Health and Medical Administration Commons^™

Experiences Of Kenyan Healthcare Workers Providing Services To Men Who Have Sex With Men: Qualitative Findings From A Sensitivity Training Programme, Elise M. Van Der Elst, Evans Gichuru, Anisa Omar, Jennifer Kanungi, Zoe Duby, Miriam Midoun, Sylvia Shangani, Susan M. Graham, Adrian D. Smith, Eduard J. Sanders, Don Operario

Community & Environmental Health Faculty Publications

Introduction

Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients.

Methods

Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in …

Shared Leadership In Six Sigma Teams From The North Shore-Lij Health System, Brian J. Galli

Engineering Management & Systems Engineering Theses & Dissertations

The main goal of the research was to identify the relationships that the internal research team environment and external coaching variables had with the degree of shared leadership in the context of Six Sigma teams from the North Shore LIJ Health System. Furthermore, the research ascertained the relationships that these variables had with two performance metrics: a team's ability to complete project deliverables and satisfy customer's requirements. This research also sought to understand additional factors that affected the five variables.

The research found that while shared leadership did not positively change as a team progressed through the phases of the …

The Factors Behind A Successful Implementation Of Electronic Health Records Systems, Anjee Gorkhali

Engineering Management & Systems Engineering Theses & Dissertations

This research explores the role that budget for Information System (IS) and technical expertise of healthcare service provider staff play on the successful leap from a partial to exhaustive implementation of Electronic Health Records (EHR) Systems. Technical expertise in Information Systems might not be easily measurable directly, but there are a number of indicators that could be used as a proxy, such as: Information System (IS) Department Budget, number of IS staff and the extent of technical trainings provided by the IS department to the clinical staff. This research study hypothesizes that quality technical trainings conducted by an IS department …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Conditions For Empathy In Medicine: A Grounded Theory Study, Hannah Barnhill Bayne

Counseling & Human Services Theses & Dissertations

Previous research in the medical setting has credited empathy with improving treatment outcomes and patient satisfaction, though operational definitions of the concept are widely varied and indicate inconsistencies in conceptualization and subsequent assessment. The purpose of this grounded theory study was to examine the role of empathy in the medical setting. A model of conditions for empathy in medicine was developed through in-depth interviews with 21 healthcare professionals, utilizing their professional experiences and perspectives to structure the multi-level model. The seven levels of the model indicate the layers of complexity inherent in facilitating optimal empathy in medicine and add to …

Early Diagnosis Of Pulmonary Embolism: Review And Cost-Effectiveness Analysis, Efstathios Polychronopoulos

Health Services Research Dissertations

Pulmonary embolism (PE) is a serious, life-threatening thrombotic disease, which results in considerable health and economic consequences each year for the United States. These consequences include a toll of 83,000 deaths and an economic impact between 1,5 and 5 billion. Approaches to strategy selection by physicians and other health-care specialists are based mainly upon cost, technology availability, and cultural tolerance regarding radiation exposure. The purpose of this study was to determine the most cost-effective diagnostic strategy with patients suspected of PE among several strategies currently used by examining their detection failure rates. This objective was met by (a) assessing parameter …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

Rapid Sensor Technology: A Risk And System Complexity Analyses Of Early Detection Of Influenza-Like-Illnesses, Cesar Ariel Pinto, Ipek Bozkurt

Engineering Management & Systems Engineering Faculty Publications

The development of effective and reliable methods to defend the nation against biological terrorism remains an urgent challenge to researchers in the areas of risk, bio-defense, public health, and emergency medicine. The emerging threat of the avian flu pandemic also highlights the unpreparedness of our nation's health care system to meet a highly contagious and infectious disease outbreak. The implementation of a rapid sensor technology for early detection of influenza-like-illness provides possible opportunities, as well as problems. Bounding and defining such a complex problem is one of the first challenges this research addresses. Approaching this problem from various perspectives such …

Test Of A Multidisciplinary Health Behavior Model Of Medicare Elders' Antihypertensive Acquisitions, Ann Marie Kopitzke

Health Services Research Dissertations

This study examined the relative utility of the enhanced Health Belief Model as compared to the proposed Pharmaceutical Acquisition Model for Medicare Elders (PAMME) in describing antihypertensive acquisition with usage intentions for Medicare elders (65 years or older) in Southeastern Virginia. Data collection included record reviews to identify hypertensive Medicare elders. Consenting Medicare elders were randomly selected for invitation, with consenting Medicare elders contacted by telephone or in-person interviews. The survey instrument utilized open and closed ended questions. The target population for this study is Southeastern Virginia Medicare elders enrolled in a Part D plan and prescribed at least one …

The Criminal Justice Response To Elder Abuse In Nursing Homes: A Routine Activities Perspective, Brian K. Payne, Randy R. Gainey

Sociology & Criminal Justice Faculty Publications

Politicians and researchers have begun to pay more attention to elder abuse in recent times. Most of the research on elder abuse has focused on cases of abuse perpetrated by family members, treating the phenomenon as a social problem, but it is increasingly being conceptualized as a crime problem. The current study examines elder abuse in nursing homes from a criminological perspective. Using routine activities theory as a guide, particular attention is given to the criminal justice system's response to abusive activities committed by nursing home employees. In all, 801 cases of abuse investigated by Medicaid Fraud Control Units are …

Application Of Queuing Theory And Procedure Time Estimation In A Local Healthcare System, Galina Tsoy

Engineering Management & Systems Engineering Theses & Dissertations

People in the United States pay more for their basic healthcare needs than do people in any other nation in the world. When we consider that the United States is the wealthiest nation in the world, controlling the majority of the world's resources, it seems only reasonable to ask: Why should it be this way?

In an effort to address this problem, this thesis examines two possible methods of improving health care efficiency in hospitals. The thesis is thus in two parts: the first part examines resource allocation in medical units using Queuing Theory, and the second part examines a …

Managerial And Administrative Competencies For Dental Hygiene Program Administrators, Kelly Gale Tanner

Dental Hygiene Theses & Dissertations

The purposes of this descriptive study was to validate a list of managerial competencies that may guide administrative/management curricula within master of science in dental hygiene programs nationwide, and compile strategies for the development and implementation of the administrative and managerial competencies for future dental hygiene program administrators. Of the entire population of directors and chairpersons from accredited and accreditation eligible dental hygiene programs nationwide (N=262), 10 were randomly selected and used in a pilot survey. After establishing validity and test-retest reliability, a self-designed instrument, the Managerial and Administrative Competencies for Dental Hygiene Program Administrators Questionnaire, was mailed to …

An Examinaton Of The Enhanced Primary Care Model For The Organization Of Team Care In Managing Type 2 Diabetes Mellitus In The Elderly Population, Carolyn Morcom Rutledge

Health Services Research Dissertations

The healthcare system is faced with overwhelming demands as a result of the growing elderly population, especially those with chronic illnesses. One disease that significantly impacts the morbidity and mortality of the elderly population, especially the minority and poor population, is type 2 diabetes. This population often lacks access to resources and quality healthcare that may be due to inadequate knowledge by the patients and their healthcare providers regarding available services. Current models of healthcare have not been effective in meeting the healthcare demands of this population. The purpose of this study was to evaluate the effectiveness of the Enhanced …

The Effects Of Partial Hospitalization On Acute Psychiatric Hospital Readmission Days, William E. Turner Iii

Health Services Research Dissertations

Using the theoretical construct of recidivism and pathway and gatekeeper variables associated with it, this study compared the effects of a combination of partial and acute psychiatric hospitalization and only acute psychiatric hospitalization on the total number of acute hospital readmission days over a 12 month period using a causal-comparative design. Two hundred and forty cases were randomly selected from an existing database which contained information on a population of urban insurance beneficiaries who had accessed psychiatric care during a two year period. The group accessing a combination of acute care and partial care had significantly higher readmission days. Age, …

The Influence Of National Culture On Work-Related Values And Job Satisfaction Between American And Filipino Registered Nurses, Karin Polifko-Harris

Health Services Research Dissertations

This ex post facto study explored the effects of national culture on work-related values and job satisfaction between American and Filipino registered nurses. Three questionnaires were used: Hofstede's Values Survey Module 94, the Survey of Work Values and the Minnesota Satisfaction Questionnaire. The all-female sample comprised 88 American and 56 Filipino registered nurses employed at an urban acute care facility in South Hampton Roads, Virginia.

A major finding of the study is the direction and intensity of the country scores in the Values Survey Module 94, especially in the Filipinos' scores. The masculinity value was reported as strongly feminine for …

Patient Satisfaction Among Users Of The After Hours Program, Helen L. Larocco

Community & Environmental Health Theses & Dissertations

The problem of increasing health care costs and decreasing access to health care services is a major crisis in the U.S. today. One factor contributing to the rising cost of health care is the inappropriate use of emergency rooms, (ERs). In response to escalating costs a local health care corporation implemented a telephone triage program called the After Hours Program, (AHP). The goal of the program was to reduce inappropriate utilization of emergency rooms, and to educate patients to recognize and treat specific health problems independently, i.e., home treatment.

A program evaluation was completed in which different dimensions of patient …

An Assessment Of Personal Characteristics, Job Satisfaction And Semantic Descriptors Of Virginia Acute And Tertiary Care Hospitals' Chief Executive Officers, Justin C. Matus

Health Services Research Dissertations

The purpose of the study was to identify the determinants of job satisfaction of Virginia Hospital CEO's and to identify those descriptors that best characterize the role of the hospital CEO as defined by the CEO's themselves. The study sample consisted of all hospital CEO's in Virginia as listed by the Virginia Hospital Association. The study employed a four part survey instrument that investigated four major areas: (1) personal and hospital demographics; (2) self rated performance; (3) a semantic scale measuring the concept of Hospital CEO; and (4) The Minnesota Satisfaction Questionnaire. A survey was mailed to 119 CEO's. The …

An Assessment Of Management Practices Among Virginia Acute Care Hospitals, Ogbonnia Godfrey Ochonma

Health Services Research Dissertations

The 1990's will see dramatic changes for the health care industry. At no previous time have both public and private health care institutions faced a more turbulent, confusing and threatening environment. Changes in health care arena will come from Federal, State and local governments; international as well as domestic economic and market forces; demographic shifts and life style changes; and structural evolution of the health care industry including mergers, integrations and competition.

The health care industry faces increasing financial pressures due to fundamentally new forces that affect the very viability of many health care organizations. Such pressures include prospective payment, …

A Cipp Evaluation Of The Administrative Associate Training Program Through Sentara, Patricia A. Criswell

Community & Environmental Health Theses & Dissertations

Hospitals are facing change in today's environment. In order to meet these growing challenges, they are responding by providing value added services. Value added services have been defined as reducing inefficiencies and improving quality and service. Operational restructuring in the form of a new concept called patient-focused care has become the paradigm shift and structural revamping at several hospitals across the nation. Sentara Hospitals have adopted this program to improve the clinical and service quality delivered to the patient. An integral component of this new approach is the multiskilling of staff to reduce duplication, inefficiencies, and improve the quality provided …

The Relationship Of Locus-Of-Control And Altruism To Prehospital Emergency Medical Care Providers Universal Precaution Practices, Joanne L. Wakeham

Health Services Research Dissertations

The purpose of this study was to determine the relationship between locus of control, altruism, occupational risk, and personal factors to the frequency of universal precautions practices of prehospital emergency medical care providers. The effects of OSHA's Occupational Exposure to Bloodborne Pathogens; Final Rule on reducing prehospital emergency medical care providers occupational exposure to bloodborne pathogens were also examined. Prehospital emergency medical care providers from municipal and private EMS agencies in the Tidewater Emergency Medical Services region participated in this study. Prehospital emergency medical care providers self-reported perceptions of locus of control, altruism, occupational risk, and universal precautions practices were …

An Analysis Of Quality Assessment Efforts In Health Care, Margaret M. Curran

Community & Environmental Health Theses & Dissertations

The purpose of this research was to determine whether consensus could be reached by experts in the field of quality assurance on the most important indicators of health care quality and to determine whether cause and effect relationship could be attributed to the process and outcome indicators suggested in our survey. We invited participation by a representative sample of experts in a Delphi Panel to address these issues. There were 49 respondants to our Round One Questionnaire and they evaluated the relative importance of 50 process and 50 outcome indicators. Panelists were asked to establish cause and effect relationships between …

Formal And Informal Educational Activities Of Transformational Nurse Leaders In Urban Hospitals, Sue Waltrip Young

Theses and Dissertations in Urban Services - Urban Education

Absence of educational programs designed to develop a specific leadership style has prompted educators in nursing administration to consider designing such programs. As the cost of hospital care escalates and the recruitment and retention of individuals into hospital nursing remains problematic, it is essential that methods be developed to address these issues. This study described the educational processes experienced by transformational nurse leaders employed in urban hospitals. By discovering the relative importance and amount of these activities for nurses identified as transformational leaders, data are provided for the design and testing of educational programs created to enhance a transformational leadership …

A Comparative Analysis Of Pediatric And General Hospital Nurse Recruitment Practices, Rebecca Parsons Scott

Community & Environmental Health Theses & Dissertations

The focus of this study is a comparison of the National Association of Health Care Recruiter's annual recruitment survey with a duplicate survey that was sent to pediatriconly acute care hospitals. The goal was to determine differences between the recruitment and retention statistics found in all hospitals compared to those found in pediatriconly hospitals. Also, a major consideration was to find correlations among the variables in nurse recruitment and retention that might lead to a better understanding of what influences the recruitment budgeting process and how recruitment dollars might be spent most efficiently.

There was no significant difference found between …

Productivity Measurement For Home Health Care Registered Nurses, Lazelle Emminizer Benefield

Theses and Dissertations in Urban Services - Urban Management

The purpose of this study is to develop a productivity measurement applicable to home health registered nurses (RNs) by identifying and quantifying the knowledge and ability variables that define productive nurse practice.

A preliminary set of knowledge and ability variables was identified based on content analysis of interviews with local nurse managers and round I of a three round Delphi procedure, using a purposive sample of nurse managers from nationally preeminent agencies. A randomized national sample of 337 nurse managers was then surveyed to determine the relative value and rank of the knowledge and ability variables. These variables were refined …

Identification And Ranking Of Stressors In Nuclear Medicine Technology, Scott R. Sechrist

Community & Environmental Health Theses & Dissertations

The purpose of this study was to identify the most significant stressors in the field of nuclear medicine technology. A sample of convenience of 25 nuclear medicine technologists was used to generate a list of 35 stressors specific to the occupation. Sixty-three randomly selected nuclear medicine technologists responded to a mailed questionnaire which asked the technologist to assess the relative stressfulness of each of the 35 items on a scale of "0 to 1000". Data from the 59 valid responses indicated that equipment malfunctions, add on exams, uncooperative physicians, lack of staff, and uncooperative patients were the most significant stressors …

A Comparative Analysis Of Head Nurse Role Perceptions In Acute Care Hospitals, Margaret A. Miller

Ellmer School of Nursing Theses & Dissertations

This study examined the perceptions of 43 head nurse participants from private, voluntary and government hospital settings. Utilizing a tool adapted by the researcher, the Head Nurse Role Questionnaire (HNRQ), the study sought to explore five areas of job context: Job Variability, Job Expertise, Job Definition, Job Capacity and Job Incentives. Differences in perceptions were analyzed utilizing descriptive statistics and Analyses of Variance. The three organizational dimensions of this study included: standardization, formalization and organizational culture. Findings revealed significant differences in Job Definition. Descriptive statistical results indicated differences in hospital settings. Qualitative analyses displayed three categories of head nurse attributes …

Preferred Provider Organizations: Developmental Indicators, Marcia Anne Guida

Community & Environmental Health Theses & Dissertations

The purpose of this research was to determine what factors, if any, led to the development of a preferred provider organization and if these factors were related to sponsorship. A survey instrument was developed and mailed to a random sampling of 90 existing preferred provider organizations' executive directors for their completion. A Two-Factor Contingency Table Analysis was compiled. Chi-square, and the Contingency factor, C, were computed and tested at the .05 level of significance. First and second preference analyses were done on the responses to developmental indicators. Mean percentages were tallied for: sponsorship, tax status, alternative delivery systems in the …

Correlates Of Knowledge And Locus Of Control On Burden In Professional Caregivers Of Alzheimer's Disease Victims In Three Institution Types, Ruth A. Manning-Gay

Community & Environmental Health Theses & Dissertations

In assessing professional caregivers of Alzheimer's Disease victims, this study tested whether, 1) knowledge would influence perceptions of burden in providing care to such patients, and if 2) individual locus of control would influence perceptions of burden in caring for; Alzheimer's I patients. Professional nurses (BSN's, RN's, and LPN's) from nursing banes, hospitals and psychiatric facilities were asked to complete a three part survey. Three instruments were utilized in this study: the Burden Self-Interview by Zarit, Reeves and Bach-Peterson and adapted for professional caregivers, a 15 item knowledge quiz and the North Carolina Internal External scale (short form) by Schopler, …

Tidewater Virginia: A Case Study In Health Planning, Maria Justice Moore Griffin

School of Public Service Theses & Dissertations

Leigh Memorial Hospital, a small private community care hospital merged with Norfolk General Hospital in 1972 to form an innovative health care corporation in Tidewater Virginia. By deciding to merge and alter its organizational identity, the Leigh Memorial Hospital leadership reversed a previous decision to relocate to the downtown Norfolk Medical Center complex, choosing instead to move to within a few yards of the neighboring city of Virginia Beach. Those two decisions and the story behind them are part of a complex, highly interdependent series of decisions which altered the health care delivery system in Tidewater Virginia.

This study is …