Dissertations / Theses on the topic 'Exempla Health Care Facility'

Although predictions for the supply of registered nurses (RNs) is projected to increase to 3,849,000 by 2025, the demand for RNs is projected to grow to 3,509,000. The purpose of this single case study was to explore the strategies some recruiters in a nonprofit health care facility used to recruit RNs. The conceptual lens used for this study was general systems theory. Through a purposeful sample of 3 recruiters at a nonprofit health care facility located in New York, data collection occurred through semistructured interviews, reviewing job boards and the company website, and taking field notes the day of the interviews. Data analysis involved a process of organizing, coding, arranging data into common themes relevant to the research question, and interpreting the data. Member checking was used to enhance the credibility and validity of the data. Through thematic analysis, 4 themes emerged: partnering with colleges, strategies in recruiting RNs, partnering with professional organizations to recruit RNs, and updating the website. Using multiple job boards to promote available RN positions was also identified as a strategy to recruit RNs. Identifying strategies to recruit RNs may assist human resource leaders in a challenging business environment in which the supply of qualified RNs is low. The study findings have implications for positive social change for recruiters in a nonprofit health care facility and in the community. Recruiters in a nonprofit health care facility that recruit qualified RNs may assist with improving the nonprofit mission, identifying sickness or disease, and assisting with proper treatment for patients.

GreenCare is a medical waste management facility, located in Los Angeles, California and aims at effectively treating and managing all kinds of medical wastes. GreenCare’s business plan elaborates on how it is designed to safely and effectively handle the management of medical waste, by minimizing harmful byproducts, and emissions in the process. The aim of GreenCare is to offer disposal techniques including no-burn technologies that do not emit dioxin, mercury and other fatal pollutants, which differentiates GreenCare from other competitors in the market. The unique value proposition of GreenCare is to provide advanced ecological sensitive medical waste processing, and we aim to do this in a cost-competitive manner. It aims to lessen the ecological burden of medical waste in our communities, that is bound to create a positive impact on community health, in the long run. This business proposal gives the reader a thorough insight into the legal, regulatory issues and financial assumptions based upon which this proposal was designed.

Lack of employee commitment affects the overall practice in healthcare organizations and can cause a disruption in the lives of people with intellectual disabilities who are receiving care. Researchers have demonstrated that increasing employee commitment and decreasing employee turnover are related to employee commitment in healthcare organizations. The purpose of this single case study was to explore strategies that leaders of an intermediate care facility for individuals with intellectual disabilities in the northwestern United States used to enhance employee commitment. Meyer and Herchovitch's model of employee commitment was the conceptual framework for this study. Data were collecting from semistructured interviews with 2 home managers and 1 area supervisor of a healthcare facility with experience in employee commitment. Data were transcribed, analyzed, and coded for themes and subthemes; data validity was established using member checking of the findings for accuracy and credibility. Three main themes emerged from the data analysis: organizations' healthcare insurance, bonuses, and teamwork. Healthcare leaders might implement the findings of this study to increase and develop employee commitment, improve profitability and sustainability, improve patient care, and improve safety to bring about a positive and effective social change to benefit patients, families, and communities.

The rigors of labor and childbirth are incredibly demanding on the mother's body physically, emotionally, and psychology. Most new mothers deliver in a hospital setting where they are discharged after approximately two days. However, the mother's health and well-being does not improve that drastically within those two days of post-delivery recovery. Common struggles that new mothers face include postpartum depression, intimate partner violence, mood and body changes, as well as nutrition and sleep deprivation. Therefore, it is not only important to be attentive to the newborn but to the mother's recuperation as she adjusts to postnatal life. While there are many options for new mothers to deliver their baby through hospitals or birth centers, there is a lack of postnatal care facilities in comparison.

Pamper Partum, LLC is a private company with an organizational mission to offer quality service and care that eases the transition to motherhood, to empower a new mother through education and community support, and to reduce any preventable risks associated with the postnatal period. Pamper Partum, LLC is an all-inclusive healthcare facility that provides services such as breastfeeding assistance, peer-support groups, private counseling, nutrition, general health care, and 24/7 infant monitoring in a state-of-the-art nursery. Pamper Partum, LLC will seek to be the first postnatal care facility that serves Orange County.

The purpose of this book is to explore the idea of duration of physical architectural elements, and how their relative permanence or temporariness affects time and memory. This project takes on the program of a healthcare facility in the community of Verón located in the Dominican Republic. Through the exploration of materials, the identity of the project is defined by a series of walls that bring order and scale to not only the clinic but the surrounding community as well.
Master of Architecture

The purpose of this study is to assess the attitudes towards individuals with mental illness among the healthcare providers of a long-term care facility. It takes a quantitative, non-experimental, cross-sectional, descriptive approach to view relationships. Minimal research exists in this subject matter, and literature reviews suggest that negative attitudes toward mental illness exist among healthcare providers (Ahmead et al., 2010; Aydin et al., 2003; Bjorkman et al., 2008; Rao et al., 2008; Reed & Fitzgerald, 2005; Ucok, 2008; Ross & Goldner, 2009; Smith et al., 2011; Zolnierek & Clingerman, 2012). The Community Attitudes toward the Mentally Ill (CAMI) questionnaire was given to a sample of 51 long-term care employees. Data was analyzed by using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0, focusing on significant results concerning t-test, chi-square, and correlations in order to answer the research questions. Findings suggest a majority of the employee's attitudes in this long-term care facility were nonauthoritarian, nonsocial restrictive, and nonbenevolent. While there was no significant empirical support for differences in attitudes among RNs, LPNs, and CNAs, certain questions on the CAMI did provide significant results. Related to this there was also no empirical evidence for differences among the attitudes of departments, except when individual analysis of each question was complete. Correlational analysis showed relationships between various variables: education and seeking treatment for oneself, race and previous work experience, department and previous work experience, authoritarian views and gender, authoritarian views and education, nonsocial restrictive view and age, community mental health ideology and age, and community mental health ideology and department. Implications on future research and a discussion of recommendations to further decrease stigma in the long-term care environment are completed.

The Filipino culture recognizes the elderly as part of its human resources. As a culture that considers family as a basic unit of society, the elderly play a central role. When elderly Filipinos, those that are 65 years of age and older, migrate to the United States, they expect that their families are able to take care of them. However, work demands and living situations among family members prevent them from receiving proper care.

With the increasing population of elderly Filipinos in Palm Springs, demand for a new Residential Care Facility for the Elderly (RCFE) is important. Agbayani's Residential Care Facility for Elderly Filipinos in Palm Springs, CA will offer supportive, quality, and long-term care for institutionalizing family in the facility. This business plan will show how Agbayani's RCFE intends on providing elderly Filipinos the quality of service and community they are accustomed to while maintaining a viable business.

Masters in Public Administration - MPA
The public health sector over the years had been under constant criticism for the lack of or substandard service delivery. The post1994 democratic era was accompanied by slogans such as ‘a better life for all ’. These slogans in part stem from the Constitution of the Republic of South Africa, 1996. The Constitution, chapter two, in its discussion on the Bill of Rights states that everyone has the right to quality health care services. The critics argue that the fundamental r right enshrined with in the Constitution in as far as it pertains to healthcare has been violated. The state introduced various interventions, such as human resource capacity development t programs, to turn the dismal state of public health care around. This research focused on the impact and the relevance of the human resource development within the public health sector. The following research question had been formulated to guide the research; is skills development within the state undertaken for compliance sake or is it a focused interventionist approach aimed at improving the skills set of staff to perform effectively and efficiently? The research was qualitative in nature and the case methodology was used. In this regard Tygerberg hospital was used as the case study. A number of findings emanated from the data collection process, amongst other, that the skills development is not workplace specific but rather undertaken for compliance sake. Furthermore, that no individual staff development plans exist. The end result is that the skills development intervention aimed at improving the staff capacity and the state of health service generally is not making any meaningful impact. The major recommendation is that a health audit must be done, which must inform the development of the hospital staff skills development plan. This in turn must be used to develop individual staff f development plans. This alignment of development plans from provincial level to hospitals and then to the individual will result in a more focussed skills intervention and ultimately an improved public health sector.

Substance use disorders (SUD) can lead to many adverse health effects including nutritional deficiencies and malnutrition. Research shows that proper nutrition can have a positive effect on recovery outcomes; however, nutrition services and education are often undervalued and not adequately utilized in substance abuse treatment centers. Previous research indicates that barriers to healthy eating are often due to ones lack of self-confidence in preparing and purchasing healthy foods. The purpose of this study was to investigate the effectiveness of a "hands-on" nutrition and culinary intervention in a SUD treatment center. Specifically, this study measured the participants' positive and negative attitudes towards cooking, as well as their perceived self-efficacy in relation to purchasing and preparing healthy foods.

There was a significant difference in the participants' overall self-efficacy related to food preparations skills, specifically in their ability to prepare whole grains. Participants also became more confident in purchasing whole grain products by the end of intervention. Further review of the study revealed that the participants' enjoyment of cooking increased significantly after completion of the cooking classes.

Background: According to the National Cancer Registry of South Africa 600-700 new cases of paediatric cancers have been reported every year for the past 25 years. While in the year 2000 HIV/AIDS was responsible for 42 479 deaths in children under five. However support for and research in general for the paediatric intermediate care (encompasses palliative, sub-acute and respite care) needed by these children remains sparse. Costing studies are even rarer, with the few studies conducted in South Africa reporting a broad range of average costs per inpatient day. Methods: A retrospective cost analysis for the period April 2014-March 2015 was undertaken from the provider perspective. Costs of paediatric intermediate care were estimated for an intermediate stepdown facility and a tertiary hospital in Cape Town, South Africa. A step down costing approach was employed, and the costs were inflated to 2016 values and expressed in Rand and USD using an exchange rate of 1 USD = R14.87. Results: Cost per inpatient day was USD 713.09 at the hospital and USD 695.17 at the step-down facility. The cost for a paediatric patient who is HIV/TB co-infected was USD 7130.94 and USD 6951.67 at the hospital and step-down facility respectively, assuming an average length of stay (ALOS) of 10 days. For a patient who has a terminal brain carcinoma the cost was USD 19966.63 and USD 19464.69 at the hospital and step-down facility respectively, assuming an ALOS of 28 days. Personnel costs accounted for 60% of the total cost at the hospital, compared to only 17% of the total costs at the step-down facility. Overhead costs accounted for 12.33% at the step-down facility, almost 3 times that of the hospital (4.48%). Conclusions: The study highlights that the drivers of cost are not uniform across settings. Providing intermediate care at a step-down facility can be more cost-saving than providing this care at a hospital, there are however areas in which more savings could be realized. The costs presented in this study were considerably higher than those found in other studies, however, the paucity of cost data available in the area of paediatric intermediate care makes comparisons difficult.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

The elderly frequently express dissatisfaction with sleep quality and quantity. Disturbed sleep is a common complaint of residents in long-term care facilities. The purpose of this research was to describe the subjective assessment of sleep characteristics identified by elderly individuals living in a long-term care facility. In addition, the subjects perception of sleep prior to and following admission to the long-term care facility was compared. Information about the environmental factors which may have disrupted sleep was also identified. Sixteen female and four male subjects participated in this research. Subjects verbally responded to a 39 item questionnaire which was developed specifically for this study. Forty-five percent of the subjects rated their sleep in the nursing home as being worse than when they lived at home. Their bedtime hour moved to an earlier hour and the use of sleeping medication increased when compared to use at home. Physical illness, emotional stress, and changes in the sleep environment disturbed the sleep of the subjects. Although not quantitatively measured, the subjects reported that emotional stress disturbed their sleep more than physical illness or change in sleep environment.

Objectives: To evaluate the oral health knowledge of legally authorized representatives of long term care facility residents to assess whether oral health knowledge is associated with the representatives’ understanding of the residents’ oral health status and treatment needs. Methods: The study participants were legally authorized representatives (LARs) of long term care facility (LTCF) residents who were visited by the Geriatric Mobile Unit (GMU) of the University of Iowa College of Dentistry & Dental Clinics. Once IRB approval was obtained, a mailing was sent out to the LARs after the GMU visited the LTCF. LARs were asked to complete a survey and were also asked permission to obtain dental records of the LTCF resident they represented. The survey contained questions pertaining to the LAR as well as the LTCF resident. With respect to the LAR, questions on socio-demographics, oral health literacy, oral health knowledge, oral health behavior and oral health status were asked. For questions about the LTCF resident, the LARs were asked about the resident’s prior oral health behavior, current oral health status, oral health treatment needs, and dental insurance status. They were also asked what factors would influence their decision to seek oral health care for the LTCF resident, and when they last spoke to the LTCF resident about their oral health. Bivariate analyses were conducted using Chi-square and Cochran-Mantel-Haenszel tests with LARs knowledge about the LTCF residents’ missing teeth and various oral health treatment needs being the outcome variables. Significant variables were entered into a multiple logistic regression model for each outcome variables. Statistical significance was set at p<0.05 and p=0.05-0.2. Results: Four hundred and thirty-one surveys were mailed out to the LARs. One hundred LARs consented to participate in the study and returned the completed questionnaire. Fifty-two percent of the LARs got all nine oral health knowledge questions correct. The questions that were the most frequently missed included “Losing teeth is a natural process of aging” (77% answered correctly), and “Blood on your toothbrush is a sign of gum disease” (74% answered in correctly). Thirty-eight percent of the LARs said they were extremely confident filling out medical forms by themselves, and 37% said they were quite a bit confident. When asked about the missing teeth of the LTCF resident, ten LARs reported that their LTCF resident had all teeth missing, while only 9 LTCF residents had all teeth missing as per chart review. Seventy-six residents had some upper back teeth missing and 71 residents had some lower back teeth missing. Twenty-eight LARs reported some upper back teeth were missing in their resident and 24 LARs reported some lower back teeth was missing. Treatment needs of the resident were in general underestimated by the LAR. Thirty-five LTCF residents needed a filling and 15 needed extractions, however LARs reported 21 residents needed fillings, and 8 needed extractions. Fifty-six LARs did not know if the resident needed a filling, and 49 LARs did not know if the resident needed an extraction. Bivariate analyses reported a number of significant variables in each domain for p values <0.05 and between 0.05 and 0.2. In the final logistic regression model, retirement status of the LAR and LARs’ confidence filling out medical forms were most commonly significant for LARs’ knowledge about treatment needs of the LTCF resident; and self-reported oral health status, age of the resident, and physical health status of the resident influencing the LARs decision to seek care dental care for the resident were significant for LARs’ knowledge about missing teeth of the LTCF resident. Conclusion: Although the majority of LARs indicated that oral health is important for nursing home residents, many LARs were unaware of the oral health status and the treatment needs of the LTCF residents. While a single variable was not found to be commonly associated across LARs’ knowledge of the oral health status and treatment needs of the residents, several variables were associated with the knowledge of one treatment need only as opposed to the knowledge of multiple treatment needs. Understanding if and how oral health literacy and oral health knowledge influence LARs’ and as well as nursing home caregivers’ decisions to seek dental care for LTCF residents may help address the gaps in oral health care for LTCF residents, thereby improving their quality of life.

Master of Public Health - MPH
Background: HIV remains a global concern. Consequently, global institutions such as the World Health Organisation (WHO) and United Nations Programme on HIV and AIDS (UNAIDS) continue to work towards ending HIV/AIDS by facilitating innovative strategies to improve service delivery of antiretroviral therapy (ART). In 2016 WHO issued the ‘test and treat’ policy recommendation in line with the UNAIDS 2020, 90-90-90 target of reaching 90% people to know their HIV status, get 90% of these on ART treatment and to have 90% of those on treatment virally suppressed. Differentiated Care Models (DCMs) has been put in place for all stakeholders, from global, institutes, government departments and civil society to improve patient access to treatment and retention in care. While various evaluation studies have shown that DCMs improve the retention in care and adherence to medication behaviours of patients on ART, little is known about the patients’ experiences and preferences. The aim of the current study was to explore and compare the experiences of patients in three DCMs (Facility Adherence Clubs [FAC], Community Adherence Club [CAC] and Quick Pharmacy Pick-up [QPUP]) in a community health care facility in a township in Cape Town, South Africa. Methods: An exploratory qualitative study design was used. Data were collected through semi-structured interviews (12) and focus group discussions (6) with purposively selected participants from six DCMs. Thematic analysis was done using Atlas.ti version 8.0. Results: Patients found DCMs easily accessible and convenient and presented positive experiences in relation to the National Health Services (NHS) patients experience principles. FACs and CAC presented attributes of patient-centeredness as prescribed by the NHI. We found that the QPUP model fell short on attributes of patient-centeredness such as coordination and integration of care, information sharing, communication and education, and emotional/psychological support. Conclusions: The principles of DCMs acknowledge the diversity and preference of PLHIV in addressing the barriers they face in accessing ART while empowering these patients to self-manage their disease. Understanding the experiences of patients using DCMs could improve our understanding of how DCMs promote self-management among PLHIV (or not) and some of the challenges faced by the patients using these care models. This understanding could inform strategies to tailor ART delivery services that suit the patients’ needs and enhance their abilities to achieve optimal retention in care and viral suppression.

Thesis (MBA (Business Management))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: Purpose – The health care industry is faced with numerous challenges ranging from rising medical costs, poor state of hospitals, deteriorating health care services and an increasing number of hospital deaths. All these disparities present tremendous challenges for the health care managers in charge of the health care services. As a result, they are forced to try new management methods that will assist their organizations to remain cost effective and efficient. Total Quality Management (TQM) constitutes an appropriate response to these challenges and it has become the strategy of choice to improve organization’s performance and patient satisfaction. However, in practice the implementation of TQM is often unsuccessful. Certain barriers have been identified which prevent the successful implementation of TQM in other industries as well as in the health care industry. The main aim of this research is to investigate the barriers to the successful implementation of Total Quality Management in Kraaifontein health care service organization in the Western Cape Province, 2008. Design/methodology/approach – The study employed a quasi-qualitative and quantitative case study. For the quantitative section a questionnaire with a 5–point Likert style scale was used to quantify the response (strongly disagree=1; strongly agree=5). For the qualitative section a focus group discussion was conducted to verify the results obtained from the questionnaire which addressed the challenges of TQM implementation. The statistical population of this research consisted of all health care workers working the pharmacy department who were involved in the implementation of TQM in their organization. Data was analyzed using appropriate statistical procedures. The mean score of each of the dimensions was used as a representative performance indicator and the coefficient of variation (CV) was used as a general measure of standardized skewness on the performance of each dimension. A high means score indicated desired outcomes while low scores indicated poor outcomes. Findings – Major barriers that were encountered during the implementation of TQM in this case study included the lack of top management active involvement and full commitment in the initiative, rigid organizational structure, culture towards quality changes that inhibited communication between management and employees which in turn hindered employee empowerment. Other obstacles that were encountered were lack of continuous improvement processes and initiative, improper evaluation, the lack of a recognition and reward system for team work, poor collection and analysis of data that resulted in difficulty to convert this data into meaningful information to improve quality. The absence of an integrated performance measurement system also exhibited a problem as employees were not aware what was being assessed during performance appraisals. Lack of evidence based decision making, poor communication and inflexible organizational structure and culture were also viewed as barriers. Research limitations/implications – Although conducted in Kraaifontein health care facility, it is expected that the results of the study may be relevant on a broader scale to other health care departments and facilities. The results could assist the health care managers to develop a plan that addresses the barriers and challenges faced during the implementation of TQM, yielding fruitful results which allow TQM to be implemented easily, effectively, efficiently and successfully in health care facilities.
AFRIKAANSE OPSOMMING: Doel – Die gesondheidsorg sektor het vele uitdagings wat wissel van stygende mediese kostes, lae standaarde in hospitale, die agteruitgang van gesondheidsorg dienste, en die toename in sterftes in hospitale. Hierdie en ander probleme stel groot uitdagings aan diegene verantwoordelik vir die lewering van gesondheidsorg, met die gevolg dat diesulkes nuwe bestuursmetodes moet vind om te verseker dat hulle organisasies steeds koste-effektief en doeltreffend funksioneer. Totale Gehalte Bestuur (TGB) is ‘n geskikte en toepaslike alternatief om genoemde probleme aan te spreek, en word toenemend as oplossing gesien om organisasies se dienslewering te verbeter, en pasiënt-tevredenheid te verseker. Die implementering van TGB blyk egter nie altyd suksesvol te wees nie. Daar is spesifieke struikelblokke geidentifiseer wat as redes aangevoer word vir die onsuksesvolle implementering van TGB in verskeie sektore, insluitend die van gesondheidsorg. Die hoof doel van hierdie navorsing was om die struikelblokke te ondersoek wat verhoed dat TGB suskesvol toegepas word in Kraaifontein gesondheidsdienste in die Weskaap, 2008. Ontwerp/Metode/Benadering – Die studie was ‘n kwasi kwalitatiewe en kwantitatiewe gevallestudie; vir die kwantitatiewe komponent is ‘n 5 punt Likert tipe skaal gebruik om die response (verskil beslis = 1; stem beslis saam = 5) te kwantifiseer. Die kwalitatiewe komponent het ‘n fokusgroep bespreking behels, waartydends die resultate van die vraelys geverifiëer is, wat die uitdagings van die implementering van TGB uitgewys het. Die statistiese populasie vir hierdie navorsing was al die gesondheidsorg werknemers in diens van die aptekers-departement, wat betrokke was in die implemetering van TGB in hulle organisasie. Die data is geanaliseer met toepaslike statistiese metodes. Die gemiddelde telling van elkeen van die dimensies was gebruik as ‘n verteenwoordigende aanduiding van prestasie, en die koëfisiënt van veranderlikheid was gebruik as ‘n algemene maatstaf van die gestandardiseerde skeefheid soos gemeet op elkeen van die dimensies. ‘n Hoë gemiddelde telling was ‘n aanduiding van die beoogde uitkomste, en lae tellings aanduidend van swak uitkomste. Bevindinge – Belangrike uitdagings wat ondervind is tydens die implementering van die TGB in hierdie gevallestudie sluit in, die gebrek aan aktiewe betrokkenheid en toewyding van die topbestuur vir hierdie inisiatief, rigiede organisatoriese strukture, die kultuur teenoor gehalte veranderinge wat kommunikasie tussen bestuur en werknemers belemmer, wat op sy beurt werknemer-bemagtiging verhoed. Ander struikelblokke wat geidentifiseer is, was ‘n afwesigheid van voortdurende verbeteringsprosesse en inisiatief, swak evaluering, ‘n gebrek aan ‘n sisteem vir erkenning en vergoeding vir spanwerk, swak data insameling en ontleding, wat tot probleme gelei het om die data in betekenisvolle inligting te verwerk wat kon lei tot ‘n verbetering in gehalte. Die afwesigheid van ‘n geintegreerde prestasie-beoordeling sisteem is ook as probleem geidentifiseer omdat werknemers nie ingelig was oor wat die prestasie-beoordelings behels nie. Die gebrek aan navorsingsgesteunde besluitneming, swak kommunikasie, en onbuigsame organisatoriese strukture en kultuur, was ook gesien as struikelblokke. Navorsing-beperkinge/implikasies – Alhoewel die studie in Kraaifontein gesondheidsorgfasiliteit gedoen is, word dit aanvaar dat die bevindinge van hierdie studie ook van toepassing is op ander gesondheidsorg departmente en fasiliteite. Die resultate kan gesondheidsorgbestuurders help om die uitdagings en struikelblokke te identifiseer in die implementering van TGB. Hierdie identifikasie kan lei tot ’n meer effektiewe en suksesvolle implementering van TGB in gesondheidsorgfasiliteite.

Individuals diagnosed with dementia make up the majority of the population in skilled nursing facilities (SNFs). Certified Nursing Assistants (CNAs) are the primary caretakers of older adults living in SNFs. The purpose of this grant project was to write a proposal for funding to provide Person-Centered Care (PCC) training to help CNAs enhance their skills to better enhance the quality of life of older adults living with dementia in SNFs.

The goal of PCC training is to help CNAs better understand the signs and symptoms of Alzheimer’s and dementia, improve communication skills, and provide strategies to manage the behavioral and psychological symptoms of dementia. Previous research on PCC has found it to be effective in improving the quality of care of older adults who are affected by dementia and who are living in nursing homes.

Actual submission or funding of the grant was not required for the successful completion of this project.

Magister Curationis - MCur
Despite the awareness of the importance of initiating antenatal care in the first trimester of a pregnancy (before 12 weeks gestation), late initiation of antenatal care (on or after 24 weeks of gestation) remains a common trend amongst pregnant women. The late initiation of antenatal care poses such a risk, to both the pregnant women and their unborn babies that it can contribute to maternal and foetal mortality and morbidity. The late initiation of antenatal care, an entirely avoidable occurrence, has an impact on targets set by the United Nations Millennium Development Goals (MDGs), now focusing on the Sustainable Development Goals (SDG‟s) set out by the United Nations. This study aim to investigate the factors which contribute to and cause the late initiation of antenatal care in pregnant women in a region in the Western Cape. Aim: The aim of this study was to investigate the factors that influence pregnant woman and contribute to late initiation of antenatal care (after 24 weeks gestational age) in one health facility/district in Cape Town. The findings of the study identified possible factors that may cause pregnant women to initiate antenatal care late in pregnancy and these findings could facilitate planning and possible interventions targeting the importance of early initiation in the community.

This thesis investigates the utilisation of maternal health care in Zambia, where despite being a signatory to the Safe Motherhood Initiative and Millennium Development Goals, which are aimed at improving maternal health, indicators of maternal health continue to perform poorly. The need to understand crucial factors in improving maternal health motivated the current research, especially since there is a dearth of literature in this area in Zambia. The thesis focuses on two aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, to answer two broad questions. Firstly, what factors determine the use of ANC in Zambia? Secondly, to what extent has the abolition of user fees affected facility-based deliveries? An assessment of the factors, which explain the utilisation of ANC in Zambia, using three sets of comparable datasets reveals that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among the poor and less educated, and there are marked regional differences in utilisation. The most appropriate econometric specification for antenatal visits, according to different performance indicators, was the two-part model, which differs from recent research favouring more complex methodologies. The analysis is further extended through the inclusion of supply-side factors and the examination of individual and community level factors associated with inadequate and non-use of ANC, following the adoption of the focused ANC approach in Zambia. To incorporate the supply side factors, the 2007 Zambia Demographic and Health Survey was linked to administrative and health facility census data using geo-referenced data. To assess the factors associated with (1) the inadequate use of ANC (defined as three or less visits), and (2) the non-use of ANC in the first trimester of pregnancy, we specify two multilevel logistic models. At the individual level, the woman’s employment status, quality of ANC received and the husband’s educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilisation of ANC. Both individual and community level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community level factors are relatively stronger in rural areas. Although ANC is an important facet of maternal care, it occurs before delivery, but does not necessarily provide much information with respect to delivery decisions. Therefore, the thesis investigates delivery decisions, as well, in particular, the effect of user fee removal in rural areas of Zambia on facility-based deliveries. To account for regional differences, we employ a Seemingly Unrelated Regression model incorporating an Interrupted Time Series design. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are controlled for, user fee removal is found to immediately increase aggregate facility-based deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence facility-based deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase facility-based deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities. Additionally, we analyse the effect of user fee abolition on the location of childbirth, focussing on deliveries that occur in public health facilities using household survey data. To elicit the causal relationship, we exploit the relative change in fees across health districts within a difference-in-differences framework. Surprisingly, although reductions in home deliveries were observed, as expected, reductions in public health facility-based deliveries were also uncovered, along with increases in deliveries at private health facilities. However, these findings were statistically insignificant; suggesting that the abolition of user fees had little, if any, impact on the choice of location for childbirth. The statistically insignificant, but unexpected, causal effects further suggest that the removal of user fees have unintended consequences, possibly the transference of facility costs to the client, which would deter the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in outcomes; instead, other efforts, such as improving service quality, could have a greater impact.
Thesis (PhD)--University of Pretoria, 2013.
gm2014
Economics
unrestricted

The elderly population, defined as 65 and older, is the fastest growing demographic group in the United States. As baby boomers' reliance on healthcare systems increase, housing with medical accessibility becomes a vital need in today's economy. As the market appears to signal an increase in the need and desire for home and community based services, important questions arise about how assisted living executives' leadership styles affects his/her entrepreneurial orientation. This study analyzed the relationship between the full range of leadership model as measured by the multifactor leadership questionnaire and entrepreneurial orientation (innovativeness, proactiveness, and risktaking) of executives within the licensed assisted living facility industry in Indiana. The researcher used the multifactor leadership questionnaire and the entrepreneurial orientation questionnaire to determine whether assisted living executives were innovative, proactive, and risk-taking based on their leadership style.

The primary purpose of this clinical scholarly research project is to determine whether there are undiagnosed symptoms of depression among the residents in a small population Long Term Care facility (LTC). Caregivers at the LTC receive specific knowledge regarding older adult late-life depression and then apply said knowledge by surveying the LTC residents (LTCR’s) using the Geriatric Depression Scale instrument (GDS-15). The secondary purpose is to determine whether the LTC caregivers perceive this training as beneficial. Using two-sample t-test statistical analysis, the results of this study indicate a positive correlation with the alternative hypothesis; the number of LTCRs with previously undetected depressive symptoms increased. H_a: μ LTCR with depression or delirium ≠ μ LTCR with depression or delirium. In this study, the number of LTCRs with symptoms of depression or delirium increased by 60.4 percent. The P (T<=t) two-tail value is less than 0.001. In the literature, this difference is extremely statistically significant. The mean of the medical records examined minus the mean of the number of medical records with an indication of depression or delirium is 0.60. For a 95% confidence interval, this difference must fall between the ranges of 0.45 to 0.76. These data confirm the alternative hypothesis.

Additionally, the caregiver participant’s satisfaction outcome survey results reported the training was substantially beneficial.

The problem of this study is to compare prior health care experience with satisfactory adjustment in a long-term care facility. Both quantity and quality of prior experience in a health care facility are examined in terms of the significance to successful relocation. Demographic data and perceived control of health are examined in relation to significance of the findings.

People with severe mental illnesses (SMI) face barriers that contribute to poor physical health outcomes. However, these barriers have not been systematically investigated in Ethiopia. Aim: The aim of this study was to examine barriers to care for physical co-morbidities among SMI patients. It achieves this by: i) estimating the prevalence of physical co-morbidities in SMI in-patients in a psychiatric referral hospital over a two month period; ii) describing potential associations of various socio-demographic and clinical factors with the occurrence of physical co- morbidities in admitted patients with SMI; and iii) exploring barriers in recognition and management of these physical comorbidities in the immediate curative medical care environment of admitted SMI patients in the psychiatric referral hospital. Methods: The study used a mixed methods design that included: i) a quantitative cross-sectional facilitybased record review; and ii) a qualitative exploration of potential or experienced barriers to physical health care provision by patients, caregivers, mental and general health professionals. The quantitative component estimated prevalence and examined risk factors associated with the presence of co-morbid physical health conditions among people with SMI. For this, clinical records of all admitted patients with diagnosis of SMI were reviewed over a two-months period. To check the reliability of the clinical records, a pilot test was done for two weeks before actual data collection. By using systematic random sampling of the records reviewed, 30 patients were selected for physician assessment in order to check the accuracy of the information included in records. The qualitative section was conducted using semistructured interviews with SMI patients and their caregivers and focus group discussions with service providers.

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.

Research studies show that work engagement is credited with having a positive effect on business outcomes. As health care leaders and administrators continue to make efforts to improve work engagement, the global nursing shortage has become a major problem that can affect registered nurses (RNs') work engagement and turnover intentions. RNs are important to the nation's well-being as everyone's health care needs involve the role of a nurse, but RNs currently in practice experience higher demands in an environment already constrained. This qualitative case study explored the perceptions of eight RNs in a long-term health care facility located in a Northeastern region of the United States utilizing semi-structured open-ended interviews. The study illustrated how RNs' work engagement could be improved and strengthened, turnover intentions minimized to make nurses' practice environment more attractive to motivate and retain nurses in long-term care setting. Study results suggest that nurses are highly engaged in their work though they encounter several issues including understaffing that creates work overload leading to burnout and job-related stress that challenge and undermine their engagement. Results also indicate that in order to improve RNs' practice environment and minimize turnover intentions and turnover, concerns regarding understaffing, job role stress, and nurse-management conflicts need to be addressed. Study results imply that to be effective as a nurse one has to be dedicated and committed to his or her work and the profession. Additionally, organizational leaders should make concerted effort to identify and address nurses' issues to create practice environments that attract and retain nurses.

Background: To achieve better health outcomes it is important to identify those aspects of health care delivery system that determines patient satisfaction. The health care planners must therefore be cognizant of the opinions and expectations of those who utilize health care facilities to achieve better health outcomes. This also applies to maternal satisfaction. The study aimed to measure mothers satisfaction with maternity care and its association with various socio-demographic characteristics. Method: The study presented here is a quantitative cross-sectional study that utilizes secondary data from facility-based survey conducted in 12 different tertiary hospitals of Nepal and included client exit interviews  (n=43756). The maternal satisfaction association with different exposures and potential confounders was determined using multivariate logistic regression analysis. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results:. Better information and counselling is seen to be associated with higher satisfaction and recommendation [AOR: 1.67 [1.60-1.75]] and [1.68[1.57-1.80], respectively. Higher level of delivery preparation indicates lower overall satisfaction [AOR: 0.70 [0.66-0.74]]. Mothers were seen to be less satisfied with the religious and cultural aspects of the maternal health services. Mothers age and sex of child was not seen to be significant with any outcome. Conclusion: Better information and counselling indicates more satisfaction and recommendation. Mothers delivery preparation is seen as a significant predictor of their overall satisfaction; therefore, this should be a part of education and information strategy for mothers from the different backgrounds.

Buildings which address space through all the senses, rather than being dominated by ocular centric considerations solely, have become the minority within the discipline of Architecture. This can create an imbalance, perceivable as feelings of estrangement and detachment for the inhabitant. Estrangement is particularly evident within health care architecture, which owes much of its current form to ideas developed during Modernism. In response to this imbalance, Architecture from the past may have lessons which can be applied. This thesis investigates the potential of applying spatial techniques and approaches learned from the 16th century Japanese tea-house. A health care building which benefits from the same kind of reflective and contemplative spaces inherent in the tea-house includes counseling facilities, and therefore an outpatient cancer care center was chosen to apply these lessons. Among the techniques researched and applied, the use of a sequential vision of spatial experience, which reveals the building in stages and facilitates spaces for pause and reflection, was particularly powerful. The result is a building with spaces that take on an almost sacred tone, where one can be at peace with the realities of their current situation, and begin thinking about the path forward.
Master of Architecture

Research shows that one of the major contributors for an extended stay in a long-term care facility is lack of knowledge regarding goals for rehabilitation after being discharged from an acute care facility. It is important to determine patients’ levels of engagement because individuals who are actively involved in discharge planning and rehabilitation goals are able to manage their ongoing care more effectively, which results in increased quality of life. The data was collected using a survey method and the instrument used was the Patient Activation Measure or PAM which is a highly accurate and reliable tool. The 22 question survey was used to determine the level of patient activation among patients who are currently receiving rehabilitation services at a rehabilitation or long-term care facility. Determining the level of engagement in patients receiving rehabilitation services will provide health care providers insight into the how willing patients are to be engaged in their own care. A total of 11 surveys were completed by patients varying age, gender, and length of stay. Each patient was currently receiving rehabilitation services at National Healthcare Corporation of Johnson City or John M. Reed Health and Rehabilitation Facility in Limestone.

Goal: On the base of analysis of cost make suggestion for effective data assimilation for added value in health care facility. Introduction: Every manager needs tools to manage company which help him to lead company to prosperity. There are direct tools as comands, meetings, etc. and indirect tools, for example economic management. Economic management includes whole line of elements which in their cohesion are integral part of every business, for example controlling, cost management, dealing with short term-assets, management accouting, investment decisions, financial analysis, material incentives. Recently every company focuses its management attention to cost management. We often meet such efforts to reduce costs, which in fact cal lead to damage in short-time or long-time period. In my thesis I will analyse main traps which managers confront while working in chosen health care facility. I will also describe more flexibile access to management costs which provides company with stable and tenable position in global market conditions. Achieving maximal outcomes from company resources and all at once minimalize costs is still one of main strategic target of company.

Background: Diabetes is now the most common non-communicable disease globally and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, self-management of diabetes and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for DM states that carbohydrates should make up 45-60% of the total nutritional intake and that low carbohydrate or high protein diets offer no long term success over healthy eating plans. Recent studies suggest that there may be merit in using low carbohydrate diets in diabetic patients. Aim and Objectives: The study aimed to implement and evaluate a program for weight loss in Diabetes Mellitus type 2 patients by comparing a Low carbohydrate diet to the conventional low fat diet. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded in both groups. Methods: The study design was that of a two group randomised parallel design, with one group following a low fat diet and the other a low carbohydrate diet. Both groups received advice on exercise and behaviour change. Clinical parameters were recorded at week 0 (baseline) and week 12 of the program. Patients were invited to participate in the study using leaflets, posters and via staff. A total of 10 patients per group were identified and followed. Results: Significant reductions were seen in weight loss and Hba1c in the Low Carbohydrate diet group which was not evident in the Low fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low Carbohydrate diets are effective in promoting weight loss and glucose control in diabetic patients. More research is recommended to assess patient's experience of following a low carbohydrate diet. Recommendations include training staff at facilities in our Sub-District on understanding and implementing Low Carbohydrate diets.

Doctor Educationis
Background: Since 2005 the Chronic Dispensing Unit (CDU) has been part of the Western Cape Government’s strategy to address increasing demand for chronic medication for patients with non-communicable diseases. However, some patients are unable to collect their pre-packed chronic medication parcels from health care facilities on the due date. Recent research reported that some patients utilise collectors or medicine agents to collect their prepacked chronic medication parcels. Currently little is known about this phenomenon of collectors. Aim and Objectives: This study explored the acceptability of collectors of CDU chronic medication parcels to improve access to medicines for patients with non-communicable diseases at Lotus River Community Day Centre (LRCDC). Methodology: An exploratory descriptive qualitative study using semi-structured interviews in English and Afrikaans was conducted with six purposively selected collectors, three patients who use collectors and three key informants who have intimate knowledge of the collectors and system at the health facility. Interviews were recorded, transcribed, translated into English (where applicable) and thematically coded to derive themes from the data. Ethical approval was provided by the University of the Western Cape Bio-Medical Research Ethics Committee and informed consent was obtained from all study participants. Results: Patients reported that their collectors exhibited positive characteristics such as trust, patience and reliability, as well as, a passion for helping the community and organisational skills. All patients acknowledged the benefits of utilising a collector and found them to be highly acceptable. Key informants, however, had some reservations about the characteristics of collectors and their role in medication distribution and were sceptical as to whether collectors were suitably equipped to perform this function. Patients were grateful when their collector had some knowledge about their condition and were able to converse with them regarding their medication. Key informants suggested that with sufficient training and skills development, collectors could potentially improve access to chronic medication parcels and impart basic knowledge about chronic medication adherence to patients. iv Conclusion: The collector system that has emerged at LRCDC is highly acceptable to patients, but health facility staff were more measured in their assessments. Health facility staff, however, acknowledged the potential of collectors to improve access to chronic medication parcels for patients with chronic conditions and the benefit of upskilling collectors to perform this function. Recommendations: As a short-term measure, collectors should be formally accepted at facilities as medicine agents. They should receive basic education about safe medication distribution practices. Patients should screen collectors to ensure that they have the desired positive attributes. Furthermore, future research is necessary to comprehensively understand the current scope of practice of collectors within communities

In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.

Master of Philosophy (Medicine)
Health care evaluation serves the purpose of monitoring the quality of health care provided by Health Care Providers (HCP), so that health care services can be provided most effectively and efficiently. Patient satisfaction studies are widely used to assess the quality of outpatient care. A client satisfaction study was conducted at an HIV health care facility in Sydney, Australia during 2007-2008. There were three objectives: 1.) To validate a questionnaire for future determination of client satisfaction in HIV health care facilities. 2.) To identify the levels of satisfaction of clients, and investigate any dissatisfaction and unmet needs towards HIV health care. 3.) To provide recommendations for improving client satisfaction levels in HIV health care. This research used a mixed method approach and consisted of two phases. The first phase was a quantitative survey conducted with 166 clients (both HIV positive and negative) at Albion Street Centre (ASC) using a newly-devised questionnaire. Clients were asked to answer demographic questions, rate their levels of satisfaction with each aspect and each HCP category, and provide suggestions for improvement. Quantitative statistical analysis was conducted to obtain a general view of client satisfaction levels. Dissatisfaction and unmet needs of clients were then investigated in-depth in the second phase of the research through qualitative face-to-face semi-structured interviews. Twenty-two clients (both HIV positive and negative) at ASC were interviewed individually and asked about their attitudes, perceptions, and experiences towards their HCP and the HIV health care services received. Thematic analysis was used to categorise and interpret the qualitative data. More than 90% of the clients were satisfied with most of the aspects covered in the survey, with a mean overall satisfaction score of 84 out of 100. Clients were most iii satisfied with the “technical quality” and “interpersonal manner” of the HCP, and were least satisfied with “waiting time” and “availability of HCP”. The HCP category with which the clients has the highest level of satisfaction was “nurses” (86%), followed by “psychologists” (84%), then “doctors” (83%). Clients who were HIV negative, had a full time job, visited ASC less frequently, or did not possess any type of Health Care Card were more satisfied with the services overall. No common dissatisfaction or unmet needs towards HIV health care service were identified. “Technical quality of HCP” and “the relationship with HCP” were the two most important determinants of client satisfaction, which outweighed the inconvenience contributed by the poor availability of HCP and the location of ASC. The maintenance of “confidentiality/privacy” was shown to be fundamental in HIV health care facilities. The multi-disciplinary nature of ASC increased the degree of convenience and satisfaction level among clients. Suggestions for improvement in client satisfaction levels include increasing the attractiveness of the physical environment and the variety of educational reading materials in the waiting area; introducing beverages, and encouraging clients to be involved in their treatment decisions. Health care administrative staff in particular are reminded not to neglect the importance of the availability of HCP, accessibility, and physical environment when establishing a new HIV health care facility. The mixed method approach (quantitative survey and qualitative interviews) proved beneficial. It increased the validity of the findings by assessing client satisfaction levels using more than one method. This enabled clarification of ambiguities noted in the initial survey through probes used in the interviews, and also allowed investigation of the determinants of client satisfaction through understanding their experiences in HIV health care. Future client satisfaction studies would benefit from using this approach.

Thesis (MA)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The aim of this pilot study was to do a needs analysis with a selected group of nurses with regard to the following three aspects: nurses' experiences of their involvement in termination of pregnancy (TOP) services, the effects of their involvement in TOP service provision on a personal, familial and career level, as well as their needs with regard to support. An important aspect of the needs analysis was to develop a questionnaire which can be used as basis for future research purposes. A qualitative, explorative, descriptive and contextual research design was applied in order to conduct this study. Participants were recruited from a health care facility in the Western Cape, v~ and the small sample group (seven out of a possible fifteen) consisted of a selected group of nurses who are currently involved in performing TOPs, as well as nurses involved in pre- and/or post-procedure care of patients. Each participant completed a self-administered biographical dataand semi-structured questionnaire, which was compiled specifically for the purpose of the pilot study. Specific guidelines according to previous research findings were incorporated. The results of the pilot study revealed that most of the participants experience some sort of cognitive, emotional and/or behavioural reaction before, during and after TOP procedures are performed. -Feelings of anxiety, sadness, anger, depression and guilt were reported in some cases, as well as moral-ethical conflicts. With regard to the effect on a personal, familial and career level, it was confirmed that the work has an effect on the majority of respondents' personal life and career to a certain extent, although family life did not seem te be affected significantly. The results conveyed that the majority of the nurses experienced that the impact of their work with TOPs seemed to be different from that of their other nursing duties. It was found that participating nurses are in need of some sort of support service, and that the practicality of the services which are currently provided, should be investigated further. Although the ability to generalise the results, was limited by the small research sample, valuable information was gained with regard to nurses' needs for support, as confirmed by other South African research findings. Suggestions for improvements in the questionnaire, as well as other further research possibilities, are provided.
AFRIKAANSE OPSOMMING: Die doel van hierdie loodsstudie was om 'n behoeftebepaling te doen met 'n geselekteerde groep verpleegpersoneel met betrekking tot die volgende drie aspekte: verpleegpersoneel se ervaring van hul betrokkenheid by terminasie van swangerskap (TOP) dienste, die effek van hul betrokkenheid by TOP diensvoorsiening op 'n persoonlike, gesins- en beroepsvlak, sowel as hul behoeftes met betrekking tot ondersteuning. 'n Belangrike aspek van die behoeftebepaling was om 'n vraelys saam te stel wat as basis vir toekomstige navorsingsdoeleindes sou kon dien. 'n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp is toegepas ten einde hierdie loodsstudie uit te voer. Deelnemers is gewerf by 'n gesondheidsorgfasiliteit in die Wes-Kaap en die klein steekproef (sewe uit 'n moontlike vyftien) het bestaan uit 'n geselekteerde groep verpleegpersoneel wat tans betrokke is by die uitvoering van terminasie van swangerskappe, sowel as verpleegsters wat betrokke is in pre- en/of post-prosedurele versorging van pasiente. Elke respondent het 'n selfgeadministreerde biografiese en semi-gestrulctureerde vraelys voltooi, wat spesifiek vir die doel van die loodsstudie saamgestel is. Spesifieke riglyne op grond van vorige navorsingsbevindinge is geinkorporeer. Die resultate van die loodsstudie het aan die lig gebring dat die meeste van die respondente een of ander kognitiewe, emosionele en/of gedragsreaksie ervaar voor, tydens en na die uitvoering van TOP prosedures. Gevoelens van angs, hartseer, woede, depressie en skuld is gerapporteer in sornmige gevalle, sowel as moreel-etiese konflikte. Wat betref die effek op 'n persoonlike, gesins- en beroepsvlak, is dit ook bevestig dat die werk 'n effek blyk te he op respondente se persoonlike en beroepslewe tot 'n sekere mate, alhoewel dit geblyk het dat gesinslewe nie beduidend bemvloed word nie. Dit het ook uit die resultate van die studie geblyk dat die meerderheid van verpleegsters die impak van hul werk met TOP as anders as die van hul ander verplegingstake ervaar. Daar is bevind dat deelnemende verpleegpersoneel 'n behoefte het aan een of ander tipe ondersteuningsdiens en dat die praktiese aspekte van die dienste wat tans voorsien word, verder ondersoek behoort te word. Alhoewel die veralgemeenbaarheid van die resultate deur die klein steekproef beperk word, is waardevolle inligting bekom met betrekking tot verpleegpersoneel se behoeftes aan ondersteuning, soos bevestig deur ander Suid-Afrikaanse navorsingsbevindinge. Aanbevelings vir verbeteringe aan die vraelys, sowel as verdere navorsingsmoontlikhede word gemaak.

This retrospective study examined records of 230 low-income elderly and disabled individuals enrolled in the Georgia Community Care Services Program (CCSP) which provides home health services in the client’s home rather than a nursing facility (NF). This study sought to determine if any common characteristics exist in program enrollees who enter a NF within one year of enrollment. Common factors found could be used to identify those who are at the highest risk for entering an NF. This knowledge could lead to reduced costs for the State of Georgia and better service for CCSP enrollees. Findings associated with NF entry include: age, Medicaid status, and monthly income. Further study is recommended to determine which common factors could be developed into a screening tool used to identify individuals at highest risk for NF entry. Specific care plans could then be developed to avoid or delay NF admission for CCSP enrollees.

OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities. METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission. RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure. CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.