Dissertations / Theses on the topic 'Patient education – Swaziland – Methods'

A quasi-experimental design was used in this study to determine if guided practice would result in higher breast cancer knowledge scores, higher breast self-examination (BSE) knowledge scores and higher intent to practice scores then modeling alone or teaching without modeling or guided practice. Fifty-eight women participated in the study. There were 19 women in the guided practice group, 22 in the modeling group and 17 in the control group. A pre-test, post-test format was used. ANCOVA was used to statistically control for the variance in pre-test scores. Descriptive statistics were used to analyze demographic data. The results showed that all methods of teaching resulted in higher breast cancer and BSE knowledge scores and in higher intent to practice scores. There were no statistically significant differences between the groups. Nursing research need to continue in this area to find the most effective method of teaching women breast self-examination.

Patient education has become more important in decreasing patient anxiety about surgery. The purpose of this study was to examine the effects of two methods of teaching instruction on 2 groups of surgical patients (25 in each group): traditional (film and interview) and traditional plus nurse teaching-coaching on anxiety scores on two groups of surgical patients. Sister Callista Roy's Adaptation Model (1984) was the conceptual framework for this study.The research questions are a) "Are there significant differences between preoperative and postoperative scores on State Anxiety between two groups of surgical patients using two methods of preoperative instruction: traditional preoperative teaching and traditional preoperative teaching plus nurse teaching-coaching interventions" and b) "Are there significant differences in pre- and postanxiety scores of men and women?"State anxiety was measured by Form Y-1 of the State-Trait Anxiety Inventory by Speilberger, Gorsuch, & Lushene (1983). The nurse teaching-coaching intervention was performed in a 30 minute session that focused on content covered in the traditional preoperative teaching. Procedures for the protection of human subjects were followed.Findings of this study showed that no significant differences between pre- and post- anxiety scores for two groups of surgical patients, regardless of the method of instruction. There was, however, a significant difference between pre- and post- scores for two groups of surgical patients in regards to men and women. Women had greater levels of anxiety before surgery and greater decreases postoperatively than did men.Conclusions indicated that further research is needed to demonstrate the effectiveness of the nurse teaching-coaching intervention on decreasing anxiety levels of surgical patients. The nurse teaching-coaching intervention warrants strong consideration for further study and use in nursing practice in assisting in recovering from surgery.
School of Nursing

Health care consumers are under-represented in literature when defining patient and family engagement. The proportion of people living longer is rapidly growing. Future research is needed to evaluate which strategies of patient and family engagement are most useful in real-world health care settings for patient and families. The purpose of this study was to describe the lived experiences of patient/family advisors working within patient family advisory councils at an academic medical center in the Midwestern United States. The conceptual framework is based on Greenleaf's servant leadership and Bass's transformational leadership. The research questions examined how patient/family advisors describe patient and family engagement, their experiences from the advisor program, and what is most meaningful to them. A phenomenological design was employed with a purposeful sample of 19 interview respondents drawn from 5 different advisory councils. Data analysis consisted of interpretive phenomenological analysis and a detailed, in-depth account of participant experiences. Transcripts from semi structured face-to-face interviews were collected, coded, validated by member checking, and triangulated with emergent themes. Emergent themes included patient/family advisors' descriptions of patient and family engagement within the patient family advisory councils and organizational efforts most meaningful to patient/family advisors. The results of this study may help create social change by improving the standards and quality of patient and family engagement by preparing health care professionals to better meet the needs of health care consumers.

The problem of this study was to compare and evaluate two methods of teaching medication compliance to an elderly population with a variety of medical problems, cultural backgrounds, and educational levels. Eighty patients over 65 years old who were attending clinic at a county health care facility participated in the study and were randomly placed into two groups. The Medication Knowledge and Compliance Scale was used to assess the patients' medication knowledge and self—reported compliance. Group I (control) received only verbal teaching. Group II (experimental) received verbal teaching as well as a Picture Schedule designed to tailor the patients' medication schedule to their daily activities. Each patient was re—evaluated two to three weeks later. Medications were also counted at each visit and prescription refill records were examined. Knowledge and compliance did increase significantly among all 80 participants. Patients in Group II demonstrated a significantly greater increase in compliance than Group I but did not show a greater increase in knowledge. Patients in Group II also improved compliance as evidenced by their prescription refill records. This study demonstrates that even though significant barriers to learning exist, knowledge and compliance can be significantly improved when proper teaching techniques are utilized.

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists. Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. Next, semi-structured interviews were conducted with 13 stroke survivors and 12 caregivers from rural Appalachian Kentucky, a region with high incidence of stroke and lower levels of educational attainment. Lastly, 13 physical therapists, representing inpatient rehabilitation, outpatient, and home health, were recruited and participated in pre-interview reflection activities and interviews. Data analysis involved predetermined and emerging coding and a constant comparative method was employed. Verification strategies included self-reflective memos, analytic memos, peer debriefing, and triangulation. The theory generated from this dissertation is: physical therapists continually assess the educational needs of stroke survivors and caregivers, to participate in dynamic educational interactions that involve the provision of comprehensive content, at a point in time, delivered through diverse teaching methods and skilled communication. This phenomenon is influenced by characteristics of the physical therapist and receiver (stroke survivor/caregiver) and occurs within the context of the physical therapist’s professional responsibility, the multidisciplinary team, a complex healthcare system, and the environmental/socio-cultural context. The RECAP theoretical model depicts the relationships between the core and encompassing constructs of the theory. The RECAP theory and model presents a significant advancement in the study of patient and caregiver education in physical therapy in stroke rehabilitation. This research provides a springboard to inform future research, guide RECAP in stroke physical therapy practice, design optimal educational interventions, develop training tools for entry-level curriculum and practicing clinicians, and to potentially translate to the practice of patient and caregiver education for other rehabilitation professionals and patient populations.

The effect of psychosocial information resources on the psychological impact of genetic testing for patients Background: The genetic testing process has been shown to have a profound psychosocial impact on patients and families, yet research suggests that there is a lack of practical and helpful psychosocial information written to support decision-making. Ideally, this should be available for use both before and after genetic testing and should be easily accessed through genetic clinics. The development of pre-written leaflets or on-line resources which draw on the experiences and advice of families who have been through similar experiences, and are readily available through genetic clinics, might be one way of helping families make necessary adjustments. Aim: The aim of this study was to develop information resources for a) people undergoing carrier testing, and b) parents of children with undiagnosed conditions, and to pilot the use of these resources with service users. Methods: A systematic literature review was conducted to identify key themes to inform the content of the resources. To build on these findings, in-depth interviews were conducted with 11 people who had undergone carrier testing and 14 parents of children without a diagnosis. Interview data were analysed using the grounded theory method. A grey literature search of existing patient information was also conducted. These three phases informed the content of information resources. The development process also included input from genetic specialists, patient group representatives and interviewees. Finally, a pilot study was conducted through three genetic centres to assess the feasibility of a study testing the use of the resources. Findings: The participants in this study were striving for empowerment: carriers sought reproductive empowerment; parents developed empowerment strategies in order to advocate for their child. Moreover, a theory named ‘reconstructing the meaning of being a parent’ was constructed to describe the experience of parenting a child for whom no clear care pathway existed. The importance of providing timely information was identified as being a key factor in supporting parents during their search for a diagnosis. A new model was built to summarise the overarching experience of participants in this study. Conclusions: Empowerment was identified as a dynamic and multi-faceted construct. Health professionals and support groups can help facilitate the empowerment process through the provision of timely psychosocial information. This is particularly important in an age when patients are expected to take greater control than ever before over decisions affecting their healthcare.

As the U.S. population continues to diversify, hospitals need to understand and care for patients of diverse backgrounds and provide quality service for positive patient satisfaction scores. The purpose of this nonexperimental quantitative retrospective survey design was to determine what relationship exists between cultural competence initiatives (CCI) and patient satisfaction scores as reported by the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey in U.S. hospitals. The theoretical framework for this study was based upon CCI and patient satisfaction through the lens of service quality. The research questions were created to understand the relationship between CCI and patient satisfaction scores and weigh the cultural competence components relative to each other and their effect on patient satisfaction. The study's data was gathered from secondary sources: the HCAHPS and Diversity and Disparities: A Benchmark Study of U.S. Hospitals in 2013 (DDBS). Through a multiple linear regression analysis, the findings were CCI does have a significant but weak relationship with patient satisfaction. Leadership, a component of CCI, also resulted in a significant but weak relationship with patient satisfaction. The social change implications of this study are that by understanding the diverse cultural needs of its customers, health care organizations will be able to improve patient satisfaction scores. Understanding the relationship between CCI and patient satisfaction scores will aid health care organizations in determining if these initiatives are worth an investment of resources. A broader look at the significance to practice with improved patient satisfaction scores is an increased bottom line, marketing ability, and consumer attraction for hospitals.

Nursing faculty are utilizing high-fidelity patient simulation (HPS) with debriefing to help engage nursing students in making competent clinical decisions. This quasi-experimental study examined the use of HPS with debriefing and students’ ability to make nursing care decisions using standardized exams. The experimental group received debriefing after HPS and the control group did not receive debriefing after HPS. The pre- and post-test assessed participants’ ability to make clinical care decisions. The analysis of the pre-test and post-test HESI scores showed that there was no significant difference between the two groups.

Public Health
Ph.D.
Computer Assisted Patient Decision Aids (CAPtDA) are important tools to address informed decision making. This parallel mixed methods study described patterns of use of a CAPtDA among men with early stage prostate cancer and explored their perceptions of a CAPtDA and its role in their decision-making process. Men (N=56) with early stage prostate cancer, seeking consultations for surgery and/or radiation therapy at Fox Chase Cancer Center, were recruited by telephone. Those who consented completed a background questionnaire prior to their initial treatment consult. Variables included demographics, decisional factors (such as decision-making style, treatment preference, stage of decision making, Ottawa decisional conflict) and health communication factors (health literacy and computer facility). The CAPtDA had embedded web log tracking capabilities. Men were also asked to participate in an in-depth qualitative interview within 2-4 weeks of their consult visit to explore their perceptions of the software. Twenty five men participated (14 surgical consult patients and 11 radiation consult patients). Specific CAPtDA components were more highly utilized while other components were rarely used. The Men's Stories, with actual men's stories about their diagnosis, treatment decision and challenges, was viewed by 77% of the men and they spent almost half of their time (46%) here. In contrast, the Notebook, which is the values clarification tool, was viewed by only 4 men and they spent about one minute in this section. Men with lower levels of health literacy spent more time in the Men's Stories than men with higher levels of literacy. However, literacy level was not associated with multiple uses and men reported that the content was easy to understand regardless of health literacy level. Those with higher decisional conflict spent more time overall and those who were less confident in their treatment choice were less likely to use it again. Fifteen percent of the sample was minority, but the drop-off rate in participation in the in-depth interviews among minorities and those with limited literacy was dramatic. Opening this "black box" showed different patterns of use and confirmed that not everyone uses it in the same way, or as we intend.
Temple University--Theses

Läkemedels relaterade problem är en stor orsak till återinläggningar på sjukhus. Problemen orsakar både fysiska, psykiska och ekonomiska konsekvenser för patienten och samhället. Tidigare studier visar att många patienter har dålig kunskap om sin läkemedelsbehandling. Syftet med denna studie är att undersöka patienters upplevelser av läkemedelshantering såväl inneliggande som i den vana hemmiljön, samt att inhämta underlag för förbättringar i läkemedelshanteringen. Metoden är kvalitativ med fenomenologisk ansats och elva intervjuer har utförts. Analysen utfördes enligt kvalitativ innehållsanalys. Resultatet visar att patienter känner att de måste lita på det vårdpersonalen säger och gör och ser inget annat val. Bristande information leder till att patienten ifrågasätter om det verkligen är rätt medicin han eller hon får. Resultatet visar på vissa faktorer som är viktiga för att få en väl fungerande läkemedelshantering och det latenta innehållet i resultatet sammanfattas som att en väl fungerande läkemedelshantering bygger på goda kunskaper, kommunikation och delaktighet.

 

Drug related problems (DRP) are a major concern for hospital readmissions. These problems have physical, physiological and economical implications for the patients and for society. Research has shown that many patients´ have a lack of knowledge about their drug therapy. The aim of this study was to investigate patients´ perceptions of the medication use process in hospitals as well as in their own home environment, and in addition to establish foundations to provide a better medication use process. The research was based on eleven interviews using a qualitative method with a phenomenological approach. A qualitative content analysis was applied. The study shows that patients´ have a feeling that they have to trust their caregivers for what they say and what they do and there is no other choice. Lack of information leads to questioning if its´ the right medication he or she received. The results show that certain main factors are important for a functional medication use process. The main factor being that a good medication use process is based on good knowledge, communication and involvement.

" En säker läkemedelsprocess"

ABSTRACT: Tobacco use remains the most significant modifiable cause of disability, death and illness1. In Portugal, 19,6% of the population aged ten years or more smoke3. A Cochrane review of 20087 concluded that a brief advice intervention (compared to usual care) can increase the likelihood of a smoker to quit and remain nonsmoker 12 months later by a further 1 to 3 %. Several studies have shown that Primary Care Physicians can play a key role in these interventions8,9,10. However we did not find studies about the effectiveness of brief interventions in routine consultations of Family Doctors in Portugal. For this reason we designed a Cohort Study to make an exploratory study about the effectiveness of brief interventions of less than three minutes in comparison with usual care in routine consultations. The study will be implemented in a Family Healthcare Unit in Beja, during six months. Family Doctors of the intervention group should be submitted for an educational and training program before the study begin. Quit smoking sustained rates will be estimated one year after the first intervention in each smoker. If, as we expect, quit smoking rates will be higher in the intervention group than in the control group, this may change Portuguese Family Doctors attitudes and increase the provision of brief interventions in routine consultations in Primary Healthcare Centers.

Antecedents: el dolor lumbar és el problema musculoesquelètic més freqüent a tot el món. Fins a un 90% de pacients amb dolor lumbar no han rebut una explicació clara sobre la font i l'origen del seu dolor. Aquestes persones normalment reben un diagnòstic de dolor lumbar inespecífic. L'educació del pacient és una manera de donar informació i consell amb l'objectiu de modificar la cognició i el coneixement que aquests pacients tenen sobre el seu estat crònic. Això s'aconsegueix a través de la reducció de la por anticipatòria a les conseqüències i la represa de les activitats normals. Les tecnologies de la informació i els processos de comunicació associats es poden utilitzar com un mitjà per donar informació mèdica als pacients. Per tant, aquestes tecnologies i la seva capacitat per proporcionar informació vital ha crescut com una eina poderosa i alternativa per a la promoció de la salut. Diversos estudis han suggerit que les intervencions educatives basades en la web poden canviar i millorar el coneixement dels pacients crònics i tenir un impacte positiu en les actituds i conductes d'aquests pacients. Objectiu: L'objectiu d'aquest projecte va ser explorar les creences dels pacients respecte a l'origen i significat del seu dolor lumbar crònic per desenvolupar i avaluar una intervenció educativa biopsicosocial sobre el dolor al web utilitzant diferents formats educatius i tècniques de gamificació. Mètodes/disseny: Aquest estudi va fer servir un disseny mixt exploratori seqüencial. Un total de 48 pacients amb dolor lumbar crònic entre 20 i 65 anys d'edat que estaven rebent tractament en atenció primària van participar en aquest estudi. Per a la fase qualitativa de l'estudi, 16 subjectes (8 homes i 8 dones) van ser contactats pel seu metge de família i convidats a participar en una entrevista personal semiestructurada. La fase quantitativa es va estructurar com un assaig controlat aleatori paral·lel. La durada de la intervenció va ser de 15 dies. 48 xii subjectes van ser assignats a l'atzar utilitzant una tècnica de mostreig aleatòria simple. L'aleatorització i l'assignació als grups es van dur a terme mitjançant un sistema informàtic central. Els pacients i investigadors van ser cegats a l'assignació de grup. El grup d'intervenció (n = 26) va tenir accés a un lloc web on se'ls va proporcionar informació relacionada amb el seu dolor lumbar crònic. Aquesta informació va ser proporcionada en diferents formats. Tot aquest material es va basar en la informació obtinguda en la fase qualitativa. El grup control (n = 22) va seguir el tractament convencional proporcionat pel seu metge de família. La variable de resultat principal de l'estudi va ser la intensitat del dolor mesurada mitjançant una escala visual analògica de 0-100. Les variables de resultat secundàries van ser les creences de por-evitació, la kinesiofòbia i la discapacitat. Resultats: Es va realitzar una anàlisi per intenció de tractar (n = 44), usant una anàlisi factorial mixt. La interacció entre tractament i temps per a la intensitat del dolor va ser estadísticament no significatiu (F[1, 42] = 0.847, p = 0.36). La interacció entre tractament i temps va ser estadísticament significatiu per a les variables de resultat creences de por-evitació (F[1, 42] = 4.516, p = 0.04), kinesiofòbia (F[1, 42] = 5.388, p = 0.02) i discapacitat (F[1, 42] = 4.379, p = 0.04), amb resultats més favorables al grup experimental. A curt termini el grup experimental va mostrar unes diferències estadísticament significatives a favor seu en la discapacitat (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representant una mida de l'efecte mitjà. No es van trobar diferències estadísticament significatives en la intensitat del dolor, les creences de por-evitació i la kinesiofòbia entre els grups. Conclusions: Els pacients han expressat la necessitat de comprendre millor el seu dolor, el que implica que els professionals de la salut haurien de ser més didàctics en el tractament dels pacients amb dolor lumbar crònic. Una intervenció educativa biopsicosocial sobre el dolor al web per a pacients amb dolor lumbar crònic va demostrar ser més beneficiosa que el tractament convencional proporcionat pels metges de família en atenció primària sobre la discapacitat, encara que aquest resultat podria estar més relacionat amb les puntuacions de discapacitat més elevades mostrades pel grup control post-test que amb la millora obtinguda pel grup experimental. Registre de l'estudi: ClinicalTrials.gov NCT02369120 Data: 02/20/2015.
Antecedentes: el dolor lumbar es el problema musculoesquelético más frecuente en todo el mundo. Hasta un 90% de pacientes con dolor lumbar no han recibido una explicación clara sobre la fuente y el origen de su dolor. Estas personas comúnmente reciben un diagnóstico de dolor lumbar inespecífico. La educación del paciente es una manera de dar información y consejo con el objetivo de modificar la cognición y el conocimiento que estos pacientes tienen sobre su estado crónico. Esto se consigue a través de la reducción del miedo anticipatorio a las consecuencias y la reanudación de las actividades normales. Las tecnologías de la información y los procesos de comunicación asociados se pueden utilizar como un medio para dar información médica a los pacientes. Por lo tanto, estas tecnologías y su capacidad para proporcionar información vital ha crecido como una herramienta poderosa y alternativa para la promoción de la salud. Varios estudios han sugerido que las intervenciones educativas basadas en la web pueden cambiar y mejorar el conocimiento de los pacientes crónicos y tener un impacto positivo en las actitudes y conductas de estos pacientes. Objetivo: El objetivo de este proyecto fue explorar las creencias de los pacientes con respecto al origen y significado de su dolor lumbar crónico para desarrollar y evaluar una intervención educativa biopsicosocial sobre el dolor en la web utilizando diferentes formatos educativos y técnicas de gamificación. Métodos/diseño: Este estudio usó un diseño mixto exploratorio secuencial. Un total de 48 pacientes con dolor lumbar crónico entre 20 y 65 años de edad que estaban recibiendo tratamiento en atención primaria participaron en este estudio. Para la fase cualitativa del estudio, 16 sujetos (8 hombres y 8 mujeres) fueron contactados por su médico de familia e invitados a participar en una entrevista personal semiestructurada. La fase cuantitativa se estructuró como un ensayo controlado aleatorio paralelo. La duración de la intervención fue de 15 días. 48 sujetos fueron asignados al azar utilizando una técnica de muestreo aleatoria simple. La aleatorización y la asignación a los grupos se llevaron a cabo mediante un sistema informático central. Los pacientes e investigadores fueron cegados a la asignación de grupo. El grupo de intervención (n = 26) tuvo acceso a un sitio web donde se les proporcionó información relacionada con su dolor lumbar crónico. Esta información fue proporcionada en diferentes formatos. Todo este material se basó en la información obtenida en la fase cualitativa. El grupo control (n = 22) siguió el tratamiento convencional proporcionado por su médico de familia. La variable de resultado principal del estudio fue la intensidad del dolor medida mediante una escala visual analógica de 0-100. Las variables de resultado secundarias fueron las creencias de miedo-evitación, la kinesiofobia y la discapacidad. Resultados: Se realizó un análisis por protocolo (n = 44), usando un análisis factorial mixto. La interacción entre tratamiento y tiempo para la intensidad del dolor fue estadísticamente no significativo (F[1, 42] = 0.847, p = 0.36). La interacción entre tratamiento y tiempo fue estadísticamente significativo para las variables de resultado creencias de miedo-evitación (F[1, 42] = 4.516, p = 0.04), kinesiofobia (F[1, 42] = 5.388, p = 0.02) y discapacidad (F[1, 42] = 4.379, p = 0.04), con resultados más favorables al grupo experimental. A corto plazo el grupo experimental mostró unas diferencias estadísticamente significativas a su favor en la discapacidad (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representando un tamaño del efecto medio. No se encontraron diferencias estadísticamente significativas en la intensidad del dolor, las creencias de miedo-evitación y la kinesiofobia entre los grupos. Conclusiones: Los pacientes han expresado la necesidad de comprender mejor su dolor, lo que implica que los profesionales de la salud deberían ser más didácticos en el tratamiento de los pacientes con dolor lumbar crónico. x Una intervención educativa biopsicosocial sobre el dolor en la web para pacientes con dolor lumbar crónico demostró ser más beneficiosa que el tratamiento convencional proporcionado por los médicos de familia en atención primaria sobre la discapacidad, aunque este resultado podría estar más relacionado con los puntajes de discapacidad más elevados mostrados por el grupo control post-test que con la mejora obtenida por el grupo experimental. Registro del estudio: ClinicalTrials.gov NCT02369120 Fecha: 02/20/2015.
Background: Low back pain is the most frequently reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have not received a clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients’ cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver healthcare information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have suggested that web-based educational interventions can change and improve the knowledge of patients with chronic pain and have a positive impact on their attitudes and behaviors. Objective: The aim of this project was to explore patients’ beliefs regarding the origin and meaning of their chronic low back pain in order to develop and evaluate a web-based biopsychosocial pain education intervention using different educational formats and gamification techniques. Methods/design: This study had a mixed-method sequential exploratory design. A total of 48 patients suffering from chronic low back pain between 20–65 years of age who were receiving treatment in a primary care setting in Spain, took part in this study. For the qualitative phase of the study, 16 subjects (8 men and 8 women) were contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase was structured as a parallel randomized controlled trial. The duration of the intervention was 15 days. 48 subjects were randomly allocated using a simple random sample technique. vi Randomization and allocation to trial group were carried out by a central computer system. Patients and researchers were blinded to group assignment. The intervention group (n = 26) had access to a specific website where they were given information related to their chronic low back pain. This information was provided in different formats. All of this material was based on the information obtained in the qualitative phase. The control group (n = 22) followed conventional care provided by their family physician. The main outcome variable was pain intensity measured using a 0-100 visual analogue scale. Secondary outcome measures were fear-avoidance beliefs, kinesiophobia, and disability. Results: A per-protocol analysis was carried out (n = 44) using a two-way mixed factorial analysis of variance. There was no statistically significant interaction between treatment and time for pain intensity (F[1, 42] = 0.847, p = 0.36). There was a statistically significant interaction between time and treatment for fear-avoidance beliefs (F[1, 42] = 4.516, p = 0.04), kinesiophobia (F[1, 42] = 5.388, p = 0.02), and disability (F[1, 42] = 4.379, p = 0.04) with more favorable results for the experimental group. In the short term, there was a statistically significant difference on disability favoring the experimental group (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representing a medium effect size. No statistically significant differences were found in pain intensity, fear-avoidance beliefs and kinesiophobia between groups. Conclusions: The patients have expressed the need to better understand their pain, which implies that health professionals should be more didactic in the management of patients with chronic low back pain. A web-based biopsychosocial pain education intervention for patients with chronic low back pain proved to be more beneficial than conventional care provided by family physicians in primary care on disability, although this result could be more related to the greater disability scores post-test in the control group rather than with the improvement obtained in the experimental group. Trial registration: ClinicalTrials.gov NCT02369120 Date: 02/20/2015.

Este trabalho tem como objetivo propor um modelo para o uso de ferramentas tecnológicas (em especial simuladores de casos clínicos) como mediadoras do processo de implementação de métodos ativos de aprendizagem no ensino de medicina. A metodologia empregada é a pesquisa-ação, onde o pesquisador é membro ativo da ação e, ao mesmo tempo, a partir da realidade observada, busca na pesquisa soluções para os problemas encontrados. Um estudo teórico sobre métodos ativos de aprendizagem, com ênfase em aprendizagem baseada em problemas e problematização, é apresentado no decorrer do trabalho, seguido de uma revisão sistemática sobre o uso de simuladores no ensino de medicina. O modelo proposto é composto de quatro pilares que lhe dão suporte: metodológicos, organizacionais, tecnológicos e estruturantes. Os pilares metodológicos foram obtidos por meio do estudo teórico sobre métodos ativos de aprendizagem. Os pilares organizacionais são provenientes da revisão sistemática. Quanto aos aspectos tecnológicos, esses foram desenvolvidos abarcando simuladores (SIACC e SimDeCS), banco de imagens médicas, banco de dados e plataformas. Os simuladores foram validados em duas oficinas de formação de professores, e os resultados de um questionário aplicado foram analisados, comparando os dois sistemas e demonstrando os aspectos positivos e os que devem ser melhorados para que possam ser utilizados em sala de aula. Os aspectos estruturantes provêm do estudo de diversas plataformas para disponibilizar os simuladores de paciente virtual. O modelo foi concluído e validado em suas partes no decorrer da pesquisaação e deverá ser validado na sua completude junto a uma faculdade de Medicina.
This work has as its objective proposing a model for the use of technological tools (especially simulators of clinical cases) as mediators of the implementing process of active methods of learning in the Medicine Teaching. The applied methodology is the research-action one, where the researcher is an active member of the action and at the same time, from the observed reality, searches in the research, solutions to the problems found. A theoretical study about active methods of learning, with emphasis on the learning based on problems and problematization, it is presented throughout the work, followed with a systematic review about the using of simulators in the Medicine Teaching. The proposed model is composed by four pillar bases: methodological, organizational, technological and structural. The methodological pillars were obtained by means of theoretical study about active methods of learning. The organizational pillars come from the systematical review. As for the technological aspects, these ones were developed embracing simulators (SIACC and SimDeCS), medical images bank, data bank and platforms. The simulators were validated in two workshops of teachers’ formation and the results of an applied questionnaire were analyzed, comparing the two systems, displaying the positive aspects and the ones that must be improved to be used in the classroom. The structural aspects come from the study of several platforms to release the simulators of virtual patient. The model was concluded and validated in parts throughout the research-action and it must be validated in its complete in a Medicine Faculty.

The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach Type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Post-intervention, researchers interviewed twelve grandparents (50% HPS, 50% non-HPS) who scored highest and lowest on the Hypoglycemia Fear Survey. Using a mixed-method design, researchers integrated study instrument data and post-intervention interview data to describe grandparent’s experience learning T1DM management. Post-intervention, grandparent scores for knowledge, confidence, and fear showed no significant difference by group assignment, however, all grandparent scores showed improvement from Time 1 to Time 2. Grandparents described how taking part in T1DM education heightened their awareness of T1DM risks. GP T1DM knowledge gains aided GPs to make sense of T1DM risks. Newfound T1DM knowledge enhanced GP T1DM management confidence. Improved T1DM knowledge and confidence helped to defuse T1DM management fear. Although study instruments did not measure significant difference between grandparents who received the HPS intervention and those who did not, the consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for HPS.

The American Indians population in Minneapolis, Minnesota has experienced limited health care access and threefold diabetes health disparity. The purpose of this study was to measure the extent to which collaborating marketplace clinics and community-based support groups expanded diabetes care and provided self-management education for this largely urban Indian neighborhood. The marketplace clinics located in nearby CVS, Walmart, Target, and Supervalu stores committed financial support, certified educators, and pharmacy staff for the community-based support group. The study was conducted within the patient activation measure (PAM) analytical framework to assess the participants' acquired knowledge, skills, and confidence for diabetes self-management. A case-control study and 3 years retrospective analysis of secondary data were used to test whether the Minneapolis marketplace clinics and the Phillips community diabetes support group participants (n = 48) had improved diabetes health outcomes relative to the control group (n = 87). The intervention group employed motivational interviewing and PAM in coaching diabetes self-care and behavioral modification. The control group received only basic self-management education. T test and Cohen's d effect size measurements were used to quantify the size of the health outcome variables' difference between the study intervention and comparison groups. The positive effects of marketplace clinics and community-based complementation were shown through improved blood sugar control (A1C), weight loss (BMI), and healthful lifestyle changes. Social change progress could be realized by incorporating PAM with diabetes prevention programs for 33 Urban Indian Health Organizations that are located in large cities throughout the United States.

INTRODUÇÃO: O modelo epistemológico humanista na Medicina redefine o bom médico como um profissional que detém tanto excelência técnica quanto traços humanísticos. Os currículos médicos tiveram que se adaptar e se preocupar com projetos pedagógicos que dessem conta de promover o ensino/aprendizagem desses traços humanísticos. Esses projetos têm tentado resgatar a Educação Liberal nos currículos de Medicina através da introdução das Humanidades Médicas. Essa introdução tem sido tentada ao redor do mundo nos últimos 40 anos e requer cada vez mais novos projetos pedagógicos. Essa tese propõe o uso de uma atividade instrucional específica no campo das Artes Cinemáticas (enquanto Humanidade Médica) com a finalidade de mediar junto aos alunos a consecução de objetivos humanísticos pertinentes à Educação Médica. OBJETIVOS: Pretendeu-se analisar o filme And the band played on, produzindo possibilidades interpretativas sobre ele, justificando-as e comunicando-as através de uma síntese elucidativa; identificar aspectos de relevância médica cujo ensino/aprendizagem pode ser mediado pela discussão estruturada do filme como atividade instrucional; compilar esses aspectos em termos de objetivos educacionais humanísticos e de sua alocação a uma das taxonomias de objetivos educacionais nas Humanidades Médicas e prover exemplos concretos de possibilidades de ensino/aprendizagem relacionadas a essa atividade instrucional. METODOLOGIA: A análise fílmica abordou a obra nos seus aspectos narratológicos (como personagens e convenções de ponto de vista e narração) e estilísticos específicos do cinema. Observou os vários eixos que geram significação no cinema (linguagem verbal, linguagem escrita, visualidade, ruídos e música). Foi macro-analítica (analisando a obra como um todo), mas necessitou de momentos de micro-análise (seqüências e planos específicos). Envolveu a análise descritiva e formal da obra e sua interpretação através da análise interna (aspectos inerentes como iconografia e simbolismo) e externa (sistemas referenciais externos como teorias psicológicas) de sentido. Os aspectos de relevância médica passíveis de ensino/aprendizagem através dessa atividade instrucional foram procurados e alocados nos campos das grandes taxonomias que organizam os objetivos educacionais (Taxonomia de Objetivos Educacionais, Campos de Significado e Competências). RESULTADOS: Descreveram-se possibilidades de uso do filme de duas maneiras instrucionais: assistência do filme inteiro e assistência de excertos, em ambos os casos com posterior discussão. Em relação ao filme como um todo, duas propostas interpretativas diferentes foram geradas com base no seu potencial uso no ensino/aprendizagem em Medicina. A primeira baseia-se na narrativa romanesca da crise vocacional vivenciada pelo protagonista e a segunda centra-se na análise da instância narrativa e seus dispositivos. Em relação aos excertos, pinçaram-se algumas seqüências para ilustrar alguns de seus possíveis usos instrucionais. CONCLUSÕES: O filme pode ser usado instrucionalmente com vistas à abordagem educacional de objetivos humanísticos. Esses objetivos são pertinentes a diversas áreas do conhecimento, entre as quais citam-se os Domínio Afetivo e Emocional, os Campos Ético e Sinoético, e as Competências Adaptativa, Contextual, de Identidade Profissional e Motivação para Aprendizagem Continuada. Esses objetivos abordam áreas de conteúdo relevantes, como a relação médico-paciente, a vocação médica, o contar notícias ruins, a persona médica, o arquétipo do médico ferido, a comunicação humana e a identidade profissional médica, entre outras.
INTRODUCTION: The humanist epistemological model in Medicine redefines the good physician as a professional that has technical excellence, but also wields humanistic traits. Medical curricula have had to adapt themselves and make efforts to generate pedagogical projects that could foster the teaching/learning of these traits. These projects have attempted to address a Liberal Education in medical curricula by means of the introduction of the Medical Humanities. This introduction has been attempted worldwide in the latest 40 years and is still in need of new pedagogical projects. This thesis proposes the use of a specific instructional activity in the Cinematic Arts (as Medical Humanity) so as to provide mediation to the accomplishment by students of humanistic objectives. OBJECTIVES: The objectives of this thesis were to analyze the film And the band played on, producing interpretative possibilities about it, justifying them and communicating them by means of an elucidative work of synthesis; to identify aspects of medical relevance, whose teaching/learning could be mediated by the structured discussion of the film as an instructional activity; to compile these aspects in terms of humanistic educational objectives and their allocation to one of the taxonomies for educational objectives in Medical Humanities; and to provide concrete examples of teaching/learning possibilities related to this instructional activity. METHODS: Film analysis approached the movie through narratological (characters and conventions of narration and point of view) and cinema-specific stylistic aspects. The several axes that generate meaning in cinema have been considered (verbal language, written word, visuality, sounds and music). The analysis was macro-analytic (approaching the film as a whole), but contemplated micro-analysis (specific sequences). It involved the descriptive and formal analysis of the film and its interpretation in the light of internal (inherent aspects such as iconography and symbolism) and external (external referential systems such as psychological theories) analysis of meaning. The aspects of medical relevance were allocated to and searched for in the fields of the great taxonomies that organize educational objectives (Taxonomy of Educational Objectives, Realms of Meaning and Competences). RESULTS: Two instructional uses of the film were described: projection of the whole film, as opposed to the projection of excerpts. In both cases, a discussion should follow. In the first case, two different interpretative proposals were generated, based on their potential use in teaching/learning in Medicine. The first is based on a romanesque narrative about the vocational crisis experienced by the protagonist, whereas the second one focuses on the narrating instance and its dispositions. In terms of the excerpts, some sequences were pinpointed to illustrate some of their possible instructional uses. CONCLUSIONS: The film may be used instructionally within the educational approach to humanistic objectives. These objectives pertain to several areas of knowledge, among which, the Affective and Emotional Domains; Ethics and Synnoetics (Realms of Meaning); and Lifelong Learning, Professional Identity, Adaptative and Contextual Competences. These objectives comprehend relevant contents, such as the physician-patient relationship, medical vocation, breaking bad news, the medical persona, human communication and medical professional identity, among others.

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening.

The purpose of the study was to evaluate the health education for clients diagnosed with diabetes mellitus by nurses working in the diabetes clinic of the specific hospital. The quantitative descriptive cross sectional design used two questionnaires to collect data from all 20 nurses working in the diabetes clinic and from a convenient sample of 132 clients diagnosed with diabetes mellitus, making use of the health services at the diabetes clinic of the hospital. Data was analysed by a computer program, statistical package for social science (SPSS). Measures were taken to ensure acceptable ethical practice, validity and reliability of the study. Findings revealed the absence of official documents to guide the health education and other factors, such as not knowing the learning needs of the clients, not utilising teaching methods optimally. Recommendations address the development of standard procedures, lesson plans, recording of health education sessions and education skills development for the nurses.
Health Studies
M. A. (Nursing Science)

Text in English
In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland.
Health Studies
D. Litt et Phil. (Nursing Sciences)

This research project explores the views of secondary school Development Studies teachers on the subject in Swaziland. Development Studies as a school subject, was designed to integrate environmental education into the secondary school curricula in Swaziland. The study followed a qualitative, explorative, descriptive and contextual grounded theory design. Face-to-face individual interviews were carried out where the respondents expressed their thoughts, concerns and feelings about Development Studies as a school subject. Eight Development Studies teachers and one curriculum designer were interviewed. Only one question, followed by relevant probes was presented to the respondents. The question asked was: What do you think of Development Studies as a school subject? This study followed Tesch's approach to data analysis. The study revealed that Development Studies teachers in Swaziland were generally not trained in environmental education. Recommendations are made.
Educational Studies
M.Ed.(Environmental Ed.)

A qualitative study following a phenomenological approach was undertaken to explore voluntary counselling and testing nurses' perception of educating HIV+ people about ARVs. Non-probability convenience sampling was used and in-depth semi-structured face-to-face interviews were conducted to collect data from 12 participants. The most important results were:  The need for extensive education on ARVs since it is a new technology used to curb the infection therefore clients need the information in order to use them effectively.  Stumbling blocks encountered when educating HIV+ people about the drugs. The problems are mainly due to the nurses lack of current knowledge about the drugs; patients' low economic status; severe side effects; difficulties in behaviour change; poor quality of life on ARVs and medical terminology.  Inability of clients to comply to the regimen because of severe side effects, complex regimen, lack of support from family and friends, lack of motivation, depression, cultural beliefs, lack of knowledge on how to use them and financial constraints.  Challenges for continuous education because of current nursing shortage, negative attitudes of some nurses, demotivation and inadequate funding for such activity. Recommendations include provision of continuing education and the incorporation of ARV therapy knowledge in the basic nursing curriculum in nursing education.
Health Studies
MA (HEALTH STUDIES)

INTRODUCTION: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. METHODS: Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). RESULTS: All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. DISCUSSION: This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations.

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours.
Health Studies
D.Litt. et Phil.

"August 2003"
Includes biblographical references.
227 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2004

Communication seems to play a pivotal role in any high school classroom. But it was found those classes or certain individual students shy away from engaging in effective communication during natural science lessons in Swaziland. One of the directives in the Swaziland National Education Policy states that syllabuses for studies in Form 4 and 5 should enable learners to develop essential skills which include communication and language skills. This study then, on realising that there was a gap between what was stated in the Education Policy and what was actually the case in the natural science classrooms, sought for a solution that would encourage effective communication in natural sciences. Therefore, the main purpose of the study was to encourage active participation of high school students in natural science lessons. The main research question posed for this purpose was: Can student motivation enhance classroom discourse for the negotiation of science understanding? Five sub-questions emanated from the main research question: (a) How does classroom discourse relate to natural science understanding? (b) What effect does external motivation have on discourse during natural science lessons? (c) What is the effect of feedback during natural science learning? (d) How can feedback be enhanced in the natural science class? (e) Which teaching strategies improve interactions during natural science learning? The study is organised into five chapters. The first chapter summarises the whole study by giving the problem statement, research aim and objectives, definition of terms, as well as chapter divisions. Chapter two provides the background to the study through the discussion of education theories based on classroom discourse and motivation. The third chapter presents detailed information about the research design, methods of data collection and analysis, as well as a proposed method for motivating students. The fourth chapter presents the research results, analysis and discussion. The fifth and the final chapter presents research findings, concluding remarks drawn from the research findings, as well as recommendations for similar future research. The case study style uses a qualitative, descriptive and exploratory approach. The study concentrated on theories explaining learning and motivation. The sample comprised six purposefully selected students and their two physical science teachers. Data were collected using the standardised open-ended interview and non-participant lesson observation methods, and from documents. The data were collected in two phases, the pre-motivation phase and the motivation phase. The collected data was further categorised into two segments, with each segment being a unit of analysis. One of the segments was composed of oral interchanges, while the other was composed of students’ written work. The data was then transcribed, coded, analysed and discussed using the thematic discourse analysis approach. The principles of triangulation, reliability and validity ensured the credibility of the study remained intact. Research ethics were also observed by the researcher and there was trust, respect and autonomy during data collection. The ethics observed included informed consent, confidentiality, beneficence, anonymity and non-malificence. Permission to collect data was sought and obtained from all concerned. The motivation method helped the physics group improve more (55%) than the chemistry group (7%) in tests. In the overall performance the two groups improved more or less the same: the chemistry group improved by 4% while the physics group improved by 5%. There were three main findings for the study and they revolved around the purpose and the research question. The first major finding was that the motivation method used with the students instilled self-discipline in the students, resulting in self-regulated behaviour and better understanding of science concepts. The finding suggested that motivated students are self-disciplined and take ownership of their learning. The second major finding was that during the motivation phase of data collection interactions improved between the students and their science teachers. These interactions were in the form of classroom talk, submission of school work and feedback. It was inferred that motivated students communicate more effectively and with better understanding of the concepts taught. The third major revelation was that the students were motivated by learner-centred teaching strategies and the use of teaching aids in a science laboratory. A main finding for the first sub-question was that the more students interacted with each other, with their natural science teachers, and with their books the more they appreciated and understood science concepts. For the second sub-question the main finding was, the motivation method used with the students improved discourse during natural science lessons. The marks the students were awarded gave them the energy to engage more in science activities and to behave well. The main finding for the third sub-question was that prompt feedback and positive comments motivated students to engage more in science discourse and to understand science concepts better. An important finding from the fourth sub-question was that prompt and positive feedback enhanced feedback, as well as giving students tasks that were not too far above their abilities, enhanced feedback in the natural science class. For the fifth sub-question it was found that student-centred teaching methods as well as teaching aids and learning in science laboratories improved interactions during natural science learning.
Curriculum and Instructional Studies
D. Ed. (Curriculum Studies)

Indiana University-Purdue University Indianapolis (IUPUI)
High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature.

Thesis (M.S.)--University of Wisconsin--Madison, 1990.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 38-49).

Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care.
Graduate
0992
0451
0350
shealing@uvic.ca

Deterrents to family planning practices were investigated among Swazi women between 1999- 2001. A total of 171 adolescents, women and men participated in focus group interviews. Information obtained in this way served as a framework for designing structured interview schedules. The views of 205 women were investigated, concerning factors deterring them from using family planning practices by means of conducting face to face studied interviews. Qualitative data were analysed using the NU*DIST and for the quantitative data the SPPS computer programs were used respectively. The results revealed that socio-cultural deterrents to family planning included high cultural value of children determining women's social status, the lack of knowledge about contraceptives, women's dependence on their husbands' decisions concerning reproductive issues and inefficient family planning services. Recommendations included that specific adolescent reproductive health services should be instituted and that the policy on reproductive health for Swaziland be revised. Reproductive health issues should be addressed in the school curriculum. All Swazi men and women, both adolescents and adults, should be educated about contraceptives.
Health Studies
D. Litt. et Phil. (Advanced Nursing Sciences)

Leung, Yiu Cho Joseph.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 116-118).
Abstracts in English and Chinese.
LIST OF ABBREVIATIONS --- p.viii
LIST OF TABLES --- p.xiii
LIST OF FIGURES --- p.xv
Chapter CHAPTER 1: --- INTRODUCTION --- p.1
Chapter CHAPTER 2: --- VIRTUAL PATIENT AND IT USES AROUND THE WORLD --- p.5
Chapter 2.1: --- Introduction --- p.5
Chapter 2.2: --- Advantages of Virtual Patient --- p.6
Chapter 2.2.1: --- Improved Access to Learning Material --- p.6
Chapter 2.2.2: --- Development of Higher Order Learning Skills --- p.6
Chapter 2.2.3: --- Provide an Environment for Safe Practice --- p.7
Chapter 2.2.4: --- Efficient Use of Teacher's Time --- p.7
Chapter 2.2.5: --- Teach Interdisciplinary Care --- p.7
Chapter 2.2.6: --- Used for Assessment --- p.8
Chapter 2.3: --- Categorizing Virtual Patients --- p.8
Chapter 2.4: --- Virtual Patient Authoring System --- p.9
Chapter 2.5: --- Virtual Patients Authoring Systems around the World --- p.10
Chapter 2.5.1: --- Introduction --- p.10
Chapter 2.5.2: --- The CASUS System --- p.10
Chapter 2.5.3: --- The CAMPUS System --- p.10
Chapter 2.5.4: --- Web-SP --- p.11
Chapter 2.5.5: --- OpenLabyrinth --- p.11
Chapter 2.5.6: --- vpSim --- p.12
Chapter 2.5.7: --- Others Centres Using VPs --- p.12
Chapter CHAPTER 3: --- FORMATIVE ASSESSMENT CASES STUDIES --- p.13
Chapter 3.1: --- History of FACS --- p.13
Chapter 3.2: --- FACS Authoring System --- p.13
Chapter 3.3: --- Teaching and Learning Resources Centre --- p.16
Chapter CHAPTER 4: --- ANAESTHESIA TEACHING IN CUHK --- p.18
Chapter 4.1: --- Introduction --- p.18
Chapter 4.2: --- E-learning in Anaesthesia in CUHK --- p.19
Chapter 4.2.1: --- Introduction: --- p.19
Chapter 4.2.2: --- Preoperative Assessment FACS --- p.19
Chapter 4.2.3: --- Storyline Virtual Patient --- p.23
Chapter 4.3: --- Preparing the VPs --- p.27
Chapter 4.3.1: --- Introduction --- p.27
Chapter 4.3.2: --- Focus Group Interview --- p.28
Chapter 4.3.3: --- Summary of Findings --- p.29
Chapter 4.4.1: --- Methods --- p.29
Chapter 4.4.2: --- Results --- p.31
Chapter 4.4.2.1: --- Student Usage --- p.31
Chapter 4.4.2.2: --- Surveys --- p.32
Chapter CHAPTER 5: --- ACUTE PAIN MANAGEMENT VIRTUAL PATIENTS --- p.37
Chapter 5.1: --- Introduction --- p.37
Chapter 5.2: --- Acute Pain Management FACS --- p.38
Chapter 5.3: --- Storyline Virtual Patient Chapter 6 --- p.40
Chapter CHAPTER 6: --- COMPARING FACS AND SL-VP ON APM (2009-2010) --- p.41
Chapter 6.1: --- Introduction --- p.41
Chapter 6.2: --- Study Design --- p.42
Chapter 6.2.1: --- Background Information --- p.42
Chapter 6.2.2: --- Research Plan --- p.43
Chapter 6.3: --- Hypothesis --- p.44
Chapter 6.4: --- Module MCQ Examination --- p.44
Chapter 6.4.1 --- Administration of Test: --- p.44
Chapter 6.4.2 --- IDEAL Programme: --- p.46
Chapter 6.5: --- Module MEQ Examination --- p.51
Chapter 6.6: --- Final MEQ Examination --- p.52
Chapter 6.7: --- Login Data --- p.52
Chapter 6.8: --- Survey --- p.53
Chapter 6.9: --- Student-Teacher Questionnaire --- p.53
Chapter 6.10: --- Results and Findings --- p.54
Chapter 6.10.1: --- Introduction --- p.54
Chapter 6.10.2 --- Module MCQ Examination --- p.55
Chapter 6.10.2.1: --- Result --- p.55
Chapter 6.10.2.2: --- Discussion --- p.58
Chapter 6.10.3: --- Module MEQ Examination --- p.59
Chapter 6.10.3.1: --- Result --- p.59
Chapter 6.10.3.2: --- Discussion --- p.61
Chapter 6.10.4.1: --- Result --- p.62
Chapter 6.10.4.2: --- Discussion --- p.67
Chapter 6.10.5: --- Login Time --- p.68
Chapter 6.10.5.1: --- Result --- p.68
Chapter 6.10.5.2: --- Discussion --- p.69
Chapter 6.10.6: --- Survey --- p.70
Chapter 6.10.6.1: --- Usage --- p.70
Chapter 6.10.6.2: --- E-Learning Material from Anaesthesia Department --- p.71
Chapter 6.10.6.3: --- Comparisons between FACS and SL-VP --- p.72
Chapter 6.10.6.4: --- Improving Students for their Future Role as Surgical House Officers --- p.73
Chapter 6.10.6.5: --- Students' opinion on teaching methods --- p.74
Chapter 6.10.6.6: --- Free text comments --- p.74
Chapter 6.10.6.7: --- Discussion --- p.75
Chapter 6.10.7: --- Student-Teacher Questionnaire --- p.77
Chapter 6.10.7.1: --- Result --- p.77
Chapter 6.11: --- Discussion --- p.78
Chapter 6.11.1: --- VPs on students' examination outcome --- p.78
Chapter 6.11.2: --- Comparing between FACS and SL-VP --- p.79
Chapter 7.1: --- Introduction --- p.82
Chapter 7.2: --- Study Design --- p.82
Chapter 7.3: --- Research Plan --- p.83
Chapter 7.3.1: --- Module MCQ Examination --- p.84
Chapter 7.3.2: --- Module MEQ Examination --- p.84
Chapter 7.3.3: --- Final MEQ Examination --- p.84
Chapter 7.4: --- Hypothesis --- p.85
Chapter 7.5: --- Result and Findings --- p.85
Chapter 7.5.1: --- Introduction --- p.85
Chapter 7.4.2: --- Module MCQ Examination --- p.85
Chapter 7.4.2.1: --- Result --- p.85
Chapter 7.4.2.2: --- Discussion --- p.88
Chapter 7.4.3: --- Module MEQ Examination --- p.89
Chapter 7.4.3.1: --- Result --- p.89
Chapter 7.4.3.2: --- Discussion --- p.90
Chapter 7.4.4: --- Final MEQ Examination --- p.91
Chapter 7.4.4.1: --- Result --- p.91
Chapter 7.4.4.2: --- Discussion --- p.92
Chapter 7.5: --- Conclusion --- p.93
Chapter CHAPTER 8: --- SUMMARY AND CONCLUSION --- p.94
Chapter 8.1: --- Summary of thesis --- p.94
Chapter 8.2: --- Limitation --- p.94
Chapter 8.3: --- Conclusion --- p.95
APPENDIX --- p.96
REFERENCES --- p.116

The thesis is focused on a research and the evaluation of the nurse role during the invasive methods in chronic pain treatment and on a research the patient satisfaction and expectation with the nurses approach during the invasive methods in chronic pain treatment. The basis for the thesis processing is qualitative ? quantitative research carried out in the departments of pain treatment in four hospitals, in University Hospital Motol, University Hospital Brno, Hospital České Budějovice a.s., University Hospital PlzeňAlejSvobody. Qualitative research focuses on nurses working in the department of pain treatment using a method of questioning with the technique of non-standardized interview. Within qualitative research, we was looking for the answer to the research question: What is the nurse role during the invasive technique in chronic pain treatment? It was found, from the results of the interviews and their analysis, that nurses have within the invasive performance wide field of action and their role is changing in various stages of the entire performance. In all phases of the invasive performance, it´s essential the communication between the nurse and the patient. In the phase before the invasive performance and afterwards is the most dominated the educational role, except for the nursing role. Quantitative research using the questionnaire was intended for patients in the departments of pain treatment. The following predetermined hypothesis were verified using quantitative research: H1: Patients are satisfied with the nurses approach during the invasive techniques in pain treatment. H2: Patients with chronic pain during the invasive methods are expecting especially the empathetic approach from nurses. Evaluation of the questionnaires, which were voluntarily completed by patients, can be ended that both given hypothesis H1 and H2 have been confirmed and that the targets of qualitative researches have been met. The space for improvement can be found in the patient education before the invasive performance. Therefore We created educational material for patients. This educational material is not intended to replace the education conducted by nurses, it rather serves as a basis for the questions preparation that the patient will want to clarify before the invasive performance.

背景: 高擬真情境模擬（HFS）已成為一種流行的護理教育教學法，能讓學生安全及有效地利用高擬真情境模擬人練習護理。許多西方的研究報告指出，HFS對護理學生的自信心培育、解決問題的能力和批判性思維均有正面影響。然而，對本地護理學生所做的研究有限。基於文化差異，以及不同的學習風格，西方國家的證據未必能套用在香港的護理學生身上。
目的: 本研究志在探討高級護理文憑課程的學生對研究員研發的高擬真情境模擬訓練課程(HFSTP)的滿意度，及HFSTP對學生的學習自信及批判性思維發展的影響。
研究方法: 這項研究採用了混合方法研究設計，分為兩個階段。第一階段為準實驗性研究，利用前測後測設計，以探討HFSTP對護理學生的自信心、滿意度以及批判性思維發展的影響。共90位護理學高級文憑課程二年級學生，按他們就讀課程的要求，參加了第一階段的研究。而HFSTP是参照科爾布的經驗學習週期所研發，當中包括兩個1小時的小組研討和兩個1小時HFS實驗室培訓。第一階段的研究採用了四份問卷，包括學生滿意度和學習中自信量表（SCL），批判性思維調查（CTS），仿真設計量表（SDS）和人口表。而在SCL得分最高及最低各12位學生會被邀請參加第二階段的焦點團體訪談。這階段研究以半結構化面試指南來探索學生們對HFSTP的看法。所得數據以內容分析法作分析。
結果: 配對t檢驗結果表明，SCL和CTS的後測平均分均顯著高於前測（P = 0.001）。而對HFSTP的設計評價，學生評定保真度和匯報會為HFSTP學習中最重要的元素。大部份學生在定性訪談中表示滿意這嶄新的學習方法。根據定性數據分析的結果得出四大主題：（1）模擬臨床環境，（2）整體護理經驗，（3）信息和反思的思維，及（4）HFS的用量，研究人員得出結論，參照科爾布的經驗學習週期所研發的高擬真情境模擬訓練課程，是一種有效的教學策略，它能有效地提高學生的學習自信及培養出批判性思維。同時，學生表示滿意這次課程的安排。至於這次研究結果對護理教育，護理實務和高等教育管理的影響將會在這論文的最後部份發表。
Background: High-fidelity simulation (HFS) has become a popular teaching method in nursing education that allows students to practice their nursing care skills safely and effectively on human patient stimulators. Many studies have reported the positive impacts of nursing students’ learning experience with the use of HFS on their development of self-confidence, problem solving and critical thinking. However, studies done on local nursing students are limited. Acknowledging that there may be cultural differences in the learning styles between Chinese and non-Chinese people, the existing evidence mainly come from western countries, which may have limited generalizability to Hong Kong nursing students.
Aims: This study aims to examine the satisfaction of the higher diploma nursing students on the researcher-developed high-fidelity simulation training program (HFSTP), and the effects of HFSTP on the students’ self-confidence in learning and development in critical thinking.
Methods: A mixed methods study design was used in two phases. In Phase I, a quasi-experimental, one-group pretest-posttest design was employed to investigate the effects of HFSTP on nursing students’ satisfaction, self-confidence, and critical thinking development. A total of 90 year 2 higher diploma nursing students participated in the Phase I study. The Kolb’s experiential learning cycle guided the development of the HFSTP including two 1-hour simulation tutorials and two 1-hour HFS laboratory and debriefing sessions. Four questionnaires including Student Satisfaction and Self-Confidence in Learning (SCL), Critical Thinking Survey (CTS), Simulation Design Scale (SDS), and a Demographic Sheet were employed in the Phase I study. In Phase II, a focus-group interview was conducted to explore students’ perception of HFSTP. A total of 24 students from the highest or lowest scores in the posttest SCL in Phase I were invited for the focus group interview. A self-developed semi-structured interview guide was used to explore the participants’ perception of the HFSTP. Content analysis was used for data analysis.
Results: Results of paired t-test indicated that the mean scores of both SCL and CTS in the posttest were significantly higher than those of the pretest (p = <0.001). With regard to the evaluation of the design of HFSTP, the participants rated the fidelity and debriefing sessions as the most important learning features in the HFSTP. In the qualitative interview, most of the students expressed satisfaction towards the learning of HFSTP. Four main themes (1) A mimic clinical environment, (2) Holistic care experience, (3) Information and reflective thinking, and (4) Dosage of the HFS, emerged from the analysis of the qualitative data based on students’ perceptions of having HFSTP as a new teaching strategy. Researcher concluded that the HFSTP, which is based on Kolb’s experiential learning cycle, is an effective teaching strategy for promoting nursing students’ self-confidence in learning and critical thinking development. Students were satisfied with the program design. Fidelity and debriefing sessions were reported as the two most important learning features of the HFSTP. Implications of the findings for nursing education, nursing practice and higher education administration will be presented at the end of the paper.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Fong, Wan Ching Kathryn.
Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 154-161).
Abstracts also in Chinese.
Chapter CHAPTER ONE --- INTRODUCTION --- p.1
Introduction --- p.1
Background of the Study --- p.1
Justification for the Study --- p.5
Research Questions --- p.6
Conceptual and Operational Definitions --- p.7
Significance of the Study --- p.9
Overview of the Study --- p.10
Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.12
Introduction --- p.12
Search Strategy --- p.13
Development of Simulation --- p.13
History of Simulation Learning in Nursing Education --- p.16
HFS used in Nursing Education --- p.17
Self-Confidence in Learning --- p.25
Satisfaction with Learning Experience --- p.37
Critical Thinking --- p.43
Theoretical Framework: Kolb’s Experiential Learning Cycle --- p.48
Conclusion --- p.52
Chapter CHAPTER THREE --- METHODOLOGY --- p.55
Introduction --- p.55
Research Questions --- p.56
Aims --- p.56
Research Objectives --- p.56
Research Design --- p.57
Setting --- p.61
Phase I Study --- p.63
Phase II Study --- p.83
Ethical Issues --- p.90
Pilot Study --- p.91
Summary --- p.91
Chapter CHAPTER FOUR --- RESULTS --- p.93
Introduction --- p.93
Research Hypotheses --- p.94
Phase I Study --- p.94
Phase II Study --- p.105
Summary --- p.126
Chapter CHAPTER FIVE --- DISCUSSION --- p.128
Introduction --- p.128
Participant Recruitment and Response --- p.128
Issues of Dropouts and Participant Non-attendance --- p.129
Discussion on Study Findings --- p.129
The Use of Assessment Tools --- p.142
Limitations of the Study --- p.143
Implications for Nursing Education --- p.144
Implications for Nursing Practice --- p.146
Implications for Higher Education Administration --- p.148
Recommendations for Future Studies --- p.150
Conclusions --- p.151
REFERENCES --- p.154

Our purpose is to examine the possibilities of Bakhtinian dialogical analysis for understanding students' experiences of medical training. Twenty-three interviews were conducted with eleven British medical students intercalating in psychology. Forty emotionally resonant key moments were identified for analysis. Our analysis illustrates students' use of the professional genre to present their training as emotionally neutral. However, we show how medical training can be framed in more unofficial and affective-laden ways in which threshold moments of crisis are presented as space-time breaches characteristic of the genres of adventure-wonder and adventure-ordeal. This affect was often depotentiated in the narratives through brief allusion to the professional genre. This cycling between genres suggests that the students were searching for an appropriate way in which to frame their experiences, a central dilemma being the extent to which medical training makes sense within an immediate and affect-laden, or future-orientated and affect-neutral, pedagogy. Finally, we identify how consultants are an important aspect of the affective experience of medical training who, at their best, offer inspiring exemplars of flexible movement between official and unofficial ways of being a doctor. In conclusion, we demonstrate the potential of genres to make sense, and to organize the experience, of medical training spatially in terms of moving between personal and impersonal contact, temporally in terms of moving between the extraordinary and routine, and affectively in terms of moving between potent and neutral affect. Learning to use the professional genre is part of enculturation as a doctor and can be helpful in providing a framework restoring coherence and composure through engaging with, and reformulating, difficult experiences. However, it is important to take seriously the resistance many of the students demonstrated to the professional genre as a possible barometer of its acceptability to the general public.