The issue of overcrowding has become one of the major concerns within the Department of Correctional Services in S.A. According to Judicial Inspectorate of Prisons quoted in Annual Report (2002/2003:4) in 2002 the South African offender population has been overpopulated by 72 000. The 236 correctional centres designed to accommodate 100 668 offenders were accommodating 172 071. The focus of this study is to explore the impact of prison circumstances in perpetuating recidivism. Glencoe correctional center is identified as the target centre. The total offender population has been estimated at 950 with 650 offenders being categorised as recidivists. The conclusions were drawn and presented as follows: • Peers have been found to be exercising a crucial role in influencing the behaviour of the offenders. The impact of this influence has been found to be posing a challenge on both individual and family values. • The impact of prison life manifested through processes like the use of drugs, involvement in gangs and identification with the prison life. • The prison system has not been able to convince the iii offenders in terms of fighting crime. Lack of proper security measures, lack of skills training interventions, unemployability of the offender and lack of job opportunities have been identified as challenges that disqualify the prison system as an effective crime prevention institution. • Lack of personnel and lack of policy implementation knowledge are some of the challenges associated with the difficulty in evaluating the appropriateness of rehabilitation programmes. • Sustaining the prison subculture manifested through processes such as identification with the negative role models, purposeful alienation from the community and condoning of violence. • The family system has been identified as another institution that contributes to the development of the prison subculture. • Family-related aspects were identified by the respondents as an area affected by imprisonment. • As indicated in by the theory of Kohlberg in Glick iv (1995:110), high levels of moral development would serve to keep offenders from committing further crime. • To promote offender’s readiness to face the societal life from a positive point of view, there is a need for assistance in drafting individual plans and strategies. • The expectations of the respondents on effective offender reintegration were shared and the relevant role-players were identified. Having drawn the conclusions, the following recommendations were made: • The research focused on sociologically related factors and as a result the need for further research, especially on biologically related factors, emerged. • The scope of the research widened to such an extent that the contributory factors of recidivism were covered at a more general level. Further research to cover the individual factors in more depth is recommended. • There is a need for structures to exercise advocacy intervention on behalf of the offenders in such a manner that they would have a say in issues affecting them. v • Attendance of rehabilitation programmes and demonstration of behavioural change should be awarded in order to serve as a motivation for positive behaviour change. • The need for equipping prison officials to be effective rehabilitators has been identified as a challenge to the prison system. • Integrated functioning of different role-players would serve to promote effective offender reintegration. • The offender needs to be assisted to envision and plan for the future. / Mrs. H.F. Ellis

published_or_final_version / Journalism and Media Studies Centre / Master / Master of Journalism

We give overcrowding estimates for the Sine(beta) process, the bulk point process limit of the Gaussian beta-ensemble. We show that the probability of having exactly n points in a fixed interval is given by e(-beta/2n2) log(n)+O(n(2)) as n -> infinity. We also identify the next order term in the exponent if the size of the interval goes to zero.

Masters in Public Administration - MPA / Overcrowding in prisons is a global phenomenon that undermines efforts by prison or correctional system officials to rehabilitate offenders so that they can be successfully reintegrated into society. Overcrowding in South African correctional facilities has been identified as a key challenge, which negatively affects the ability of the Department of Justice and Constitutional Development (DOJ & CD) and the Department of Correctional Services (DCS) firstly, to guarantee the rights of inmates and secondly, to create an environment that is conducive for rehabilitation. The legislation and statutory framework outline the options available to both South African courts and Correctional Officers for imposing non-custodial sentencing. Non-custodial sentencing can be imposed on: (a) offenders found guilty by courts of law and given noncustodial sentencing; and (b) offenders already in custody who are eligible for parole or correctional community supervision, in accordance with the dictates of applicable legislation. However, despite the visible gains and benefits provided for within the South African legal framework and statutory books on alternative sentencing, South African prisons continue to be overcrowded. Studies show that in the last 15 years South African correctional facilities have not experienced a situation whereby its population was below 120%. This study aims to explore the role of leadership in the implementation of non-custodial sentencing and subsequent reduction in overcrowding within the correctional facilities. Following a qualitative research approach, the researcher conducted interviews with executive leaders and operational managers of the three Western Cape management areas to determine the role of leaders in the implementation of non-custodial sentencing. In total five (5) executive leaders and ten (10) operational managers were interviewed. The findings showed that there is a need for the Department of Justice and Constitutional Development (DOJ & CD) and the Department of Correctional Services (DCS) to have a structured approach with regard to the implementation of non-custodial sentencing when dealing with problems that affect overcrowding, including the implementation of non-custodial sentences by the leadership of the DOJ & CD and the DCS.

Antalet besök till akutmottagningar runt om i Sverige ökar årligen. Ökat inflöde av patienter resulterar i ökad belastning, ”Overcrowding” och ”Exit-block” och influerar på patientens vänte- och vistelsetid på akutmottagningen. En tilltagande tillströmning av patienter kan påverka patientsäkerheten och medföra ökad risk för vårdskada. Simultant pågående arbetsprocesser gör akutmottagningens vårdmiljö särskilt utsatt för medicinska misstag. Säker vård är en essentiell kärnkompetens och en central del i sjuksköterskans arbete för att upprätthålla patientsäkerhet.  Syftet med studien var att beskriva sjuksköterskors upplevelser av patientsäkerhet på akutmottagning. Datainsamlingen genomfördes genom kvalitativ metod. Semistrukturerade intervjuer genomfördes på en akutmottagning i Mellansverige. Åtta sjuksköterskor, med minst ett års yrkeserfarenhet på akutmottagningen, intervjuades. Insamlat material analyserades genom en kvalitativ innehållsanalys. Genom analysen framkom att sjuksköterskorna upplevde att ökad belastning, patientens omvårdnadsbehov, akutmottagningens bemanning och arbetsmiljö påverkade patientsäkerheten på akutmottagningen. Tilltagande söktryck med förlängda vistelsetider på akutmottagningen med ”Overcrowding” och ”Exit-block” som följd, komplexa omvårdnadsbehov och tidsbrist påverkade förutsättningarna för säker vård och god omvårdnad. Två övergripande kategorier formulerades genom analysens förfarande: När vårdbehovet överstiger resurserna och Sjuksköterskans utmaningar i att upprätthålla patientsäkerheten. Resultaten i denna studie tyder på att sjuksköterskor på en akutmottagning upplever sitt omvårdnadsansvar som både utmanade och påfrestande vid ökad belastning vilket påverkar patientsäkerheten negativt. Omvårdnadsarbetet på akutmottagningen påverkas vid ökat inflöde av patienter, ”Overcrowding” och ”Exit-block” vilket utsätter patienten för risker. Vidare tyder resultatet på att akutmottagningens resurser ibland inte är tillräckliga för att uppfylla kraven för god omvårdnad, hög patientsäkerhet och säker vård. Studiens slutsats antyder att sjuksköterskorna upplever patientsäkerheten på akutmottagningen som bristfällig och att patientsäkerheten påverkas negativt av ”Overcrowding” och ”Exit-block”.

Bakgrund: Nedskärningar inom sjukvården har lett till att antalet akutmottagningar i Sverige minskat drastiskt. Vistelse- och väntetider ökar årligen. Fler patienter som väntar längre på akutsjukvård orsakar overcrowding på akutmottagningen. De resurser som finns tillgängliga räcker då inte till för antalet patienter i behov av akutsjukvård och arbetsbelastningen blir överväldigande. Att patienter drabbas av vårdskada när de söker vård har statistik och forskning visat. Däremot saknas forskning kring hur overcrowding påverkar omvårdnaden på akutmottagningen och hur overcrowding i förlängningen orsakar vårdskador relaterat till utebliven omvårdnad. Syfte: Att belysa vilken betydelse overcrowding har för omvårdnad på akutmottagningen. Metod: Litteraturöversikt med integrerad analys. Databassökning i Cinahl, Medline och Swepub på sökorden “overcrowding”, “nursing”, “patient safety” och “emergency department” gav 15 kvalitativa artiklar. Efter att dessa kvalitetsgranskats inkluderades samtliga 15. Resultat: Två huvudkategorier identifierades. Den första huvudkategorin patientsäkerhet innefattar sju underkategorier; materiel räcker inte till, lokaler räcker inte till, svårigheter att följa rutiner och behandlingsmål, påverkan på prioritering av patienter och deras behov, påverkan på informationsöverföring och dokumentering, förlorad kontroll samt ökad vårdskada. Den andra huvudkategorin vårdkvalitet innefattar tre underkategorier; utebliven omvårdnad, svårigheter att upprätthålla värdighet samt påverkan på sjuksköterskan. Slutsats: Resultatet visar att overcrowding på akutmottagning har en negativ inverkan på omvårdnaden. Vid overcrowding påverkas flera faktorer på akutmottagningen och dessa utövar samtliga en effekt på sjuksköterskans möjlighet att ge god omvårdnad till patienten. Detta fenomen inte är något unikt för den enskilda akutmottagningen, utan att brister i omvårdnaden på grund av overcrowding är ett problem världen över. / Background: Cuts in healthcare have led to a drastic reduction in the number of emergency departments in Sweden. Residence and waiting times increase annually. The increased number of patients who wait an extended amount of time for emergency care causes overcrowding in the emergency department. The resources available are then insufficient for the number of patients in need of emergency care and the workload becomes overwhelming. Statistics and research have shown that seeking care can cause the patient to suffer from patient harm. But there is a lack of research on how overcrowding affects nursing in the emergency department and how overcrowding in the long run causes patient harm related to missed nursing care. Aim: To shed light on overcrowding and its meaning for nursing in the emergency department. Methods: Literature overview with integrated analysis. Searches in the databases Cinahl, Medline and Swepub for the keywords “overcrowding”, “nursing”, “patient safety” and “emergency department” yielded 15 qualitative articles. After these had been run through quality audits, all 15 were included. Results: Two main categories were identified. The first main category patient safety includes seven subcategories; equipment is not enough, premises are not enough, difficulties in following routines and treatment goals, impact on prioritization of patients and their needs, impact on information transfer and documentation, lost control and increased patient harm. The second main category quality of care includes three subcategories; lack of care, difficulties in maintaining dignity and the impact on the nurse. Conclusion: The results show that overcrowding in the emergency department has a negative impact on nursing. In case of overcrowding, several factors are affected in the emergency department and these all have an effect on the nurse's ability to provide good care to the patient. This phenomenon is not unique to the individual emergency department, shortcomings in nursing due to overcrowding are a worldwide problem.

Bakgrunden var att överbeläggningar inom akutsjukvården har ökat de senaste åren i och med högre patientantal. Syftet med denna studie var att beskriva sjuksköterskans upplevelser av arbetet vid överbeläggningar på en akutmottagning. Metoden var en kvalitativ deskriptiv design där information samlades in via intervjuer. För att analysera data från de åtta informanterna valdes en kvalitativ innehållsanalys. Studien genomfördes på en akutmottagning i mellersta Sverige. Huvudresultatet från de åtta intervjuer som genomfördes skapade tre kategorier med tio subkategorier. Samtliga informanter berättade om sina upplevelser av att arbeta vid överbeläggningar. De mest frekventa upplevelserna handlade om en stressad och frustrerande arbetssituation. De uppgav att upplevelserna av störningsmoment och irritation blev mer förekommande vid överbeläggningar samt att de upplevde otillräcklighet. Stressen uppenbarade sig på olika sätt hos sjuksköterskorna. De stressade situationerna avspeglade sig i sjuksköterskornas yrkesroll, hälsa och privatliv. Många sjuksköterskor upplevde även att patienternas säkerhet försummades vid överbeläggningar, då de fick ligga i korridoren. Detta upplevdes ge ökade risker för smitta, minskad sekretess och integritet för patienterna. Det sjuksköterskorna upplevde som positivt vid överbeläggningarna var att de inom arbetsgruppen försökte stötta varandra samt att arbetstiden gick fort. Slutsatsen var att sjuksköterskorna upplevde stress, frustration, irritation och störningsmoment på sitt arbete, akutmottagningen, vid överbeläggningar. Arbetsgivarna för akutmottagningen bör uppmärksamma arbetsmiljön för sjuksköterskorna så att de kan ge stöd till dem, så att de ska veta vart bristerna finns samt för hur de ska fördela resurserna vid överbeläggningar. / The background was that overcrowding in emergency care has increased in recent years with higher patient numbers. The aim of this study was to describe nurses' experiences of the work in an overcrowded emergency department. The method was a qualitative descriptive design where information was collected through interviews. To analyze the data from the eight informants a qualitative content manifest analysis was chosen. The study was conducted in an emergency department in a hospital in central Sweden. The main results from the eight informants indicate that overcrowding leads to major problems. The most frequent experiences was about a stressful and frustrating work situation. The nurses felt that distraction, insufficiency and irritation was occurring at the overcrowding. The stressful situations reflected in nurses' professional roles, health and personal life. Many nurses felt that patients' safety was overridden at overcrowding. Patients must be in the corridors which gives increased risk of infection, poorer and reduced privacy. The thing that nurses experienced as positive in overcrowding was that the work group tried to support each other and working hours passed quickly. The conclusion was that the nurses experienced stress, frustration, irritation and distraction from their work, the emergency department, at overcrowding. Employers at the emergency department should pay attention to the work environment for nurses so that they can support them, so they'll know where the weaknesses are and how they should distribute resources when the ward is overcrowded.

Bakgrund: Brist på vårdplatser innebär att en patient får vårdas på en vårdplats som inte uppfyller kraven på utformning, utrustning och säkerhet eller att kunskapen hos sjuksköterskor inte stämmer överens med vårdbehovet (Socialstyrelsen 2016, s. 93). Syfte: Att undersöka om patientsäkerheten påverkas vid platsbrist och överbeläggning. Metod: Examensarbetet är en litteraturstudie där 11 artiklar granskats och analyserats samt presenteras i resultatet. Resultat: Överbeläggningar och utlokaliseringar leder till ökade vårdskador och orsakar ett lidande för patienten. Brister i sjukvårdsmiljön visade sig genom att utrustning eller läkemedel inte var tillgängliga, vilket ledde till ytterligare fördröjning av behandling för patienten och till en förlängd sjukhusvistelse. En annan effekt var ökad risk att smittas av vårdrelaterade infektioner.

Master of Public Health - MPH / Background: The largest focus areas for the department of health is ensuring access to quality healthcare. The district health system (DHS) model remains the vehicle used by the district managers to deliver on the health department’s goals, objectives and priority focus areas. Strengthening the district health system platform is therefore important to the department to improve access and quality of care to the clients serviced in the province. The district hospitals play a fundamental role since they support primary health care (PHC) and serve as the entry point to more specialised care. The efficient management of beds in the district hospitals is the key in ensuring access to care and preventing bed blocking. Bed Utilisation Rate (BUR) and Average Length of Stay (ALOS) are indicators used to measure the efficiency of hospital beds. This study provides a description of the trends in bed utilisation within the inpatient wards of eight district hospitals in the Cape Town metro district in the 2016-2017 financial period. Methodology: To analyse and compare wards a quantitative approach was used. Inpatient ward activity reports for eight district hospitals were accessed from the department of health’s routine data collection repository. A total of fifty-five wards were compared across small and large hospitals for BUR and ALOS during the financial year period 1 April 2016 to 31 March 2017. Data entry was done in MS EXCEL and analyses were done using STATA 11.0.

Emergency Departments (ED) are highly dynamic environments comprising complex multi-dimensional patient-care processes. In recent decades, there has been increased pressure to improve ED services, while taking into account various aspects such as clinical quality, operational efficiency, and cost performance. Overcrowding has become a major barrier to receiving a proper and timely emergency care in many acute hospitals throughout the world. Patients often face long waiting times to be seen and treated. Those who require admission may even wait longer. The scope of this research is to focus on ED factors that lead to overcrowding and their management. Technology is being cited as one of the management tools, specifically the utilization of Radio Frequency Identification (RFID) for tracking patients as their journey progresses through an ED. Like any technology, RFID has potential and pitfalls. The author chose to use Failure Mode and Effect Analysis (FMEA) as a tool to explore the possible failures of RFID technology as it is utilized in one of the ED in Riyadh Military Hospital (RMH). This particular ED has been used as a case study to explore those failures and, with the use of FMEA, propose a set of recommendations to address those failures and improve the design and implementation of RFID. The experience of RMH-ED was explored through interviews and a survey in which 100 participants took part. The survey touched upon various aspects of this experience. This was due to the various roles of the surveyed staff who were involved with this technology. These roles ranged from front line clinical staff to administrative staff, management staff and technical support staff. Data analysis showed convincing evidence of the positive impact RFID had on managing ED overcrowding. However, and as expected, there are some pitfalls and failures that FMEA helped identifying and suggested potential solutions to them. RFID is a small link in the chain of other technological innovations and solutions. It is by no means capable of solving the problems associated with ED overcrowding by itself. Most of the search carried out by the author identified large variation in approaches to dealing with the issue of ED overcrowding. Those ranged from applying more human resources to altering the pathways of managing patients journey through healthcare system to applying more intermediate layers of management to ease the pressure of the Emergency departments. Other approaches included some aspects of technology such as development of early warning systems that have not been widely adopted and remained as isolated efforts.