While insulin omission has been found to be a common behavior in those with type I diabetes, it has been primarily studied within the context of disordered eating behavior. Previous research supports medical providers and patients lack of comfort in discussing insulin omission. This study was designed to answer two questions. Why do young adult college students with type I diabetes omit insulin? and what factors facilitate and act as barriers to open communication regarding insulin omission in the patient-provider interaction. A total 13 (10 females, 3 males) college students completed a qualitative interview focused on insulin omission and communication of this behavior to medical providers, and 11 of the 13 completed a modified EAT-26. Using consensual qualitative research methods CQR (Hill, Thompson, & Williams, 1997), domains that emerged were reasons for insulin, predominant reason for insulin omission, motivators to give insulin as prescribed (i.e., adhere), overall communication of insulin omission to medical providers, and factors facilitating and barriers inhibiting communication regarding insulin omission to medical providers. Typical reasons for insulin omission included forgetting or delaying and forgetting, worrying about hypoglycemia and its social implications, being in situations where limited access to food/medical supplies, planning to be physically active, or being unsure of carbohydrate count in food. Insulin omission as a weight loss behavior was not reported by any of the participants during the interviews and all denied using insulin as a way to control their weight or shape on the EAT-26. Clinical implications and future research directions are discussed. / Department of Counseling Psychology and Guidance Services

The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables. I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements. II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up. III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage. IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate. In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.

Purpose: To examine the relationship between social engagement (SE) and health care use (HCU) in baby-boomers (age 45-64) and older adults (65+). Methods: Data from the Wellness Institute Services Evaluation Research III was used. SE was assessed using measures of formal, informal, and civic activities. HCU was assessed using administrative health care records (hospital use and length of stay, overall general and family physician use). Results: Higher formal SE indicated higher contact with physicians in general, higher hospital visits, and longer lengths of stay in hospital. Higher informal SE indicated shorter lengths of stay. Results were found while controlling for demographic variables, chronic conditions, and self-rated health. Older adults had higher HCU overall, compared to baby-boomers. Conclusion: While further research is necessary, this study has implications in determining the impact that certain types of SE can have on the health care system for different age groups.

Patient centred collaborative practice between nurses and physicians is currently being promoted worldwide. There is increasing evidence that post licensure interprofessional educational interventions improve patient outcomes but similar evidence for pre-licensure interprofessional learning is lacking. The impact of contemporary nursing and medical education on graduates’ ability to collaborate in the workplace is also unclear. To address this gap, an interview based qualitative study underpinned by hermeneutic phenomenology and informed by the theoretical lens of social identity was designed. Eleven junior registered nurses and eleven junior residents from a single healthcare jurisdiction each, in Canada and the United Kingdom (UK) were interviewed to explore how the processes that lead to socialization, professional identification and identity formation in professional schools are perceived to influence collaborative teamwork upon graduation. Data were as analyzed through iterative naive and thematic interpretations aligned with the hermeneutic process, to arrive at a comprehensive understanding. The impact of contemporary undergraduate nursing and medical education on the ability to practice collaboratively was found to be obfuscated by internal contradictions and overshadowed by the contingencies and demands of the workplace, during residency and early nursing practice in both locations. In medical schools, the intense socialization described in literature was replaced by individual reflection and a struggle to maintain work-life balance. Values internalized were of a sense of responsibility and hard work. Students espoused an attitude of collaboration but lacked training in enabling competencies and practical application. Exposure to interprofessional learning and its impact was variable and inconsistent and formal assertions of collaboration were not consistently modeled by faculty. In nursing schools, the value of caring, self-awareness and assertiveness was promoted. Training for collaboration with physicians was largely transactional and teaching about the status of the nurse vis-à-vis the physician was mired in contradictions. Residents and the nurses could not rely on their experience of professional school as they transited to the workplace. Initiation was frequently precipitous and contingencies of the workplace determined how they acted. For residents the community of clinical practice was fluid and repeatedly new. Both residents and nurses were overwhelmed by unpreparedness, workload, and responsibility and acted to get by and get the job done. Residents learned to preface doing the best for the patient and not compromising patient care, while nurses became proficient at routine tasks and found fulfilment as the patient’s advocate. There was a propensity for conflict when uniprofessional roles and values collided. In busy wards each group had interdependent but competing priorities which lead to adversarial expressions of uniprofessional identity and consequent derogatory out-group stereotyping. In contrast situations demanding urgent focused attention, such as a cardiac arrest, lead to the spontaneous formation of a collaborative team which briefly expressed an interprofessional identity. Complex cross-generational and gender based interactions were sometimes adversarial and provoked resentment. Consequently junior nurses retreated to derive fulfilment as the patient`s advocate while residents looked forward to collaborating with other health professionals on their own terms, in the future. Neither contemporary professional education nor the hospital environment sustained consistent collaborative practice. / Graduate

The General Medical Council has emphasised the importance of teaching communication skills to medical undergraduates. A two year follow-up study was undertaken, therefore, to assess the possible short-term and long-term benefits of the participation of cancer patients in communication skills training. Two hundred and forty nine third year students in the academic years 1992-1993 and 1993-94 received communication skills training (9 hours) in small groups: half the students were taught with patients who had cancer and the other half with patients who had another diagnosis. Each student was required to make a videotaped interview. These recorded interviews were evaluated by a trained rater. In addition, students completed a pre-course and post-course Attitude Questionnaire to assess their knowledge of and attitudes toward cancer and its management. Of the 1992-93 cohort of third year students, a sample of 54 students participated in the follow-up evaluation in fifth year. Fifty four Attitude Questionnaires were satisfactorily completed. All of the 54 students made a videotaped interview with a gynaecological cancer patient in a standardised setting. Each interview was rated independently by two raters. Analyses of the third year video recordings revealed differences in interview performance between the two groups. Following the course, between-group analyses and with-in group analyses identified various attitudinal differences. Analyses of the fifth year video recordings revealed that the interview performance of both groups had improved since their third year. However, those students originally taught with cancer patients were more likely to assess the impact of the symptoms on the patient's life. In addition, between-group and within-group analyses of the attitudinal data showed that both groups had retained positive attitudes with regard to the psychosocial aspects of cancer. These findings have implications for training medical undergraduates in communication skills.

Darbo tikslas - Išanalizuoti šeimos gydytojų ir bendros praktikos slaugytojų darbo krūvio pasiskirstymą darbo metu. Uždaviniai: 1. Įvertinti šeimos gydytojo darbo krūvį pacientų priėmimo metu. 2. Įvertinti bendros praktikos slaugytojo darbo krūvį. 3. Palyginti privačiose ir valstybinėse PSPC dirbančių šeimos gydytojų ir bendros praktikos slaugytojų darbo krūvį. Tyrimo metodika: anoniminė anketinė apklausa. Šeimos gydytojams ir bendros praktikos slaugytojams atsitiktine tvarka buvo pateiktos anketos, į kurias jie atsakydavo ir grąžindavo apklausėjui. Anketos buvo dalinamos darbo vietose, konferencijų, mokymų metu. Dėmesys buvo kreipiamas į apklausiamojo specialybę ( šeimos gydytojas ar bendros praktikos slaugytojas ), o ne į tai, kokioje PSPĮ jis dirba. Anketos buvo pateiktos 145 šeimos gydytojams ir 139 bendros praktikos slaugytojams. Į anketas respondentai atsakė 100%. Naudoti statistinės analizės metodai: SPSS Statistics 20.0 programa, Kolmogorovo ir Smirnovo testas, Spearman koreliacijos koeficientas, nepriklausomų imčių Stjudento t testas, blokuotų duomenų dispersinė analizė (ANOVA) su post hoc analizės Bonferonni kriterijumi, tiesinės regresijos metodas. Tyrimo rezultatai: Pastebėta, kad dubliuojasi dauguma šeimos gydytojų ir slaugytojų atliekamų manipuliacijų, kai kurių dokumentų pildymas, visos pateiktos apklausos metu funkcijos. Šeimos gydytojai daugiausiai priima lėtinėmis neinfekcinėmis ligomis sergančių pacientų. Tarp privačiose ir valstybinėse gydymo... [toliau žr. visą tekstą] / Purpose: To analyse the distribution of workload of family physicians and general practice nurses during the working hours. Tasks: 1. To assess the workload of family physician during the working hours. 2. To assess the workload of general practice nurses during the working hours. 3. To compare the workload of family physicians and general practice nurses employed in the private and public health care centers. Methods: Anonymous questionnaires were presented to the family physicians and general practice nurses in randomised order. The questionnaires were distributed at working places during conferences and training courses. The attention was drawn to the professional qualification of the interviewed person (family physician or general practice nurse) rather than to a primary health care institution where the person was employed. The questionnaires were presented to 145 family physicians and 139 general practice nurses. 100 % of the respondents presented completed questionnaires. SPSS Statistics 20.0 software was used for statistical analysis. Kolmogorov's and Smirnov's test, Spearman's correlation coefficient, Student's T-test for the independent samples, dispersive analysis of blocked data (ANOVA) with Benferonni criterion for the post hoc analysis and method of linear regression were calculated Results: The data showed that many manipulations all functions listed in the questionnaires and completion of some documents duplicated between nurses and physicians. Patients... [to full text]

Effective communication in the doctor-patient relationship is an essential component to proper diagnosis and treatment (Gordon & Gerber, 2010). While a greater focus on improving doctor-patient communication needs to be addressed, nowhere is it more important than in interactions between geriatric patients and general practitioners. This study analyzes and synthesizes the findings of 16 selected socio-medical journal articles that report on the views of geriatric patients’ needs and desires when interacting with general practitioners. The findings of this study contribute a geriatric perspective to the current debate regarding patient-centred care and also identify communication barriers and facilitators that can be avoided or used by physicians when interacting with geriatric patients. By bringing together multiple socio-medical qualitative studies that look at geriatric patients’ perspectives, this research seeks to create an evidence base that is valued by both medical practitioners and policy-makers. / Thesis (Master, Cultural Studies) -- Queen's University, 2013-09-27 14:34:32.474

This thesis critically reviews medical journal literature on the physician-patient interview. The review focuses on literature which is written by and for physicians, in Canadian and American, English language medical journals. Articles, essays and letters to the editor are examined as a cultural exchange amongst physicians that both shapes and is shaped by the values of the medical profession. Chapter One presents literature concerning physician-patient communication in general. The following Chapters Two, Three and Four ("The Physician as Medical Interpreter," "Physician and Patient: in Conflict and in Silence," and "The Patient as Narrator,") focus on themes in the medical journal literature written by physicians on the clinical interview. These Chapters examine the values, explicit and implicit, of this literature. The values are examined for possible epistemological origins in traditional medical ethics, philosophical bioethics, contemporary social movements for the dignity and rights of the individual, and other sources. Thematic shifts in these values over the past twenty years, and the sources of these shifts, are also examined. Finally, the Conclusion evaluates the significance of this literature for the development of a medical morality.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1985. / Bibliography: leaves 236-245. / Photocopy. / Microfilm. / v, 245 leaves, bound

Abstract Background The National Health and Medical Research Council and the Royal Australian College of General Practitioners recommend exclusive breastfeeding for the first six months of an infant’s life and continued breastfeeding with the addition of appropriate complementary food until at least 12 months. While most Australian women initiate breastfeeding, many wean earlier than recommended due to breastfeeding difficulties. As most women consult their GP frequently in the first six months postpartum, GPs are in an ideal position to provide encouragement, evidence-based information and advice that breastfeeding women need. In addition, women are more likely to initiate and continue to breastfeed if their doctor supports and encourages them to do so. The limited Australian data available question whether GPs have the skills to be able to effectively assist breastfeeding women, although no research has specifically addressed the breastfeeding knowledge or attitudes of Australian GPs. Additionally, there are no data detailing the breastfeeding training available to medical students, GP registrars or GPs. Aim This study aimed to identify the breastfeeding educational needs of Australian GP registrars and to develop a relevant and applicable breastfeeding educational resource within the context of these identified needs. Research design Triangulation methodology, using more than one data source and qualitative and quantitative data-collection methods, was chosen for this study to give a richer, more inclusive and wider reaching understanding of the issues involved than could be obtained by using one method alone. Therefore, to meet the aims of the study, a three phase mixed-method project with triangulation of data was designed. Phase 1 had three distinct data-collection arms: a quantitative survey of medical school curricula; focus groups with medical students from two Queensland medical schools; and interviews with eight GP registrars. Data from Phase 1 provided information about breastfeeding attitudes, knowledge needs and learning opportunities, and informed the development of a questionnaire sent to final-year GP registrars Australia-wide (Phase 2). The aim of this phase was to ascertain the GP registrars’ breastfeeding attitudes and knowledge gaps. Phase 3 used the outcomes of Phases 1 and 2 to design an educational resource that would meet the needs of GP registrars. Results Breastfeeding was included in the curricula of most of the Australian medical schools surveyed (n = 10). Many medical schools relied on contact between the student and patients to provide clinical experience and practical knowledge. Medical students and GP registrars reported marked variability in breastfeeding learning opportunities. Although both groups had positive breastfeeding attitudes, participants had differing opinions regarding doctors’ involvement in infant feeding decisions and the type of support and information offered to women. Overall, the breastfeeding attitudes of the 161 GP registrars who returned the questionnaire were positive (mean 3.99, 1 = least positive, 5 = most positive). However, while the mean breastfeeding knowledge score was 3.40, (1 = minimum score, 5 = maximum score) 40 percent of the knowledge items were incorrectly answered by more than half the cohort. Approximately 40 percent of the registrars were confident and thought they were effective assisting breastfeeding women. Nevertheless, only 23 percent thought they had had sufficient breastfeeding training. Registrars who thought their previous training was inadequate had lower knowledge scores, were less confident and perceived that they were less effective than the remainder of the cohort. A new finding from this study was that Australian-born registrars had more positive breastfeeding attitudes and higher knowledge scores than their overseas-born counterparts. In addition, while parents with more than 26 weeks’ personal breastfeeding experience (self or partner) had more positive breastfeeding attitudes and higher breastfeeding knowledge, confidence and perceived effectiveness scores, parents with less experience had less positive attitudes and poorer knowledge than non-parent participants. Similar to previous studies, gender had no effect on breastfeeding knowledge or attitudes. Using adult learning principles, a five-session, case-based breastfeeding educational resource addressing the knowledge deficits identified in the previous phases of the study was developed. Evaluation activities before and after each session, as well as exercises designed for reflection and critical thinking, were an integral part of the resource. Conclusion This study found that the breastfeeding training of Australian medical students and GP registrars was inadequate and, regardless of their positive breastfeeding attitudes, resulted in registrars being ill-prepared to assist breastfeeding women. Based on the training needs identified in the study and in the literature, an educational resource was developed that presented information within real-life case-based scenarios. Additional background information provided logic and rationale for diagnosis, management and treatment. While the implementation of the resource is outside the scope of this thesis (but will be the focus of post-doctoral work), it is believed that the resource has the potential to provide GP registrars with training opportunities to improve their breastfeeding knowledge and skills, thus better meeting the needs of breastfeeding women.