bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of after‐sales service behaviors of Ethiopia Telecom customers
Authors: Mouly Potluri Rajasekhara , Hawariat Hailemichael W. 
Published: April 2010

PurposeThe primary purpose of this paper is to assess and review fixed‐line telecom customers' perception of the quality of after‐sales services provided by Ethiopian Telecom.Design/methodology/approachThe paper was conducted on telecom customers who are in Addis Ababa using self‐administered questionnaires sent to a sample of 450 respondents. In addition to this, interviews were conducted with managers and selected employees to provide supporting data. The data were processed, analyzed and interpreted using Statistical Package for the Social Sciences.FindingsThe results show some degree of customer dissatisfaction, but not to the extent expected. Dissatisfied customers point at lack of clarities of bills and delays in making decisions on complaints as some of the main reasons for their dissatisfactions. Other reasons include telephone interruptions during rainy seasons, old cables and networks, and damaged and stolen cables, which combined, increase the frequency of faults and interruptions. Nearly 40 percent of respondents have negative assessments of the role of employees in delivering good quality after‐sales service.Practical implicationsDespite the fact that some improvements have been shown in recent reports, Ethiopian Telecom has a long way to go in achieving its objectives with respect to customers' satisfaction.Originality/valuePrevious studies on telecommunication in Africa have not focused on service delivery and customer satisfaction. The paper, therefore, contributes to filling a research gap in telecommunication studies in Africa in general and in Ethiopia in particular.
Lean Six Sigma – getting better all the time
Authors: Snee Ronald D. 
Published: April 2010

PurposeThe purpose of this paper is to assess Lean Six Sigma to identify important advances over the last ten to 15 years and discuss emerging trends that suggest how the methodology needs to evolve. The goal is to aid those who want to use the method to improve performance as well as assist those developing improvement methodologies.Design/methodology/approachThe use and development of Lean Six Sigma is reviewed including the origins of the method, the what, why and benefits of the method, how the approach is different, the integration of Lean and Six Sigma, implementation mistakes made, lessons learned and developments needed in the future.FindingsIt is found that organizations have many different improvement needs that require the objectives and methods contained in the lean and Six Sigma methodologies. It is also found that deployment and sustaining improvements are major issues that can be overcome by building a sustaining infrastructure and making improvement a business process. Critical issues include using Lean Six Sigma to generate cash in difficult economic times, development of data‐based process management systems and the use of working on improvement as a leadership development tool.Practical implicationsThese findings suggest that improvement is most effective when approached in an holistic manner addressing improvement in all parts of the organization using a holistic improvement methodology such as Lean Six Sigma. Improvement must address the flow of information and materials thorough processes as well as the enhancement of value‐adding process steps that create the product for the customer. This leads naturally to making improvement a business process that is planned for, operated and reviewed as any other important business process is.Originality/valueThe roadmaps, guiding principles, and deployment pitfalls identified will be of value to those initiating and operating improvement processes in their organizations enabling them to rapidly create useful and sustainable improvements. The discussion of needed enhancements will be of value to those who are working to improve the effectiveness of the approach.
A modern framework for achieving enterprise excellence
Authors: Montgomery Douglas C. 
Published: April 2010

PurposeThis paper aims to present a quality and business improvement framework based on Six Sigma/design, measure, analyze, improve, and control (DMAIC); design for Six Sigma (DFSS); and Lean principles. An historical perspective on these methods is also provided.Design/methodology/approachThrough a discussion of the fundamental components of Six Sigma, DFSS and Lean a deployment strategy is developed. This approach is consistent with Deming's philosophy of quality improvement and is based on his system of profound knowledge.FindingsA quality/process improvement effort that utilizes Six Sigma and DMAIC, DFSS, and Lean can form two of the three basic building blocks of a company‐wide quality management system.Research limitations/implicationsSome implications for education of future business leaders in a variety of disciplines including engineering, statistics and business administration are discussed. More widespread education about DMAIC and the associated problem‐solving tools is needed.Originality/valueThis paper provides practical guidance for implementing quality and productivity improvement across a wide range of industrial and business endeavors.
The sources of disease‐related information for Estonia’s rheumatoid arthritis patients: a qualitative study
Authors: Tammaru Marika , Polluste Kaja , Lember Margus 
Published: April 2010

Objective.  To describe rheumatoid arthritis patients’ perceptions of being informed and of the value of the information obtained.Background.  About the accessibility of the disease‐specific information to the patients, a prerequisite for any kind of the patient empowerment, can be considered as a priority area for investigation.Design.  Six focus groups (involving 27 patients) were conducted. For analysing the data, thematic analysis was applied.Results.  The participants referred to the media and the Internet, in‐patient units, physicians at out‐patient consultations, patients organisations, fellow patients and their own experience as the sources of disease‐related information. The information delivered by the physicians was valued highest; satisfaction with the information received from the in‐patient units was expressed. The knowledge acquired through the experience was mentioned as being important for coping with the disease. The media was an easily accessible information channel, although the information from this source was less trusted. The access to the Internet was seen as being limited for certain patients groups. The availability of physician‐delivered information was described as unsatisfactory due to the organisation of information transmittal in out‐patient settings.Conclusions.  The results indicated the current balance of information sources as being incongruous with the provision of systematic and reliable disease‐related information. The available information may also be qualitatively incomplete.Relevance to clinical practice.  Recognition of the weak and strong points of the structure of information provision is valuable when considering the development of educational opportunities for rheumatoid arthritis patients.
The inner door: toward an understanding of suicidal patients
Authors: Tzeng Wen‐Chii , Yang Cheng‐I , Tzeng Nian‐Sheng , Ma Hei‐Shan , Chen Lin 
Published: April 2010

Aims and objectives.  To describe the suicide care dilemmas that psychiatric nurses experience and how they respond to suicidal patients.Background.  Psychiatric nurses play a major role in helping patients after suicide attempts. Little is known, however, about the ways nurses resolve their suicide care dilemmas.Design.  Focused ethnography was used to describe the meanings and patterns of actions of psychiatric nurses in a medical centre in Taipei, Taiwan.Methods.  Fieldwork included two years of participant observation and individual interviews with 18 psychiatric nurses. Data from transcripts of observation field notes and interviews were transcribed verbatim and analysed.Results.  An important factor, the inner door (an invisible door inside the nurse’s mind), determined the nurse’s ability to understand the inner worlds of suicidal patients and the nurse himself or herself. In the absence of such understanding, nurses felt discouraged, labelled the patients and even restrained them, thus closing their inner doors. On the other hand, the nurses’ willingness to reflect on their own experiences and receive the patients’ teaching helped them understand the defensive patients and nurses themselves, thus opening the inner doors and enabling them to treat patients as their family or friends.Conclusions.  The opening and closing of the inner door is a dynamic process. Nurses need to understand the essential meaning of a suicide experience to develop the insight to open the door and keep it open.Relevance to clinical practice.  The concept of an inner door helps nurses better understand why they distance themselves from patients when they encounter clinical dilemmas and offers a way to resolve their inner conflicts through self‐reflection and appreciation of the patient’s experiences.
A review of the cultural competence view of cardiac rehabilitation
Authors: Davidson Patricia M , Gholizadeh Leila , Haghshenas Abbas , Rotem Arie , DiGiacomo Michelle , Eisenbruch Maurice , Salamonson Yenna 
Published: April 2010

Aims and objectives.  This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR).Background.  CR is an important secondary prevention strategy, improving health‐related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations.Design.  Systematic review.Methods.  Search of electronic databases.Conclusions.  Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions.Relevance to clinical practice.  There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically diverse backgrounds.
The information and support needs of Faroese women hospitalised with an acute coronary syndrome
Authors: Askham Jórun , Kuhn Lisa , Frederiksen Kirsten , Davidson Patricia , Edward Karen‐Leigh , Worrall‐Carter Linda 
Published: April 2010

Aim and objectives.  The aim of this study was to describe the information and support needs of Faroese women after their hospitalisation for acute coronary syndrome. The Faroe Islands are located between Iceland and Norway. There are no published studies examining recovery for women following an acute cardiac event.Background.  Coronary heart disease remains the greatest killer of women worldwide, including on the Faroe Islands. Describing women’s experiences of their recovery processes following acute coronary syndrome can enable timely information and support for the women who are affected. It is important that this information is tailored to the cultural context of women.Design.  This qualitative study used a descriptive‐exploratory approach.Method.  Data were obtained by semi‐structured interviews with participants three to four weeks after hospital discharge for their first acute coronary syndrome event.Results.  Eight women aged from 48–70 years diagnosed with acute coronary syndrome participated in the research. Two key themes emerged from the data: (1) ‘Discharged home, now what?’: illustrated the difficulties experienced by these women following discharge and (2) risk factor management and lifestyle adjustments: related to perceptions relating to risk, loss, recovery and support.Conclusions.  The findings from this study highlight these women had minimal understanding of the risks and management of heart disease. Participants revealed their in‐hospital and postdischarge information and support needs were generally unmet.Relevance to clinical practice.  The experience of Faroese women parallels those of women in other published studies. Nurses are well placed in healthcare to facilitate individualised support and information requirements to this clinical group. Assessing information and support needs of women is of primary importance in preparing for discharge following acute coronary syndrome.
A preliminary study to evaluate a patient‐centred asthma education programme on parental control of home environment and asthma signs and symptoms in children with moderate‐to‐severe asthma
Authors: Tzeng Li‐Fen , Chiang Li‐Chi , Hsueh Kai‐Chung , Ma Wei‐Fen , Fu Lin‐Shien 
Published: April 2010

Aims and objectives.  To evaluate the effectiveness of a nurse‐led patient‐centred asthma education programme on home environmental control behaviours of parents of children with moderate or severe asthma.Background.  Reducing allergic triggers is important self‐management behaviour for preventing asthma attacks and patient‐centred asthma education has been shown to effectively manage chronic disease.Design.  A preliminary quasi‐experimental, non‐equivalent control group design was used.Method.  Dyads (n = 75) of parents and their children with moderate or severe asthma (ages 6–14 years) were purposively recruited from the asthma clinics of two hospitals in central Taiwan. The experimental group of 38 children/parents from one hospital received patient‐centred asthma education. The comparison group of 37 children/parents from the other hospital received routine individual education. At pretest and at the end of the three‐month patient‐centred asthma education programme, we measured parents’ control of home environmental triggers, children’s asthma signs/symptoms and children’s pulmonary function. Data were analysed by the general linear model for repeat measures.Results.  The level of improvement in dust and cleaning methods was significantly greater among parents in the experimental group than among those in the comparison group (p < 0·05). Children with moderate or severe asthma in the experimental group had fewer signs/symptoms of asthma and better lung function than children in the comparison group.Conclusions.  Our patient‐centred asthma education programme improved parents’ home environmental control and children’s asthma sign/symptoms and lung function.Relevance to clinical practice.  Nurses can play primary roles as patient educators in asthma clinics. Well‐trained patient educators can continuously monitor self‐management behaviours to improve patients’ compliance with home environmental control, thus leading to better physical outcomes in children with asthma than routine individual asthma education alone.
Nurses’ experiences of caring for non‐catheterised older infirmed patients: a descriptive study of what nurses actually do?
Authors: Ling Man Elaine Siu , Le Low Lisa Pau 
Published: April 2010

Aims.  This study aims to explore nurses’ experiences of caring for non‐catheterised older infirmed patients who had suffered from recurrent urinary tract infection and strategies adopted to prevent and manage the problem.Background.  Urinary tract infection is a complex and significant infection affecting frail older patients. Most literature focuses on prescribing treatment to treat the micro‐organisms causing the infection, with less emphasis to understand nursing perspectives of caring for frail and highly dependent older patients suffering from this condition.Design.  Qualitative.Methods.  A qualitative research methodology was conducted in a hospital‐based infirmary unit (composing of four wards) in Hong Kong. Fourteen nurses were interviewed using a semi‐structured interview guide.Results.  When managing recurrent urinary tract infection of non‐catheterised older patients, nurses described the need to promptly recognise the urinary tract infection symptoms and to know the causes of the symptoms before administering any care. These formed the basis for deciding whether the patient’s urinary condition should be managed by nurses themselves or be referred to the physician for medical treatment. Based on this initial judgement, subsequent non‐invasive measures perceived by nurses to be effective were undertaken to manage the non‐medically intervened problem. Ways to improve nurses’ existing roles and work practices to better manage recurrent urinary tract infection of non‐catheterised older patients were also identified.Conclusion.  Nurses working in infirmary wards refocused on the value of providing basic nursing care to manage this emergent and overlooked clinical problem.Relevance to clinical practice.  Asymptomatic urinary tract infection cases should continue to receive ‘basic urinary tract infection care’ on a daily basis, as ignoring these symptoms could bring on adverse consequences. Prior knowledge and experiences acquired by nurses who cared for previously infected patients can assist in the development of interventions, so comparison of different nursing measures is possible to determine which one is the most effective in managing this clinical issue.
Walking a fine line: managing the tensions associated with medication non‐adherence in an acute inpatient psychiatric setting
Authors: Wijnveld Anne‐Marie , Crowe Marie 
Published: April 2010

Aims.  The aim of this study was to use a phenomenological methodology to examine mental health nurses’ experiences of administering medications to patients who were non‐adherent in an acute inpatient service.Background.  There is a large body of literature focused on exploring the issue of non‐adherence to prescribed medication, but there is very little examining this from mental health nurses’ perspectives. Many of the medications prescribed for patients diagnosed with a psychiatric disorder have serious side effects and limited efficacy. Mental health nurses in acute inpatient environments are regularly confronted with the difficulties inherent in the conflicting roles associated with the need to maintain therapeutic relationships and the expectation that they ensure patients take their medications.Design.  This is a qualitative study exploring mental health nurses' descriptions of managing medication adherence in an acute inpatient unit.Methods.  The interpretive phenomenological methodology of Van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990) was used in this study to capture the experiences of a group of nurses. This research process involves a dynamic interplay between the following six research activities: (1) turning to the nature of the lived experience; (2) investigating the experience as we live it; (3) reflecting on essential themes; (4) a description of the phenomenon through the art of writing and rewriting; (5) maintaining a strong and oriented pedagogical relation to the phenomenon; and (6) balancing the research context by considering parts and whole.Results.  Four themes emerged from the existential analysis that described the mental health nurses’ experiences: doing the job for doctors (relationality); stopping and listening (temporality); stepping in (corporeality); and walking a fine line (spatiality).Conclusions.  It is proposed that models of therapeutic interventions offering alternative or conjunctive treatment to medications could be incorporated into acute inpatient care and provide an enhanced therapeutic model.Relevance to clinical practice.  Nurses in many areas struggle to manage the tensions between a medical model and a nursing model of care. This study describes how one group of nurses manage these tensions and suggests a more patient‐centred model of care.
Relationship between depression and health‐related quality of life in older Korean patients with chronic obstructive pulmonary disease
Authors: Kil Suk Yong , Oh Won Oak , Koo Bon Jin , Suk Min Hyun 
Published: April 2010

Aims and objectives.  The aims are to determine the prevalence of depression and examine its impact on the health‐related quality of life (HRQoL) among older Korean patients with chronic obstructive pulmonary disease (COPD).Background.  Realising the effects of depression on HRQoL, many studies have reported the prevalence of depression and its negative impacts on HRQoL in COPD patients. However, the majority of the studies were performed in developed countries, with very few studies occurring in developing or non‐developed countries.Design.  Survey with the comparison of HRQoL between the COPD patients with and without depression.Methods.  A total of 91 COPD patients completed the St. George respiratory questionnaire (SGRQ), Medical outcomes short form‐36 (SF‐36) and Beck depression inventory (BDI).Results.  The prevalence of depression was 15·4%. The SGRQ total and impact subscores were significantly worse in the patients with depression (p < 0·05). The physical functioning, bodily pain, vitality and general health dimensions from the SF‐36 were statistically poor in the patients with depression (p < 0·05). The patients with severe and very severe lung function defects showed significantly worse total, activity and impact scores of the SGRQ and significantly poor physical functioning, role physical, bodily pain, social functioning, mental health, role emotional and general health scores on the SF‐36 (p < 0·05).Conclusion.  In South Korea, the prevalence of depression is considerable, and depression has a negative impact on the HRQoL among older COPD patients.Relevance to clinical practice.  The study results suggest that depression is prevalent in older COPD patients in South Korea. The presence of depression negatively impacts on the HRQoL of the COPD patients. Considering the importance of the relationship between psychological problems and HRQoL in caring for and promoting the welfare of COPD patients, this study provides fundamental information and a basis for further evaluation of this issue in developing and non‐developed countries.