741 resultados para Mental health. Mental health services. Health manpower. Professional role. Politics. Teaching
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Purpose This study aims to explore the scope of consumers defective co-creation behaviour in professional service encounters. One of the founding premises of service-dominant logic (Vargo and Lusch, 2004, 2008) is that consumers co-create the value they derive from service encounters. In practice, however, dysfunctional consumer behaviour can obstruct value co-creation. Extant research has not yet investigated consumers defective co-creation behaviour in highly relational services, such as professional services, that are heavily reliant on co-creation. Design/methodology/approach To investigate defective co-creation in professional services, 164 critical incidents were collected from 38 health-care and financial service providers using the critical incident technique within semi-structured, in-depth interviews. Thematic coding was used to identify emergent themes and patterns of consumer behaviour. Findings Thematic coding resulted in a comprehensive typology of consumers defective co-creation behaviour that both confirms the prevalence of previously identified dysfunctional behaviours (e.g. verbal abuse and physical aggression) and identifies two new forms of consumer misbehaviour: underparticipation and overparticipation. Further, these behaviours can vary, escalate and co-occur during service encounters. Originality/value Both underparticipation and overparticipation are newly identified forms of defective co-creation that need to be examined within the broader framework of service-dominant logic (SDL).
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UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.
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This paper reports the findings of an evaluation of the Housing Support, Outreach and Referral service developed to support people living with HIV who were homeless or at risk of homelessness. The service was set up as part of the Supporting People Health Pilot programme established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper considers the role of housing support in improving people's health, and considers the challenges of working across housing, health and social care boundaries. The evaluation of the health pilot employed two main sources of data collection: quarterly project evaluation reports, which collected process data as well as reporting progress against aims and objectives, and semi-structured interviews with professionals from all key stakeholder groups and agencies, and with people who used services. Over the course of 15 months, 56 referrals were received of which 27 were accepted. Fifteen people received tenancy support of whom 12 were helped to access temporary accommodation. At the end of the 15 months, all of the tenancies had been maintained. In addition, 18 people registered with a general practitioner and 13 registered with an HIV clinic. Interviews with professionals emphasised the importance of the local joint working context, the involvement of the voluntary sector and the role of the support workers as factors that accounted for these outcomes. Those using services placed most emphasis on the flexibility of the support worker role. Importantly, interviews with professionals and those using services suggest that the role of support worker incorporates two dimensions those of networker/navigator as well as advocate and that both dimensions are important in determining the effectiveness of the service.
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Contexte : Une tentative de suicide antrieure et les troubles mentaux constituent dimportants facteurs de risque de suicide. Les services de sant ont un rle important jouer en matire de prvention. Objectif : Analyser les patrons de recours aux services des fins de sant mentale avant et aprs une hospitalisation pour tentative de suicide chez les rsidents montralais qui ont reu un diagnostic de schizophrnie ou de dpression. Mthode : Les donnes proviennent de la banque mdico administrative jumele de lAgence de Montral. Les caractristiques des patients et les taux de contacts avec les services trois mois avant et aprs lhospitalisation index furent compares. Lchantillon reprsentatif compte 525 Montralais hospitaliss la suite dune tentative de suicide (avr. 2003-dc. 2004) qui ont reu un diagnostic de schizophrnie ou de dpression. Rsultats : Le recours aux services a augment de manire significative suivant lhospitalisation index. Les patients dj en contact avec les services et les hommes avec comorbidit en termes dabus de substances semblent en contact avec les services au cours des trois mois suivant leur hospitalisation contrairement aux femmes avec comorbidit. Le profil urgence de recours aux services semble prdire une absence de recours aux services. Conclusions : Les services de sant rpondent aux tentatives de suicide, particulirement chez les hommes avec troubles dabus de substances. Cependant, des interventions sont requises en vue damliorer la coordination des services, principalement pour les personnes qui se prsentent lurgence, les femmes avec troubles dabus de substances et les patients en marge du systme avant leur hospitalisation.
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The Community Therapy (CT) is in a practice of therapeutic effect and may also be considered as a technology takes care of the therapeutic procedure group, whose purpose is to promote health, prevent illness, developed within primary care in mental health. In this study we sought to understand the social representations of health professionals who work with the Community Therapy, on use of the Family Health Strategy (FHS) in the city of Joao Pessoa. This is a field research with a qualitative view Moscovician Theory of Social Representations, held with seven professionals of the FHS, therapists of Community Health District II. The empirical data were obtained by carrying out two thematic therapies in April 2009, which were wheeled CT. It was used as a technique for analyzing the collective subject discourse, and the data presented through graphs, charts, maps, pictures and graphics and arranged in three stages: Subjects of the study, characterizing the study participants; Social Representations of Therapist Community presenting and discussing the social representations of therapists community studied on CT, and Consequences of Community Therapy at the Family Health Strategy, discussing the meanings attributed by the study participants about changes in FHS. Meanings were attributed to the CT by the therapists studied originated from the speeches, songs, drawings and constructed, and that presented by schematic illustration show the relation between the representations: life, listening, faith / light, change, transformation. The web, symbol of CT, appeared on the images constructed by the representatives of the study and represents the formation of bonds that allows the construction of social support networks that strengthen relationships among community. In the study, proved by professionals who have the meanings about the changes in the work process from the introduction of CT, and shown that the change took place within a more welcoming attitude on the part of professionals, the relationship between Team members had no significant changes, explained by the low compliance of team members to the CT in relation to the user front, the bond was strengthened, and this involved strengthening the role of the therapist community. It is recognized, thereby transforming the character of CT in building links with users, requiring, however, that the team is viewed as offering therapeutic services, not the professional therapist. Therefore, the CT for being a new phenomenon in health services and community belonging, it fits like a novelty which affects the construction of a representation dispute. Still, can contribute to the reorganization of mental health care in line with the new model of mental health care advocated by the Psychiatric Reform.
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Monteiro Lobato's opinions with regard to the health and disease themes were not restricted to Jeca Tatu's condition; he went beyond, and his opinions and reports about the illness experience can be observed in several excerpts of his adult work. This paper highlights the health and illness conceptions observed in Monteiro Lobato's writings. Through the analysis of his adult work, we could learn about his opinions and reports on his beloved ones' experience of being sick, the possibility that the disease offers of socializing individuals, medical corporativism, his participation in the Pro-Sanitation League, some paternalistic health practices and the vulnerability of those with unfavorable social conditions, among other topics, in some occasions with comical characteristics, in others with resignation and even anger. Therefore, this study analyzed his adult work, discussing the excerpts that deal with health and illness experienced in the first decades of the 20th century.
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The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? And (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. The fit of the final structural equation model was good (root mean square error of approximation = .055, Comparative Fit Index=.953, Tucker Lewis Index=.945). Standardized effects with bootstrap confidence intervals are reported. Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.
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Objectives Illegitimate tasks refer to tasks that do not conform to what can appropriately be expected from an employee. Violating role expectations, they constitute identity-stressors, as ones professional role tends to become part of ones identity. The current study investigated the impact of illegitimate tasks on salivary cortisol. We analyzed data on an intra-individual level, that is, by examining fluctuations in illegitimate tasks and cortisol within individuals. Furthermore, we investigated the moderating role of perceived health, expecting that illegitimate tasks evoke stronger reactions when perceived health is relatively poor. Methods Illegitimate tasks, salivary cortisol, and perceived health were assessed in each of three waves (time lag: 6 months) in a sample of 104 male employees. Data were analyzed by multilevel analysis using group mean centering. Results Controlling for social stressors, work interruptions, and emotional stability, the experience of more illegitimate tasks was associated with increased cortisol release if personal health resources were low compared to ones mean value of perceived health. Results cannot be explained by inter-individual differences. Conclusions This is the first study showing that illegitimate tasks predict a biological indicator of stress, thus confirming and extending previous research on illegitimate tasks. The moderating role of perceived health confirms its importance as a personal resource, implying augmented vulnerability when perceived health is below its usual value. It is plausible to assume that increased stress reactions due to relatively poor health may further weaken available personal resources. Both avoiding illegitimate tasks and restoring personal health seem to be crucial.
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This dissertation focuses on Project HOPE, an American medical aid agency, and its work in Tunisia. More specifically this is a study of the implementation strategies of those HOPE sponsored projects and programs designed to solve the problems of high morbidity and infant mortality rates due to environmentally related diarrheal and enteric diseases. Several environmental health programs and projects developed in cooperation with Tunisian counterparts are described and analyzed. These include (1) a paramedical manpower training program; (2) a national hospital sanitation and infection control program; (3) a community sewage disposal project; (4) a well reconstruction project; and (5) a solid-waste disposal project for a hospital.^ After independence, Tunisia, like many developing countries, encountered several difficulties which hindered progress toward solving basic environmental health problems and prompted a request for aid. This study discusses the need for all who work in development programs to recognize and assess those difficulties or constraints which affect the program planning process, including those latent cultural and political constraints which not only exist within the host country but within the aid agency as well. For example, failure to recognize cultural differences may adversely affect the attitudes of the host staff towards their work and towards the aid agency and its task. These factors, therefore, play a significant role in influencing program development decisions and must be taken into account in order to maximize the probability of successful outcomes.^ In 1969 Project HOPE was asked by the Tunisian government to assist the Ministry of Health in solving its health manpower problems. HOPE responded with several programs, one of which concerned the training of public health nurses, sanitary technicians, and aids at Tunisia's school of public health in Nabeul. The outcome of that program as well as the strategies used in its development are analyzed. Also, certain questions are addressed such as, what should the indicators of success be, and when is the time right to phase out?^ Another HOPE program analyzed involved hospital sanitation and infection control. Certain generic aspects of basic hospital sanitation procedures were documented and presented in the form of a process model which was later used as a "microplan" in setting up similar programs in other Tunisian hospitals. In this study the details of the "microplan" are discussed. The development of a nation-wide program without any further need of external assistance illustrated the success of HOPE's implementation strategies.^ Finally, although it is known that the high incidence of enteric disease in developing countries is due to poor environmental sanitation and poor hygiene practices, efforts by aid agencies to correct these conditions have often resulted in failure. Project HOPE's strategy was to maximize limited resources by using a systems approach to program development and by becoming actively involved in the design and implementation of environmental health projects utilizing "appropriate" technology. Three innovative projects and their implementation strategies (including technical specifications) are described.^ It is advocated that if aid agencies are to make any progress in helping developing countries basic sanitation problems, they must take an interdisciplinary approach to progrm development and play an active role in helping counterparts seek and identify appropriate technologies which are socially and economically acceptable. ^
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Existing data, collected from 1st-year students enrolled in a major Health Science Community College in the south central United States, for Fall 2010, Spring 2011, Fall 2011 and Spring 2012 semesters as part of the "Online Navigational Assessment Vehicle, Intervention Guidance, and Targeting of Risks (NAVIGATOR) for Undergraduate Minority Student Success" with CPHS approval number HSC-GEN-07-0158, was used for this thesis. The Personal Background and Preparation Survey (PBPS) and a two-question risk self-assessment subscale were administered to students during their 1st-year orientation. The PBPS total risk score, risk self-assessment total and overall scores, and Under Representative Minority Student (URMS) status were recorded. The purpose of this study is to evaluate and report the predictive validity of the indicators identified above for Adverse Academic Status Events (AASE) and Nonadvancement Adverse Academic Status Events (NAASE) as well as the effectiveness of interventions targeted using the PBPS among a diverse population of health science community college students. The predictive validity of the PBPS for AASE has previously been demonstrated among health science professions and graduate students (Johnson, Johnson, Kim, & McKee, 2009a; Johnson, Johnson, McKee, & Kim, 2009b). Data will be analyzed using binary logistic regression and correlation using SPSS 19 statistical package. Independent variables will include baseline- versus intervention-year treatments, PBPS, risk self-assessment, and URMS status. The dependent variables will be binary AASE and NAASE status. ^ The PBPS was the first reliable diagnostic and prescriptive instrument to establish documented predictive validity for student Adverse Academic Status Events (AASE) among students attending health science professional schools. These results extend the documented validity for the PBPS in predicting AASE to a health science community college student population. Results further demonstrated that interventions introduced using the PBPS were followed by approximately one-third reduction in the odds of Nonadvancement Adverse Academic Status Events (NAASE), controlling for URMS status and risk self-assessment scores. These results indicate interventions introduced using the PBPS may have potential to reduce AASE or attrition among URMS and nonURMS attending health science community colleges on a broader scale; positively impacting costs, shortages, and diversity of health science professionals.^
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A formao em servio realizada pelo programa de Residncia Multiprofissional em Sade (RMS) uma estratgia educativa que visa a mudana do perfil dos profissionais da sade para atuao no Sistema nico de Sade (SUS). Dentre as profisses que compem as residncias, a terapia ocupacional foi eleita como foco deste estudo com o objetivo de conhecer e refletir sobre os desafios e tendncias do processo de educao profissional e interprofissional na perspectiva de tutores, preceptores e residentes terapeutas ocupacionais. A metodologia eleita foi a abordagem qualitativa com realizao de entrevistas e anlise de contedo para a elaborao dos resultados e discusso. Foram realizadas 17 entrevistas em trs programas de RMS de diferentes municpios do estado de So Paulo com cenrios educativos realizados na ateno hospitalar e na ateno bsica. Duas categorias empricas foram identificadas nos resultados: (i) \"Residncia multiprofissional de sade como dispositivo de mudana\" dividida em duas subcategorias: \"Trabalho em equipe\" e \"Trabalho na perspectiva do SUS\" e (ii) \"Singularidades na formao do terapeuta ocupacional em RMS\" agrupada nas subcategorias: \"Particularidades da insero profissional do terapeuta ocupacional nos cenrios educativos\", \"Produo de identidades e a fragmentao da atuao do terapeuta ocupacional nas RMS\" e \"Terapia ocupacional e as prticas colaborativas e interprofissionais no SUS\". A pesquisa permitiu conhecer o potencial de mudanas dos programas de RMS em relao formao dos residentes e disseminao de prticas em sade, colaborativas em equipe e sob a perspectiva do SUS. Os resultados apontaram a singularidade do processo formativo de terapeutas ocupacionais nas RMS que sofrem impactos pela insuficiente contratao de profissionais nos servios, pelo desconhecimento do papel profissional do terapeuta ocupacional e pela fragmentao da atuao profissional nos cenrios de prtica; experincias que geram insegurana de residentes e profissionais quanto aos limites da atuao profissional e interprofissional no trabalho em equipe. O foco da terapia ocupacional nas atividades e cotidianos das pessoas no processo do cuidado em sade e a mediao do cuidado de pessoas com deficincia e transtornos mentais foram identificados como contribuies da terapia ocupacional para as prticas colaborativas e interprofissionais no SUS. Conclui-se que o potencial de mudanas dos programas para a atuao dos residentes como futuros profissionais est diretamente relacionado com as estratgias pedaggicas desenvolvidas nos cenrios educativos. A formao de terapeutas ocupacionais nas RMS depende das caractersticas dos cenrios educativos, no que se refere a sua organizao e interao interprofissional pr-existente, suficincia do nmero de preceptores, consolidao de fluxos assistenciais e ao (re)conhecimento da Terapia Ocupacional pelos demais profissionais dos servios. Por fim, os participantes afirmaram a importncia da RMS para a aprendizagem de saberes e prticas - prprios da profisso, comuns aos profissionais de sade e construdos em equipe de forma colaborativa - com o propsito da qualificao do cuidado em sade
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"December 7, 1979."
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Chiefly tables.
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Mode of access: Internet.
