CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O presente estudo apresenta como temÃtica o luto vivido por famÃlias cujos entes queridos foram doadores de ÃrgÃos. Discute-se a necessidade de os profissionais de saÃde conhecer as etapas do luto e a sutileza em percebÃ-las nos momentos de aproximaÃÃo com a famÃlia, instrumento valioso no processo de cuidar, em especial no enfrentamento da morte. Teve como objetivos, assistir a famÃlia no processo do luto apÃs doaÃÃo de ÃrgÃos; descrever as histÃrias das famÃlias de doadores de ÃrgÃos, focando nas experiÃncias de perda e no processo de doaÃÃo, analisar o processo de enfrentamento do luto da famÃlia apÃs doaÃÃo de ÃrgÃos e analisar a visita domiciliÃria como estratÃgia de promoÃÃo da saÃde de famÃlias em luto. Pesquisa qualitativa, utilizou a HistÃria TÃpica de vida. O local do estudo foi a Zona norte do estado do CearÃ, Brasil, onde foram identificados 39 doadores de mÃltiplos ÃrgÃos no perÃodo de 2009 a 2011, sendo a visita domiciliar a estratÃgia de cuidado e coleta de dados com oito famÃlias. Foram descritas as HistÃrias tÃpicas das famÃlias e analisados os seus lutos: identificou-se a estrutura familiar, o desenvolvimento e a sua funcionalidade, pelo Modelo Calgary de AvaliaÃÃo Familiar. Este estudo fornece contribuiÃÃes para os profissionais da saÃde, principalmente para enfermeiros, em relaÃÃo à importÃncia do cuidado à pessoa em processo de luto, sendo necessÃria a revisÃo de prÃticas que inibem a exposiÃÃo dos sentimentos, as polÃticas de acolhimento familiar em InstituiÃÃes e a prÃtica efetiva de visitas domiciliarias como metodologia de cuidado familiar. AlÃm disso, essa aproximaÃÃo entre famÃlia e equipe à uma oportunidade de os profissionais reverem suas prÃticas, nas suas fragilidades e possibilidades terapÃuticas. Esse processo proporcionaria a elaboraÃÃo constante do cuidado compartilhado. Essa pesquisa evidencia a necessidade, ainda, de estudos para sistematizaÃÃo de prÃticas de profissionais em especial de enfermeiros com a visÃo da promoÃÃo da saÃde mental de familiares em luto, visto que para o sofrimento da perda, o abraÃo cuidador à o ponto de partida. / The present study has as its central theme of discussion grief experienced by families whose loved ones were organ donors. It discusses the need for health professionals to know the stages of grief and subtlety to perceive them approaching in moments with family, valuable tool in the care process, especially in the face of death. This research aimed to assist the family in the grieving process after organ donation. Specifically, the objective is also to describe the stories of the families of organ donors, focusing on the experiences of loss and the donation process, analyze the coping process of grieving family after organ donation and analyze how the home visit strategy to promote the health of families in mourning. It is a qualitative research and used the Topical History of life. The site was the area north of the state of CearÃ, where 39 were identified multiple organ donors in the period from 2009 to 2011, being the home visit strategy and careful data collection with eight families who agreed to participate. Were described topical stories of families and analyzed their grief: identified the family structure, development and its functionality at Calgary Family Assessment Model. This study provides contributions for health professionals, mainly nurses about the importance of care for the person grieving process, necessitating a revision of practices that inhibit the exposure of feelings, policies foster care in institutions and effective practice home visits as a method of family care. Moreover, this approach between family and staff is an opportunity for professionals to review their practices, their weaknesses and therapeutic possibilities. This process would provide the constant construction of shared care. In this sense, it signals the need also to work with the vision of promoting the mental health of families in mourning, as for the pain of loss, the embrace caregiver is the starting point.

Māori are the indigenous people of New Zealand. As a population group Māori have on average the poorest health status of any ethnic group in New Zealand (Ministry of Health, 2007). Much of this disproportionate ill-health is linked to manageable and/or preventable conditions. Given this, there is much scope for effective Māori health promotion in particular, as the Māori population is relatively young. The primary objective of the case study research was to determine the organisational pre-requisites necessary to fund, implement and sustain Māori health promotion within a primary care setting. Secondary aims were to; identify how health promotion is perceived within a ‘Māori’ primary health care setting, identify existing health promotion practice, and test the feasibility of implementing a current Māori health promotion framework. The case study research was informed by 19 key informant interviews and two focus group sessions. A literature review including an organisational document review was also undertaken. Findings indicated that many of the pre-requisites necessary for effective Māori health promotion implementation sat outside the scope of the organisation and needed to come from a variety of sources including the Ministry of Health, District Health Board’s (DHB’s), community organisations and health providers, whānau (family), hapū (sub tribe) and iwi (tribe), including support from other sectors. The research also found a number of underlying issues that impacted greatly on the health of the Māori population within the PHO. These issues need to be addressed at a number of levels and given high New Zealand priority. In testing the feasibility of a current Māori health promotion model (Kia Uruuru Mai a Hauora) it was considered by participants to fit well with the goals, principles and values of the case study site and within primary health care in general, complementing critical health care service delivery components that already exist. The study’s conclusion found that there was much scope for Māori health promotion that was fully supported, recognised, and adequately and appropriately resourced by the New Zealand Government, Ministry of Health and DHB’s in order to provide long term cost effective and sustainable health benefits.

Cardiovascular disease (CVD) represents a large portion of the burden of illness for industrial nations, and biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive and population health promoting strategies to reduce this burden of illness. The present research is part of a larger research program, the Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study designed to investigate and strengthen community-based heart health activities in both the formal and informal public health systems. This study builds upon CHHIOP's qualitative findings to examine how community relationships and community development approaches play out in local contexts to shape the reality of (heart) health promotion practice. Although community development is a central concept in heart health policy there has been no analysis of its understanding, support or use among community health stakeholders. In order to address these questions thirty key informant interviews were conducted with community heart health stakeholders from eight of the 42 health unit areas across Ontario. The findings reveal that three patterns of community heart health practice appeared across the communities, illustrating a continuum of collaboration. These patterns are typfied by different community atmospheres for collaboration, the divergent nature of agency inter-relations, and distinct composites in the use of community (development) approaches. Central themes across communities illustrated the importance of local community contexts, the lack of a common understanding of community development, and the emergence of a shift in health agencies' ways of doing business. Local perspectives and the dynamics of intra-community relations were allowed to emerge and highlight the need for place-sensitive implementation of health promotion strategies at the community level. / Thesis / Master of Arts (MA)

The health service provides a Child Health Programme (CHP) to all children to help them attain their health and development potential. Core elements include screening, immunisations, growth and development surveillance, health promotion advice, and parenting support. The surveillance/advice/support components (known as Child Health Surveillance CHS) are delivered through a series of universally offered child health reviews mainly provided by Health Visitors (HVs) supplemented by additional support as required. Scottish policy issued in 2005 led to considerable changes to the CHP. The number of CHS reviews was substantially reduced to enable more intensive support of children who required it. A three category indicator of need was introduced at the same time to facilitate the identification of children requiring enhanced support. This thesis aims to explore the shift to more targeted provision of CHS that occurred from 2005 onwards, and to examine the impact of this on the preventive health care provided to pre-school children. The specific objectives are: · To describe the development of professional guidance on the CHP and how this has been adopted into Scottish policy. · To compare the CHP provided in Scotland to that offered in other high income countries. · To examine the impact of the changes to CHS on the coverage of universally offered child health reviews. · To explore, following the changes to CHS, which factors are associated with children being identified as in need of enhanced CHP support. · To assess the impact of the changes to CHS on the totality of preventive care provided to pre-school children by HVs and General Practitioners (GPs). The key methods used are literature review, policy analysis, and analysis of routine health data. Selected findings include the following: · All the high income countries studied provide the same basic elements as the Scottish CHP but the detail of the different programmes varies considerably. Some of the variation may reflect the different needs of different populations, but much seems to reflect different approaches to evidence interpretation and policy making in different settings. · Not all children offered ‘universal’ child health reviews actually receive them. Children from deprived areas are less likely to receive their reviews. Inequalities in review coverage have remained unchanged after the changes to CHS. · Many factors, including those reflecting infant and maternal health and family social risk, are associated with being identified by HVs as needing enhanced CHP support. The threshold at which children are identified as needing enhanced support varies between areas across Scotland. · GP provision of child health reviews has reduced after the changes to CHS as would be expected. Recorded GP provision of other preventive care consultations is uncommon and has not changed. Currently available routine data do not allow trends in the totality of HV provided care to be examined. In summary, the Child Health Programme makes an important contribution to supporting young children and their families but it is a complex service and considerable uncertainty about aspects of its content and delivery remain.

I mötet med patienter i livets slut övergår sjuksköterskans handlingar från botande till lindrande. Bakgrunden beskriver begreppet hälsa som ett flerdefinierbart begrepp och sjuksköterskans roll i vården. Den palliativa vårdens förhållningssätt och de sex S:en beskriver att sjuksköterskan ska utgå från patientens livsvärld för att få kunskap om hur livskvalité och hälsa kan främjas i livets slut. I problemformuleringen beskrivs vikten av att se patienters behov och önskningar, det är deras berättelser som bör ligga till grund för sjuksköterskans agerande. Syftet var att belysa vad patienter upplever som hälsobefrämjande omvårdnad vid livets slut. Metoden som använts är litteraturstudie och resultatet är funnet i åtta vårdvetenskapliga artiklar. Resultatet redovisades i tre teman som uppfattades som viktiga för att uppleva välbefinnande och hälsa i livets slut. Hälsofrämjande relationer beskriver närståendes betydelse och sjuksköterskans förmåga att ha både en professionell och personlig roll. Möjliggöra delaktighet, genom god kommunikation och att patienten har kontroll skapas delaktighet i vården. Möjliggöra ett gott liv, genom symtomkontroll och att bevara det vanliga, främjas en känsla av värdighet för patienter i livets slut. Betydelsen av sjuksköterskans roller framkom i diskussionen, vikten av att vara både personlig och professionell. Medvetenhet krävs hos sjuksköterskan för att se patientens verkliga behov. Det visade sig att närstående inte enbart var något positivt för patienterna, de känner ett ansvar för sina närståendes välmående och det kan innebära ytterligare en påfrestning för den som är sjuk.

Chronic diseases such as diabetes, cardiovascular disease, cancer, and depression exist in 45% of the U.S. population and are responsible for 70% of the deaths and 75% of the $2 trillion in annual medical expenditures. Healthy eating, being physically active, managing stress, and avoiding tobacco have well-documented relationships to improved health and well-being, and chronic disease prevention.Integrative healthcare, a holistic approach to care that is patient-centered, personalized, and focused on health and well-being, incorporates conventional and complementary and alternative medicine (CAM). Integrative healthcare has the potential to provide high quality care that prevents illness and promotes optimal wellness, resulting in decreased health care costs and a healthier nation. Although integrative healthcare is increasing in popularity, few integrative healthcare programs have been studied and relatively little is known about the processes, outcomes, feasibility, efficacy, effectiveness, or sustainability of these programs.The purpose of this project was to evaluate selected organizational processes and patient outcomes of an integrative health care program. The three specific aims of the project were to analyze the program theory through the development and evaluation of the program logic model, to evaluate selected organizational processes, and to examine selected client outcomes, including satisfaction.This inquiry used the CDC Framework for Program Evaluation as a guide. The study employed a descriptive design with both qualitative and quantitative methods, including key informant interviews with program staff and a client focus group. De-identified data on pre and post measurements of client Wellness Inventory scores, weight, BMI, and advanced cardiac panels, and post program surveys obtained from the program director were analyzed using descriptive statistics and the paired t test or the Wilcoxon signed-rank test.The evaluation of an existing integrative healthcare program provides potentially useful information to the stakeholders of the program and a valuable referral resource for other providers in the community. Dissemination of the information may also be used as a model and an inspiration for other advanced practice nurses to develop innovative practice models that support holistic, wellness-focused care.

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