Čížková, B. (2011). International standards Quality for Children in the practice of the social and legal protection of children in the Czech republic. Praha: Faculty of Arts, Charles University. Master's Degree Thesis. The object of this work is to identify the weaknesses of the current system of the alternative care by comparing casuistry with the standards of quality. I use casuistry of the current or former clients of foster care. In the first part I put the topic of social and legal protection of children into context of international and constitutional documents. There is also a chapter about the Standars Quality4Children. Then I focus on the situation in the Czech republic. I start with the descripction of the current system and finish with the process of transformation of the system of care for children at risk. The bill changing the Act No. 359/1999 Coll. on the social and legal protection of children was published. It is the first step to the transformartion and it's necessary to be followed-up other steps. The actual explorative empirical part of this work is conducted by a qualitative research strategy. The empirical investigation was executed in form of interviews with twelve respondents. Research sample consists of two social workers (from authority for social and legal protection of...

Situation of families in which a child with spinal muscular atrophy was born, is the topic of this thesis. This rare genetic disease affects neuromuscular system of children and shortens their lives. In most severe cases the failure of respiratory functions comes in the first year of child's life. This thesis is focused on support that Czech system of social and medical services provides to families with this disease. Next, it looks into needs of these families and examine the extent to which the system is able to saturate them. Very important point in this research is also families' perception of quality of care. The research was implemented with use of qualitative methods, mostly by semi-structured interviews which followed families' journey through the system of social and medical services. Then there is a comparison of experience of families with theories, policy and other normative framework and suggestion of steps that should be taken to improve families' satisfaction with services they receive concerning the child's disease. Key words: spinal muscular atrophy, rare diseases, patient's autonomy, patient- centered care, patient journey, quality of care.

The diploma thesis "The organization of work in health care. Case study of implementing employee manual on standard hospital wards Pelhřimov "manual describes the creation of employment for nurses working in inpatient department standard and the introduction of this manual into practice. The work is divided into theoretical part, which consists of five chapters and practical. The theoretical part of the information, human resources management, teamwork, employee evaluation, problem solving and team work quality in healthcare facilities. The practical part describes the process of creating the manual setting of the main goals and sub-goals and progress of cooperation author of the thesis members of the team formed for the creation of the manual. We'll also find an evaluation questionnaire, finding an employee satisfaction nurses manual and usability of information for practice. The result of the research is to determine employee satisfaction to employee maual. Powered by TCPDF (www.tcpdf.org)

Ces 15 dernières années, la recherche sur l'empathie clinique dans le contexte de la médecine somatique s'est développée de manière significative. Cette empathie clinique est donc de mieux en mieux cernée : élaboration de différentes modélisations et identification de ses bénéfices. Aujourd'hui, il reste certains challenges à relever, et notamment celui d'améliorer et de préserver l'empathie clinique au fil de la formation et de la pratique médicales tout en protégeant le bien-être des médecins. Ce travail de thèse a pour objectif de définir l'empathie clinique dans le cadre des maladies chroniques graves : son processus, ses déterminants, ses conséquences et les ressources nécessaires. Ce travail propose trois études successives portant sur des patients (N=15) et des médecins hospitaliers (N=235) selon un design mixte, recueils de données quantitatifs et qualitatifs associés à des analyses de données quantitatives. Ces études cherchent à définir l'empathie, identifier et tester ses antécédents et conséquences, en explorant les vécus des médecins et des patients. Par ailleurs, une quatrième étude longitudinale dite pilote a été mise en place. Les résultats ont mis en évidence la spécificité de l'empathie à une clinique spécifique, ont souligné sa nature majoritairement cognitive et comportementale et son rôle primordial dans la clinique et le bien-être des patients et des médecins. Ce travail propose ainsi une définition empirique qui concilie et enrichit les précédentes tout en développant la connaissance des déterminants de cette compétence clinique dans le cas spécifique des maladies chroniques graves. L'empathie clinique résulte de nombreux éléments tant individuels que situationnels ou encore interindividuels. Alors le développement de l'empathie des médecins auprès des personnes atteintes de maladies chroniques graves ne peut être considéré sans développer des recommandations à destination des institutions, des programmes de formation, et des dispositifs de soutien individuel et collectif. / Over the last 15 years, research on clinical empathy in somatic medicine has increased significantly. This clinical empathy is therefore becoming better understood, which shows by the appearance of various models and benefits on patients and physicians. Today, the challenge is to improve and to maintain clinical empathy through medical training and practice while protecting the well-being of physicians. This thesis' aim is to define clinical empathy in the context of serious chronic diseases: its process, its determinants, its consequences and the resources it needs. This work proposes three sequential studies involving patients (N = 15) and hospital doctors (N = 233). The design is mixed between qualitative and quantitative data and methods. These studies seek to define empathy, identify and test its antecedents and its consequences, exploring both the experiences of physicians and patients. Furthermore, a fourth study, a pilot one, has been conducted. Empathy appears as specific to a clinic. The results emphasize its cognitive and behavioral facets. Clinical empathy has a key role in patients' care and wellbeing but also in physicians' wellbeing. This work proposes an empirical definition that reconciles and enriches the preceding ones. It gives the opportunity to develop knowledge of empathy's determinants in the specific case of serious chronic diseases. Clinical empathy is the result of many individual, situational and inter-individual elements. Therefore, the development of doctors' empathy with patients with severe chronic diseases cannot be considered without developing recommendations to institutions, training programs, and individual and collective supports.

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Contexte. Un nombre important de patients souffrant de troubles mentaux reçoivent des soins ambulatoires insuffisants ou inadéquats, les conduisant à visiter régulièrement les urgences. L’accès aux soins et la continuité du suivi offert à ces patients après une visite aux urgences, régulièrement rapportés comme étant faibles, sont des indicateurs clés de la qualité des soins de santé dans une optique de rétablissement. Il semble donc nécessaire d’évaluer l’accès et la continuité du suivi après une visite aux urgences pour ces patients, d’en cerner les déterminants ainsi que les profils de patients les plus susceptibles d’en bénéficier. De plus, pour renforcer l’amélioration de l’organisation des services en santé mentale à partir des urgences pour ces patients, il serait pertinent de développer des interventions innovantes à la lumière d’une meilleure connaissance des conditions qui en facilitent ou limitent l’implantation et l’efficacité. Objectifs et méthodes. Cette étude a, dans un premier temps, utilisé des données extraites de bases de données administratives de patients ayant visité les urgences au Québec (Canada) en 2014-2015 (visite index) et ayant un trouble mental. Les caractéristiques cliniques et sociodémographiques des patients de 2012-2013 à 2014-2015 ainsi que l’utilisation des services 12 mois avant la visite index ont été étudiées en tant que déterminants pour les patients avec ou sans suivi rapide, et ce, à l’aide d’une régression logistique hiérarchique. Une analyse de classes latentes a également été réalisée pour identifier les profils des patients en fonction du suivi ambulatoire qu’ils ont reçu après leur visite à l’urgence. Des analyses bivariées ont examiné les associations entre les variables sociodémographiques et cliniques, les profils des patients ainsi que le suivi ambulatoire que ceux-ci ont reçu après la visite à l’urgence. Plus spécifiquement, notre premier article portait sur l’identification des caractéristiques cliniques, sociodémographiques et d’utilisation des services des patients associées à l’accès à un suivi rapide (≤ 30 jours) pour les patients ayant visité les urgences et ayant un trouble mental. Dans le deuxième article, il s’agissait d’identifier : les profils des patients ayant un trouble mental incident selon un suivi ambulatoire accessible et continu après une visite aux urgences sur une période de 12 mois (à 30, 90 et 365 jours) ; les variables sociodémographiques et cliniques associées ; et les résultats de santé de ces patients à long terme (24 mois). Par la suite, deux recensions de la littérature ont été menées. Dans le troisième article, une recension narrative des innovations organisationnelles destinées à améliorer la qualité des soins offerts aux patients ayant des troubles de santé mentale et visitant les urgences, en particulier à partir de leurs conditions d’implantation, a été menée. Enfin, pour le quatrième article, nous avons réalisé une recension systématique sur l’efficacité des innovations aux urgences étant destinées à améliorer la qualité des soins offerts aux grands utilisateurs en santé mentale. Résultats. Moins d’un tiers des patients ayant des troubles mentaux ont expérimenté un accès et une continuité de suivi adéquats après leur visite aux urgences. Globalement, ce sont les patients peu connus du système de santé, ceux avec des troubles liés à l’usage de substances qui connaissent une faible priorité au triage lors de la visite aux urgences, mais aussi les patients plus jeunes, résidant en milieux ruraux et les hommes qui ont été identifiés comme ayant bénéficié d’un accès et d’une continuité du suivi moindres après leur visite aux urgences. L’accès et la continuité du suivi restent donc à être grandement améliorés pour les patients ayant des TM, une population aux besoins importants qui fréquente régulièrement les urgences du Québec. Conclusions. Malgré de nombreuses réformes, trop peu d’efforts semblent avoir été investis dans les services en santé mentale en regard des besoins des patients et du fait que les urgences restent une porte d’entrée aux soins peu adaptée et très coûteuse pour les patients ayant des TM. De plus, l’organisation actuelle du système répond mieux aux patients déjà desservis par le système, ce qui démontre une capacité réactive ; en revanche, peu d’activités ou d’interventions proactives ont été relevées malgré l’importance du dépistage et de l’intervention précoce. Ce constat est en cohérence avec les dernières priorités ministérielles (PQPTM, 2020 et PAISM, 2022) qui visent à renforcer la prévention-promotion ainsi que certaines interventions, notamment à l’urgence, comme celles liées aux plans de soins et à la gestion de cas. Néanmoins, il sera important de considérer les nombreux défis limitant l’implantation de ces innovations, sans quoi leur efficacité pourrait être limitée. / Context. Some patients with mental disorders receive insufficient or inadequate outpatient care, leading to frequent visits to emergencies. Access to and continuity of follow-up care for these patients after an emergency department visit, regularly reported as poor, is a key indicator of the quality of care they received and ultimately their recovery. It therefore seems necessary to evaluate access and continuity of follow-up care after an emergency department visit for these patients, and to better identify determinants of these quality-of-care indicators and patient profiles most likely to benefit from better care. In addition, to improve the organization of mental health services for these patients in the emergency departments, it would be relevant to develop innovative interventions with a better understanding of the conditions that facilitate or limit their implementation and effectiveness. Objectives and methods. This study initially used data extracted from administrative databases of patients who visited emergency departments in Quebec (Canada) in 2014-2015 (index visit) and had a mental health disorder. Clinical and sociodemographic characteristics of patients from 2012-2013 to 2014-2015, as well as service utilization 12 months before the index visit, were studied as determinants for patients with and without prompt follow-up care, using hierarchical logistic regression. Latent class analysis was also performed to identify patient profiles based on an outpatient follow-up received after their ED visit. Bivariate analyses examined associations between sociodemographic and clinical variables and each of the patient profiles, as well as the ambulatory follow-up received after the ED visit. Specifically, our first article focused on identifying patient characteristics (clinical, sociodemographic, service utilization) associated with access to prompt follow-up care (≤30 days) for patients after they visited the ED for mental health reasons. The second article aimed to identify profiles of patients with incident mental disorder based on accessible and continuous ambulatory follow-up care after an ED visit over a 12-month period (at 30, 90, and 365 days), associated sociodemographic and clinical variables, and long-term (24 months) health outcomes for these patients. Subsequently, two literature reviews were conducted. The third article, based on a narrative review, identified organizational innovations designed to improve quality of care for patients visiting emergency departments for mental health reasons, particularly in terms of their implementation. For the fourth article, a systematic review of the effectiveness of innovations in emergency departments to improve quality of care for high users of mental healthcare was conducted. Results. Less than one third of patients with mental health issues experienced adequate access and continuous follow-up care after their emergency department visit. Overall, patients with little knowledge of the healthcare system, with substance use disorder, experiencing low triage priority at their emergency department visit, but also younger patients, residing in rural areas, and men, were found to experience the least access and continuity of follow-up care after their emergency department visit. Access and continuity of follow-up care therefore remain to be improved for patients with MD, a high-need population that regularly visits Quebec emergency departments. Conclusions. Despite numerous reforms, insufficient effort seems to have been invested in mental health services compared to the needs of patients and the fact that emergency departments remain an ill-adapted and very costly gateway to care for patients with MD. In addition, the current organization of the system is more responsive to patients already served by the system, demonstrating a reactive capacity. In contrast, few proactive activities or interventions were identified, despite the importance of early detected and deployed interventions in this area. These findings are consistent with the latest Quebec policy orientations (PQPTM, 2020 and PAISM, 2022), which aimed to strengthen prevention and deploy new interventions including in the ED, such as those related to care plans and case management. Nevertheless, it will be important to consider the many persistent implementation challenges, that may limit efficiency of those innovations.

Psykiatrisk öppenvård utgör en viktig komponent inom den svenska psykiatriska vården och behovet av sådan verksamhet ökar för varje år. Specialistsjuksköterskans kompetens och patientdelaktighet utgör en framgångsfaktor för en god psykiatrisk vård, samtidigt som denna delaktighet ofta kommer med utmaningar. Utebliven delaktighet riskerar att leda till vårdlidande. Den här studiens syfte var att undersöka sjuksköterskors upplevelser av patientdelaktighet inom den svenska psykiatriska öppenvården. Upplevelsen av patientdelaktighet utforskas genom kvalitativa intervjuer med sju sjuksköterskor, som arbetar i den öppen psykiatriska vården i Västra Götalandsregionen. Studien har sin metodologiska utgångspunkt i reflekterande livsvärldsforskning och intervjuerna analyserades med hjälp av induktiv innehållsanalys. Resultatet sammanfattades till tre huvudkategorier, Främja patientens deltagande, att skapa rum för patientens röst och sjuksköterskans roll i patientens vårdresa, vilka sammanfattade intervjuernas huvudlinjer. Resultatet indikerar att patientdelaktighet i likhet med tidigare forskning är central för ökad vårdkvalitet, men också hur denna begränsas av resursbrist. Vårdrelationen framträder som en nyckelfaktor i patientdelaktigheten, men resursbrist hindrar sjuksköterskan från att bygga och bibehålla dessa. Studien bidrar med insikter gällande resurstilldelning och organisatoriska förändringar, som kan stärka patientens delaktighet, öka vårdkvalitet och minska vårdlidande. Genom att åskådliggöra sjuksköterskornas röster, belyser denna studie behovet av förändringar som möjliggör ökat patientengagemang och ökad patientdelaktighet inom psykiatrisk öppenvård. Studien belyser behovet av att adressera resursbegränsningar och implementering av individuellt anpassad delaktighet genom exempelvis tekniska hjälpmedel. Fortsatt forskning föreslås fokusera på just detta. Studien uppmanar specialistsjuksköterskor inom psykiatri att prioritera byggandet av starka, förtroendefulla relationer till sina patienter i syfte att främja patientdelaktigheten samt att använda sin expertis för att individanpassa denna. / Psychiatric outpatient care is an important component of Swedish psychiatric care, and the need for such activities increases every year. The specialist nurse's competence and patient participation are a success factor for good psychiatric care, while this participation often comes with challenges. Non-participation risks leading to poor care. The purpose of this study was to investigate nurses' experiences of patient participation in Swedish psychiatric outpatient care. The experience of patient participation is explored through qualitative interviews with seven nurses, who work in outpatient psychiatric care in the Västra Götaland region. The study has its methodological point of departure in reflective life-world research and the interviews were analyzed using inductive content analysis. The results were summarized into three main categories, promote the Patient´s Participation, to Create Space for the Patient's Voice and The Nurse's Role in the Patient's Care Journey, which summarized the main lines of the interviews. The results indicate that, similar to previous research, patient participation is central to increased quality of care, but also how this is limited by a lack of resources. The care relationship appears as a key factor in patient participation, but a lack of resources prevents the nurse from building and maintaining these. The study contributes insights regarding resource allocation and organizational changes, which can strengthen patient participation, increase care quality and reduce care suffering. By illustrating the nurses' voices, this study highlights the need for changes that enable increased patient engagement and increased patient participation in psychiatric outpatient care. The study highlights the need to address resource limitations and implementation of individually adapted participation through, for example, technical aids. It is suggested that further research focus on precisely this. The study urges specialist nurses in psychiatry to prioritize the building of strong, trusting relationships with their patients in order to promote patient participation and to use their expertise to tailor this to the individual.

The study aimed to explore and described the assessment of patient’s satisfaction with the quality of health care services rendered by the Crossroads Community Health Centre (CHCC). The target population comprised of adult male and female patients who have attended the clinic more than once. One hundred and twenty patients participated in the study. The convenience sampling method was used to select the respondents. A questionnaire was used to collect data. Validity and reliability were ensured. The Chronbach’s alpha reliability test was used to measure the internal consistency of the likert scale questionnaire items and was less than 0.4 for sections B-F, and 0.675 for section E. Descriptive and inferential data analysis was conducted using the Statistical Package for the Social Sciences 16.0 for Windows, release 16.0.1 with the assistance of a statistician. The findings indicated a positive perception of the quality of health care services rendered by the Crossroads CHCC. It was concluded that despite a positive perception of the health care services, there was a percentage of the respondents that rated the quality of the service as poor in relation to environmental cleanliness, staff attitudes, long waiting times, medications shortage, the complaints system reporting and health care service drainage to other CHCC where patient’s resided. The issue of quality improvement in these aspects was noted to be crucial and recommendations were made to improve the quality of the health care service at Crossroads CHCC. / Healh Studies / M.A. (Health Studies)

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined. / Health Studies / M. A. (Nursing Science)