Tesi: "Care and support pathways"

1

Eshareturi, Cyril. "Mapping the offender health pathway : challenges and opportunities for support through community nursing". Thesis, University of Wolverhampton, 2016. http://hdl.handle.net/2436/614998.

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The current context of offender health in England and Wales indicates that offenders re-enter their communities with limited pre-release preparation for the continuity of access to healthcare and an increased risk of release with a health condition and very little support to cope in the community. This study was aimed at mapping the ex-offender health pathway towards identifying ‘touch points’ in the community for the delivery of a nurse led intervention. The study was a qualitative case study underpinned by ‘The Silences Framework’ which enabled it to gain theoretically by situating power with offenders, thus, aiding their ‘Silences’ to be heard, explored and brought to light. Participants meeting the study inclusion criteria were quantitatively ranked on the basis of poor health with those scoring the lowest and confirming their ranking through a confirmation of a health condition selected as cases and interviewed over the course of six months. These interview narratives were confirmed by interviewing individuals in the professional networks of offenders. The study identified the site of post-release supervision as the ‘touch point’ where a nurse led intervention could be delivered. With regards to the delivery of the health intervention, the study indicated that the nurse led intervention be provided as an advisory and signposting service structured on a drop-in and appointment basis. Furthermore, the study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community on release. On-release, offenders’ on-release preparation did not enquire as a matter of procedure on whether offenders were registered with a GP or had the agency to register self with a GP practice in the community. Post release, the study uncovered a disparity between services which address the physical health needs of offenders and those which address their mental and substance misuse health needs.

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2

Gatuguta, A. "Pathways of care for sexual violence survivors and the benefits and drawbacks of using community health workers to provide support health services to sexual violence survivors : a systematic review and case study in Kenya". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4646633/.

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Background: Research shows that sexual violence is widespread and has multiple adverse health consequences. Globally, majority of sexual violence survivors either do not access care or access care late. Many of those who access care are lost to treatment follow-up before they can fully realise the benefits of medical care. Evidence suggests that community health workers (CHWs) have the potential to improve healthcare for survivors. There is limited data however, on how to deliver these services effectively. Aim: To explore sexual violence survivors’ experience of seeking healthcare and experiences through the continuum of care in Kenya; and, to understand the benefits and drawbacks of using CHWs to provide support health services to sexual violence survivors. Methods: A mixed methods approach was used: 1) a systematic literature review of CHWs services for sexual violence to explore the existing models of services as well as the benefits and drawbacks; 2) records for 543 survivors were reviewed and key informant interviews conducted with healthcare providers in two referral hospitals. These hospital data were compared with national-level data on survivors from the Kenya Demographic and Health Survey 2014, and the Violence Against Children Survey 2010; 3) survivors were interviewed on their care pathways, current experience of services, perceived health service’s needs and experience of CHWs services; 4) CHWs, healthcare workers and other stakeholder’s with expertise in providing care for sexual violence were interviewed on their experiences and views on CHWs services for sexual violence. Results: There are multiple barriers to healthcare and missed treatment opportunities for survivors, both at the community and hospital level. Children, men, partnered or ever-partnered survivors and survivors experiencing violence from intimate partners are more likely to miss treatment. CHWs are already involved in sexual violence healthcare pathways carrying out awareness creation, identifying survivors, linking survivors to care and providing psychosocial support. However, training, better definition of roles and support from the healthcare system is needed. Conclusions: This thesis has identified specific barriers to services for sexual violence survivors and specific groups at risk of missing treatment. CHWs can form a part of interventions aimed to address the current barriers to treatment; however, more research is required to inform designing the models of services.

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3

Smeds, Magdalena. "Managing care pathways for patients with complex care needs". Licentiate thesis, Linköpings universitet, Logistik- och kvalitetsutveckling, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156836.

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One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.

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4

Brown, Christine S. H. "Pathways into High Security Psychiatric Care". Thesis, University of Exeter, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486662.

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5

Bekele, Yilma Yitayew. "Pathways to psychiatric care in Ethiopia". Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/10132.

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Includes bibliographical references.
It is recognized that the pathways patients take en route to psychiatric services vary between countries and socio-cultural groups. Delay along the pathway to care is not a mere reflection of organization of health care and referral systems but also of availability and accessibilty of services. Studies have shown associations between delay and various sociodemographic, clinical and service related factors. Understanding the pathway to psychiatric care, and recognition od delay points along the pathway, is a crucial step for the development of intervention programs geared at improving the provision of mental health care.

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6

Alsalamah, Hessah. "Supporting integrated care pathways with workflow technology". Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/28816/.

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Modern healthcare has moved to a focus on providing patient centric care rather than disease centred care. This new approach is provided by a unique care team which is formed to treat a patient. At the start of the treatment, the care team decide on the treatment pathway for the patient. This is a series of treatment stages where at the end of each stage, the care team use the patient’s current condition to decide whether the treatment moves to the next stage, continues in the treatment stage, or moves to an unanticipated stage. The initial treatment pathway for each patient is based on the clinical guidelines in an Integrated Care Pathway (ICP) [1] modified to suit the patient state. This research mapped a patient ICP decided by the healthcare providers into a Workflow Management System (WFMS) [2]. The clinical guidelines reflect the patient-centric flow to create an IT system supporting the care team. In the initial stage of the research the IT development team at Velindre Hospital identified that team communication and care coordination were obstacles hindering the implementation of a patient-centric delivery model. This was investigated to determine the causes, which were identified as difficulty in accessing the medical information held in dispersed legacy systems. Moreover, a major constraint in the domain is the need to keep legacy systems in operation and so there is a need to investigate approaches to enhance their functionalities. These information systems cannot be changed across all healthcare organisations and their complete autonomy needs to be retained as they are in constant use at the sites. Using workflow technology, an independent application representing an ICP was implemented. This was used to construct an independent layer in the software architecture to interact with legacy Clinical Information Systems (CISs) and so evolve their offered functionalities to support the teams. This was used to build a Virtual Organisation (VO) [3, 4] around a patient which facilitates patient-centric care. Moreover, the VO virtually integrates the data from legacy systems and ensures its availability (as needed) at the different treatment stages along the care pathway. Implications of the proposal include: formalising the treatment process, filtering and gathering the patient’s information, ensuring care continuity, and pro-acting to change. Evaluation of the proposal involved three stages; First, usefulness evaluation by the healthcare providers representing the users; Second, setup evaluation by developers of CISs; and Finally, technical evaluation by the community of the technology. The evaluation proved; the healthcare providers’ need for an adaptive and a proactive system, the possibility of adopting the proposed system, and the novelty and innovation of the proposed approach. The research proposes a patient-centric system achieved by creating a version of an ICP in the system for each patient. It also provides focussed support for team communication and care coordination, by identifying the treatment stages and providing the care team requirements at each stage. It utilises the data within the legacy system to be proactive. Moreover, it makes these required data for the actions available from the running legacy system which is required for patient-centred care. In the future the worth could be extended by mapping other ICPs into the system. This work has been published in four full papers. It found acceptance in the health informatics community [5, 6, 7] as well as the BPM community [8, 9]. It is also the winner of the 2011 “Global Award of Excellence in Adaptive Case Management (ACM)” in “Medical and Healthcare” [10] of the Workflow Management Coalition (WFMC) [11].

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7

Debbage, Samantha D. "Do integrated care pathways improve patient outcomes?" Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/14949/.

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The purpose of the study was to determine if the use of an Integrated Care Pathway (ICP) was associated with more positive outcomes than traditional methods of care. The effectiveness of the ICP had not previously been tested (in relation to traditional methods of care) to determine if it made any difference, at a patient, staff or system (healthcare organisation) level. In February 2001 (as part of the NHS modernisation agenda) the gynaecology services within one UK city were re-organised and two separate units were merged into one new larger unit. Prior to the reorganisation, the two units offered similar treatments and were managed collectively; however, one site had developed and implemented ICPs and the other site had continued to use traditional methods of care delivery. ICPs are multidisciplinary plans for organising and delivering patient care. The plan of care is outlined in a sequential manner including all interventions with expected patient outcomes. The literature suggests that ICPs result in improved patient outcomes and lower hospital costs by decreasing length of stay and improving observations i.e. detecting signs of infection in a timelier manner. ICPs are recognised to facilitate the multidisciplinary partnerships in planning of patient care. However the literature was primarily anecdotal or non generalisable, and therefore additional local research was deemed essential. To ensure the research problem could be answered, three specific research questions were developed for testing: (1) What effect does an /~ / ICP have on the outcomes of gynaecological patients attending for major abdominal surgery? (2) What factors, including the use of an ICP contribute to the variance in length of stay for gynaecological patients? (3) What are the opinions of the staff who have used the ICP, of the ICP itself? Relevant directional hypothesis were derived from each research question. A quasi-experimental design was used to answer the first research question. Subjects were attached to one of two groups, a treatment group, which used the ICP, and a comparison group, which continued to deliver care based on traditional methods. Descriptive correlation was used to answer research question two and for the third research question descriptive exploration was used. Variables of interest from a patient, staff and system (health care organisational) level were collected to determine the effectiveness of the ICP compared with traditional methods. One of the difficulties faced with ICP research is the number of variables that can potentially influence patient care. Holzemer's model (1994, based on the work of Donabedian, 1966) was used to conceptualise the variables (and therefore the data collection instruments) into the category of structure, process or outcome at either a patient, provider or systems (health care organisation) level. This in turn helped to theorise the linkage between the variables within this study, identifying conceptual and functional relationships. The abdominal surgery ICP supported improvements in cost and efficiency through a reduction in length of stay (treatment site = 5.29 days, comparison site = 6.16 days) and a positive return to patients' perception of health. However, there was a reduction in patient satisfaction with nursing care with the introduction of the ICP and this needs further study. Involving patients in future developments and evaluations could promote long-term patient satisfaction.

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8

Hall, Julie. "Using integrated care pathways in mental health care : a case study". Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/12749/.

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Background: Integrated Care Pathways (ICPs) are prearranged processes of care which are being increasingly used to deliver mental health services. The literature reveals difficulties in their development and implementation, and a lack of empirical evidence to support their use. Aims: The aim of this research was to investigate how an ICP has been used to manage mental health care in one selected mental health Trust in England. Methods: A case study approach was adopted with several units of analysis. The views of healthcare professionals using semi structured interviews; the experiences of service users and carers using focus groups; contrasting hospital episode and performance statistics with a comparison Trust and documentary analysis of the ICP. Findings & Discussion: Of the healthcare professions, only nurses used the ICP. No professionals used the ICP to support clinical decision making and risk management. However, just over two-thirds (67.2%) of the interventions described in the pathway were delivered. There was no statistically significant difference when comparing performance indicators for an equivalent episode of care between the ICP Trust and non ICP Trust. Service user and carers' experiences revealed that peopled did not feel that their care was individualised to them, although amongst them they had different perceptions of the care process. Conclusions: Mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care in the future that accords with the needs of people using mental health services.

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9

O'Brien, Sarah Victoria. "Impact of care pathways on the care of people with diabetes mellitus". Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428994.

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This thesis aimed to develop care pathways for the management of in-patients and outpatients with diabetes in an acute NHS Trust, to review the evidence-base for existing care pathways and to evaluate the impact of care pathways on the management of in-patients with diabetes and patients with Diabetic Nephropathy. A comprehensive literature review (using the principles of a systematic review) was completed to determine whether care pathways improved the management and or outcome of hospital in-patients with a medical or surgical condition. From this review it appears that the main potential benefits associated with the introduction of a care pathway are a reduction in length of stay, reduced costs and possible improvements in the quality of patient care. However, these findings are limited because of the poor methodology used in all of the papers reviewed and there is a need for more robust research concerning care pathways. This work has provided a systematic process for developing diabetes care pathways and examples of diabetes care pathways that could be used and adapted by other clinicians managing patients with diabetes. A randomised controlled trial examined the impact of the in-patient diabetes care pathway on HbA1c, length of stay, re-admissions within 12 months, nurse knowledge and the quality of in-patient care. In terms of the primary endpoint of HbA 1c, the null hypothesis cannot be rejected as there was no difference between the study groups. In the main, secondary endpoints improved, but limitations in the design and execution of the study preclude excessive weight being attached to these findings. Furthermore, completion of the care pathway was poor and sustaining its ongoing use outside of a research study may be difficult, further work is needed to assess the cost of wider implementation of this care pathway. A care pathway-driven Diabetic Nephropathy service was developed, implemented and evaluated to examine whether it resulted in improvements in the management of Diabetic Kidney Disease (DKD). The results demonstrated successful implementation of six key evidence-based interventions for DKD and more importantly both surrogate and hard endpoints were comparable to those achieved in recent large clinical trials, in particular, the rate of doubling of serum creatinine, progression to End Stage Renal Failure and Death. This thesis demonstrates that in some circumstances care pathways can improve implementation of evidence-based diabetes care and lead to improvements in patient outcomes. Care pathways appear to be particularly useful when used by a dedicated, appropriately trained team dealing primarily with one condition, and can be an effective tool for the implementation of evidence-based diabetes care. Further work examining the impact of care pathways in all areas of health care would be useful.

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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform". PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.

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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

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11

Padey, Pierryves. "Modèles simplifiés d’Analyse de Cycle de Vie : cadre méthodologique et applications aux filières de conversion d’énergie". Thesis, Paris, ENMP, 2013. http://www.theses.fr/2013ENMP0083/document.

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La transition énergétique est un enjeu majeur actuel et des années à venir. Parmi les défis qu’elle va soulever figure la limitation des impacts environnementaux de la production d’électricité. Pour cela, des outils d’aide à la décision, simples d’utilisation et suffisamment précis, considérant les aspects environnementaux et permettant d’optimiser les choix énergétiques futurs, doivent être mis en place. L’analyse environnementale d’une filière de conversion d’énergie est un sujet complexe. Elle comporte en effet deux niveaux. Le niveau « filière », caractérise le profil global d’impacts environnementaux des systèmes, et le niveau « système » caractérise leurs impacts, permettant ainsi une analyse intra-filière. Pour répondre à ce besoin de caractérisation en deux niveaux, nous proposons une méthodologie générique permettant de développer des modèles d’estimation des profils environnementaux de chacune des filières et d’estimer simplement ceux des systèmes qui la composent sans avoir à réaliser une étude détaillée. Cette méthodologie repose sur la définition d’un modèle d’Analyse de Cycle de Vie paramétré prenant en compte, par Analyse Globale de Sensibilité, un large échantillon de systèmes représentatif des configurations observées en pratique au sein des filières. Dans un second temps, des modèles simplifiés estimant les performances environnementales des systèmes sont définis, en fonction de quelques paramètres clefs identifiés comme expliquant la plus grande part de variance des impacts environnementaux de la filière. Cette méthodologie de réduction de modèle a été appliquée à la filière éolienne terrestre en Europe et à la filière photovoltaïque résidentielle en France
The energy transition debate is a key issue for today and the coming years. One of the challenges is to limit the environmental impacts of electricity production. Decision support tools, sufficiently accurate, simple to use, accounting for environmental aspects and favoring future energetic choices, must be implemented. However, the environmental assessment of the energy pathways is complex, and it means considering a two levels characterization. The “energy pathway” is the 1st level and corresponds to its environmental distribution, to compare overall pathways. The “system pathway” is the 2nd level and compares environmental impacts of systems within each pathway. We have devised a generic methodology covering both necessary characterization levels by estimating the energy pathways environmental profiles while allowing a simple comparison of its systems environmental impacts. This methodology is based on the definition of a parameterized Life Cycle Assessment model and considers, through a Global Sensitivity Analysis, the environmental impacts of a large sample of systems representative of an energy pathway. As a second step, this methodology defines simplified models based on few key parameters identified as inducing the largest variability in the energy pathway environmental impacts. These models assess in a simple way the systems environmental impacts, avoiding any complex LCAs. This reduction methodology has been applied to the onshore wind power energy pathway in Europe and the photovoltaic energy pathway in France

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12

Desai, Amruta. "Design support for biomolecular systems". Cincinnati, Ohio : University of Cincinnati, 2010. http://rave.ohiolink.edu/etdc/view.cgi?acc_num=ucin1265986863.

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Thesis (M.S.)--University of Cincinnati, 2010.
Advisor: Carla Purdy. Title from electronic thesis title page (viewed Apr. 19, 2010). Includes abstract. Keywords: Biological pathways; weighted gate; BMDL; pyrimidine. Includes bibliographical references.

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13

Seaton, Sarah Emma. "Modelling neonatal care pathways for babies born very preterm". Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/41212.

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Predicting length of stay in neonatal care is important for resource planning and the counselling of parents. However, it has received limited attention and two issues are: 1. Babies who die in neonatal care are not included appropriately and research should consider all babies simultaneously, irrespective of whether they live or die 2. The different levels of neonatal care (intensive, high dependency and special care) and how they contribute towards overall length of stay have not been considered This thesis contains four inter-connected studies to investigate how statistical approaches can help to address these issues. Firstly, a systematic review was conducted to identify factors commonly used to predict length of stay and mortality. Factors measurable at or around birth, such as gestational age and birthweight, were found to be important. Secondly, competing risks methods were used to predict median length of stay in neonatal care for two competing events: babies who survive to discharge and babies who die before discharge. These estimates can be used by clinicians, with their clinical judgement, to counsel parents about the risk of mortality and about potential length of stay. The third study develops this approach to account for the different levels of care received by the baby, using multistate modelling as a natural extension of the more limited competing risks approach. Mean lengths of stay at each level of care were estimated in order to facilitate commissioning of neonatal services. Finally, the differences in length of stay between Operational Delivery Networks, (groups of neonatal units that work together) were investigated to determine if differences existed. These were examined to understand whether differences were due to varying levels of intensity of specific levels of care within a network or a difference in total length of stay.

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Jamieson, Rachel. "Parent-mediated pathways to care for rural adolescents with depression". Thesis, University of Ballarat, 2008. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/54314.

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Mani, Kartik M. 1978. "Computer support for home-based health care". Thesis, Massachusetts Institute of Technology, 2001. http://hdl.handle.net/1721.1/86818.

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Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2001.
Includes bibliographical references (leaves 75-76).
by Kartik M. Mani.
M.Eng.

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Chiu, Chim-keung, e 趙漸強. "Pathways to care: help seeking pattern of thepeople with early psychosis". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B43895244.

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Horne, David. "Pathways into psychiatric care : user characteristics, settings and the referral process". Thesis, London South Bank University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305150.

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The thesis grew out of the recognition that there is a dearth of information on the users of mental health services. It set out to describe the characteristics of users across a range of health settings and to consider the role of such characteristics in the mental health referral process. The early phases of this research project were strongly influenced by a model of the referral process developed by Goldberg & Huxley (1980). They conceptualized users of health care existing on 5 levels ranging from people living in the community to users in hospital. Hypothetical filters are said to operate between each level to govern who is referred on to the next level of services. This research project borrowed the notion of filters and their arrangement of services in a referral sequence. However, the focus of this research is on the characteristics of users, and not the detail of the filters per se. What is described is the effect of the referral process not the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg & Huxley model to produce a uniquely comprehensive analysis of the users of all the main mental health care providers in one health district. The research project uses a wholly quantitative methodology. The challenge has been to design a range of compatible survey forms to collect data in seven separate study settings, to collate information on over one thousand one hundred users, to describe the user profiles in each study and to develop a comparative analysis of users across a range of settings. The emphasis throughout has been to align the research with contemporary developments in health care policy, and as the project has progressed, to make a practical contribution to the important debate about information systems in mental health service planning. The thesis has been divided into four parts. Part I introduces and sets the context of the research, and describes the methodology. In seven chapters, Part II of the thesis reports the .findings of each of the seven study settings. Part III of the thesis reports the demographic and utilization characteristics comparatively across all the study settings. The conclusions of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and describes the characteristics and the typical profiles of mental health service users in a range of study settings, in one area. Secondly, it identifies the differences between users in each study setting. Thirdly, it identifies the overlap in use of one service and another. It is argued that the findings have profound implications for both developing a clearer picture of the referral processes and for highlighting for planners, producers, and providers possible complementary or inefficient service utilization patterns. On the fourth and macro level, this research project has developed a revised model of mental health service referral routes. This model provides a framework for further investigation, and has potential as a planning tool in and beyond the geographical boundaries of the current study area.

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18

Bergquist, Adam. "Evaluation of the pathways palliative care program at the Denver hospice". [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/ABergquist2008.pdf.

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Hutton, G. K. "Social support, marriage and psychobiological pathways to adjustment after Acute Coronary Syndrome". Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1389090/.

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The key aims of this thesis were to investigate the role of social support and marriage in adjustment and recovery in coronary heart disease (CHD). Declining death rates in CHD due to medical and surgical advances combined with increasing prevalence rates have contributed to a large and steadily growing population of chronic CHD patients, many of whom have suffered an acute cardiac event. In the context of this population, there is considerable need to determine factors that improve both adjustment and prognosis. Aspects of social support and marriage have been robustly associated with morbidity and mortality in CHD. Exploration of the potential psychological and biological pathways that link these factors forms the core of this thesis. Data from two separate studies are presented with the majority of analyses originating from data gathered in the Tracking Recovery after Acute Coronary Events (TRACE) study, a longitudinal study exploring diverse correlates of adjustment and recovery in 298 ACS patients. Associations between social support, marital satisfaction, distress, quality of life and HRV among ACS patients followed up from hospital admission to 12 months following discharge are presented. Data were also derived from a second study which explored psychobiological factors in a sample of 88 suspected coronary artery disease (CAD) patients and the analysis focused on marital influence on HRV. The overall thesis objective was to identify significant relationships between social and marital support, and various psychobiological factors that may contribute to adjustment and, ultimately, influence CHD prognosis.

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Turner, Karen Mary Thomas. "Parenting and family support in primary care settings /". St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17454.pdf.

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21

Sigurdardottir, Sigurveig. "Patterns of care and support in old age". Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Åldrande - livsvillkor och hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-20524.

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This study describes the situation for community living older people, 65 years of age and older in Iceland, analyzing their needs for care and services and how these needs are met. The study analyzes the relationship between the main providers of help and care, the formal caregivers and the informal carers. The study further depicts what kinds of care and support older informal caregivers provide and receive themselves and analyze what factors are related to providing care alone or in combination with other caregivers, informal and formal. The study also analyzes the relationship and mutual support between grandparents and grandchildren and whether there are gender differences in intergenerational relations and support. As little research has been conducted on informal care in Iceland, it is important to show the importance of the informal carers in the care paradigm. Two Icelandic studies were used for the descriptions and analysis. The main data source is the ICEOLD survey (Icelandic older people), based on a random representative national sample of 700 non-institutionalized persons in ages 65 – 79 years and 700 persons aged 80+. The final sample consists of 1,189 older persons to which an introduction letter was sent. They were contacted by phone a few days later and 782 persons, 341 men and 441 women, agreed to participate, giving a response rate of 66%. A study carried out among college students in Iceland, The Grammar School study, was also used to retrieve information on intergenerational relations between grandparents and grandchildren. The study indicates that older people in Iceland are receiving help and care from both informal and formal carers but informal help provided by family members seems to play a major role in supporting older people in their home. The great majority of the respondents with Instrumental Activities of Daily Living (IADL) limitations and Personal Activities of Daily Living (PADL) limitations received either informal or formal help but not both. The care and help provided is more often help with domestic tasks than with personal care. However, when the need increases the formal system steps in. It is not clear whether the informal care is a substitute for the formal one. As the formal help provided is rather sparse, it is suggested that when the need for personal care increases, the older person moves into a nursing home instead of increasing the formal care in the home. Women more often than men are the sole carers, and daughters are more important carers for older people than sons are. Older informal caregivers were alone in their caregiving in almost half of the cases and women more often than men. One third provided help with several tasks, such as help with errands and surveillance or keeping company in addition to ADL help. Older caregivers provide care even when they need help themselves. The results indicate that grandparents and grandchildren exchange more emotional than practical support. The emotional support provided and received by the generations is of great value. Gender influences the contact frequency between the generations, as women more often cultivate ties between grandparents and grandchildren.

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Hussin, Duratul 'Ain. "Development and evaluation of optometrist-led referral pathways in Ampang, Malaysia". Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/98401/8/98401.pdf.

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Screening for eye diseases is currently performed by ophthalmologists in most public hospitals in Malaysia, which increases workloads for ophthalmology eye-care personnel in hospitals. Optometrists also practise at hospital eye clinics in Malaysia; however, their main role currently focuses on refractive care. This study is the first in Malaysia and Asia to investigate, from a public health context, two optometry-led service pathways for triaging referrals to the hospitals and diabetic retinopathy screening in both hospital and community care. The thesis comprehensively evaluates the optometric pathways quantitatively and qualitatively considering clinical care outcomes, patient access, satisfaction and costs.

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23

Chiu, Chim-keung. "Pathways to care : help seeking pattern of the people with early psychosis /". Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B43895244.

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24

Sayal, Kapil Sen. "Pathways to care in children at risk of attention deficit / hyperactivity disorder". Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412339.

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25

Cuevas, Penelope H. (Penelope Huggins). "Visualizing the conversation pathways of telephone linked care in a directed graph". Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/54458.

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Abstract (sommario):

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 12).
Telephone linked care (TLC) is a telehealth intervention that has been shown to be effective in a variety of clinical settings. TLC is an interactive computerized telephone system. The system 'speaks' to patients, asking them questions and understanding their responses. There is logic built into the calls, so that a patient's response to a question will dictate the next question that is asked. This serves to personalize the call for each patient, and makes the conversation more realistic. All of the patients' responses are stored in a database. This database provides much opportunity for analysis because a single phone call contains many responses. Visualization is an important way of gaining insight into data. Visualization can make data easier to understand and process. Different aspects of data can be encoded in a visualization. The TLC data lends itself to visualization. By viewing each of the questions that the system asks as nodes, and connecting the nodes by the chronological order in which these questions are asked, a tree structure will reveal the conversational paths that are taken in the calls. By combining data from multiple calls and encoding them in this tree structure, new insights can be gained into the TLC data. For example, the frequency with which questions are answered in a particular way can be encoded to reveal the most common pathways through the tree. This paper describes a visualization application of TLC data which will allow researchers to gain new insights into the TLC conversations and into medical interviews in general.
by Penelope H. Cuevas.
S.M.

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26

Hines, Dana D. "Social patterns and pathways of HIV care among HIV-positive transgender women". Thesis, Indiana University - Purdue University Indianapolis, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3730539.

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Abstract (sommario):

Transgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory. The findings are a theoretical model that includes four stages: Having the world come crashing down, shutting out the world, living in a dark world, and reconstructing the world. Relationships within the social network (family, friends, and romantic partners) and the network of health care providers provided the context of the women’s illness careers. Pivotal moments marked movement from one phase to the next. Having the World Crashing Down was the first stage that occurred when the participants were diagnosed with HIV. They felt that their lives as they knew them had been destroyed. They indicated that the “whole world just shattered” the moment they found out they had HIV. Shutting Out the World occurred next. During this stage, many participants experienced withdrawal, denial, social isolation and loneliness. As they struggled with their diagnosis, they often avoided HIV care and avoided contact with important others. During the third stage, Living in a Dark World, participants descended into a dark phase of self-destructive life and health-threatening behaviors following their diagnosis. During the fourth stage, Reconstructing the World, participants began to reestablish themselves in the world and found new ways to reengage with important others and resume meaningful life activities. Findings confirm that the illness careers of HIV-positive transgender women are influenced by the social context of the health care setting and interactions with health care providers and important others.

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27

Shelmerdine, Sarah. "Pathways to inhumane care : medical culture in a South African emergency unit". Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11385.

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Abstract (sommario):

Includes bibliographical references (leaves 268-287).
While a comprehensive set of laws and ethical guidelines legally protects patients and promotes their access to good quality health care, inhumane and abusive medical practices have, nevertheless, been documented internationally. A large and varied body of work documents multiple aspects of medical culture.

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28

Hodge, Patricia Ann. "The family support services study". CSUSB ScholarWorks, 1989. https://scholarworks.lib.csusb.edu/etd-project/547.

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29

Zulkepli, Jafri. "A theoretical framework for hybrid simulation in modelling complex patient pathways". Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/6448.

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Abstract (sommario):

Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.

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30

Watkins, Jasmine J. "Victor Echo Tango (VET) Support Services Inc". Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10262256.

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Abstract (sommario):

As each year passes the number of female veterans within the United States is expected to increase; as this population increases there will be a greater need for specialized healthcare services directed at this group. One issue that affects this population and has gained more attention within the past 20 years is military sexual trauma (MST) and the effect it has on mental health. Victor Echo Tango (VET) Support Services Inc. is a proposed counseling center that focuses on providing counseling services to female veterans that have experienced military sexual trauma. VET Support Services Inc. offers various counseling services that will help teach our female veterans how to live through their trauma. The organization combines traditional counseling services, such as individual counseling and relationship counseling, with new-age counseling techniques such as group mindfulness training to offer a comprehensive care model.

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31

Kidambi, Supriya. "WeCare Home Healthcare Support Services Business Plan". Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10261395.

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Abstract (sommario):

Considering the expanding populace of elderly in the United States of America, there has been a significant growth in demand for home healthcare organizations which serve to deliver continuous quality care. Home healthcare organizations guarantee to support our economy and decrease healthcare costs to a huge level. This marketable business plan inspects the business capability of a home healthcare services startup located in San Diego Downtown.

This business plan has been broken down into several compartments where chapter 1 accounts on the market analysis of our business providing marketing strategies and intricate details of our company and its analysis, services provided, services in demand, customer and competitor analysis, marketing potential and demand. Chapter 2 deals with feasibility and SWOT analysis, to evaluate pros and cons, and to get a better idea of the organizational structure of the business plan. In Chapter 3, we talk about the legal aspects concerning State and Federal laws. Chapter 4 explains about the financial assumptions and analysis, annual expenditures as well as monthly expenses with the overall potential of home healthcare services to survive market competition.

We conclude that WeCare home healthcare services plan showed great potential to withstand the competitive market and drive towards success.

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32

Galloway, Sharon Eleanor. "Hospital to home : perceived need for care and support". Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29708.

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Abstract (sommario):

Falls are a major health problem for older women. In British Columbia, women aged 75 years and older comprise 85% of the total number of individuals admitted to hospital with a fall. Falls result in physical and psychological consequences. A review of the literature indicates that most studies on falls are epidemiological in nature. There are no studies that deal with the consequences of the fall and their effect on the older woman's perceptions of her need for care and support after hospitalization for a fall. The purpose of this study is to describe the need for care and support as perceived by women aged 75 years and older returning home to live alone after a hospitalization for a fall. Phenomenology is the chosen research method. This method describes human experience as it is lived. Subjects were recruited through the liaison nurses and home care coordinators from the Health Department. Eight women participated in the repeated interviews guided by trigger questions. Certain themes emerged from data analysis and were coded accordingly. These themes were verified, validated, and/or discounted in subsequent interviews. The findings indicated that the elderly women perceived the fall as both a significant and unpredictable event in their life. It resulted in a change of routine as they returned home to live alone. In response to this change, the women described threats to their self-esteem, particularly to their feelings of independence, activity, and autonomy. A variety of behaviours were used to cope with the threats to their self-esteem. Use of social support was one behaviour used by all the women. In describing this behaviour, reciprocity was important in the friendships of elderly women. This study also concluded that there were numerous difficulties in using social supports from a formal program. The implications for nursing research, practice, and education were discussed in light of these findings.
Applied Science, Faculty of
Nursing, School of
Graduate

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33

Kucher, Kostiantyn, e Danny Weyns. "A Self-Adaptive Software System to Support Elderly Care". Linnéuniversitetet, Institutionen för datavetenskap (DV), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-25924.

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34

Byass, Peter. "Microcomputer support for health care delivery in the Gambia". Thesis, University of Nottingham, 1990. http://eprints.nottingham.ac.uk/12413/.

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Abstract (sommario):

Microcomputer support for health care delivery is a relatively new concept in developing countries, despite serious shortages of human expertise. In this light, the concept of microcomputer-based decision support for patient management at the rural health centre level in The Gambia is discussed and developed. Possible methodologies are devised and evaluated, taking into account constraints imposed both by feasibility of hardware for the rural African setting and by appropriate software techniques. Clinical data were collected for a pilot system, which was implemented using a Bayesian methodology, and assessed, with encouraging results. Further sources of data were then considered in order to generalise the pilot system into a prototype, which was implemented on a portable solar-powered microcomputer. The evaluation of this prototype system, and the difficulties involved in undertaking rigorous evaluations of this type of decision aid, are described and discussed. Whilst it is not proven that major health benefits would arise from the widespread introduction of such systems, the results of this preliminary study suggest that this type of approach merits further consideration and development.

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35

Richardson, Gerald Anthony. "The cost-effectiveness of interventions to support self care". Thesis, University of York, 2007. http://etheses.whiterose.ac.uk/9918/.

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36

Musyoka, Kanini. "Exploring spiritual features within psychosocial support in cancer care". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-447003.

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Abstract (sommario):

Introduction:Psychosocial intervetions are the actions taken to offer psychosocial support to cancer patients and their relatives for the improvement of their quality of life. They are aimed at meeting patients' mental, emotional, social, and spiritual needs and those of their families.Various previous studies have explored different forms of psychosocial support offered to different groups of cancer patients and their relatives. However, there are few literature reviews about how spirituality is included in psychosocial support among cancer patients. Aims:The aim of this literature review is to explore the spiritual features within psychosocial interventions in cancer care. Method:Two databases were used in this study: CINAHL and PubMed.Thirteen scientific studies involving various psychosocial interventions were included. Content anlysis with three steps' strategy was done. Results:Various spiritual aspects within psychosocial interventions in cancer care were identified, and the most prevalent among them were finding meaning,spirirual coping,spiritual transecendence,connection with others and the Sacred, life completion tasks and preperation for death.Conclusion:Psychosocial spiritual support is an essential element of psychosocial cancer care.There is need for more awareness of how spiritual health is to be addressed in cancer care.
Inledning: Psykosociala interventioner är de återgärder som vidtagits för att erbjuda psykosocialt stöd till cancerpatienter och deras anhöriga för att förbättra deras livskvalitet.De är inriktade på att möta pateinternas mentala,emotionella,sociala och andliga behöv och deras familjers behov.Tidigare studier har undersökt olika former av psykosocialt stöd som erbjuds olika grupper av cancerpatienter och deras anhöriga.Det finns dock få litteraturöversikter om hur andlighet ingår i psykosocialt stöd bland cancerpatienter. Syfte:Syftet med denna litteraturöversikt är att utförska de andliga asoekter inom psykosociala interventioner i cancervård. Metod:Två databaser användes i denna i denna studie: CINAHL och PubMed. Treton vetenskapliga studier med olika psykosociala interventioner inkluderades. Trestegsstrategi innehållanalys gjordes. Resultat:Olika andliga aspekter inom psykosocialt stöd identifierades, och de vanligaste bland dem var meningsskapande, andlig hantering(spiritual coping), andlig transcedens, förbindelser med andra och det Heliga, och föberedelser inför döden. Slutsats:Psykosocialt andligt stöd är en viktig del av psykosocial cancervård. Det finns behöv av mer medvetenhet om hur andlig hälsa hanteras i cancervården.

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Schofield, Gillian. "The experience of growing up in foster care : pathways from childhood to adulthood". Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247202.

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This study is an investigation of long-term foster care, which focuses on the reflections of 40 adults, aged 18-30, who grew up in foster families. The theoretical approach taken is developmental and the study draws on theories of attachment and resilience. The research method was qualitative. In-depth interviews were conducted, transcribed and analysed in order to generate a picture of the pathways taken through childhood and into adult life. The primary focus of the interviews was on family relationships and the development of the self, but relationships with peers, school experiences and practice relevant issues, such as what it meant to be `in care', the experience of stigma and the role of social workers, were also discussed. The analysis used the dimensions of placement continuity, the quality of family relationships and the nature of family membership to identify seven different pathways. The data suggests that although the development of secure emotional relationships is an important part of successful placement experiences, the development of a sense of family membership is also highly significant, particularly in adult life. In a psychosocial model of long-term foster care, a `secure base' can therefore be understood in attachment terms as an emotional resource, but can also be understood in a more social context, as providing a family identity and a place in society. The study concludes that foster families where there are no biological or legal ties can still be a form of permanent family placement. This has important implications for social work practice, both in the way in which placements are planned and in the importance of promoting continuity into adult life of relationships which officially end when a child leaves care. It requires a change in attitudes, so that long-term foster families are no longer treated as placements for childhood only, but are recognised as offering a home and a family for life

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38

Counihan, Kate. "Analysis of care pathways of children who present with an avulsed permanent tooth". Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/5515/.

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Abstract (sommario):

This thesis, examining care pathways of children who present with an avulsed permanent tooth, is divided into four parts. Chapter 1 presents a literature review, which looks specifically at the aetiology and treatment of tooth avulsion injuries. There is also a short review on the costs, both direct and indirect, associated with treating tooth avulsion injuries Chapter 2 investigates data sources for the prevalence of tooth avulsion injuries in the Yorkshire region. Two major sources of epidemiological data on child dental health are available in the UK, decennial and annual surveys. Decennial surveys have been run in England and Wales since 1973 and in the whole of the UK since 1983 whilst the annual NHS Dental Epidemiology Programme was started in 1985 and is now run by Local Authorities. It surveys five-year-olds every other year, and older children in intervening years. The 2003 Child Dental Health Survey reported data on accidental damage to teeth but only unpublished data on traumatic damage to teeth is available from the 2008/2009 NHS Dental Epidemiology Programme surveys of 12-year-olds. This was obtained from The Dental Observatory for the purpose of this thesis. On examining the data neither survey was able to provide accurate information on the prevalence of tooth avulsion injuries in our child population. This lack of information potentially complicates the local commissioning of healthcare services, if this is to be based on the available epidemiological data. Chapter 3 investigates the experience of Yorkshire dentists’ in relation to the management of avulsed permanent incisors. The study was designed as a selfcompletion postal questionnaire of a random sample of dentists working in primary care in the Yorkshire region. A response rate of 59.7% was achieved. Thirty nine per cent of respondents had replanted an avulsed permanent tooth. The replantations took place most often in the primary dental care services. Almost forty per cent of all respondents currently have a child who has sustained an avulsion injury on review. Many dentists in the Yorkshire region have limited experience of treating children with avulsed permanent teeth. A significant percentage currently has children with avulsion injuries under their care. Current guidance advises an early specialist multi-disciplinary team consultation for children following an avulsion injury. Chapter 4 investigates parents’ experiences of accessing emergency and follow-up care for their child following a tooth avulsion injury. This study used a qualitative approach and semi-structured interviews were undertaken to explore on how parents access emergency and follow-up care. Eight parents attending the Leeds Dental Institute were recruited to the study using purposive sampling. The framework analysis approach was used to analyse the data. Two core concepts of knowledge and access were inferred from the analysis. Parents found it difficult to access emergency dental care for their child. The knowledge of the parents, laypeople at the site of the accident and health care professionals involved in providing the emergency care had a direct impact on how emergency care was accessed. Accessing follow-up care proved more straightforward in our sample as could be expected from a cohort attending a tertiary service. A further core concept of emotion was also evident – parents were distressed by what happened to their child and also frustrated and disappointed with the difficulty in accessing emergency care. The final chapter presents the conclusions of this research, together with some recommendations for further work.

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Yelverton, Rita. "Pathways to Kindergarten Growth: Synthesizing Theories of the Kindergarten Transition to Support Children's Development". PDXScholar, 2018. https://pdxscholar.library.pdx.edu/open_access_etds/4394.

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Abstract (sommario):

The transition into Kindergarten is a critical time for children's development--children's patterns of academic development and engagement with school often start in Kindergarten and persist throughout their academic careers. This is a developmental period that is marked by many changes in children's lives, and therefore it is not a surprise that many children struggle during this transition. These struggles are more common for children who are living in poverty, and although there have been national initiatives to address opportunity gaps in access to early education, investigations into the effectiveness of these programs in promoting children's Kindergarten development have shown mixed results. It is therefore essential to identify the types of early education experiences that are effective in supporting children in having a smooth Kindergarten transition. This dissertation presents and evaluates six theoretical frameworks that can be used to understand the Kindergarten transition. The school readiness approach to the Kindergarten transition focuses on the ways in which children's Kindergarten-entry skills can lead to their own development during Kindergarten. The Pre-K launch model examines the role of high-quality Pre-K in boosting children's school readiness, and subsequently their development during Kindergarten. The classroom quality perspective describes the supportive qualities of Kindergarten classrooms that may aid in children's development across this transition. The continuity perspective shows that support for continuous high-quality instruction between Pre-K and Kindergarten systems may promote children's growth. The buffer/compensation model proposes that children with higher-quality Pre-K experiences are more resilient to the effects of lower-quality Kindergarten. Finally, the consistency model suggests that alignment of quality between Pre-K and Kindergarten may be beneficial for children regardless of whether that alignment represents high quality instructional practices. Each of these perspectives provides valuable insight into the Kindergarten transition; however, these theoretical perspectives have not been studied simultaneously to determine the extent to which all may play a role in children's development during the Kindergarten transition, particularly the development of children who are living in poverty. The current study used data from the National Center for Early Development and Learning's Multi-State Pre-kindergarten Study (NCEDL) to chart children's experiences in their Pre-K and Kindergarten classes to determine whether there are qualities of children's experiences before and throughout the Kindergarten transition that support their development during Kindergarten, and evaluated the extent to which these patterns support these major theoretical perspectives. The study found that children's Kindergarten-entry skills were the best predictors of their end-of-Kindergarten outcomes, showing support for the school readiness perspective. In the domain of instructional support, children's concurrent classroom experiences predicted their academic outcomes during a given year, showing support for the classroom quality framework. In the domain of emotional support, statistical effects of Kindergarten emotional support on children's outcomes were seen only under conditions in which Pre-K emotional support had also been high, showing conditional support for the continuity model. Consistency of children's emotional support, when controlling for quality, was negatively related to their social and emotional development, indicating that consistent emotional support alone is not beneficial without taking into account the quality of that emotional support. Associations between Pre-K quality and children's Kindergarten development were not translated through boosts in school readiness, indicating that while Pre-K experiences do matter for children's development during the Kindergarten transition, that relationship is not best described through a launch model. And finally, any benefits of higher quality emotional and instructional interactions during both Pre-K and Kindergarten were largely concentrated in the group of children who were not living in poverty, while higher Pre-K quality was at times related to lower Kindergarten outcomes for children who were living in poverty. Implications for future research and policy are discussed.

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40

Eliot, Trevor G. "Provider precision labs healthcare analytics and decision support". Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10111177.

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Abstract (sommario):

The healthcare industry is undergoing a shift due to changes in revenue cycles and therefore delivery models. This shift is causing horizontal integration among providers and a subsequent assumption of risk that behooves them to operate similar to a payer. Analytics, while used predominately by healthcare payers in the past, will now be applicable to providers of care. This opens the door to a niche consulting firm that can provide these services effectively and affordably. Provider Precision Labs is an idea for a company that can render payer-like services on the scale of regional provider groups but at a manageable cost to the owner and operator.

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41

Milnes, Linda Jane. "Development of a self-care guide to support teenagers in preparing for primary care consultations". Thesis, University of Manchester, 2010. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:95591.

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42

Hohenleitner, Stacy Grant. "New nursing graduates' perceptions of support". Thesis, Villanova University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10957180.

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Abstract (sommario):

Supporting new nursing graduates (NGs) through the professional socialization transition process has been an ongoing challenge facing nursing leaders. As NGs begin their professional socialization transition process, they begin to acclimate themselves to their job responsibilities. Employers provide NGs with established education and training without established evidence-based sources of support. The literature frequently indicated that institutional support for NGs is provided or should be provided without describing how this is accomplished. Without support for NGs during their professional socialization transition period, they could feel unsatisfied within their roles and resign from their positions or leave the nursing profession. The purpose of this research study was to explore the reflective perceptions of NGs regarding the support they received as well as what support they would have liked to receive during their professional socialization transition process. Through this study, this researcher began to describe the support that NGs desire to successfully transition from NGs to registered nurses.

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Easton, Phyllis. "Exploring the pathways to poor health in the 'hidden population' with low literacy". Thesis, University of Dundee, 2011. https://discovery.dundee.ac.uk/en/studentTheses/b87ea302-9fdb-4cdf-9243-4d70b1991a4d.

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Low literacy remains a problem across the developed world. Health literacy has emerged as a specialist literacy, although its conceptualisation and measurement overlap with those of functional literacy. The social practice view, which conceptualises literacy as an activity rather than a skill, is useful in examining literacy-related practices and demands in healthcare contexts. Associations between low functional or health literacy and poorer health outcomes have been established in the research literature but studies have included participants whose low literacy may be obvious to healthcare providers and others. This thesis presents first a systematic review that focuses on literacy and health outcomes in the ‘hidden population’ with low literacy, defined as those of working age whose first language is that of their resident country but who score low on literacy measures. The review concludes that there is a link between low literacy and poorer health in this ‘hidden population’ but that potential pathways have not been explored to any extent. The thesis then presents a primary research study which sought to explore links between low literacy and poor health from the perspectives of people with low literacy; and how the health service might respond to address the issues raised. The findings from 25 in-depth interviews and 2 focus groups with adult learners highlighted the various ways that people with low literacy struggle with written and spoken communication in clinical encounters and in self-care activities. They further revealed that stigma frequently plays a central role in the social practices of those with low literacy, affecting their mental wellbeing and social relationships, including those with healthcare staff. The potential solutions identified for service providers would benefit from piloting and evaluation to help create a literacy-sensitive health service, which could improve engagement; enable self-care and enhance capabilities for health in those with low literacy.

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44

Arana, Carla Paola. "WeCare Fertility Support Center| A Business Plan". Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839065.

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Many individuals or couples have a strong desire to have their own biological children. When experiencing difficulty conceiving many struggle with high levels of anxiety, stress, and depression. Infertility is caused by a variety of factors affecting both women and men. Treatment can be medically invasive and expensive. The purpose of this project is to offer a well-rounded perspective on infertility to help clients cope and start a family. WeCare Fertility Support Center will be a comprehensive counseling center improving the lives of many individuals and couples by providing educational guidance on infertility treatments, communication skills, psychological support and direction with adoption. Patient’s will have someone to rely on every step of the way offering support and guidance. WeCare Fertility Support Center will provide physical, emotional and psychological well-being for patients in Long Beach CA and its surrounding neighborhoods.

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Warr, Jeremy George. "Support or supplant? A study into the effects of introducing level three NVQ support workers to nurses". Thesis, University of Southampton, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242634.

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46

Kwan, Joseph Shiu Kwong. "Integrated care pathways for acute stroke : an evaluation of their effects using multiple approaches". Thesis, University of Edinburgh, 2003. http://hdl.handle.net/1842/24798.

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Methods and results: I sought to evaluate the effects of ICPs for acute stroke using four approaches: 1) Assessment of the evidence from previous studies of ICPs for non-stroke conditions: I performed a review of the recent literature and found that there were a large number of randomised and non-randomised studies of ICPs for non-stroke conditions. Positive, neutral and negative findings have been reported. 2) Assessment of the evidence from previous studies of ICPs for acute stroke: I performed a Cochrane systematic review and found three randomised trials and seven non-randomised studies. There were substantial heterogeneity between the studies and most of the evidence came from non-randomised studies. I found that ICP care may significantly improve the process of care and reduce in-hospital complications, but patient satisfaction and quality of life may be lower. 3) Undertaking of a non-randomised study of the ICP introduced for acute stroke at the Western General Hospital (WGH): I performed a before-and-after study (total of 351 patients) to assess the effects of introducing an ICP in a stroke unit. I found that, after its introduction, there were significant improvements in the quality of documentation and certain aspects of patient care, and the risk of urinary tract infection was reduced. However, there was no significant difference in death or discharge destination. I also assessed in the process of care and outcomes between stroke unit care after the introduction of the ICP and general medical ward care (total of 285 patients). The results were consistent with those of the before-and-after study. 4) Undertaking of a questionnaire survey to assess the experience of the stroke unit staff regarding the use of the ICP for acute stroke at the WGH: I found that, when the ICP was first introduced, the staff expected the ICP to improve the process and quality of care, communication and the general working environment. I repeated the survey at seven months after its introduction and found that, although certain aspects of care were felt to have improved, many of the staff’s expectations were not realised.

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Engström, Maria. "A Caregiver Perspective on Incorporating IT Support into Dementia Care". Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7267.

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Aim: The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. Methods: A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. Findings and conclusions: Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.

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48

Wilson, Kelly Patricia. "Social support and health, the role of exercise self-care". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0017/MQ52408.pdf.

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49

Lindgren, Helena. "Decision support in dementia care : developing systems for interactive reasoning". Doctoral thesis, Umeå : Datavetenskap Computing Science, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1138.

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50

Maimbolwa, Margaret C. "Maternity care in Zambia : with special reference to social support /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-612-X/.

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Tesi sul tema "Care and support pathways"

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