Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.

Excess inpatient length of stay (LOS) varies between hospitals and is burdensome to patients and the overall healthcare system. Variation in LOS has often been associated with hospital-level factors, such as hospital efficiency and quality. Clostridium difficile infection (CDI) is an increasingly common hospital-acquired (HA) infection. This thesis explores the connection between hospital incidence of CDI and excess LOS in patients without a CDI. It is hypothesized that HA-CDI incidence may act as a "proxy variable" to capture unobserved hospital characteristics, such as hospital quality or efficiency, associated with prolonged LOS. In addition, hospitals with longer LOS may tend to observe more HA-CDI cases prior to discharge. This thesis analyzes the ability of CDI incidence to capture excess LOS variation across hospitals, while controlling for CDI cases that occur after discharge. We use data on hospital inpatient visits, spanning the years 2005-2011, from three data sources distributed by the Healthcare Cost and Utilization Project: the Nationwide Inpatient Sample (NIS), and the State Inpatient Databases (SID) for California and New York. The NIS provides discharge records from a nationwide sampling of hospitals in a given year. The SIDs are longitudinal populations of inpatient records in each state, and patient records can be linked across stays. We compute a variety of different measures of hospital CDI incidence and identify HA-CDI cases that occur after a patient is discharged. Various multivariable regression models are analyzed to predict LOS at an individual patient level. A generalized linear modeling approach is used, and different distributions and link functions are compared using the Akaike information criterion. A multilevel modeling approach is also used to estimate the amount of between-hospital variation in LOS that can be explained by HA-CDI incidence. We find CDI incidence to be a strong predictive factor for explaining a patient's LOS and is one of the strongest predictive variables we identified. Moreover, CDI incidence appears to primarily capture between-hospital variation in excess LOS. Although we find evidence that present-on-admission indicators may underreport cases of HA CDI, our findings suggest the connection between CDI incidence and excess LOS is driven primarily by CDI cases that are HA. In addition, when we account for HA-CDI cases that occur post-discharge, the relationship between CDI incidence and LOS appears even stronger. Our results suggest that CDI incidence may be a powerful tool for making comparisons of excess LOS across hospitals.

The purpose of this study was to determine whether children can learn to cooperate in what has been described as the "minimal social situation." The research also compared the effectiveness of verbal instructions and a training task for teaching subjects the "win-stay, lose-change" rule. This rule has been used to explain the development of cooperation in the minimal social situation. Subjects were 19 teams of first-, second-, and third-graders. Five teams were composed of two girls; six were girl-boy teams; and eight were boy-boy teams. Ten of the 19 teams learned to cooperate in the minimal social situation without treatment. Two of four teams given the rule training procedure learned to cooperate after having failed to learn under typical minimal social conditions. Of five teams given verbal instructions, four learned to cooperate immediately. The probability of following the win-stay, lose-change rule was approximately 50% initially and did not increase significantly in later sessions. It is not clear then that following this rule is a prerequisite for the development of a cooperative exchange. Explanations in the literature which suggest subjects learn a single rule, i.e., win-stay, lose-change, may be misleading since children evidenced a variety of rules, any of which might have been reinforced or punished over the course of the experiment.

<p>Många patienter upplever en känsla av oro och frustration under vårdvistelsen. Obehandlad oro kan leda till ökade komplikationer. Oro och ångest är vanligt förekommande hos patienter, men går ofta sjuksköterskan obemärkt förbi. Det är av betydelse att sjuksköterskan kan identifiera och kommunicera om känslor med patienten, samt känna trygghet i sitt sätt att kommunicera. Syftet var att belysa hur sjuksköterskan genom kommunikation kan hjälpa patienten att reducera oro och ångest under vårdvistelsen. Studien genomfördes som en litteraturstudie baserad på 16 vetenskapliga artiklar. Resultatet visade att identifiering är en förutsättning för att kunna reducera oro hos patienten. Faktorer som ökar oro är rädsla, tid och bristande kommunikationsfärdigheter hos sjuksköterskan. Patientcentrerad vård, samt interpersonell förmåga är av stor betydelse för att minska oro. Effektiv reducering av oro sker när sjuksköterskan tillämpar interaktionsprocesser. Betydelsen ligger i att finna kommunikativa tekniker som sjuksköterskan kan använda i mötet med patienten. Ett sätt kan vara att använda det sokratiska samtalet för att kommunicera om känslor. Vidare forskning om det sokratiska samtalets betydelse i omvårdnaden, för att minska oro hos patienten är av intresse.</p>

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Många patienter upplever en känsla av oro och frustration under vårdvistelsen. Obehandlad oro kan leda till ökade komplikationer. Oro och ångest är vanligt förekommande hos patienter, men går ofta sjuksköterskan obemärkt förbi. Det är av betydelse att sjuksköterskan kan identifiera och kommunicera om känslor med patienten, samt känna trygghet i sitt sätt att kommunicera. Syftet var att belysa hur sjuksköterskan genom kommunikation kan hjälpa patienten att reducera oro och ångest under vårdvistelsen. Studien genomfördes som en litteraturstudie baserad på 16 vetenskapliga artiklar. Resultatet visade att identifiering är en förutsättning för att kunna reducera oro hos patienten. Faktorer som ökar oro är rädsla, tid och bristande kommunikationsfärdigheter hos sjuksköterskan. Patientcentrerad vård, samt interpersonell förmåga är av stor betydelse för att minska oro. Effektiv reducering av oro sker när sjuksköterskan tillämpar interaktionsprocesser. Betydelsen ligger i att finna kommunikativa tekniker som sjuksköterskan kan använda i mötet med patienten. Ett sätt kan vara att använda det sokratiska samtalet för att kommunicera om känslor. Vidare forskning om det sokratiska samtalets betydelse i omvårdnaden, för att minska oro hos patienten är av intresse.

The system of General Health Insurance was carried out since 1995 promoting the convenience for people seeking the medical care and helping a lot of medical disadvantaged minority. Moreover, this system also makes the medical resource differential obviously in the area of off-shore and main islands of Taiwan. The medical resource in main island of Taiwan is centralized and syndicated which reveals the helpless plight of poor medical resources and isolated geography in the remote area of off-shore islands conspicuously. This study researches into the mutual moderating effects of the doctors' perception of the work environment, job satisfaction, role stress, and intent to stay for the doctors in the off-shore islands of Penghu. This study retrieves 102 effective questionnaires by a census-taking. The collected data is carried on SPSS15.0 statistical analysis and test by utilizing t-test and ANOVA analysis to calculate the differences of the demographic statistics parameters, perception of the work environment, job satisfaction, role stress, and intent to stay in isolated island area. Moreover, the mutually influenced degree of constructs is scrutinized by multi-regression and path analyses. This research finds that: 1. Sufficient medical and human resources, good medical cooperation, and high working aspiration can improve the doctors' job satisfaction in the off-shore islands of Penghu. 2. Ample medical and human resources and good medical cooperation can reduce the role stress of doctors. 3. Application of the factors in stimulation and sound health care will lead negative and positive influences on doctors. 4. Good medical cooperation encourages the doctors to concentrate their attention on medical work and seldom interference in the doctor's medical work or values can further their intent to stay in the off-shore islands of Penghu.

President Ma Ying-jeou proposed that the all volunteer force as one of his presidential election campaign view in 2004. He carried out his politics when he took office in 2008. All volunteer force policy will complete and work in 2014. At this moment, the armed forces structure is facing a critical transition phase. There are two major elements that will determine the development and the success of all volunteer force policy. The first one will be the enlists recruitment. But this thesis will focus on the next factor. The willingness of continuing service of active duty officers and non-commissioned officers stays in military for a long-term considerations is more appropriate and practical solution. Therefore, MND expect to achieve the objectives of all volunteer service policy in 2014. The difficulties of conduct the policy are the considerations of skills learning, career development in service, reasonable salary and welfare and competitive power when leave the military. Those are the factors that will affect willingness to stay in the military as wel as the all volunteer service policy still exist problems there. In this study, demand communication is the key element whether the compulsory service soldier transfers to voluntary service or the volunteer service continues service in military. We use Maslow needs factor and Herzberg two-factor factor as the theoretical basis. Using the questionnaires to analyze the willingness to stay in the military, and find out the exist difficulties of implement the al volunteer service. According to the statistics of this study, the demand factor for non-commissioned officers have some degree of influence. In view of this, the military can use the communication skill effectively, it will crate the win-win situation for both the policy implementation and stability of human resources. All volunteer service policy is indeed an important resource of high combat capability. However, the military is willing to communicate through a demand point of view with basic level personnel to understand how to adapt to each other's practices and the concept of emotional commitment, promotes organizational loyalty, unconditional acceptance and even unconditional pay. The all volunteer service system is just around the corner.

The study applied for a social network analysis tool and HLM method to analysis cross level dataset which will specify an integrated ¡¥meso¡¦ framework of linking diversified relationships and employees¡¦ attitudes and behavior within the work group settings. The effective sample size of this study collected by whole completed survey involved 317 employees within 26 different workgroups representing diversified industries in Taiwan. This study provided evidence that density of informal development network (informal network, advice network, and mentoring network) are related to both employees¡¦ intention to stay and individual job performance. As hypothesized, both In-degree centrality of advice network was positively related to individual job performance. Perceived career success was positively related to in-degree centrality of advice network. In-degree centrality of friendship network was negatively related to intention to stay. Furthermore, Density of mentoring network will be positively related to intention to stay and individual job performance. Density of advice network was related negatively to individual job performance and density of friendship was related positively to individual job performance. The effect of in-degree centrality of advice network on individual job performance will be partially mediated by mediating variable - perceived career success as well as the effect of in-degree centrality of friendship network will be partially mediated by mediating variable - perceived career success.

Abstract After the Mainland China¡¦s opening policy, more and more enterprises invested in this giant business market, which is full of adventures and opportunities . In earlier days, only few people wanted to be assigned for working in Mainland China. Nowadays, much more people volunteer to develop their careers in Mainland China for a longer period. The thesis is trying to study the expartiate¡¦s personal characters, career orientations, expatriate motivation and expatriate adjustment, and further understanding the impacts of these four facters on the intention to stay in Mainland China. The results of this study indicate that: 1.The more voluntary expatriate have to work in Mainland China, the higher intention expatriate have to stay in Mainland China. 2.The expatriates who live with their families will have higher intention to stay in Mainland China. 3.People whose career orientation indicates ¡§getting ahead¡¨ have positive correlation with the expatriate motivations, which indicate self-fulfilling, self-esteem and security. The ¡§getting secure¡¨ people have negative correlation with the self- fulfilling motivation. 4.People whose personal characters indicate high ¡§interpersonal skills¡¨ will positively affect the expatriates¡¦ ¡§getting high¡¨ and ¡§getting ahead¡¨ career orientations, but negatively affect¡§getting balance¡¨ career orientation. Expatriates¡¦ high ¡§ability of conflict solving¡¨ will negaitively influent the ¡§getting ahead¡¨ career orientation. Furthermore obvious, their highly ¡§optimistic tendency¡¨ will negaitively influent the ¡§getting secure¡¨ career orientation. 5.People whose personal characters indicate high ¡§interpersonal skills¡¨, ¡¨ability of culture adjustment and ¡§optimistic tendency¡¨ will positively influent the expatriate whose expatriate motivation indicates ¡§self-actualization¡¨.Their high ¡§ability of conflict solvingl¡¨ will negaitively affect the ¡§secure¡¨ expatriate motivation. Expatriates¡¦ high ¡§ambiguous tolerance¡¨ will negaitively influent their ¡§social¡¨ expatriate motivation 6.People whose career orientation indicates ¡§getting free¡¨ have negaitive impact on their intention to stay in Mainland China. 7.People whose expatriate motivation are showing ¡§self- actualization¡¨ and ¡§social¡¨ have positively influence to their intention to stay in Mainland China. 8. People whose personal characters are showing high ¡¨ability of culture adjustment and interpersonal skills¡¨ positively influenceing their intention to stay in Mainland China. The expatriate¡¦ adjustment is a mediating factor between personal characters and the intention to stay in Mainland China.