabalhador-cidadão que se sente parte integrante do problema e da solução / Abstract: Various aspects of social structure are involved in the construction of health policies. Tensions arising from distinct looks for common problems, the organization of actions and the choice of priorities, the continued exercise of power relations. Studying health policies and the organization of services is not just a complex task. In the case of health policies for people with disabilities, an important guideline is a greater degree of equity of this population to access health offering in order to meet their needs in the search of physical and mental well-being. This work proposed to analyze the implantation of the Municipal Secretary Health of Campinas¿ Technical Chamber of Rehabilitation as an instrument of public management. Thus, it was done a qualitative study, based on the research of documentary sources relating to the care for people with disabilities inside this organization. Among the documents studied, there were leaflets, minutes of meetings, reports and manuals, seeking in them the facts and events related to the implantation of the Technical Chamber. In addition, questionnaires applied by the rehabilitation area manager to the workers of the Rehabilitation Reference Center, whose purpose was, at the time, to evaluate the work done by the group and to plan activities for the coming year. The results allowed, in principle, the survey of a brief history of rehabilitation in the borough of Campinas, contextualizing the conception of the Technical Chamber; showed the area of rehabilitation being organized and getting visibility inside the Municipal Secretary of Health's structure; emphasized the study of a manual that showed the organization of a care network based in the collaboration between its services; allowed, in the reading of the minutes of the Technical Chamber's meetings, the correlation of proposals with facts described at the time. The analyses of the content of the questionnaires highlighted three main axes: the perception of a network of services aimed at rehabilitation; the finding of internal and subjective changes of the Technical Chamber's workers and the understanding of interdisciplinarity and intersectoriality by them. In the speeches of workers was possible to point the autonomy of the technical group and its members as they knew their peers and have organized a network of actions and knowledge. In the speeches of these workers we realized the image of the worker-citizen who feels part of the problem as well of the solution / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Orientador: César Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T20:25:56Z (GMT). No. of bitstreams: 1 Brandalise_PatriciaAndrade_M.pdf: 1718214 bytes, checksum: fb36dfb38c6e51cfd4849e6c0346f1ba (MD5) Previous issue date: 2011 / Resumo: Introdução: A discussão sobre a melhor maneira de realizar o seguimento de mulheres que foram submetidas ao tratamento de câncer de mama ainda persiste e não há consenso quanto a melhor prática. As normativas internacionais, baseadas em estudos clínicos aleatorizados, orientam que o exame físico periódico e a mamografia anual são suficientes e que outros exames que possibilitem a detecção precoce de metástases não têm impacto na sobrevida destas pacientes. Porém, a opinião das mulheres sobre este assunto não foi ainda avaliada adequadamente. Objetivos: Avaliar a opinião das pacientes que estavam em acompanhamento clínico após o tratamento de câncer de mama com exames complementares de cintilografia óssea, radiografia de tórax e ecografia abdominal sobre a suspensão destes exames em seu seguimento. Sujeitos e métodos: Durante o período de março de 2007 a junho de 2008, pacientes em acompanhamento por câncer de mama no ambulatório do Hospital da Mulher Prof.Dr. José Aristodemo Pinotti-Centro de Atenção Integral à Saúde da Mulher (CAISM) foram submetidas a um questionário que avaliava a opinião a respeito da interrupção do seguimento com exames complementares. Estas pacientes estavam necessariamente fora de tratamento com quimioterapia ou radioterapia, mas foram incluídas as que estavam em tratamento adjuvante hormonal. Foram excluídas as pacientes com doença metastática. Resultados: Foram submetidas ao questionário 116 pacientes. A maioria das mulheres entrevistadas relatou que se sentiria insegura caso parasse de realizar os exames (84%). As variáveis que se relacionaram com uma maior chance (OR) de as mulheres se sentirem inseguras foram: percepção de doença inicial (OR=7,0), idade menor que 50 anos (OR=4,01), maior escolaridade (OR=3,45) e menor tempo de seguimento (OR=2,83). Conclusões: A maioria das pacientes entrevistadas mostrou-se insegura quanto à possibilidade de suspender o seguimento que vinha sendo realizado com exames complementares. A insegurança é mais pronunciada nas mulheres com precepção de doença inicial, mais jovens, com maior escolaridade e menor tempo de tratamento / Abstract: Introduction: The discussion about the best way to perform the follow-up of women with breast cancer still persists and there is no consensus on best practice. International guidelines, based on randomized clinical trials suggests that periodic physical examinations and annual mammograms are sufficient and other exams that enable early detection of metastases have no impact on survival of these women. However, the opinion of the women about a new model of follow up was not accessed yet. Objectives: Evaluate the opinion of women who were in follow up for breast cancer with bone scans, chest X- rays and abdominal echograpy about the interruption of these exams. Subjects and methods: During the period from March 2007 until June 2008 patients monitored for breast cancer were subjected to a questionnaire regarding their opinion about the discontinuation of supplementary follow-up exams, these patients were necessarily out of treatment with chemotherapy or radiotherapy, but women who were on hormonal adjuvant treatment were included. We excluded patients with metastatic disease. Results: 116 patients were submitted to the questionnaire. The majority of interviewed women said that they would feel insecure if stopped performing the supplementary exams (84%). The variables correlated with a higher Odds Ratio (OR) for insecurity were: patients with a perception of their disease as initial (OR=7.0), patients younger than 50 years-old (OR = 4.01), with higher educational level (OR = 3.45) and shorter follow-up (OR=2.83). Conclusions: The majority of interviewed patients are insecure about the possibility of suspending the current follow up with supplementary exams. The insecurity is more pronounced in women with a self perception of early disease, younger ones with higher educational level and shorter follow up time / Mestrado / Oncologia Ginecológica e Mamária / Mestre em Ciências da Saúde

Orientador: Marcio de Moraes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba. / Made available in DSpace on 2018-08-19T03:59:09Z (GMT). No. of bitstreams: 1 Rodrigues_RenatoMarano_M.pdf: 1149996 bytes, checksum: b41fcb207a02454e6a29a366464ada15 (MD5) Previous issue date: 2011 / Resumo: O objetivo deste trabalho foi avaliar separadamente a eficácia do tratamento realizado pelo serviço de cirurgia bucomaxilofacial da FOP-UNICAMP em três lesões ósseas que podem acometer a região maxilofacial: cisto ósseo simples (COS), lesão central de células gigantes (LCCG) e queratocisto odontogênico (QO). 1) 12 casos de COS, sendo a curetagem o tratamento de escolha. Nenhuma alteração dentária ou sensorial foi percebida e não houve recorrência; 2) 20 casos de LCCG, sendo o tratamento de escolha baseado na característica de lesão: 6 foram tratados por meio de cirurgia (3 ambulatoriais e 3 hospitalares). As demais lesões (14) foram tratadas com injeção intra-lesional de triancinolona semanalmente, associada a calcitonina (5 casos) ou enucleação (2 casos). Não houve recorrência; 3) 53 casos (59 lesões) de queratocisto, sendo que 47 foram tratadas por meio de descompressão e 12 por meio de enucleação. Ocorreu recidiva em 8 casos (6 por descompressão e 2 por enucleação). Todas estas foram tratadas em um segundo momento com enucleação/curetagem, associadas a ostectomia periférica. Não houve recorrência após esta segunda abordagem. De acordo com a metodologia empregada neste estudo concluímos que os tratamentos adotados se mostraram efetivos e com resultados semelhantes aos de outros trabalhos na literatura, sendo que a escolha do tratamento a ser realizado deve levar sempre em consideração o tipo e tamanho da lesão, bem como as condições clínicas/anatômicas e radiográficas da lesão, assim como a colaboração do paciente / Abstract: The objective of this study was to evaluate separately the effectiveness of the treatment by oral and maxillofacial surgery service by FOP-UNICAMP in three bone lesions that may affect the maxillofacial region: simple bone cyst (SBC), central giant cell lesion (CGCL) and odontogenic keratocysts (OQ). 1) 12 cases of SBC, and curettage treatment of choice. No dental or sensory changes were noted and no recurrence, 2) 20 cases of CGCL, and the treatment of choice based on characteristic lesions: six were treated by surgery (3 hospital and 3 outpatient). The remaining injuries (14) were treated with intra-lesional triamcinolone weekly associated with calcitonin (5 cases) or enucleation (two cases). No recurrence, 3) 53 cases (59 lesions) of OK, and 47 were treated by decompression and enucleation through 12. Relapse occurred in 8 cases (6 per second for decompression and enucleation). All these were treated in a second time with enucleation / curettage associated with periferic ostectomy. There was no recurrence after this second approach. According to the methodology used in this study, the standard treatment proved effective, with results similar to those of other studies in literature, and the choice of treatment to be performed must always take into account the type and size of the lesion, as well as clinical conditions/anatomical and radiographic lesion, as well as the collaboration of the patient / Mestrado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Mestre em Clínica Odontológica

This experimental study was designed to evaluate the effect of planned teaching on the self-medication practices of ambulatory cardiac patients. The sample was composed of forty male and female cardiac patients who were over the age of forty-five years, who lived at home and were of low socio-economic status. They all lived in a large urban centre and attended an outpatient clinic for medical attention. All were taking digoxin and thirty-six, 18 from each group, were also taking a diuretic. They were randomly assigned to two groups, experimental and control, when they visited the outpatient clinic. The twenty patients in the control group were given the usual routine factual information during their clinic visit. The twenty patients in the experimental group received additional planned teaching over a thirty-minute period by the researcher. The data were gathered by means of a twenty-item questionnaire designed to elicit information regarding the self-medication behavior of the study population. The questionnaire was administered in the homes of the patients ten to fourteen days following their visit to the outpatient clinic. Three hypotheses were tested in the study. Analysis of the data in relation to Hypothesis I indicated a statistically significant difference in the number of self-medication errors in digoxin and diuretics made in a twenty-four-hour period by patients in the experimental group as compared with the control group. The experimental group made significantly fewer errors. Although patients in the experimental group made fewer errors of the four types of errors studied with regard to Hypothesis II, there was not a statistically significant difference in errors related to time, dosage and non-prescribed medications made in a twenty-four-hour period by patients in the experimental group as compared with the control group. There was, however, a statistically significant difference in the fourth type of error--that of omission. The testing of Hypothesis III showed a statistically significant difference in the level of knowledge of the two groups of patients. The experimental group had a higher level of knowledge of their medications. The study concludes with consideration of implications for nursing practice and research. / Applied Science, Faculty of / Nursing, School of / Graduate

The increasing waiting times to access healthcare services are a major concern for pa-tients in hospitals. Due to the unpredictability of health issues, hospitals and clinical ser-vices are provided to patients even without prescheduled medical appointments. Unex-pected and random patient arrivals can result in high waiting times. Waiting occurs most-ly because of insufficient resources available compared to demanding service delivery requirements at a given time. Thus, appropriate management of resource scheduling over time can help reduce patient wait times. So far, simulation has mostly been used as a support for strategic decision making in healthcare environments. We are proposing a complementary approach, namely, real-time simulation, to support operational decision making rather than long-term strategic decision making. Real-time simulation is a technique used to get a timely prediction of the system status in a near future (e.g., a few hours). Hospitals can benefit from the capa-bilities of real-time simulations by predicting upcoming bottleneck occurrences in patient care processes and make effective decisions in the present time to avoid undesirable out-comes in the near future. This research presents real-time simulation capabilities for short-term operational decision making of patient care processes in hospitals and the possible ways to run alter-native scenarios and evaluate their results to come up with the most effective solution considering various factors. This thesis also provides tool support based on a leading simulation environment, namely Arena. The tool-supported methodology is evaluated through a realistic cardiac care process in an Ontario community hospital, with encourag-ing results.

The aim of this study is to determine the effect of two approaches of social work intervention, a continuity approach, and a team approach, upon the three dependent variables of subject satisfaction, control, and mood. In order to determine differences in outcome, subjects were administered psychological tests to determine changes in their reported sense of control and mood (hopelessness) in relation to their response to the diagnosis and treatment of cancer. At follow-up, subjects also completed a questionnaire designed to determine their satisfaction with social work services received. The amount of time spent in contact with social workers was also assessed at this time. The analysis of the relationship between these variables revealed that there were no statistically significant differences between the study groups; subjects were equally satisfied with the two approaches in social work intervention, and there were no major differences between the reported changes in mood and control by the subjects in the study groups. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This exploratory study examined the phenomenon of loss as expressed by the spouses of myocardial infarction patients. The purpose of the study was to describe the thoughts, feelings, actions and observable behaviours of the spouses from the initial impact of illness to six weeks post myocardial infarction and to develop a framework, based on the literature, which related the concept of loss to the experience of spouses of M.I. patients. The study was conducted with a convenience sample of 12 spouses, ten women and two men, whose partners had experienced their first myocardial infarction. Using a semi-structured interview guide with open-ended questions, the investigator interviewed each subject four times over a six week period; from the initial impact of illness to approximately six weeks post myocardial infarction. Each interview covered three content areas: thoughts, feelings and actions. Broad open-ended questions were used to elicit data on the spouses thoughts, feelings and actions. During the interview the investigator observed the verbal (type, quality, characteristics of speech, focus of conversation) and non-verbal (activity, eye contact, body language, appearance) behaviours of the spouses. An empirical inductive approach was used as the methodology for this study. Data coding and analysis were approached using the constant comparative method, an inductive method of discovering grounded theory developed by Glaser and Strauss (1967). The findings revealed that the spouses experienced behaviours in response to loss that were common and formed a pattern through time. Three distinct phases were identified: Phase I The Event and Initial Spousal Response; Phase II Reaction to the Event; Phase III Impact of the Event. The phases were described further in light of the constructs formulated from the literature review: (1) Reactions to Loss; (2) The Elements of Loss; (3) The Meaning of Loss. This study was designed to provide insight into understanding the event of a myocardial infarction within the context of the phenomenon of loss. The findings supported the use of a loss framework for assessing the reactions of spouses who are threatened with the death of their partner. Nurses are in a critical position to assist spouses experiencing loss. Implications and recommendations for nursing education, practice and research were delineated in light of the conclusions of the present study. / Applied Science, Faculty of / Nursing, School of / Graduate

Approximately 49 million Americans are 65 years and older, 80% of whom have ≥1 chronic condition, while nearly 70% of Medicare beneficiaries have ≥2 such conditions. Moreover, avoidance of medical care is frequently seen among older adults; a national survey reported that over 33% of participants avoided seeking care even when they suspected that they should go to the doctor. Healthcare avoidance, especially by older adults, can result in adverse health and economic outcomes including higher use of emergency department (ED), longer inpatient stays, and poorer health status, alongside emotional burden. Studies have shown that perceived satisfaction of care and the need to seek care as a result of presence of illness are associated with care seeking behaviors. Thus, this study aimed to examine the extent to which these enabling and need factors translate to care seeking behaviors among Medicare beneficiaries. This is a cross-sectional study that includes 13,441 Medicare beneficiaries who responded to the 2018 Medicare Current Beneficiary Survey (MCBS). MCBS provides information on the beneficiaries’ medical conditions including healthcare utilization, healthcare access, and satisfaction with care. Multivariate logistic regression analyses were conducted to test the association between satisfaction of available care by specialists; satisfaction with the quality of medical care received the year before; presence of chronic illness like cardiovascular diseases (CVD), diabetes, arthritis, lung disease (chronic obstructive pulmonary disease (COPD), asthma, etc.) and depression, with care seeking behavior among Medicare beneficiaries. Care seeking behavior, which is the outcome of interest, was defined using three measures: not doing anything to avoid going to the doctor, not keeping sickness to self, and going to the doctor as soon as one feels sick. Of the total respondents, only about 29% showed care seeking behavior. Being male, being Hispanic, and having more than high school education were significantly associated with higher care seeking behavior. Lower likelihood of care seeking behavior was seen among beneficiaries who were dissatisfied with ease getting to doctor from home [adjusted odd’s ratio (aOR)=0.635; p