published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Community Medicine / Master / Master of Public Health

<p>A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.</p><p>The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.</p><p>Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.</p><p>Social desirability was lower among care utilisers and was associated with burn-related health aspects.</p><p>The participants reported a low level of negative care experiences, the most common of which was Powerlessness.</p><p>Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R² was 0.25.</p><p>In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R² was 0.19.</p><p>The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.</p>

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A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

Bakgrund: De medicinska insatser, omvårdnad och rehabilitering som erbjuds patienter i primärvård idag är vedertagna och vanligtvisevidensbaserade. Patienter kan få diagnos, behandling och ofta bot för många åkommor. En dimension som dock mindre ofta är tillvaratagen är effekterna av en genomtänkt fysisk miljö. Ett respektfullt bemötande i kombination med en genomtänkt vårdmiljö kan beskrivas som en god vårdatmosfär. Syftet med studien är att undersöka hur patienter upplever och uppfattar vårdatmosfären vid besök på en rehabiliteringsenhet i primärvård. Metod: Kvalitativaforskningsintervjuer och kvalitativ innehållsanalys Huvudresultat: En vårdatmosfär kan delas in i tre domäner: Fysisk miljö, Bemötande och Organisation. Inom domänerna finns ett antal kategoriermed variationer: Känsla av kontroll, Fysiska förutsättningar för att bli uppmärksammad, Subjektiva upplevelser av miljön, Kunskap om miljöns effekter, Uppmärksammar och bekräftar, Kommunicerar, Helhetssyn, Patienten i fokus, Delaktighet, Empati, Jämlikt möte, Att göradet ‖lilla extra‖, Innehåll och utbud, Tillgänglighet, Kontinuitet, Vårdkedjor och samverkan, Jämlik vård, Patientens rättigheter, Bemötandeandaoch förbättrings-och utvecklingsanda.Temat som framkommit är Att bli sedd, att vara värdefull. Slutsats: Till begreppet vårdatmosfär kan förutom vårdmiljö och bemötande, organisation läggastill. Organisationen ger förutsättningar eller kan försvåra. Ett tema håller samman alla kategorier och det är betydelsen av att bli sedd som ger budskap om att vara värdeful / Background: Medical treatment, care, and rehabilitation offered to patients in primary care settings are established and mostly evidence-based. Patients can receive diagnose, treatment and, quite often, cure. A dimension that receives less attention involves the effects of a carefully planned physical environment. Combined with a carefully planned environment, respectful interaction between patients and health professionals enhancesthe atmosphere of care settings. Aim: This study aimed to investigate how patients experience the atmosphere they encounter when visiting a rehabilitation unit within a primary care unit. Method: Qualitative research interviews and qualitative content analysisResults: The atmosphere in care settings encompasses three domains: physical environment, interaction between patients and health professionals, and the organization. Within these domains, categories include sense of control, physical conditionsfor to attract attention, subjective experience, knowledge of the effects of the environment, attention to and confirmation of the patient, communication, holistic view of the patient, patient in focus, participation, empathy, equality in the meeting, To do ―the little more‖, healthcare content, accessibility, continuity, cooperation, equal care, patient rights, spirit of interaction between patient and health professional, and spirit of improvement and development. The major themes that emerged were the patient’s need to be noticed and valued. Conclusion: Our results suggest that the organization should be added to the concepts of atmosphere in care settings. The organization can create and obstruct careconditions. The overarching theme of these categories is the patient’s need to be noticed and valued / <p>ISBN 978-91-86739-27-0</p>

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: All services should use quality assurance mechanisms to evaluate performance. To this end, studies have been completed in various settings including teaching clinics. Little attention has been placed on rural communities and community clinics with regards to satisfaction. This is an important aspect to investigate as these locations are valuable teaching sites. The aim of this study was to determine patient satisfaction levels at the Durban University of Technology Chiropractic Satellite Clinics (Marburg Haven Centre for the Aged [MHCA] and Narain Jeawon Vedic Centre [NJWC]). Methods: This cross sectional study (ethical approval IREC 35/15) surveyed patients with regards to their service delivery satisfaction via a researcher developed questionnaire dealing with knowledge of the clinic, environmental questions, reception and waiting area, finance, the student doctor, the assessment, treatment, overall care and future care. The study aimed to recruit the majority of patients that presented at the two clinics. The population at the was 123 files, of which 19 were active and 104 were dormant. The population at the MHCA was 237, of which 78 were active and 159 were dormant. A minimum response rate of 70% of active patients for each clinic was set for this study. This resulted in a minimum sample of 55 MHCA patients and 14 NJVC patients. The minimum response rate was achieved for this study. Data was analysed using IBM SPSS version 23. Results: The majority of patients at both clinics were satisfied although reservations were expressed regarding disabled facilities. Satisfaction was not influenced by age (p = 0.034), ethnicity (p = 0.773), gender (p = 0.169), type of visit (p = 0.355), pain rating (p = 0.058) or venue (p = 0.361). Satisfaction was influenced by the year of the student doctor (p = 0.011) and the anatomical site of injury. The overriding factor of income levels for this study neutralised the satisfaction of these patients, as the majority of patients came from poor backgrounds and were more than likely to be satisfied with the care provided. Conclusion: Patients surveyed at both clinics were satisfied. Repeated evaluations in the future would be good indicators to see if the standard of chiropractic care is upheld, and would also aid in improving facilities at both clinics. / M

After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.

Patient satisfaction has been identified as an indicator of quality care. There is no research on patient satisfaction with Nurse Practitioner (NP) care on Guam. Therefore, a cross sectional descriptive study was conducted to assess patient satisfaction with NP care at three primary care clinics on Guam. A convenience sample of patients 18 years and older, seen by an NP were invited to participate in completing the Nurse Practitioner Satisfaction Survey (NPSS). Data collection concluded after a one-month period (N = 108). Descriptive statistics, between group differences, and correlational analyses were conducted. Participation in the survey was voluntary and anonymity, confidentiality, and privacy were ensured. General patient satisfaction was very high for NP care on Guam. "My NP is caring" was the highest scoring item on the NPSS with a mean score of 4.43 (n=56). Participants selected the NP as providing the health education and care the patient found most satisfying. A statistically significant weak negative correlation between patient satisfaction and age and level of injury was found. Singles reported significantly higher patient satisfaction scores than widowers. Study limitations included the small sample size, convenience sampling, social desirability and selection bias. Caring is an essential tenet of NP care and patient satisfaction. Improving NP role clarity is vital to the continued success and growth of the NP profession. The value that NPs bring to primary care is substantiated by the high patient satisfaction levels consistently produced from studies across the globe. In order for NPs to significantly impact the primary care provider shortage all 50 states and the US territories must enact full practice authority (FPA).

Obesity is a steadily growing problem, and has both physiological and psychological consequences during pregnancy. Obese women may face discrimination which could shape their perceptions of maternity care. To date, few studies have studied the influence of body weight on patient satisfaction with care. The objectives of this study were: (1) to compare childbirth experiences and satisfaction with intrapartum care of normal weight (BMI between 18.5 and 24.9 kg/m2) and obese (BMI greater than or equal to 30.0 kg/m2) women and (2) to determine factors associated with satisfaction with intrapartum care. Guided by Barker’s (1997) pragmatic model of patient satisfaction, a descriptive comparative and correlational design was used to examine the relationship between childbirth experiences, weight discrimination, and satisfaction with intrapartum care among normal weight and obese women. Postpartum primiparous women (N = 138) in two Winnipeg hospitals completed a questionnaire package and had their chart reviewed (70 normal weight, 68 obese weight). Results: Using independent t-test, no significant differences in satisfaction with intrapartum care or childbirth experiences were found in the two weight groups. In the linear multiple regression model, perceived weight discrimination during labour and delivery was negatively associated (β = -5.78, p = 0.032), while professional support (β = 13.11, p < .001) and perceived control and safety (β = 3.25, p = 0.032) were positively associated with satisfaction with intrapartum care. Understanding factors that influence satisfaction with intrapartum care will assist healthcare providers and administrators to improve satisfaction in all women regardless of their weight. / May 2016