Thesis (Ph.D.) - University of St Andrews, November 2008.

Thesis (M.S.)--University of Michigan, 1991.

The way healthcare services are delivered in remote and rural Scottish communities is in a state of reconfiguration. At the same time the NHS faces pressure to plan these new services in partnership with communities themselves. Evidence, however, suggests that this is not necessarily being done well. This study considered the contextual aspects of remote and rural Scottish communities that may impact on healthcare-related engagement, and examined current understanding of what constitutes a ‘good’ engagement process. It then went on to consider a two-year action research project (RSF) that took place in four remote and rural Scottish communities to engage local residents in an anticipatory process co-designing their own future healthcare services. Finally, this study examined ways in which individuals were able to wield power within the engagement described in the RSF project, by using a combination of participant observation and Foucauldian Discourse Analysis. As well as making a number of practical recommendations for future engagement practice in a remote and rural context, this study makes three key contributions. Firstly, it contributes further contextual knowledge about the challenges of engaging with remote and rural Scottish communities for local healthcare service design; a topic about which little has been written. Secondly, it contributes a novel method for anticipatory healthcare budgeting aimed at a remote and rural Scottish context, namely the RSF Game. Thirdly, it draws the conclusion that individual (non-elite) community members have the ability to use French and Raven’s bases of social power to impact the engagement process at all stages, and also posits that discourse can be used within rural engagement as a new ‘base of power’, which contributes to the debate around individual power and agency within remote and rural community engagement for healthcare, which few studies have examined.

The purpose of this project was to identify the current status of education/training of rural health care providers and identify gaps in training/education to better prepare rural providers to care for victims of disasters. A survey was conducted and distributed to 21 physicians, nurse practitioners, and physician assistants employed at rural clinic/critical access hospital. The survey consisted of quantitative and fill in the blank questions. The survey was distributed through the electronic survey engine “Qualtrics.” Participation in the survey was voluntary and responses were anonymous. The survey addressed/identified: basic demographic information, knowledge of disaster/emergency preparedness and care of victims as a first receiver, experience and education related to disasters/emergencies, perceptions of emergencies/disaster types most likely to impact their facility, future education/training preferences, and barriers to participation in disaster/emergency education/training. The survey also assessed the providers’ comfort level with suggested disaster/emergency core competencies put forth from professional emergency/trauma organizations. The response rate to the survey was 57.14%. Of those that responded 41.67% reported experience in caring for victims of disaster. Participation in previous disaster education/training was reported by 83.3% and these same respondents were familiar with their role according to the facility’s Emergency Operations Manual (EOM). The providers perceived that natural disasters were most likely to affect their community (83.33%) in relation to events from the facility’s Hazard Vulnerability Analysis (HVA). Respondents that reported having not participated in disaster education/training indicated a lack of time and new employment as barriers. For future training 66.66% of those that responded would prefer hands on training and were willing to spend one hour per year on disaster training/education. In regard to their ability to care for disaster/emergency victims, participating providers considered themselves novice (25%), advanced beginner (25%), competent (16.67%), proficient (25%) and expert (8.33%). Overall, results indicate that most respondents had experience and are currently participating in education/training. However, the majority still consider themselves novice or advanced beginner in their ability to care for disaster/emergency victims. Most felt that there was little likelihood for most disaster events to occur in their community other than natural disasters.

No description available.

Thesis (Ph. D.)--University of Missouri--Columbia, 1998. / Typescript. Vita. Includes bibliographical references (leaves : 67-70). Also available on the Internet.

Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2019 / Quality health care includes availability, accessibility, affordability, acceptability, competence of health care providers, reducing waiting time, ensuring privacy and confidentiality, ensuring safety and security, and reducing mortality and morbidity. Despite many initiatives made by the National Department of Health through the Minister of Health, provision of quality health care services remains a serious challenge in South Africa, especially in the public rural clinics. Communities from rural areas face many challenges at the public healthcare clinics such as poor infrastructure, attitudes from staff, old equipment, insufficient medicines, dirty healthcare sectors, and longer waiting times, which has led to provision of poor health care services. Methodology A quantitative research approach was used to conduct this study. The study was conducted in the Capricorn District of the Limpopo Province. Three municipalities; namely Blouberg, Lepelle-Nkumpi and Aganang, were selected from the five municipalities located in the Capricorn District because they are predominantly rural. A simple random sampling applying fish bowl method was used to select the public clinics in each municipality. A cross-sectional study design was used to conduct the study. Only professional nurses were selected to participate in this study. Data were collected using a structured self-administered questionnaire, over a period of three months. A total of 155 professional nurses were selected because they met the selection criteria. The response rate was 100% because all the 155 questionnaires distributed were completed. Data were analysed using the Statistical Package for Social Sciences program version 22.0 with the assistance of the University of Limpopo statistician. Results The findings of the study indicated that only 3 (2%) of the clinics operated for 24 hours, 72 (46%) operated for 8 hours and 80 (52%) operated for 12 hours. The majority of the professional nurses 123 (83%) said that the clinics are overwhelmed by large numbers of patients, whereas 26 (17%) of the professional nurses said that the clinics are not overwhelmed by large numbers of patients. Very few 29 (19%) professional nurses were satisfied with the salary they were paid, whereas the majority 124 (80%) were not satisfied with salary they were paid, and only 2 (1%) were unsure. Recommendations Recommendations were made to improve the quality of healthcare services in the public rural clinics: The Department of Health should review the salaries they pay professional nurses in rural clinics, particularly the Occupational Specific Dispensation, and they should be given a higher salary. Furthermore, the government should increase the salaries of nurses working in the public rural clinics to at least 10% higher than those in urban clinics within the next 5 years to attract more nurses to the public rural clinics. The Limpopo Provincial Department of Health should liaise with the treasury department to provide realistic budget to accommodate the population. Conclusion The findings of this study revealed the factors related to the provision of quality health care services at the selected public clinics in the rural areas of the Capricorn District, Limpopo Province. The study was limited to public clinics in the rural areas; therefore, the findings of this study cannot be generalised to the clinics that did not participate in the study. Keywords: Quality, healthcare services, public rural clinics.

No description available.

Economic, political and social forces are driving the implementation of reforms in health service systems worldwide. As the health industry concentrates on ways to improve operations and to achieve overall cost effectiveness, health service organisations are developing and implementing structural changes to address issues of cost containment, utilisation and resource allocation. One approach has been to devolve resource allocation and utilisation decisions to the program or unit level. Clinical practitioners have been required to assume general management responsibilities in addition to their clinical role. A new type of clinician, the clinician manager has emerged to take on this task. Despite the trend towards the clinician manager role in many sections of health care world wide, there is little research in the area and a poor understanding of the experience of the role.The aim of this research was to explore clinician managers' perceptions of their experiences in their adaptation to and their enactment of the new role. The study was based in the symbolic interactionist paradigm. Sensemaking, the process by which individuals ascribe meaning to the events in their environment, provided a theoretical context that directed the inquiry. Grounded theory was the methodological approach. The research sample was made up of Directors of Nursing/Health Service Managers, a clinician manager role that had emerged from the restructuring of rural health services in Western Australia. Data was gathered from in-depth interviews.Findings suggested that sensemaking was influenced by structural and personal elements. Structural elements were created by the stakeholders, individuals and groups who relied on the clinician manager for the achievement of their goals but upon whom, in turn, the clinician manager relied upon for their support and cooperation. The sensemaking process of the ++ / clinician manager was mediated by the interaction with the stakeholders - the most influential factors being the clinician manager's perceptions of the trustworthiness of the stakeholders, the political behaviour that characterised the interactions with the stakeholder and role stress. In particular, role conflict, role ambiguity and role overload emerged. Personal elements were the personal characteristics of the clinician manager - the most salient being the experience of role strain, self-efficacy (i.e. their belief in their ability to do the job) and their commitment to the sensemaking process.Circumstances in the environment constrained their reliance on others for validation of their explanations of events and the actions they took. Most made decisions based on intuition and "gut feeling" - validating these decisions with subjective evaluations of outcomes and retrospective explanations. These processes were further mediated by the characteristics of the individual, particularly perceptions of self-efficacy. The ways in which the clinician managers adapted to and interpreted their role was diverse, which made the role more an expression of individual preferences than a coherent part of a larger organisational structure. Findings indicated that the clinician managers relied on their sensemaking processes in order to explain the ambiguous nature of their practice environment and to plan actions within the context of a role that was poorly defined by the organisation.

The first twelve months operation of a five-bed rehydration unit at Osindisweni Hospital is described and data related to admissions presented. Osindisweni hospital is situated in a rural area north of Durban and has approximately 300 general beds with 60 000 outpatient attendances per year. A profile of children admitted to this unit was obtained and results are analysed according to the objectives of this study. The main findings of the study showed that 269 children were admitted to the unit during the study year and the majority of children were black African children, below three years of age, coming from rural areas. The children presented with acute diarrhoeal dehydration mostly of mild to moderate degree and were normally managed by oral rehydration therapy. Eighty-four percent of these children were successfully managed on the rehydration unit and only 13,7% received IV fluids. The majority of children requiring transfer to the ward had either persistent dehydrating diarrhoea or other complications such as malnutrition or septicaemia. No child died on the unit and no child died as a result of dehydration but 4 children died later as inpatients on the children's ward. The mortality of children admitted to the unit was therefore 1,5%. One hundred and nine patients were followed up (41,6% of questionnaires) and of these only 76 (69,7%) actually came for review the others presenting for other illnesses or else interviewed on the wards after transfer. However, most of these children had either no or minor complaints on follow up. Seventeen and a half percent of children were below the 3rd centile for age on discharge. Children with marasmus and/or kwashiorkor were not admitted to the unit. The availability of health care was poorly assessed but indicated a general lack of facilities for the rural population served. Also it was noted that the principles of G.O.B.I. had been poorly taught at Osindisweni in the past, particularly growth . charts. Mothers received health education on the unit and were found to have a good understanding of G.O.B.I. after their stay on the unit. On the whole the unit was well accepted by the mothers. It is thought that this short-stay oral rehydration unit offers a more appropriate and more cost effective alternative to previous methods of in-patient management of children with diarrhoeal dehydration and that it offers an excellent opportunity for health education. / Thesis (MMed)-University of Natal, Durban, 1988.