자연주의적 탐구조사(Naturalistic Inquiry)

Social Network Analysis

This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

This chapter explores the ecology of human development, those forces in the person's environment that affect and influence development. Urie Bronfenbrenner's model of the human ecosystem guides the discussion, making connections between children in families and in communities and the larger society that surrounds them. The human ecosystem model is much like the study of the natural ecology, focusing on the interactions between subjects at various levels of the environment as they affect each other. The interaction between individual and environment forms the basis of an ecological approach to human development. This view sees the process of development as the expansion of the child's conception of the world and the child's ability to act on that world. Risks to development can come from both direct threats and the absence of opportunities for development. Sociocultural risk refers to the impoverishment in the child's world of essential experiences and relationships.

The Ecology of Human Development

The present report is submitted in response to General Assembly resolution 61/106, by which the Assembly adopted the Convention on the Rights of Persons with Disabilities and the Optional Protocol thereto. As requested by the Assembly, a brief overview of the status of the Convention as at 3 August 2007 is presented. The report also contains a brief description of technical arrangements on staff and facilities made necessary for the effective performance of the functions of the Conference of States Parties and the Committee under the Convention and the Optional Protocol, and a description on the progressive implementation of standards and guidelines for the accessibility of facilities and services of the United Nations system. Recent efforts of the United Nations and agencies to disseminate information on the Convention and the Optional Protocol are also described.

わかりやすい障害者の権利条約 : 知的障害のある人の権利のために = Convention on the rights of persons with disabilities

Health systems are often evaluated using indicators such as maternal mortality, which reflect the health status of the population and the effectiveness of health services. Addressing the right to health of persons with disabilities is a significant challenge for health systems because health services for this subgroup are interdependent on other sectors in society, such as education, employment and transportation. By considering health care access of persons with disabilities, it is possible to evaluate the overall effectiveness of the health system in terms of equity, accessibility and right to health.

Access to health care of persons with disabilities as an indicator of equity in health systems.

Purpose – The reporting of incidents or “whistleblowing” occurs when a member of staff within an organisation discloses that an employee has acted in a way that is a cause for concern, and the person it is reported to has the ability to do something about it. Surveys in the UK and the USA have shown that errors in healthcare are unacceptably high. It is also known that under‐reporting of errors is the norm. There is a need to understand why people fail to report so that systems and more open cultures which support staff in reporting poor practice can be introduced. Research that captures the experiences of those who have observed poor care and what they experience if they report an incident is critical to developing such an understanding. This paper aims to address this issue.Design/methodology/approach – An exploratory quantitative research design, based on a similar study in the NHS UK, was utilised to answer the research questions of this study. Data were collected in eight acute hospitals in the Healt...

Is inadequate response to whistleblowing perpetuating a culture of silence in hospitals

Purpose – Why do some healthcare professionals report incidents while others fail to do so? In a previous paper, the authors explored the culture of hospitals in Ireland and the response to those who reported poor care. In this paper the authors aim to advance understanding of reporting behaviour by exploring differences between those who report incidents and those who choose not to report.Design/methodology/approach – An exploratory quantitative research design was utilised for this study. Data from eight acute hospitals in the Health Services Executive (HSE) regions in Ireland – two hospitals from each of the four regions and nursing staff on three wards within each hospital – provided the sample. A total of 575 anonymous questionnaires were distributed.Findings – Eighty‐eight per cent of nurses working in acute hospitals have observed an incident of poor care in the past six months, but only 70 per cent of those reported it. Non‐reporters are significantly more likely than those who have reported incid...

To report or not to report? Why some nurses are reluctant to whistleblow

Psychological safety allows healthcare professionals to take the interpersonal risks needed to engage in effective teamwork and to maintain patient safety. In order to improve psychological safety in healthcare teams, an in-depth understanding of the complex and nuanced nature of psychological safety is needed. Psychological safety concepts, including voice, silence, learning behaviour, support and familiarity, informed the current study’s investigation of psychological safety. This study aims to use a mixed-methods approach to develop an in-depth understanding of psychological safety within healthcare teams and to build on this understanding to inform the development of future interventions to improve it. Survey, observational and interview data are triangulated in order to develop an in- depth understanding of psychological safety within four healthcare teams, working within one case study hospital. The teams taking part included one multidisciplinary and three unidisciplinary teams. Observational and survey data were collected during and immediately following team meetings. Individual interviews were conducted with 31 individuals across the four teams. Thematic analysis was used to analyse these interviews. Survey results indicated a high level of psychological safety. However, observations and interviews captured examples of silence and situations where participants felt less psychologically safe. Findings from across all three data sources are discussed in relation to voice and silence, learning, familiarity and support. The results of this study provide a detailed description and in-depth understanding of psychological safety within four healthcare teams. Based on this, recommendations are made for future research and the development of interventions to improve psychological safety.

/pdf/exploring-psychological-safety-in-healthcare-teams-to-inform-e6onnbm0d4.pdf

Exploring psychological safety in healthcare teams to inform the development of interventions: combining observational, survey and interview data.

The Millennium Development Goals (MDGs) aim to improve population health and the quality and dignity of people’s lives, but their achievement is constrained by the crisis in human resources for health. An important potential contribution towards achieving the MDGs for persons with disabilities will be the newly developed Guidelines for Community Based Rehabilitation (CBR), launched in 2010. Given the global shortage of medical and nursing personnel and highly skilled rehabilitation practitioners, effective implementation of the CBR guidelines will require additional health workers, with improved distribution and a new skill set, allowing them to work across the health, education, livelihoods, social, and development sectors. We conducted a systematic review to evaluate existing evidence regarding the effectiveness of alternative cadres working in CBR in low and middle income countries. We searched the following databases: PUBMED, LILACS, SCIE, ISMEAR, WHOLIS, AFRICAN MED IND. We also searched the online archive of the Asia Pacific Disability Rehabilitation Journal (available from 2002 to 2010), which was not covered by any of the other databases. There was no limit set on inclusion with regard to how recent a publication was in the general search. The search yielded 235 abstracts, only 6 of which addressed CBR through some type of evaluative component. Three of the studies explored the effects of CBR interventions, mainly related to physical disabilities, while three explored issues concerned with the work performance of rehabilitation workers. Altogether the studies covered four different countries. All six studies related to specific service delivery in local contexts, using outcome measures that were not comparable across studies. We do not, therefore, feel that the current results provide adequate methodology or evidence for reliably generalizing their results. Due to the dearth of evidence regarding the effectiveness of alternative cadres in CBR, systematic research is needed on the training, performance and impacts of rehabilitation workers, including their capability of working across sectors and engaging with and making use of health systems research.

/pdf/a-systematic-review-of-the-effectiveness-of-alternative-10w054bvn8.pdf

Eilish McAuliffe

Papers

Access to health care of persons with disabilities as an indicator of equity in health systems.

Is inadequate response to whistleblowing perpetuating a culture of silence in hospitals

To report or not to report? Why some nurses are reluctant to whistleblow

Exploring psychological safety in healthcare teams to inform the development of interventions: combining observational, survey and interview data.

A systematic review of the effectiveness of alternative cadres in community based rehabilitation.