Healthcare agencies and researchers identify several areas in which healthcare disparity affects elder, African-American diabetics including higher rates of diagnosis, higher limb amputation, increased kidney failure, and stroke. While the disparities have been documented, elder, African-American diabetics rarely have been invited into discussions concerning these disparities, research questions, project or program design, and results. They are not asked to be stakeholders in health care or health policy discussions. This study used grounded theory as a participatory action research method to invite elder, African-American, diabetics into the discussion using focus groups. The patient participants then suggested providers they believed to be "successful" in their care who were then interviewed. The analysis suggests that where patient/ provider communication has been peripheral that care and perception of care and patient suffer. Where successful communication was central to the patient/provider relationship, provider preconceptions lessened and patient compliance levels rose. This dissertation offers several downstream, midstream, and upstream recommendations using a patient-focused lens. / Ph. D.

The purpose of this study was to determine whether the job satisfaction and motivating potential of nursing jobs would be higher for nurses using Patient Focused Care (PFC) compared with nurses not using PFC. Nurses from a large metropolitan hospital served as subjects. Data were collected using three instruments designed to measure job satisfaction and motivating potential. Those instruments were the Job Diagnostic Survey, the Job Descriptive Inventory, and the McCloskey/Mueller Satisfaction Scale. It was hypothesized that nurses working on PFC nursing units would demonstrate greater job satisfaction and motivating potential than nurses working on non-PFC nursing units. The hypotheses were not supported. Results were explained by, among other things, accounting for the nature of the instruments used. The two instruments which gave data counter to the hypothesized direction were not nursing-oriented.

<p> </p><p>Syftet med denna studie var att undersöka hur stor del av ett dagarbetspass som sjuksköterskor på en medicinavdelning ägnar sig åt omvårdnad i relation till andra arbetsuppgifter samt sjuksköterskans uppfattning om den tid denne lägger ner på olika arbetsuppgifter. Metod som använts var observation av nio sjuksköterskor med avseende på tidsåtgång för sex fördefinierade arbetsuppgifter; administration, omvårdnad, läkemedelshantering, ansvarsområden, rond och rapport. Enkäter delades även ut till sjuksköterskorna på avdelningen gällande självskattning av tidsåtgång för arbetsuppgifterna samt instämmande till påståenden angående deras uppfattning om tiden räckte för de olika arbetsuppgifterna. Resultatet visar att sjuksköterskorna lägger ned mest tid på administration följt av omvårdnad, rond, läkemedelshantering, rapport och sist ansvarsområden. Omvårdnad utgjorde 21 % av den sammanlagda arbetstiden och de uppgav att de för närvarande inte har tillräckligt med tid för denna arbetsuppgift.</p><p> </p> / <p>The aim of the study was to examine how much time nurses at a medical ward spend on nursing care in relation to other work assignments during a daytime shift and the nurses' own view on the time they spend on the different work assignments. Nine nurses were observed regarding time requirement for six predefined work assignments; administration, care, medication, areas of responsibility, round and report. Questionnaires were also distributed to the nurses at the medical ward concerning self-assessment of time requirement for the work assignments and their opinions if they had enough time for the different tasks. The result showed that the nurses spent most time on administration, followed by care, round, medication, report and areas of responsibility. Nursing care represented 21 % of the total working time for the nurses and the nurses reported that they do not have enough time for it.</p>

Syftet med denna studie var att undersöka hur stor del av ett dagarbetspass som sjuksköterskor på en medicinavdelning ägnar sig åt omvårdnad i relation till andra arbetsuppgifter samt sjuksköterskans uppfattning om den tid denne lägger ner på olika arbetsuppgifter. Metod som använts var observation av nio sjuksköterskor med avseende på tidsåtgång för sex fördefinierade arbetsuppgifter; administration, omvårdnad, läkemedelshantering, ansvarsområden, rond och rapport. Enkäter delades även ut till sjuksköterskorna på avdelningen gällande självskattning av tidsåtgång för arbetsuppgifterna samt instämmande till påståenden angående deras uppfattning om tiden räckte för de olika arbetsuppgifterna. Resultatet visar att sjuksköterskorna lägger ned mest tid på administration följt av omvårdnad, rond, läkemedelshantering, rapport och sist ansvarsområden. Omvårdnad utgjorde 21 % av den sammanlagda arbetstiden och de uppgav att de för närvarande inte har tillräckligt med tid för denna arbetsuppgift. / The aim of the study was to examine how much time nurses at a medical ward spend on nursing care in relation to other work assignments during a daytime shift and the nurses' own view on the time they spend on the different work assignments. Nine nurses were observed regarding time requirement for six predefined work assignments; administration, care, medication, areas of responsibility, round and report. Questionnaires were also distributed to the nurses at the medical ward concerning self-assessment of time requirement for the work assignments and their opinions if they had enough time for the different tasks. The result showed that the nurses spent most time on administration, followed by care, round, medication, report and areas of responsibility. Nursing care represented 21 % of the total working time for the nurses and the nurses reported that they do not have enough time for it.

While the beneficial effects of psychotherapy have been well documented, the fact remains that 5 to 10 percent of clients get worse while in treatment (Lambert & Ogles, 2004) and a large minority of patients show little response (Hansen, Lambert, & Forman, 2003). The effects of four interventions, aimed at reducing deterioration and enhancing positive outcomes were examined in an Immediate Electronic Feedback sample of 1101 patients whose outcome was contrasted across experimental groups and with two archival groups: the Week-Delayed Feedback group, consisting of archival data from 1374 patients and the treatment-as-usual control group consisting of archival data from 1445 patients. Results indicate that feedback to therapists improved outcome across clients, especially for signal-alarm cases. Therapist feedback effects were enhanced by the use of manually based Clinical Support Tools, but not by providing direct feedback to clients about their progress. There were no significant differences in outcome between the Week-Delayed CST feedback and the 2-Week-Delayed CST feedback groups; however, clients in the Week-Delayed CST feedback condition, attended 3 less sessions, on average, than their 2-Week-Delayed CST feedback counterparts. Furthermore, a significantly greater number of people in the Week-Delayed CST Feedback group ended treatment in the Recovered/Improved classification of the Jacobson/Truax model.

While most clients show improvement in therapy, anomalously, 5% to 10% actually worsen, and a significant minority of clients shows little or no response to therapy. Earlier studies developed clinical support tools (CSTs) designed to provide feedback to therapists about potential problem areas and to improve the likelihood of a positive outcome for clients identified as at-risk for a negative outcome in therapy (Harmon et. al. 2007; Slade, Lambert, Harmon, Smart, & Bailey, 2008; Whipple et al., 2003). While varying from study to study, the CSTs looked at five domains: therapeutic alliance, motivation to change, social support, life events, and perfectionism. More than 100 questions were used to assess these domains. The major goal of this study was to streamline the CST measures to increase efficiency. Toward that end, a new instrument consisting of 37 questions was developed by administering questionnaires to 169 patients at a rural Utah mental health center. In addition, the life events and social support questions were given to 76 students at Brigham Young University and 88 randomly selected residents of Utah County. Using item response analysis and mean scores for each dimension, subscale cut scores were developed for four dimensions: therapeutic alliance, motivation for therapy, social support, and life events. The perfectionism subscale was dropped from the questionnaire because perfectionism was deemed to be too stable to be useful for the intended use of the measure. Cut scores were also developed for each individual question. These subscale and individual item cut scores are intended to help clinicians identify potential problem areas to be explored during the course of therapy.

Diese publikationsgestützte Dissertation umfasst Arbeiten zum Thema Monitoring und Feedback in der stationären Psychosomatik. In zwei Arbeiten wurde untersucht, ob die Effektivität von psychosomatischen Behandlungen gesteigert werden kann, wenn Therapeuten regelmäßig Feedbackberichte der Monitoring- und Feedbacksoftware OQ-Analyst erhalten Hier zeigte sich, dass Feedback den Outcome von Patienten mit erhöhtem Risiko einer Verschlechterung verbessern kann. Bei den restlichen Patienten dagegen konnte Feedback den Therapieprozess nur schwach und nur kurzfristig für eine Behandlungswoche verbessern. In einer weiteren Arbeit wurde untersucht, ob sich unterschiedliche Belastungsgrade im wöchentlichen Monitoring differenziell verändern. Hierfür wurde das ICD-10-Symptomrating herangezogen. Die Ergebnisse lieferten Hinweise darauf, dass sich depressive Beschwerden und Angstbeschwerden schon in der ersten Behandlungswoche verbessern, somatoforme Beschwerden jedoch erst im späteren Behandlungsverlauf. Die vierte Arbeit setze sich mit der Fragestellung auseinander, ob Therapiebeziehung, soziale Unterstützung, Motivation, und Lebensereignisse mit bedeutsamen Verbesserungen und bedeutsamen Verschlechterungen assoziiert sind. Während alle vier Bereiche mit bedeutsamen Verbesserungen verknüpft waren, waren nur soziale Unterstützung und Lebensereignisse mit bedeutsamen Verschlechterungen assoziiert. / This dissertation is based on four publications on monitoring and feedback in psychosomatic in-patient therapy. In two publication it was investigated whether the effectiveness of psychosomatic in-patient therapy can be increased when therapists routinely receive the feedback reports of the monitoring and feedback software OQ-Analyst. Feedback could improve the outcome of patients at risk of treatment failure. For the remaining patients, feedback could optimize the therapy process only slightly for one treatment week. In another publication, the ICD-10-Symptom-Rating was used to explore how different symptoms change on a weekly basis. While depressive symptoms and symptoms of anxiety disorders improved already in the first treatment week, more treatment weeks were required to improve somatoform symptoms. In a fourth publication, associations between considerable positive as well as considerable negative change and the therapeutic alliance, social support, motivation, and life events were investigated. While all four factors were associated with considerable improvements, only social support and life events correlated with considerable deteriorations.

Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced. This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment. The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded. The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated. An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.

<p>Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced.</p><p>This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment.</p><p>The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded.</p><p>The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated.</p><p>An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.</p>

Made available in DSpace on 2014-12-17T14:13:28Z (GMT). No. of bitstreams: 1 AnnataliaMAG.pdf: 525935 bytes, checksum: 09c7dcbf450f58547b91f6293fe51bae (MD5) Previous issue date: 2008-10-29 / This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals? human and technical competence, the hospital?s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user?s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user?s perspective as a socially critical ethnoevaluator / Este estudo etnogr?fico investiga a experi?ncia vivida do paciente internado em hospital p?blico (HPU) e privado (HPR) no Nordeste brasileiro. Os participantes da pesquisa foram 28 pacientes adultos atendidos nas diversas cl?nicas. Os dados foram estudados pelo m?todo O Percurso do Paciente , consistindo de uma combina??o complementar e articulada de t?cnicas - observa??o livre, observa??o participante, entrevista etnogr?fica e narrativas do paciente, coletadas prospectivamente durante a hospitaliza??o, desde a sua chegada at? a alta. A an?lise ocorreu conforme a T?cnica de An?lise Categorial Tem?tica e os dados foram interpretados ? luz dos referenciais te?ricos da Antropologia M?dica, humaniza??o do cuidado e promo??o da sa?de. Foram observados os princ?pios ?ticos da Resolu??o 196/96. O hospital humano, revelado pelo paciente, destaca a import?ncia da subjetividade. Das 411 unidades de significados desveladas, 225 (54,7%) foram no hospital p?blico (HPU) e 186 (45,3%) no hospital privado (HPR). Os resultados indicam que o paciente etnoavalia no HPU e no HPR aspectos da compet?ncia humana e t?cnica do profissional da sa?de, a estrutura e funcionamento hospitalar, o acesso e a ?tica na condu??o das finan?as; e desenvolve estrat?gias de supera??o da hospitaliza??o. Esta etnoavalia??o ? mediada por diversos fatores: condi??o socioecon?mica, personalidade, religiosidade, discurso ir?nico, diagn?stico sombrio e necessidades atendidas, experi?ncia anterior de hospitaliza??o e condi??es da entrevista. Uma proposta pedag?gica para humaniza??o hospitalar dever? vincular-se ?s mudan?as estruturais, gerenciais e organizacionais dos servi?os; utilizar-se de metodologias ativas que visem ? politiza??o, ? problematiza??o das situa??es concretas de trabalho e ? inclus?o dos afetos e intersubjetividades; al?m de constituir-se em aprendizagem coletiva. O estudo mostra a import?ncia de a etnoavalia??o do usu?rio ser incorporada ao projeto da gest?o e aten??o hospitalar como orientadora de decis?es e a??es cl?nicas, consistindo em promotora de pr?ticas que levem a um cuidado resolutivo, digno e humanizado. A multidisciplinaridade da pesquisa permitiu ampla apreens?o da perspectiva do usu?rio como etnoavaliador cr?tico social