This analysis of secondary data collected from family members of nursing home residents in North Texas (n = 422) used a mixed methods approach to determine if there is a difference in perspectives on quality care among family members of Alzheimer’s/Dementia Special Care Unit (ADSCU) residents compared to those of non-ADSCU residents. Descriptive content analysis was used identify and condense responses to an open-ended question into four meaningful categories of qualities of care. An independent t-test was employed to determine if there was a difference between family members of ADSCU residents and family members of non-ADSCU residents regarding their rating of their loved-ones’ nursing home on the important qualities of care they identified from the open-ended question. Closed-ended questions were organized into indices of these qualities of care, and ordinary least square regression was employed to determine if there were significant differences between perceptions of family members of ADSCU residents and those of non-ADSCU residents regarding care their loved-ones are receiving on these qualities of care, controlling for frequency of visit.

Background: Root Cause Analysis (RCA) is a method of investigating adverse events (AEs). The purpose of RCA is to improve quality of care and patient safety through a retrospective, structured investigative process of an incident, resulting in recommendations to prevent the recurrence of medical errors. Aim: The aim of the study was to develop and validate a prototype questionnaire to establish whether the RCA model and processes employed at the research setting were perceived by the users to be acceptable, thorough and credible in terms of internationally established criteria. Methods: This is a validation study comprising four phases to meet the study objectives: 1) the development of a prototype questionnaire guided by a literature review; 2) assessing the validity of the content of the questionnaire by and numerical evaluation of the face validity thereof; 3) assessing the qualitative face validity cognitive interviews; and 4) reliability by test-retest. Results: Content validity assessment in Phase 2 resulted in removal of 1/36 (2.77%) question items and amendment of 7/36 (19.44%), resulting in 35 for the revised questionnaire. Analysis of data from the cognitive interviews resulted in amendment of 20/35 (57.14%) question items but no removal. Reliability of the final questionnaire achieved the predetermined ≥0.7 level of agreement. Conclusion: The questionnaire achieved a high content validity index and face validity was enhanced by cognitive interviews by providing qualitative data. The inter-rater coefficient indicated a high level of reliability. The tool was designed for a local private healthcare sector and this may limit its use.

The quality of care of residents in nursing homes receive is an important issue facing our society, and reliable methods to assess and measure important indicators of quality of care are necessary to ensure that nursing homes are providing adequate services. Previous researchers have developed methodologies to evaluate indicators of quality of care, including environmental conditions, resident conditions, resident activities, and staff activities using momentary-time sampling procedures across a variety of settings and populations. The purpose of the present study was to replicate and extend the time-sampling methodology used in previous research in two units in a nursing home.

MCur / Department of Advanced Nursing Science / Professional nurses have the responsibility of supervising the care that is rendered, the nursing personnel and patients throughout 24 hours of the day, for the purpose of ensuring quality patient care and patient safety. However, it seems that this is not happening as expected because there are continuous complaints from the patients about the poor quality of care. This study was aimed at exploring the challenges that are encountered by professional nurses during supervision of care in the district hospitals of Vhembe. A qualitative study was conducted which was explorative, descriptive, contextual and guided by an Appreciative inquiry approach. A purposive sample was used where thirty-six (36) participants were recruited and consent was obtained. Individual semi structured interviews were conducted. Data was analysed according to Tesch‟s eight steps. Trustworthiness was ensured through following the principles which are credibility, dependability, confirmability, transferability and authenticity. The findings revealed multiple challenges that professional nurses encountered during supervision of care. The main themes found were lack of resources, challenges related to the supervisees, cultural changes in nursing affecting supervision, and challenges related to education and training. Apart from challenges, there were positive aspects verbalised that enhance supervision The researcher recommended that nursing practice through the Department of Health should address issues such as shortage of staff, shortage of equipment and inadequate and/or poor infrastructure. Professional nurses should be trained on diversity management and emotional intelligence in order address the ever changing culture in nursing. Students‟ accompaniment and clinical exposure should be addressed. Future research should be conducted to outline what causes these challenges in supervision in other districts so that the findings could be representable. / NRF

Accreditation is recognized worldwide as a tool to improve health care quality. In developing countries, the interest in attaining international accreditation is growing despite the considerable resources the accreditation process consumes and the lack of information about its impact on quality of care. The purpose of this study was to assess the impact of Joint Commission International (JCI) accreditation on health care quality and to explore the contributing factors that affect quality of care as perceived by nurses. The theoretical foundation for this study was based on total quality management theory and Donabedian's model. The research questions for the study examined the impact of JCI accreditation on quality of care and the relationship between quality improvement activities and quality of care. A cross-sectional quantitative design was employed in which a self-administered questionnaire was used to collect data. Participants from one accredited and another nonaccredited hospital in a developing country in the Middle East formed the purposive nonprobability sample that included 353 nurses. The results of a Wilcoxon Rank Sum Test and a correlation analysis indicated that JCI accreditation has a significant impact on quality of care ratings by nurses. Also, multiple regression analysis showed that leadership commitment is the best predictor of quality of care as perceived by nurses. This study may foster social change by encouraging hospital administrators and policy makers, particularly in developing countries, to implement quality improvement programs that will eventually improve the health care system in their countries.

The purpose of this research was to understand cost containment strategies used by private hospitals under managed care plans and their relationship to quality of care within the South African environment. The data was collected using a questionnaire consisting of closed questions requesting respondents to rate statements about costs and quality of care, as well as open questions for additional information about costs and quality of care. The study found that managed care has the ability to control costs and that hospitals monitor LOS and prescribe generic medication in order to control costs. The study also found that cost control strategies have a negative impact on quality of care and that hospitals place more emphasis on cost control than quality of care. In addition, large hospitals that enjoy high occupancy rates experienced an increase in patient complaints since the introduction of managed care, compared to small and medium hospitals. The study found that managed care has had a better than average impact on controlling costs and a better than average impact in quality reduction, however the correlation between cost control and quality reduction was negative. Finally, the study found that technology has an impact on rising healthcare costs and that any constraints placed on rising costs associated with technology will have a negative impact on quality of care. Copyright / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

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Those who have known an individual with a chronic medical condition or someone that has been diagnosed with a terminal illness have experienced the physical and emotional toll these diagnoses have on both patients and their loved ones. Medical providers encounter these situations daily and are often responsible for assisting the patient and their family in the decision-making process. The specialty of Hospice and Palliative Medicine was created specifically with these difficult, but very common, situations in mind. Even though the concept of palliative care has become mainstream and its practice is considered standard of care in many situations, it continues to be misunderstood, misrepresented, and underutilized, despite providing measurable benefits to patients, families and the healthcare system. This paper explores two systemic barriers to palliative care that contribute to this problem and highlights how race, cultural mistrust, and a long history of racial disparities in health care work together to undermine the effective delivery of palliative care. / Urban Bioethics