The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Promoção das competências parentais no auto cuidado terapêutico à criança

O presente relatório expõe todo o percurso feito ao longo do estágio no âmbito do curso de Mestrado em Enfermagem, na área de especialização em Saúde Infantil e Pediátrica. A base conceptual do mesmo reporta-se ao Modelo de Auto Cuidado de Dorothea E.Orem. A escolha do tema “Promoção das competências parentais no auto cuidado terapêutico à criança” surgiu devido a uma sucessiva constatação da prática da educação para a saúde não abranger uma base/modelo teórico de enfermagem, o que seria uma mais-valia na sua organização e estruturação, possuir um suporte teórico e científico favorecendo uma atitude coerente frente à promoção do desenvolvimento parental, beneficiando a sistematização do cuidado de enfermagem. Os pais, são segundo a Teoria do Défice de Auto Cuidado (TDACE), agentes de cuidar dependentes, pois têm de colmatar a necessidade terapêutica de auto cuidado (AC) de outros relevantes (a criança), que é socialmente dependente deles. O enfermeiro especialista em saúde infantil e pediátrica (EESIP) é aquele que tem competências para assistir e cuidar desta criança e família, em todos os seus níveis de desenvolvimento, quer na saúde quer na doença. Deste modo, foi tido em consideração a “ (…) a natural dependência da criança, a sua progressiva autonomização e o binómio criança/família como alvo do cuidar do enfermeiro especialista de saúde infantil e pediatria, [que] estabelece com ambos uma parceria de cuidar promotora da optimização da saúde, no sentido da adequação da gestão do regime e da parentalidade” (SIECE 2009, p.21). Para além disso, foi respeitada a interculturalidade das diferentes populações e foi adjudicado o etnocentrismo,adequando o cuidar a cada cultura. Como objectivo geral deste relatório pretendo divulgar o percurso feito e os resultados do trabalho de aprendizagem na prestação de cuidados globais à criança/família, no decorrer do estágio. Pude adquirir competências para promover a adaptação da criança/jovem e família à doença oncológica, através do conhecimento aprofundado de uma instituição de suporte que apoia estas crianças, podendo referencia-la posteriormente. Nos diferentes módulos colaborei e prestei cuidados às crianças/famílias, identifiquei as suas necessidades do ciclo de vida e de desenvolvimento, quer no internamento de pediatria, na neonatologia e na urgência pediátrica, promovendo o desenvolvimento das competências parentais e melhoria do AC terapêutico às mesmas, maximizando a sua saúde e prestando cuidados em situações de maior complexidade. Pude ainda desenvolver a praxis clínica especializada em sólidos e válidos padrões de conhecimento, diagnosticando necessidades formativas, actuando como formadora, favoreci a aprendizagem e competências dos enfermeiros e da criança/família. No fim deste percurso posso referir que foram atingidos totalmente os objectivos inicialmente planeados, com adaptações ao longo dos diferentes contextos.This report exposes the whole course done over the internship under the Master of Nursing, in area of specialization in Pediatrics and Child Health. The conceptual basis of the same reports is based on the Model of Self Care by Dorothea E.Orem. The choice of the theme "Promoting parenting skills in self care treatment to the child" emerged due to a subsequent finding of the practice of health education that should embrace a nursing theoretical basis/model, which would be an asset in their organization and structure, having a theoretical basis and scientific attitude favoring a coherent front to the promotion of parental development and benefiting the systematization of nursing care. The parents are according to the theory of Self Care Deficit (TDACE), dependent care agents, as they have to address the therapeutic need for self care (AC) of other relevant (the child) who is socially dependent on them. The nurse specialist in child health and pediatrics (EESIP) has skills to assist and care for this child and family at all levels of development, whether in health or disease. Thus, it is considered that "(...) the natural dependence of children, their empowerment and progressive binomial child / family as the focus of nursing care specialist pediatrics and child health, establishes a partnership with both care promotes the optimal health in the sense of the adequacy of management arrangements and parenthood "(SIECE 2009, p.21). Furthermore the interculturality of different populations has been respected and is also a granted ethnocentrism, tailoring care to each culture. The overall objective of this report is to inform which course I have taken and show results of the work of learning through a critical analysis of the activities and resources I used in providing comprehensive care to children/families during the internship. I was able to acquire skills to help the working child/youth and family to cancer disease through the knowledge of a supporting institution that supports these children and can reference it later. In different modules I collaborated and provided care for children/families, identified their needs in their life cycle of development, which also includes inpatient pediatrics, neonatology and pediatric emergency, promoting the development of parenting skills and improving the therapeutic to the same AC, maximizing their health and providing care in situations of greater complexity. I could still develop clinical praxis specializing in sound and valid standards of knowledge, acting as a trainer, diagnosing needs, but also favored the learning and skills of nurses and child/family. At the end of this course I can refer that the originally planned goals, along with adaptations of different contexts, were fully achieved