<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>

<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>

SAMMANFATTNING Trakeotomi är ett operativt ingrepp och innebär att man gör ett strupsnitt på halsens framsida för att skapa fri luftväg. Denna öppning, trakeostoma, som skapats på halsen hålls öppen av en trakealkanyl. Trakealkanylen sitter i luftstrupen och skapar patientens artificiella andningsväg. Trakeostomi är ett ingrepp som ökar i Sverige och görs när sjukdomar eller skador i luftvägarna eller i centrala nervsystemet försämrar eller hindrar patienten från att andas genom näsan och munnen. Ingreppet genomförs också på patienter som behöver långvarig respiratorbehandling. Komplikationer av olika allvarlighetsgrad förekommer hos trakeostomerade patienter. Vård av trakeostomerade patienter är komplext och kräver ibland fördjupad förståelse och specialistkunskap av varje enskilt aspekt och därför kan samverkan i team mellan olika professioner behövas för professionellt omhändertagande. Syftet med denna studie var att beskriva vilken effekt multidisciplinärt trakeostomiteam har på vården av trakeostomerade patienter. Studien är en litteraturöversikt och sökning av de 15 inkluderade artiklarna genomfördes i PubMed och CINAHL. Majoriteten av de inkluderade artiklarna är baserade på observationsstudier där data insamlades retrospektivt. Litteraturöversikten resulterade i följande beskrivna effekter av multidisciplinärt trakeostomiteam på vården av trakeostomerade patienter, minskade komplikationer av olika allvarlighetsgrad. De minskade vårdtiden, den totala längden på sjukhusvistelse, vistelsetid efter utskrivning från intensivvårdsavdelningen och den totala tiden på intensivvårdsavdelningen. Teamet bidrog även till snabbare handläggning och beslut om dekanylering, förbättrade kommunikationsmöjligheter för patienten men även bättre kommunikation inom teamet. Utöver detta utarbetade och implementerade teamet kliniska riktlinjer och ansvarade för utbildning av personal, patienter och anhöriga. Några få studier visade även på kostnadseffektivitet. Resultatet av denna litteraturöversikt visade att multidisciplinärt trakeostomiteam har positiva effekter i vården av trakeostomerade patienter framförallt i form av minskade komplikationer och reducerad vårdtid. Teamet bidrar även till effektivare dekanyleringsprocess och snabbare initiering av talventil. Men dessa effekter måste tolkas med stor försiktighet pga. de inkluderade studiernas metodologiska svaghet och för att resultaten inte rakt av går att generalisera och överföra till svenska förhållanden och sjukvård.

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

The dualistic South African health system is divided into a private and public health care sector. The core difference between these two sectors is that private hospitals are based on a business model with a profit motive, while public hospitals offer a free service, accessible to all citizens of South Africa and is nurse-driven. The increased need towards higher quality health care is evident in the launching of the National Health Insurance system. The pilot of this system was activated in ten sub-districts in South Africa and will become the mechanism to enhance quality and safety of patient care in the private and public sectors. Registered nurses’ reporting of quality and safety of patient care is an important factor in quality-related research and has been linked with international studies on quality of care. As the registered nurses are directly involved in all the facets of patient care, this population serves as a valuable contribution in the assessment of quality care. In this research quality of care refers to quality, patient safety and adverse events. Quality of care refers to the extent to which actual care is in conformity with the present criteria for good care. Patient safety is a parameter used to monitor and enhance quality. Through enhanced patient safety, adverse events can be prevented. Adverse events refer to all the incidents that can affect a patient during hospitalisation that is not due to the patient’s illness, such as hospital acquired infections, medication safety and patient falls with injury. This research aimed to explore and describe the nurse reported differences in quality of care, patient safety and adverse events in the adult medical and surgical units of private and public hospitals in the Free State and North West Provinces. This study was conducted within the RN4CAST research programme, an international consortium of fifteen countries working together towards the formulation of nurse workforce forecasting models. A quantitative, correlational, explorative, descriptive and contextual design was followed. The population consisted of registered nurses employed for at least one year in the selected private and public hospitals in the two participating provinces. Private hospitals with more than 100 beds were included. The public hospitals had a level three status. An all-inclusive sampling was conducted (n=332) after participants gave informed consent. Data was collected through the completion of the National Nurse Survey that covered four sections of which quality of care, patient safety and adverse events was one. Field workers were utilised during data collection. Data capturing was conducted by means of EpiData 3.1. Secondary data analysis was utilised by means of SPSS 16.0. Descriptive statistics were extracted with regard to the demographic status of the participants. The descriptive statistics were congruent with the demographic profile of nursing in South Africa. The inferential statistics included the difference in quality of care, patient safety and adverse events between the private and public hospitals in the selected provinces. Both the t-test based on the quality of care and patient safety as well as the Mann-Whitney test on adverse events indicated an insignificant difference between nurse reported quality of care, patient safety and adverse events between the private and public hospitals. Reliability and validity were assured and recommendations were formulated for nursing education, practice and research. / MCur, North-West University, Potchefstroom Campus, 2013

The dualistic South African health system is divided into a private and public health care sector. The core difference between these two sectors is that private hospitals are based on a business model with a profit motive, while public hospitals offer a free service, accessible to all citizens of South Africa and is nurse-driven. The increased need towards higher quality health care is evident in the launching of the National Health Insurance system. The pilot of this system was activated in ten sub-districts in South Africa and will become the mechanism to enhance quality and safety of patient care in the private and public sectors. Registered nurses’ reporting of quality and safety of patient care is an important factor in quality-related research and has been linked with international studies on quality of care. As the registered nurses are directly involved in all the facets of patient care, this population serves as a valuable contribution in the assessment of quality care. In this research quality of care refers to quality, patient safety and adverse events. Quality of care refers to the extent to which actual care is in conformity with the present criteria for good care. Patient safety is a parameter used to monitor and enhance quality. Through enhanced patient safety, adverse events can be prevented. Adverse events refer to all the incidents that can affect a patient during hospitalisation that is not due to the patient’s illness, such as hospital acquired infections, medication safety and patient falls with injury. This research aimed to explore and describe the nurse reported differences in quality of care, patient safety and adverse events in the adult medical and surgical units of private and public hospitals in the Free State and North West Provinces. This study was conducted within the RN4CAST research programme, an international consortium of fifteen countries working together towards the formulation of nurse workforce forecasting models. A quantitative, correlational, explorative, descriptive and contextual design was followed. The population consisted of registered nurses employed for at least one year in the selected private and public hospitals in the two participating provinces. Private hospitals with more than 100 beds were included. The public hospitals had a level three status. An all-inclusive sampling was conducted (n=332) after participants gave informed consent. Data was collected through the completion of the National Nurse Survey that covered four sections of which quality of care, patient safety and adverse events was one. Field workers were utilised during data collection. Data capturing was conducted by means of EpiData 3.1. Secondary data analysis was utilised by means of SPSS 16.0. Descriptive statistics were extracted with regard to the demographic status of the participants. The descriptive statistics were congruent with the demographic profile of nursing in South Africa. The inferential statistics included the difference in quality of care, patient safety and adverse events between the private and public hospitals in the selected provinces. Both the t-test based on the quality of care and patient safety as well as the Mann-Whitney test on adverse events indicated an insignificant difference between nurse reported quality of care, patient safety and adverse events between the private and public hospitals. Reliability and validity were assured and recommendations were formulated for nursing education, practice and research. / MCur, North-West University, Potchefstroom Campus, 2013

Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.

The work deals with the holistic concept of comprehensive home care. First, it deals with different characteristic aspects of home care, who provides the care, the extend to which care is provided, principles to be followed when caring, attention is paid to the needs of clients and a good communication with them. Because home care often provide religious charitable organizations, it is also dealt with the Caritas Czech Republic. The last chapter of the first part deals with the common problem of workers in the helping professions, the burnout syndrome. For the implementation of quality health and social care were developed in the society quality standards, that are binding in providing care and assistance which can evaluate the quality of care provided. Our question is, how can theology contribute to the quality of home care. To implement certain elements of quality are in this work offered theological impulses, that can assist in providing quality holistic home care to clients.

No description available.

Cette thèse examine plusieurs questions relatives à la qualité des soins hospitaliers, à travers les prismes disciplinaires de l’économie et de la santé publique.Le premier chapitre introduit la notion de qualité des soins en santé publique et en économie. L’examen du traitement classique de cette notion dans les deux disciplines met en évidence la convergence des définitions de la qualité des soins proposées et la complémentarité des approches de la régulation promues par les deux disciplines.La concurrence à prix fixes, telle que celle induite par la tarification à l’activité, devrait conduire à une amélioration de la qualité des soins si la demande est sensible à la qualité. Dans le deuxième chapitre, nous exploitons des données relatives à la diffusion publique de palmarès hospitaliers pour estimer, à partir d’un panel d’établissements français et pour plusieurs situations cliniques, l’élasticité de la demande de soins vis-à-vis de la qualité, pour les secteurs public et privé. Nous mettons en évidence un impact des palmarès sur l’activité des hôpitaux privés, pour l’une des situations cliniques considérées. En revanche, la demande adressée au secteur public ne semble pas influencée par la publication des palmarès. Ces résultats questionnent l’hypothèse d’une concurrence en qualité dans le secteur public en France.Le troisième chapitre s’intéresse au coût de stratégies de lutte contre les infections nosocomiales, dans une perspective hospitalière. Nous avons évalué les coûts associés à des interventions de promotion de mesures d’hygiène générale ou de dépistage ciblé des bactéries multi-résistantes, dans le cadre de deux essais cliniques multi-centriques européens en soins intensifs et en chirurgie. Nos résultats soulignent la plus grande variabilité des coûts des stratégies de promotion globales et, pour les interventions dont l’efficacité a été démontrée dans le cadre de ces études, un coût de mise en œuvre compatible avec l’hypothèse que ces interventions sont coût-efficaces. / This work takes the perspectives of economics and public health to study issues related to the quality of hospital care.The first chapter introduces the concept of quality of care in economics and public health. We show that the two fields use similar definitions of the concept but explore differing and complementary approaches towards its regulation.Fixed price competition between hospitals, as implemented by a prospective payment system, should lead to an improvement of care quality, provided that the demand for care is increasing with quality. The second chapter evaluates the sensitivity to quality of demand for hospital care in France, using ranking lists published by the lay media as a measure of information on quality available to potential patients. We estimate changes in hospital demand caused by ranking lists on a panel of hospitals located in the Paris area, for several pathologies. We find a sizeable and significant demand shift towards hospitals belonging to the top list in the forprofit sector for one pathology. No effect is observed for non-profit hospitals, or for other pathologies in the for profit sector. Competition for quality may thus not be a feasible regulation approach for French public hospitals.The third chapter provides evidence regarding the cost of hospital infection control strategies targeting antimicrobial resistant bacteria. We estimated the burden and costs associated with two types of strategies, relying on targeted screening or on general hygiene promotion strategies, in two multinational controlled clinical trials, in surgical and intensive care units.Our results highlight the variability of costs associated with broad, non-specific hygiene promotion interventions, and, for interventions which were found to be effective by the clinical trials, costs that are consistent with the hypothesis that these interventions are costeffective.