https://www.um.edu.mt/library/oar/handle/123456789/63436 2026-04-15T12:16:04Z 2026-04-15T12:16:04Z https://www.um.edu.mt/library/oar/handle/123456789/44843 2020-11-09T08:50:34Z 2010-01-01T00:00:00Z

Title: The quality and characteristics of child primary health care services in Malta : is there a role for the paediatric nurse practitioner? Abstract: Background to the study: This research study intends to shed light on the Maltese primary health care system for children and their families by making use of the Primary Care Assessment Tool - Child Edition. The introduction of the paediatric nurse practitioner in the Maltese primary health care setting was also explored for its role as being the stepping stone to meet the health care needs of tomorrow. The primary care score and the primary care extended score consents a particular primary health care system to be compared with another. This score could eventually be used for benchmarking purposes between primary health care systems. Paediatric nurse practitioners have been shown to offer a beneficial service and fill the gap in health care provision. In this situation they would supplement physician services, and in some extents they could function as a surrogate of physicians. By working as a team, the physician and the paediatric nurse practitioner might be able to assume more responsibility for patients than each working separately. Method: A descriptive, cross-sectional, retrospective survey was carried out. Data was collected using a structured face-to-face interview which was administered to 200 parents/guardians who attended the paediatric accident and emergency department at Mater Dei Hospital between the months of March and April 2010. After appropriate translation of the original tool to the Maltese language, the reliability of the tool was assessed and was found to be more than 0.60, indicating a satisfactory reliability. Results: All the participants identified themselves with a particular place or a particular doctor. Utilisation of primary care by children and their families is quite satisfactory in Malta. Since local health centres and the paediatric accident and emergency departments are open every day providing twenty-four hour service, the accessibility score could have been misled, despite the positive accessibility result. Continuity of primary care is also quite strong, although health providers lack the knowledge with regards to the parents/guardians financial situation. Coordination of care had the lowest score and could be attributed since locally no referral is needed to visit a specialist and also no information system exists to date that allows online exchange of information between health providers and also between primary and secondary care. Comprehensiveness of primary care also had low scores and findings suggest that health providers need to step beyond the biomedical model so as to address their patients' emotional, social, and developmental needs. Family-centered care was found to be highly valued by local primary health care providers and with regards to community orientation, the score indicated that providers also extend the care to the people in the community whose health care needs are not being met. It was also found that primary health providers have a strong ability to communicate between and among cultures. Conclusion: Various gaps were found in the present primary health care system for children and their families. The paediatric nurse practitioner was shown to offer various beneficial services so as to fill these gaps. Finally, a number of recommendations are drawn up to serve as guidelines for management purposes, health education and research. Description: M.SC.HEALTH SERVICES MANGT.

2010-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/44635 2020-11-08T06:14:35Z 2010-01-01T00:00:00Z

Title: Nursing officers' role in shaping organisational culture. Abstract: The phenomena of management practices and organisational culture (OC) are defined as the driving forces in the success or failure of an organisation. Today, nursing officers must demonstrate leadership behaviours or styles that are appropriate for the constantly changing, complex and turbulent health care delivery system. While many nursing officers do not deny the importance of organisational culture in employee satisfaction, quality of service and overall performance, few fail to realise the direct impact they have in shaping it. With the recent transition from the old general hospital to a state of the art general hospital as Mater Dei, apart from the structural changes it is assumed that cultural transformation has been wrought alongside to deliver improvements in quality and performance in nursing care. Data were collected from a randomly selected sample of both nurses (n = 350) and nursing officers (n = 35) working within in-patient wards. The Denison Organisational Culture Survey (DOCM) Instrument developed by Denison (1990) was used to measure organizational culture quantitatively. To strengthen the findings, several interviews were scheduled with twelve nursing officers based on the questionnaire to explore thoroughly their views about the current scenario within inpatient wards' culture. Statistical tests were carried out to analyse the quantitative data whilst content analysis was carried out on the qualitative data. Findings revealed that there is a consistent moderate level of an internal focused culture with a flexible approach among all inpatient wards. Similarities emerged in participants' scores within the five departmental cultures suggesting a predominant homogenous Involvement trait throughout inpatient wards. Results highlight important managerial implication towards cultural transformation. Moreover, the study confirms that literature showing that Involvement, Adaptability, Consistency and Mission traits are positively correlated to the effectiveness of healthcare organisations is also applicable and relevant in the local context. Several recommendations were set forward to the obtained findings. Description: M.SC.HEALTH SERVICES MANGT.

2010-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/43188 2020-11-12T10:01:36Z 2010-01-01T00:00:00Z

Title: Case management for older persons in Malta : an evaluation. Abstract: This research is an evaluation of community case management services for older persons in Malta. The study was carried out to identify whether this innovative approach to coordinating care is enabling older persons to live longer in the community. Moreover, it identifies the service provider perspective of orchestrating managed care for this age group within a community setup. Older persons and care givers who benefit from managed care services provided by Commcare Assessment Unit participated in structured interviews facilitated by the researcher. Interviews were based on the Picker Institute Europe - Evercare Patient & Carer Questionnaires. A focus group was held with case managers to discuss their experience alongside outcome of the interviews and literature findings. A semi structured interview was performed with the administrator of Commcare Assessment Unit. Results clearly illustrate that community case management services have the potential of enabling frail older persons to live in the community. This is appreciated by older persons and caregivers, who call for innovative community services and more frequent case manager input. A number of shortcomings are experienced by Commcare Assessment Unit in realising their objectives. These include resource limitations, which are considered to be limiting the frequency of case manager contact, and fragmented community services which are considered to be short of backing managed care. Culture about hospitalisation and barriers to setting up a nurse led unit to coordinate community care are amongst problems encountered. Reports by the administrator of Co mm care Assessment Unit and enthusiasm in service delivery show that a genuine effort is employed by this unit to meet the needs of older persons and support caregivers in the community. Significant progress has been made since the unit was set up just four and a half years ago. Further achievements are possible if policy makers are sensitive to the needs of older persons and acknowledge the benefits of coordinated care for this age group. Description: M.SC.HEALTH SERVICES MANGT.

2010-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/42360 2020-11-11T12:12:09Z 2010-01-01T00:00:00Z

Title: Doctor-patient communication and information giving in an acute general hospital in Malta. Abstract: Background: Communication is an important component of patient care. Providing patients with appropriate doctor-patient interactions while offering them complete information about their condition is important for patients' health, well-being and satisfaction. Improvements in doctor-patient communication can have beneficial effects on health outcomes. Objectives: This study aimed at exploring the quality of interactions between doctors and patients at an acute general hospital in Malta namely Mater Dei Hospital. The main focus being the doctor-patient communication and information given by doctors and how the patients perceived these interactions. Methods: Three cross-sectional sub-studies were performed using quantitative and qualitative research methods. Data for the first sub-study was collected through direct observations of 80 doctor-patient interactions for 36 consultants during ward round visits. This considered medical talk much like any other source for discourse analysis, with attention to the structure and functions of the medical interaction. Data for the second sub-study was collected through patient satisfaction questionnaire which included 251 participants representing 96.2% response rate. The patient satisfaction questionnaire considered important doctor characteristics elements towards patients' health outcomes, satisfaction, adherence to medication, lifestyle regimens, and communication skills between patient and doctor. Data for the third sub-study was collected through structured interviews with 10 ward managers. The author once again focused on doctor-patient communication issues with regard to interpersonal skills and confidentiality, facilitation and listening skills, medical and healthy living information, treatment and medicinal information, technical and empathy skills, written information, and consultation time. Qualitative content analysis was applied within the structure of the thematic guide and for the data that was emerged from the materials. Main findings: The collected data was analysed by means of SPSS Student Version 17.0. Results obtained from the direct observations on doctors indicated that some important aspects of positive interactions need to be improved during ward rounds. These included: inquiry on diet compliance, inquiry on risky habits, advice on healthy lifestyle, inquiry on medicine compliance, inquiry on allergic reactions to medicines, and an explanation of medicine prescribed and its use by the patients. In the qualitative data (Structured interviews) it was argued that although doctors have very good interpersonal, technical, and empathy skills, they still need to focus on consultation privacy, encouraging the patients to ask questions, emphasising on patients' understanding of the provided information, inquiring about adverse events of medicines, and about risky habits like smoking and alcohol consumption. It was also revealed by ward managers that there exist low referrals to health educators or dietitians. Findings from the patient satisfaction questionnaire indicated that most of the patients were satisfied with the type of communication being offered to them by the doctors. However when analysing deeper the author recognised that the same communication needs match closely with those found with the previous two methods. These included: advice on healthy lifestyle, inquiry about diet, written information on patient's illness, importance on consent from patients, specifying possible side effects of prescribed treatment, information of what patient should do in case of adverse events, and inquiring from patient if help was needed at home following their discharge from hospital. Overall findings from all three methods used indicated satisfaction with doctor-patient communication and information giving. This was indicated by mean scores of > 3.5. However there were also indications that quality of communication between doctors and patients needs refining in certain areas like patient consent and involvement in decision making, medical and treatment information, written information and consultation times. Conclusion: Patient education needs to be improved and more tailored to patients' individual information, support needs and abilities. By exploring the required amount and content of information, treatment goals and expectations, doctors would be automatically directing patients to high patient involvement in self-care activities. This movement towards a more patient centred approach should ameliorate and strengthen our health care system. Recommendations are given to enhance recall of information in all patients; information giving needs to be more structured by summarising and repeating the most important, personally relevant information. Knowledge leaflets and written instructions can also be beneficial, as long as doctors use suitable language and the patient is competent to read them. To adapt to these specific information needs, communication training for doctors at all levels needs to be accentuated. Better doctor-patient communication may also be achieved through the involvement of multidisciplinary team approaches with emphasis on patient centred care. Description: M.SC.HEALTH SERVICES MANGT.

2010-01-01T00:00:00Z