Matching Items (41)
Description
Nurses are using health information technology during patient care activities in acute care at an unprecedented rate. Previous literature has presented nurses' response to technology obstacles as a work-around, a negative behavior. Using a narrative inquiry in one hospital unit, this dissertation examines nurses' interactions when they encounter technology obstacles from a complexity science perspective. In this alternative view, outcomes are understood to emerge from tensions in the environment through nonlinear and self-organizing interactions. Innovation is a process of changing interaction patterns to bring about transformation in practices or products that have the potential to contribute to social wellbeing, such as better care. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, multidirectionality, and their actions were influenced by a plethora of sets of rules. Nurses self-organized with co-workers to find a better way to deliver care to patients when using technology. Nurses rarely told others outside their work-group of the obstacles that occurred in their everyday interactions, including hospital-wide process improvement committees. Managers were infrequently consulted when nurses encountered technology obstacles, and often nurses did not find solutions to their obstacles when they contacted the Help Desk. Opportunities exist to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves quality and safety while decreasing cost in the patient experience.
ContributorsLalley, Catherine (Author) / Malloch, Kathy (Thesis advisor) / Fleury, Julie (Committee member) / Danzig, Arnold (Committee member) / Arizona State University (Publisher)
Created2013
Description
In the United States, under the provisions set forth by a policy known as community benefit, nonprofit hospitals receive special tax exemptions from government in exchange for providing a wide range of health care services to the communities in which they are located. In recent years, nonprofit hospitals have claimed billions of dollars as community benefit justifying their tax-exempt status. However, growing criticism by numerous stakeholders has questioned the extent to which the level of community benefit claimed by nonprofit hospitals reflects the exemptions they receive. In addition, a dearth of research exists to understand the relationship between community benefit claims and the impact they have on improving the health of communities. In an effort to better understand the relationship between community benefit claims, tax status, and community health outcomes this study examines the community benefit policies of a nonprofit healthcare system representing hospitals in California, Nevada, and Arizona. It does so by reviewing materials produced by the system, her hospitals, vested stakeholders, and government that have shaped the development, implementation, and assessment of community benefit policy processes. Findings of the study suggest that the majority of nonprofit hospital community benefit claims are consumed by shortfalls reported between costs associated with providing care to Medicare and Medicaid patients and the compensation nonprofit hospitals receive from government. Results of the study also demonstrate that community benefit policies do positively impact the health of communities. However, future community benefit policies need to be refined to include measures that capture the magnitude of community health improvement if the relationship between policy and health outcomes is to be fully realized.
ContributorsMartz, Mark Patrick (Author) / Cayer, Joseph (Thesis advisor) / Glaser, Mark (Committee member) / Corley, Elizabeth (Committee member) / Arizona State University (Publisher)
Created2013
Description
Some disabled users of assistive technologies (AT) have expressed concerns that their use of those AT devices brings particular attention to their disability and, in doing so, stigmatizes them in the eyes of their peers. This research studies how a wide range of design factors, influence how positively or negatively users of wearable technologies are perceived, by others. These factors are studied by asking survey respondents to estimate the degree to which they perceive disabilities in users of various products. The survey was given to 34 undergraduate Product Design students, and employed 40 pictures, each of which showed one person using a product. Some of these products were assistive technology devices, and some were not. Respondents used a five-bubble Likert scale to indicate the level of disability that they perceived in this person. Data analysis was done using SPSS software. The results showed that the gender of the respondent was not a significant factor in the respondent's estimation of the level of disability. However, the cultural background of the respondent was found to be significant in the respondent's estimates of disability for seven of the 40 pictures. The results also indicated that the size of AT, its familiarity to the mainstream population, its wearable location on the user's body, the perceived power of the user, the degree to which the AT device seemed to empower the user, the degree to which the AT device was seen as a vehicle for assertion of the user's individuality, and the successfulness of attempts to disguise the AT as some mainstream product reduced the perceived disability of the user. In contrast, symbols or stereotypes of disability, obstructing visibility of the face, an awkward complex design, a mismatch between the product's design and its context of use, and covering of the head were factors that focused attention on, and increased the perception of, the user's disability. These factors are summarized in a set of guidelines to help AT designers develop products that minimize the perceived disability and the resulting stigmatization of the user.
ContributorsValamanesh, Ronak (Author) / Velasquez, Joseph (Thesis advisor) / Black, John (Committee member) / Herring, Donald (Committee member) / Arizona State University (Publisher)
Created2014
Description
Due to the history of colonization, disruption of Indigenous life ways, and encroachment of external Western ideals and practices upon tribal peoples in New Mexico, the protection and preservation of tribal customs, values, traditions, and ways of thinking are critical to the continued existence of the tribes. It has taken many years for tribal communities, such as the 19 Pueblos of New Mexico, to get to where they find themselves today: In a paradoxical situation stemming from the fact that Pueblo people are told to pursue the iconic American Dream, which was not actually designed or intended for tribal peoples and that always seems to be just out of reach for many community members. Yet many of them do their best to emulate the capitalistic consumption and the Western way of life. What is troubling about this is that perhaps many of these people are starting to forget that it was the strength of their ancestors and their dreams that allowed Pueblo people to be here today. So, how do Pueblo people address this paradox? How do they begin to give newer generations, such as the youth, the tools to question and to assess future programs and the future of the tribal communities? Furthermore, what does such a process of preserving and reclaiming mean for future governance? Are these communities prepared to accept the outcomes?
This compilation seeks to address these issues by examining a) the creation and delivery of Western medicine for American Indians in New Mexico and b) a discussion of Pueblo culture and belief systems. The exploration will include not only discussing health and health care concerns, but it will also engage the future considerations that tribal governments in New Mexico, specifically Pueblo Indian communities, must reflect on to ensure the preservation of the culture and values of Pueblo people. Finally, specific recommendations for action and discussion will be delivered in the form of a policy paper that is designed for tribal leadership and tribal administrative audiences and suggested for implementation.
This compilation seeks to address these issues by examining a) the creation and delivery of Western medicine for American Indians in New Mexico and b) a discussion of Pueblo culture and belief systems. The exploration will include not only discussing health and health care concerns, but it will also engage the future considerations that tribal governments in New Mexico, specifically Pueblo Indian communities, must reflect on to ensure the preservation of the culture and values of Pueblo people. Finally, specific recommendations for action and discussion will be delivered in the form of a policy paper that is designed for tribal leadership and tribal administrative audiences and suggested for implementation.
ContributorsLucero, Kenneth Brian (Author) / Sumida Huaman, Elizabeth (Thesis advisor) / Brayboy, Bryan (Thesis advisor) / Martin, Nathan (Committee member) / Arizona State University (Publisher)
Created2015
Description
The United States elderly population is becoming increasingly larger, there is a need for a more adequate housing type to accommodate this population. It is estimated that by 2020, there will be a need for approximately 1.6 to 2.9 million units of affordable Assisted Living (Blake, 2005). With limited income and higher health bills, adequate housing becomes a low priority. It is estimated that 7.1 million elderly households have serious housing problems. (Blake, 2005) The scope of this research will look at literature, case studies, and interviews to begin to create and understand the necessary design aspects of Assisted Living and Affordable Housing to better create a housing typology that includes both low income residents and Assisted Living needs. This research hopes to have an outcome of Design Recommendations that can be utilized by designers when designing for an Affordable Assisted Living typology.
ContributorsRothner, Colleen (Author) / Bender, Diane (Thesis advisor) / Shraiky, James (Committee member) / Stapp, Mark (Committee member) / Arizona State University (Publisher)
Created2014
Description
"Too often, people in pain are stuck in limbo. With no diagnosis there is no prognosis. They feel that without knowing what is wrong, there is no way to make it right" (Lewandowski, 2006, p. ix). Research has shown that environmental factors, such as views of nature, positive distractions and natural light can reduce anxiety and pain (Ulrich, 1984). Patients with chronic, painful diseases are often worried, anxious and tired. Doctor's appointments for those with a chronic pain diagnosis can be devastating (Gilron, Peter, Watson, Cahill, & Moulin, 2006). The research question explored in this study is: Does the layout, seating and elements of positive distraction in the pain center waiting room relate to the patients experience of pain and distress? This study utilized a mixed-method approach. A purposive sample of 39 individuals participated in the study. The study employed the Positive and Negative Affect Schedule (PANAS), the Lewandowski Pain Scale (LPS) and a researcher developed Spatial Perception Instrument (SPI) rating the appearance and comfort of a pain center waiting room in a large metropolitan area. Results indicated that there were no significant correlations between pain, distress and the waiting room environment. It is intended that this study will provide a framework for future research in the area of chronic pain and distress in order to advance the understanding of research in the waiting area environment and the effect it may have on the patient.
ContributorsDraper, Heather (Author) / Bender, Diane (Thesis advisor) / Shraiky, James (Committee member) / Lamb, Gerri (Committee member) / Arizona State University (Publisher)
Created2012
Description
Social media sites focusing on health-related topics are rapidly gaining popularity among online health consumers, also known as "e-patients". The increasing adoption of social media by e-patients and their demand for reliable health information has prompted several health care organizations (HCOs) to establish their social media presence. HCOs are using social media to connect with current and potential e-patients, and improve patient education and overall quality of care. A significant benefit for HCOs in using social media could potentially be the improvement of their quality of care, as perceived by patients. Perceived quality of care is a key determinant of patients' experience and satisfaction with health care services, and has been a major focus of research. However, there is very little research on the relationship between patients' online social media experience and their perceived quality of care. The objective of this research was to evaluate e-patients' online experience with an HCO's social media sites and examine its impact on their perceived quality of care. Research methodology included a combination of qualitative and quantitative approaches. Data for this study was collected from Mayo Clinic's social media sites through an online survey. Descriptive statistics were used to identify basic demographic profiles of e-patients. Linear regression analysis was used to examine the relationship between online experience and perceived quality of care. Qualitative data was analyzed using thematic analysis. Results showed a positive relationship between online experience and perceived quality of care. Qualitative data provided information about e-patients' attitudes and expectations from healthcare social media. Overall, results yielded insights on design and management of social media sites for e-patients, and integration of these online applications in the health care delivery process. This study is of value to HCOs, health communicators and social media designers, and will also serve as a foundation for subsequent studies in the area of health care social media.
ContributorsAdmane, Leena (Author) / Kroelinger, Michael D. (Thesis advisor) / Cheong, Pauline (Committee member) / Weberg, Daniel (Committee member) / Arizona State University (Publisher)
Created2011
Description
ABSTRACT The massive number of baby boomers approaching retirement age has been termed the `gray tsunami.' As America's gray tsunami approaches, healthcare workers and social workers will become overwhelmed with requests for services and supports (St. Luke's Health Initiative, 2001; Bekemeier, 2009). This impact can be ameliorated by assisting aging individuals in maintaining or in some cases regaining independence. Individuals who live in assisted living facilities (AFLs) come from diverse backgrounds. Many of these individuals have lived in paternalistic environments such as prisons and mental health institutions. As a consequence of these disempowering conditions, residents of ALFs may experience increased depression, decreased self-esteem, and decreased locus of control (R. Hess, personal communication, September 30, 2010). These disabling conditions can severely limit residents' choice-making opportunities and control over their own lives. If programs can be created to provide empowering experiences and to teach self-advocacy skills, I hypothesize that residents will report an improved quality of life and display fewer depressive symptoms, increased self-esteem, and increased locus of control. Helping these individuals to maintain or regain independence will not only reduce the workload for care workers, it will enhance the lives of residents. The only hypothesis that was supported by the study was an improvement in residents' quality of life, and that hypothesis was only partially supported. Two of the five domains in the Residents' Quality of life questionnaire indicated an increase in quality of life. ii The Activities subscale of the Ferrans & Powers Quality also indicated that there was an increase in quality of life.
ContributorsHedgpeth, Jay (Author) / Napoli, Maria (Thesis advisor) / Gerdes, Karen (Committee member) / Bonifas, Robin (Committee member) / Arizona State University (Publisher)
Created2012
Description
Overcrowding of Emergency Departments (EDs) put the safety of patients at risk. Decision makers implement Ambulance Diversion (AD) as a way to relieve congestion and ensure timely treatment delivery. However, ineffective design of AD policies reduces the accessibility to emergency care and adverse events may arise. The objective of this dissertation is to propose methods to design and analyze effective AD policies that consider performance measures that are related to patient safety. First, a simulation-based methodology is proposed to evaluate the mean performance and variability of single-factor AD policies in a single hospital environment considering the trade-off between average waiting time and percentage of time spent on diversion. Regression equations are proposed to obtain parameters of AD policies that yield desired performance level. The results suggest that policies based on the total number of patients waiting are more consistent and provide a high precision in predicting policy performance. Then, a Markov Decision Process model is proposed to obtain the optimal AD policy assuming that information to start treatment in a neighboring hospital is available. The model is designed to minimize the average tardiness per patient in the long run. Tardiness is defined as the time that patients have to wait beyond a safety time threshold to start receiving treatment. Theoretical and computational analyses show that there exists an optimal policy that is of threshold type, and diversion can be a good alternative to decrease tardiness when ambulance patients cause excessive congestion in the ED. Furthermore, implementation of AD policies in a simulation model that accounts for several relaxations of the assumptions suggests that the model provides consistent policies under multiple scenarios. Finally, a genetic algorithm is combined with simulation to design effective policies for multiple hospitals simultaneously. The model has the objective of minimizing the time that patients spend in non-value added activities, including transportation, waiting and boarding in the ED. Moreover, the AD policies are combined with simple ambulance destination policies to create ambulance flow control mechanisms. Results show that effective ambulance management can significantly reduce the time that patients have to wait to receive appropriate level of care.
ContributorsRamirez Nafarrate, Adrian (Author) / Fowler, John W. (Thesis advisor) / Wu, Teresa (Thesis advisor) / Gel, Esma S. (Committee member) / Limon, Jorge (Committee member) / Arizona State University (Publisher)
Created2011
Description
Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.
ContributorsVankipuram, Mithra (Author) / Greenes, Robert A (Thesis advisor) / Patel, Vimla L. (Thesis advisor) / Petitti, Diana B. (Committee member) / Dinu, Valentin (Committee member) / Smith, Marshall L. (Committee member) / Arizona State University (Publisher)
Created2012