An overview of the research evidence on ethnicity and communication in healthcare

• The aim of the present study was to identify and review the available research evidence on 'ethnicity and communication' in areas relevant to ensuring effective provision of mainstream services (e.g. via interpreter, advocacy and translation services); provision of services targeted on communication (e.g. speech and language therapy, counselling, psychotherapy); consensual/ participatory activities (e.g. consent to interventions), and; procedures for managing and planning for linguistic diversity

Organizational and Policy Responses of Flint Area Hospitals to the Medicare Prospective Payment System

In 1983, Congress approved a Medicare prospective payment plan for most inpatient hospital services which is widely regarded as the most significant change in the government health insurance program since its beginning. The radically altered reimbursement incentives inherent in DRG-based prospective payment produce different contingencies and constraints that, in turn, require dramatically different organizational and policy responses by hospitals. This paper describes a study designed to determine the extent to which local, Flint area hospitals are choosing the predicted, advised responses, what institutional variables are operating to influence those choices, and whether there is evidence that government policy intent will be achieved. Interviews conducted with senior administrators at five sample hospitals confirmed that medical and financial information systems are being enhanced and integrated, outpatient services are expanding, hospitals are becoming more diversified in the types of services they provide, and vertically integrated healthcare provider systems are developing in response to the prospective pricing plan. Contrary to expectation, and legislative intent, little evidence was found of service (DRG) specialization by hospitals or greater physician administrative involvement. Nor are hospitals restructuring internally to a product-line, matrix management approach in response to the Medicare reimbursement policy change.Master of Public AdministrationPublic AdministrationUniversity of Michigan-Flinthttps://deepblue.lib.umich.edu/bitstream/2027.42/143476/1/McKellar.pd

An investigation of Bibring's theory of depression

Thesis (Ph.D.)--Boston UniversityThis study represents an attempt to investigate the nature of depressive psychopathology within the context of psychoanalytic theory. It poses two major research questions: can depressed patients be differentiated on the basis of particular ego states according to Bibring's theory; and will such a classification system be useful clinically and theoretically

Developing and testing a pain management program for family caregivers of advanced cancer patients

Increasingly, advanced cancer patients are receiving care in the community supported by families and hospice home care services. However, little or no preparation is provided to family caregivers who assume this supportive role, often 24 hours per day. Pain management is consistently identified by family caregivers as their primary concern related to care and support of a relative with cancer. This project involved a three-phase program of research to develop and test a pain management program (PMP) that would provide family caregivers of advanced cancer patients with information and skills to manage the patient\u27s pain

Implement exercise in the oncological setting

Over the past 20 years, the understanding of the role of physical activity in cancer has been increased. Traditionally, patients were advised to rest, recovery, and save energy during and after anticancer treatments. Nevertheless, it is now clear that physical activity may help alleviate some side effects caused by therapies and a sedentary lifestyle; consequently, cancer patients should be encouraged to perform exercise. Epidemiological evidence shows that post-diagnosis physical activity is associated with enhancing patients \u2018survival, especially in breast, colon, and prostate cancer. In cancer patients, exercise acts by improving health-related skills, particularly cardiorespiratory fitness, strength, and body composition. Moreover, several trials demonstrated that a regular exercise program effectively relieves some cancer and treatments \u2018side effects, such as fatigue, nausea, and vomiting, thereby improving patients\u2019 quality of life. The last update of the American College of Sports Medicine\u2019 guidelines recommends that patients perform 90 minutes per week of aerobic exercise at moderate intensity, with strength activities twice a week. Despite these important benefits, in Italy, the spread of exercise-oncology programs and the research in the exercise oncology field are still poor, negatively impacting patients and producing a gap in the literature. The purpose of this thesis is trying to fill this gap, increasing the available literature, and proposing an exercise program based on patients\u2019 needs and the current guidelines. Chapter one is dedicated to a brief introduction about physical activity in cancer. In chapters two, three, four, and five, the experimental studies that led to the development of patient-centred exercise program are presented. Chapters six and seven report two other studies investigating exercise as part of the multimodal approach in counteracting cancer cachexia. The last chapter is dedicated to a summary of the main thesis results

Nurses, patients, and social systems : the effects of skilled nursing intervention upon institutionalized older patients

By Martha M. Brown [and others] James M. A. Weiss, editor. With a foreword by Frederick C. RedlichThe authors, a team of nurses, behavioral scientists, and a psychiatrist, tackle a difficult, interesting, and important task: to observe and measure, objectively and under experimental conditions, the impact of skilled nursing care on the behavior of older physically ill patients. The authors carried out their experiment by comparing the interactions of patients, matched for age, sex, social status, and other factors, in contact with two groups of nursing personnel. The first group were participants with high nursing skills; the second group was a control group without such skills. The term skill in this particular context means active participation, utilizing optimal verbal communication and interaction, without attempts to control and direct, but rather to respond to requests or offers.Preliminary rationale -- Nurse-patient interaction: the conceptual model -- Method -- The environmental settings -- Assessments of the research data -- Characteristics of skilled nursing care -- Experimental findings -- Implications for nursing practice, education, and researchDigitized at the University of Missouri--Columbia MU Libraries Digitization Lab in 2012. Digitized at 600 dpi with Zeutschel, OS 15000 scanner. Access copy, available in MOspace, is 400 dpi, grayscale

The Medicare Rx: Prospective Pricing to Effect Cost Containment

This Note analyzes the impact of changing hospital reimbursement while maintaining charge-based reimbursement for physicians on hospital-physician relationships and on cost and quality of care. This Note contends that if the stated goals of redirecting incentives and containing costs are to be realized, physicians must be drawn into the revised reimbursement scheme. An indirect, aggregate approach is advocated to maintain the integrity of the physician-patient relationship and to avoid a direct financial impact upon the physician regarding patient care decisions. Part I will briefly examine the reasons for changing hospital reimbursement from retrospective cost-based reimbursement to prospective fixed rates. Part II of this Note will demonstrate that to realize the stated goals of hospital prospective payment, physicians must be drawn into the incentive structure. The necessity of incorporating physicians into this structure, however, is moderated by the desirability, indeed, necessity, of insulating the physician-patient relationship from any direct financial impact. Thus, Part III of this Note will conclude by advocating a mandatory Medicare incentive plan, administered jointly by the hospital and medical staff, that encourages physicians to share jointly in reduced cost care while forcing them to absorb any losses

Meta-Analysis on Costing Out Nursing Services

This descriptive meta-analytic study investigated 73 primary studies on costing out nursing services. A critical review of the literature revealed that findings from the various published and unpublished studies were inconsistent and inconclusive. This meta-analysis integrated the literature to identify the relationships between nursing costs and a second variable. The most frequently reported variables among the primary studies were compared using Pearson r correlations and percentages. The variables of total and direct nursing costs were correlated to the variables of length of stay, direct nursing care hours, hospital costs, and diagnostic related grouping (DRG) reimbursements. Analysis was conducted two ways. First the studies were treated as a single value for each variable reported. In addition, relationships were examined between the variables for frequently reported DRGs. Treating each study as a single finding, the research revealed statistically significant correlations between several variables. Total nursing costs were found to correlate.85 to direct nursing care hours,.99 to hospital costs, and.65 to length of stay. Direct nursing costs revealed.94 correlations to direct hours,.95 to hospital costs, and.83 to length of stay. Nursing costs did not correlate, with any statistical significance, to DRG reimbursements. When frequently studied DRGs were examined, only eight yielded statistically significant results, although no consistency between the variables was noted. When percentages were calculated, total nursing costs were reported to be 22.15% of hospital costs and direct nursing costs were found to be 15.68%. The major benefit nursing derives from costing out services is the increased ability to justify, monitor, and control costs within the cost-conscious health care environment. The use of meta-analysis, with descriptive primary studies, is validated as a tool for summarizing nursing knowledge and advancing nursing practice. A major limitation of this study was the different definitions of direct nursing care and direct nursing costs found among the primary studies. For future nursing research, specific definitions for total and direct nursing costs and direct nursing care are recommended

The Lived Experiences of Nurses\u27 Interactions with Ethnically Diverse Clients: A Phenomenological Perspective

This study explored the phenomenon of nurses\u27 lived experiences while interacting with clients who were ethnically dissimilar to themselves in a variety of nursing care settings including acute care, ambulatory care and public health. This study is timely, especially in the county in which the study was conducted because of the ongoing influx of legal and illegal immigrants from diverse foreign geographic locales. Van Kaam\u27s method for conducting phenomenological studies was employed for data gathering, categorizing and analyzing. Categories were stated in terms of perceptions and feelings. The most frequently stated perceptual moments included perceiving client ethnicities based on physical characteristics, language fluency, beliefs and practices, and presumptive clues such as address or surname. Nurses also drew conclusions about their clients\u27 ethnicities based on past, personal experiences. At the emotional level, there emerged a blend of both pleasant and difficult feelings. Nurses described experiencing feelings of heightened awareness, empathy and compassion toward their patients. There were also moments when, even in light of language difficulties, the nurses felt accepted and trusted by the careseekers. Others experienced feelings of triumph, satisfaction and reward. The pleasant emotions were at times tempered by feelings of inadequacy, frustration, anger and pressured by time constraints. For some participants, the experience of being discriminated against by clients was described. As a result of the information emerging from this study, a synthetic description of the phenomenon was composed. The study included tape-recorded interviews with fifteen nurses who were themselves members of diverse ethnicities. An interview guide was prepared and utilized to assist the volunteers in recalling the most memorable interactions in which they were not members of the patient\u27s ethnicity. These participants were chosen through a snowball sampling approach. All measures were taken to insure the confidentiality of the nurses and their clients and to maintain trustworthiness, dependability, confirmability, subjectivity, accuracy and truth. Although phenomenological findings are not generalized beyond the study participants, insight can be gained into the meaningfulness of nurses\u27 experiences which provide additional research questions and implications for nursing practice, education and research

Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Report on Typology/Segmentation of the PHS Market

This market segmentation reports for Personal Health Systems (PHS) describes the methodological background and illustrates the principles of classification and typology regarding different fragments forming this market. It discusses different aspects of the market for PHS and highlights challenges towards a stringent and clear-cut typology or defining market segmentation. Based on these findings a preliminary hybrid typology and indications and insights are created in order to be used in the continuation of the SIMPHS project. It concludes with an annex containing examples and cases studies.JRC.DDG.J.4-Information Societ