Providing effective foster care is a major undertaking that continues to plague this country. The ultimate goal of substitute care is to provide child victims of maltreatment with a safe and nurturing home environment. The goal of this theory driven research project was to identify ecological factors correlated with effective non-kin family foster care. Various levels of analysis were considered including individual, family and community. The findings of this study identified three factors as significant predictors of effective foster care. Included are implications for social work in the areas of practice, policy, and research.

Syfte: Syftet med studien var att skapa djupare förståelse kring sjuksköterskors upplevelse av mellanmänsklig kommunikation med patienter med annan kulturell bakgrund. Bakgrund: Kommunikation spelar en viktig roll i kulturen och är en stor del av relationen mellan individer. Kommmunikation är en grundbult i sjuksköterskans arbete och är av högsta vikt för att kunna erbjuda en patientcentrerad och säker vård. Transkulturell medvetenhet är essentiellt för god vård, speciellt som världen blir alltmer mångkulturell. Såväl sjukvårdsturism som utökade globala samarbeten inom Hälso- och sjukvården ökar kraven på kulturell kompetens bland sjuksköterskor. Indien är ett föregångarland inom sjukvårdsturism och människor från olika kulturell bakgrund reser dit för sjukvård. Metod: Semistrukturerade intervjuer genomfördes med 12 sjuksköterskor mellan 23 och 53 år från två indiska sjukhus. Sjuksköterskorna möter ofta patienter med olika kulturell bakgrund. En tematisk innehållsanalys utfördes på det insamlade materialet. Resultat: Två tematiska inriktningar framkom från materialet; ett tema med fokus på praktiska verktyg och tekniker för att arbeta med patienter med annan kulturell bakgrund och det andra temat handlar om att bibehålla vårdkvaliteten. Utökade språkkunskaper och kommunikationsverktyg skulle underlätta sjuksköterskans arbete. Kulturell medvetenhet leder till ett ökat självförtroende hos sjuksköterskan och hjälper denna förutse eventuella behov hos patienten. Slutsats: Transkulturell medvetenhet och kommunikationsverktyg bidrar till en säkrare och mer effektiv vård. Sjuksköterskeutbildningen behöver lägga mer fokus på kulturell mångfald inom hälso- och sjukvård. Mer forskning krävs inom detta område då vården globaliseras allt mer. / Aim: The aim of the study was to gain a deeper understanding of interpersonal communication as experienced by nurses working in culturally diverse hospitals in India. Background: Communication is an important part of culture and a base in any interpersonal relationship. Communication is a foundation in the nursing occupation in order to give patient centered care which is safe and effective. Transcultural awareness in nursing is an important factor in order to give good care, especially as the world is becoming more multicultural. Medical tourism along with the expanding network of global interactions in healthcare ads to the necessity of developing culturally competent nursing care. India in one of the forerunners in medical tourism and cares for patients from many different cultural backgrounds. Method: Semi-structured interviews were conducted on a sample of 12 nurses between the age of 23 and 53, working with diverse patients at two different hospitals in India. A thematic content analysis was performed. Results: The developed themes focus on specific tools and techniques for working with culturally diverse patients and how to sustain the quality of care in diverse hospital settings. Language resources and tool which aid in communication would alleviate the nurses work. Cultural knowledge helps the nurses gain confidence and foresee possible needs of the patient. Conclusion: Highlighting transcultural interpersonal communication techniques within nursing leads to a safer and more productive practice of nursing care. Nursing education needs to prioritize cultural diversity in health care. More research needs to be conducted on the subject of interpersonal communication in culturally diverse hospital settings since healthcare is a continuously growing globalized organization.

Childcare programs that provide high quality care can strengthen children's early development. One component of a quality program is having providers who are knowledgeable in child development; however, despite the understanding of these known predictors of child development, Wyoming does not require childcare providers to complete any training before beginning to work with children. Guided by the constructivist theories of Piaget, Vygotsky, Dewey, and Bruner, this objectives-based program evaluation investigated the Pathways to Professional Development program to determine participants' perceptions of the strengths and weaknesses of the program. A researcher-produced survey was created based on the objectives of the program and consisted of open-ended and Likert scale questions. This survey was completed by 35 childcare providers who completed the 3 modules of the Pathways program. Data analysis began by identifying potential categories, comparing and contrasting emerging themes, and looking for emerging patterns in participant responses. Key results indicated that the participants of this program gained knowledge about child development and developmentally appropriate practice. The implications for social change from this research are directly related to the early childcare providers, children, and ultimately the communities of Wyoming. By increasing the knowledge of childcare providers, higher quality care can be provided, leading to positive relationships, stimulating learning experiences, and to a greater likelihood of children reaching their full potential.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18191号 / 社医博第52号 / 新制||社医||8(附属図書館) / 31049 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 佐藤 俊哉, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Primary informal caregivers are mainly responsible for the care of persons with Alzheimer's disease (AD). Research has shown that the quality-of-life (QoL) experienced by unpaid caregivers of persons with AD is generally lower than the QoL of caregivers of persons who do not have AD. The literature does not report on any studies undertaken to examine whether caregivers' QoL is related to the level or quality of care that they provide to persons with AD. This thesis investigated the association between caregiver QoL and the level or quality of care provided. I conducted a systematic review and found no study designed specifically to examine this association. I included only one study in the systematic review because it contained variables that were relevant to caregiver QoL and the level or quality of care. However, this single included study did not specifically examine the association between QoL and level or quality of care. In addition, I could not find an instrument designed specifically to measure level or quality of care in AD. To answer this question, I contacted the authors of the single study included in the systematic review and obtained their dataset. Quantitative analysis of these data did not show a statistically significant association between caregiver well-being (surrogate for QoL) and level or quality of care. Further, I conducted a qualitative study of AD caregivers to obtain data on the components of a useful questionnaire for measuring level or quality of care. Caregivers suggested the development of a questionnaire that addresses the following areas: case management approach, increasing care demands due to declining status of the care recipient, social support, and the role of hired help. The thesis concludes with an integrative discussion of the aforementioned studies. I discuss important areas for future research, including the need for a longitudinal study. / Thesis / Doctor of Philosophy (PhD)

Bakgrund: Stress rapporteras som en av de vanligaste hälsoriskerna för vårdpersonal och en bidragande faktor till det redan höga antalet sjukdagar bland sjuksköterskor. Samtidigt ingår det i sjuksköterskans roll och ansvar att leda och samordna omvårdnadsarbetet i syfte att tillgodose varje patients individuella behov utifrån bestämda riktlinjer med ett förhållningsätt som grundas på en humanistisk människosyn, men också att vårda sin egen hälsa. Syfte: Att beskriva sjuksköterskors upplevelser av arbetsrelaterad stress. Metod: Litteraturöversikten omfattar tio vetenskapliga artiklar, som behandlar nio kvalitativa studier samt en studie som använt mixad metod. Artiklarna kvalitetsgranskades och vid dataanalysen tillämpades Fribergs analysmetod. Resultat: Resultatet beskrivs utifrån tre teman: Att arbeta i en kravfylld miljö, Att arbeta trots bristande kommunikation och samarbete samt Att sakna organisatoriskt stöd. Sammanfattning: Kravfyllt arbete och hög arbetsbelastning visade sig vara tydligt sammankopplat med upplevelse av arbetsrelaterad stress hos sjuksköterskor. Vidare framkom det att även bristfällig organisation samt bristande kommunikation och samarbete var förenat med arbetsrelaterad stress. Det stressfyllda arbetet gick dessutom ut över sjuksköterskornas fysiska och mentala hälsa vilket i sin tur ledde till försämrad motivation. Slutligen konstaterades att arbetsrelaterad stress hos sjuksköterskor inverkade negativt på omvårdnadsarbetet och därmed äventyrades kvaliteten på vården. / Background: Stress is reported as one of the most common health risks for healthcare workers and a contributing factor to the already-high number of sick days used by nurses. The role and responsibilities of a nurse include leading and coordinating nursing work in order to meet each patient’s individual needs while abiding by specific guidelines based on a humanistic approach, as well as caring for their own health. Aim: The aim of this literature review was to describe nurses’ experiences of work-related stress. Method: This literature review was based on ten scientific articles, including nine qualitative studies and one mixed-method study. The articles were reviewed for quality and analyzed using Friberg’s method. Results: The results are described using three themes: Working in a demanding environment, Working despite lack of communication and collaboration, and Lacking organizational support. Summary: Demanding work and high workload were clearly linked to the experience of work-related stress amongst nurses. Inadequate organization and lack of communication and collaboration were also associated with work-related stress. The stressful work affected nurses’ physical and mental health, which led to impaired motivation. Finally, work-related stress amongst nurses was found to have a negative effect on their nursing work, thus jeopardizing the quality of care.

No description available.

BACKGROUND AND PURPOSE OF RESEARCH: Nigeria’s National Health Insurance Scheme (NHIS) was setup to secure universal access to affordable quality care. However, after 11yrs, and despite launching different programs, NHIS coverage is still less than 3% nationally, and out-of-pocket payments (OOP) remain the major health financing mechanism. The reasons for the low level of enrollment in NHIS are not well understood. Quality of care may be a factor in enrolment. This study compares technical and perceived quality of care between NHIS enrollees and the uninsured, using diabetes as a tracer condition. It also compares OOP and generic prescription patterns by health insurance enrollment status. METHODS: We conducted a cross sectional clinic-based intercept study. Subjects were adult diabetes patients recruited from 10 NHIS accredited hospitals in Abuja, Nigeria. Data collection included survey and chart review, covering technical aspects of quality – performance of eye and feet exam and HbA1c request; perception of quality, generic medication prescribing pattern and OOP. We performed logistic regression analysis to evaluate the effect of NHIS enrollment status on the technical quality of care, perceived quality of care, generic prescribing and OOP. RESULTS: Out of 455 participants, 149 (33%) were NHIS enrollees, 10 (2%) were enrolled in private health insurance and 296 (65%) had no insurance. After adjusting for correlated data and controlling for facility, BMI, chronic disease score, age, sex, and education, patients under NHIS coverage were 0.85 times less likely to have eye exam (Cl=0.4–1.8), 0.98 times less likely to have feet exam (Cl= 0.4–2.2), and 0.98 times less likely to have A1c test requested (Cl= 0.7–1.3), compared to those without insurance. These findings were not statistically significant at alpha=0.05. On the other hand, compared to the uninsured, NHIS covered patients perceived care to be worse even though they spent significantly less, 56% (Cl=45%–69%) in OOP in public hospitals. DISCUSSION/CONCLUSION: Perception of care quality under the NHIS could be a contributory factor to the reluctance of prospective enrollees. To advance towards the goal of universal health coverage, NHIS must strengthen policy to overcome identified barriers such as medication stock outs and wait times at the facility level.

SAMMANFATTNING   Bakgrund: Psykisk ohälsa ökar och kan ses som en folksjukdom. Psykisk ohälsa leder till ett lidande för individen och dennes omgivning. Roller man har haft förändras och tidigare normala händelser kan upplevas som misslyckade. Förändringarna orsakar förlust av kontroll och ett minskat egenvärde.    Syfte: Att undersöka patienter med psykisk ohälsas upplevelser och erfarenheter av vårdandet inom hälso- och sjukvård.    Metod: En litteraturstudie med deskriptiv design baserad på totalt elva kvalitativa artiklar hämtade från PubMed och CINAHL.    Resultat: Totalt framkom fyra kategorier som beskriver patienters upplevelser och erfarenheter av vårdandet. Dessa var upplevelser av bemötandet av sjukvårdspersonal, upplevelser av att bli sedd som en människa, upplevelser av sjuksköterskans roll, upplevelser av vårdmiljön och upplevelser av familjens involvering i vårdandet.    Slutsats: Utifrån huvudresultaten i denna litteraturstudie framkom det att det finns flera förbättringsområden som bör uppmärksammas av den enskilda sjuksköterskan och av sjukvården i stort, för att utveckla och förbättra vården för denna patientgrupp. Upplevelser av att inte bli sedd som en människa och att bli dåligt bemött kan indikera att det finns outtalade negativa uppfattningar om denna patientgrupp, vilket innebär att det finns ett behov av ett fortsatt arbete för att förändra sjuksköterskans, och även annan vårdpersonals, attityder gentemot dessa patienter. / ABSTRACT  Background: Mental illness is increasing and can be seen as a public disease. This leads to suffering for the individual and his surroundings. Roles you have had change and previously normal events can be experienced as failures. The changes cause a loss of control and a reduced intrinsic value.   Aim: To investigate how patients’ with mental illness experienced the care they received in healthcare.   Method: A literature study with a descriptive design based on total of eleven qualitative articles retrieved from PubMed and CINAHL.   Result: A total of four categories emerged that describe patients’ experiences of care. These were experiences of the treatment of healthcare personnel, experiences of being seen as a human being, experiences of the role of the nurse, experiences of the care environment and experiences of the family's involvement in the care.   Conclusion: Based on the main results of this literature study, it emerged that there are several areas of improvement that should be addressed by the individual nurse and the healthcare system in general, in order to develop and improve the care for this patient group. Experiences of not being seen as a human being and being treated badly may indicate that there are unspoken negative perceptions of this patient group, which means that there is a need for continued work to change the attitudes of the nurse, and also other healthcare staff, towards these patients.

Missed nursing care, according to Kalisch and Williams, is nursing care that is not completed to the highest quality of care, leading to an increase in hospital costs and poor patient outcomes. Missed nursing care can occur with any patient population; however, a survey by Kasich called the MISSCARE Survey has only been used in the adult and neonatal populations. Pediatric patients are a diverse and complex subset of the population, differing greatly from the adult and neonatal populations, thus identifying a need for a focused pediatric survey to effectively study missed nursing care in the pediatric setting. The purpose of this research, therefore, was to create and validate a pediatric nursing care survey A convenience sample of 10 pediatric experts completed the Expert Panel Survey to determine a content validity ratio (CVR) and content validity index (CVI) of a modified, MISSCARE Survey (Kalisch & Williams, 2009). Items determined to be essential by ninety percent or more of the participants (CVR> 0.78), were included in the MISSCARE-Pediatric Survey. Results showed that the CVI of the MISSCARE-Pediatric Survey determined by the Expert Panel was 0.9, meaning the items are essential to the pediatric population (Gilbert & Prion, 2016a). The created MISSCARE-Pediatric Survey includes 18 questions in section A (Types of Missed Nursing Care), 28 questions in section B (Reasons for Missed Nursing Care), and 9 questions in Demographics. Future research will determine content reliability of the MISSCARE-Pediatric Survey.