Objective: This research explores the critical need for individualized care planning to ensure maximum cost savings by providing a balance between individuals’ care needs and care wishes. The primary objective of this research is to identify common goals of care (GoC) expressed by long-term care residents (using the interRAI LTCF) and clients receiving community supportive services (using the interRAI CHA) or community mental health services (using the interRAI CMH). Methods: Three interRAI datasets were used to perform data analyses. The responses to the open-ended GoC item were quantified and grouped into common goal categories, which were then examined against the interRAI outcome measures and Clinical Assessment Protocols (CAPs). Demographic and clinical characterisitics were compared across the sample populations using the chi-square test. Logistic regression models were created to reveal variables that are predictive of not having a GoC recorded within each care setting. Results: Twenty-five GoC categories were created. Although the GoC responses were very diverse, many persons had no goal recorded. Nearly 70% of long-term care (LTC) residents and community support service (CSS) clients were unable to state a GoC. Different populations in different service settings had distinct GoC but had some commonalities as well such as goals that focused on general physical or mental health issues. GoC varied with the CAPs- the triggering of a CAP did not necessarily mean a corresponding GoC was noted. Each care sector had different predictor variables that were strongly associated with not having a GoC. Conclusions: There is not a “one size fits all” solution to care planning. The same goals and outcome measures are not appropriate or realistic for all persons. It is critical to incorporate self-reported goals into the development of effective and individualized care plans to ultimately improve one’s quality of life, satisfaction with care, and success in achieving desired outcomes of care.

Background: Quality of life (QoL) of long term care facility (LTC) residents is being recognized as an important outcome of care by LTC providers, researchers, and policy makers. For residents, measurement of QoL is a valued opportunity to express their perception of the quality of their daily life in the LTC facility. For clinicians, self-reported QoL provides useful information in planning and implementing resident-centred care. Purpose: The purposes of this study were: (1) to examine the distributional and psychometric properties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoL Survey); and (2) to explore the relationship of selected socio-demographic and clinical characteristics of residents and LTC facility attributes with residents’ self-reported QoL. Methodology: This was a cross-sectional observational study. A convenience sample of 48 volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundred and twenty eight (928) residents agreed to participate in this study. Resident inclusion required an interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment). Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Survey instrument. Residents’ socio-demographic and clinical characteristics were obtained from the most recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoL interviews. LTC facility attributes were measured by a survey form specifically designed for this purpose. Descriptive statistics were used to describe the participating LTC facilities, the sample of residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest and internal consistency) and validity (content and convergent) were conducted. Bivariate analyses were conducted to examine the relatioships between QoL and resident and facility charateristics. Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL. Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reported QoL. The findings showed positive ratings of some aspects of residents’ daily lives while negative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Survey instrument had test-retest reliability, internal consistency, content validity and construct (convergent) validity. Several resident and facility characteristics were associated with self-reported QoL. Religiosity and highest education level attained were significantly and positively associated with QoL. Other resident characteristics such as age, gender and marital status were not. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, bowel and bladder incontinence, and extensive assistance in activities of daily living were significantly but negatively associated with QoL. LTC facility ownership showed significant association with QoL. Residents in municipal LTC facilities followed by private LTC facilities reported higer QoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stability were not associated with QoL. Residents in rural settings reported significantly higher QoL than those in urban settings. Facility size (measured in number of beds), registered nurse hours of care, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have a significant association with QoL. However, higher management hours and total hours of care had significant and positive associations with residents’ overall QoL. Multiple linear regression showed that residents’ religiosity, degree of social engagement, post secondary education, dependence in activities of daily living, and positive global disposition, and LTC facilities situated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) of the variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had a positive global disposition were less likely to report low QoL. In contrast, residents with dependence in activities of daily living and post secondary education were more likely to report low QoL. Residents in LTC facilities located in rural settings and operated by municipal or private operators were less likely to report low QoL compared to charitable facilities. Strengths and Limitations: This study had several strengths, including a sample of 928 residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, external indicators of QoL. This study had several limitations, including response bias due to method of sample selection, inability to draw causal inferences due to study design; limited generalizability due to use of a convenience sample, lack of monitoring of surveyors for the integrity of resident interviews, and exclusion of residents with cognitive performance scale scores of more than three or inability to communicate in English. Future research should address these limitations. As well, future research should conduct more stringent psychometric analyses such as factor analysis and use multi-level modeling procedures. Implications: The findings of this study have implications for improving residents’ QoL, LTC facility programming, future research, and social policy development. Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports from residents may be used by clinicians to plan and implement resident-centred care. There are significant associations of residents’ QoL with select resident socio-demographic and clinical characteristics and facility attributes. Some of these resident characteristics and facility attributes may serve as predictors of QoL.

The purpose of the present study was to examine the effect of environmental density on the behavior (Disruptive and Nondisruptive) of elderly residents with dementia living on a special care unit. A building project that led to relocation of residents from high density units to units that varied in density (low vs. high) provided a natural context for this study. Disruptive and Nondisruptive behavior are composite variables that together include the full range of behavioral responses. Both are composed of several subvariables. Data were collected using direct behavioral observation using the Environment-Behavior Interaction Code (Stewart & Hiscock, 1992b) and a hand-held computer. The first objective of the study was to examine behavior patterns in relation to density and privacy. This objective was addressed with a quasi-experimental design (Study 1), in which three hypotheses were tested. It was predicted that residents who moved from a high density unit to a low density unit would exhibit a greater reduction in rate of Disruptive behavior (Hypothesis 1) and a greater increase in rate of Nondisruptive behavior (Hypothesis 2), compared to residents in a constant high density condition. It was also predicted that use of Private Time (time spent alone in one's bedroom) would be greater on the low density unit, where residents had private rooms (Hypothesis 3). Results of Study 1 provided support for Hypotheses 1 and 2, in relation to comparisons with the External Comparison Group only. Within subjects analyses provided additional support for Hypothesis 1 (Disruptive behavior). Hypothesis 3 (Private Time) was also supported. The second objective of the study was to explore the perceptions of family and staff caregivers with regard to the effect of the environment on resident behavior. This study was addressed with a qualitative design (Study 2) using the grounded theory method. Participants in Study 2 described the needs of residents with dementia in relation to the physical and social environment, and the outcomes that occurred when these needs were met or not met. (Abstract shortened by UMI.)

Adoption of no-till (NT) and reduced tillage management is widespread on the Canadian prairies and together form the basic platform of soil management upon which most crop production is based. Elimination of tillage in cropping systems changes the physical and chemical characteristics of the soil profile and can affect crop growth and ultimately yield. As such, understanding how soil biota, as drivers of nutrient turnover, adapt to NT is important for maximizing crop productivity and mitigating environmental damage in agroecosystems. This work aims to achieve a greater understanding of microbial community structure and function in long-term NT versus conventionally tilled (CT) soils. Community phospholipid and DNA fingerprinting did not reveal any consistent tillage-induced shifts in microbial community structure, but demonstrated a clear influence of depth within the soil profile. While tillage did not result in broad changes in the community structure, total, bacterial and fungal biomass was consistently greater near the surface of NT soils. Further examination at one site near Swift Current, SK revealed differences in microbial biomass and community structure in NT and CT in field-formed aggregate size fractions. Measurement of mineralization and nitrification at the same site indicated that differences in the early-season turnover of N may be related to physical rather than microbial differences in NT and CT soils. Potential nitrification was higher prior to seeding than mid-season, was not affected by tillage and was correlated with ammonia oxidizer population size of archaea, but not bacteria. This work indicates that edaphic soil properties and spatial distribution of resources in the soil profile, rather than tillage management, are the primary factors driving microbial community structure in these soils.

Natural forest dynamics is a foundational topic of forest science. A new Wood Pasture hypothesis considering large herbivore as driving force in forest ecosystem is now challenging the traditional High Forest hypothesis, in which vegetation is regarded as main driving force. In this study, a model-based approach is applied to investigate differences between these two hypotheses and the determine factors in the system. A theoretical landscape of 1 km²formed by 100*100 cells is set up with 100 vegetation patches and free moving herbivores on. Our null hypothesis that herbivores make no difference in vegetation dynamics especially at canopy level is rejected. It is found that synchronization of herbivore behaviors is the most influencing factor of how a landscape might be shaped. It is also found that landscape could be a mosaic of both high forest and wood pasture depends on large herbivore’s herd size.

Kungsgärdets sjukhus got its name the fouth of january 1965 and is still in use today. In 1981 the hospital and became merged into Uppsala Västra sjukvårdsdistrikt and stopped being a independet fonds. Predecessor to Kungsgärdets sjukhus was Centralepidemisjukhuset, more specific its Longterm care after the Infektionskliniken had moved to Akademiska sjukhuset the first of september 1965. In the Kungsgärdets sjukhus material of archive several diffrent fonds are included: Tunåsens sjukhus, Wattholma sjukhem, Östra paviljongen and Landstingets verkstäder. Geriatriska klinik is also included in Kungsgärdets sjukhus, however it is not a fonds but a ward. However all this makes it very difficult to establish the provenance of Kungsgärdets sjukhus, because it is impossible to know how all these fonds and its material of archive affects Kungsgärdets sjukhus as a fonds specially since the other fonds have not been organized and catalogued, and There for it is difficult to know were the provenance and the truth of Kungsgärdets sjukhus is. Kungsgärdets sjukhus arrived at Landstingsarkivet in Uppsala län together with several other fonds at different times. The material of archive for Kungsgärdets sjukhus existed originally of 12 running metres, but afterwards it was down to 7,5 running metres. The material och archive existed of bound of books but mostly of folders. The material of archive was well-assorted which made the organizing and cataloguing relativly easy.

Media society is under a constant development and in line with this change, firms must adapt to the market. We have investigated what fashion companies in fact are doing to communicate in the dynamic market. We wanted to find out how to communicate and how they can market themselves in a new and innovative way to create long-term customer relationships. We have used a theoretical frame of reference based on marketing communication, fashion marketing, branding and relationship marketing theories. We have assumed four themes throughout the survey which are: customer contact and relationships, emotion in communication, branding and relational communication. The survey has been conducted by using qualitative methodswere we have interviewed three fashion companies and three consumers as well as a professor of communications. We have also examined and critically assessed the data we collected. Furthermore we have presented the empirical result of the interviews according to the previously mentioned themes. We have discussed above mentioned areas and different tools to create long-terms relationships within the fashion industry. In conclusion, we state that the one of the most effective strategy is to add more resources to create feelings among their customers with the companies advertising. It is also important to build up a strong brand that can represent the whole company.

A low-loaded constructed wetland was investigated with respect to phosphorus retention. Since the main long-term phosphorus retention mechanism is sedimentation and sediment accretion, the study focused on these processes. The purpose of the study was 1) to investigate how the calculated value of phosphorus retention (Pin – Pout), corresponded with the measured amount of phosphorus in the sediment, 2) to find out where in the wetland the phosphorus had accumulated, and in what form it was retained, and 3) to investigate the role of vegetation. The calculated value was 12 kg ha-1 and the measured value was 104 kg ha-1, which indicated the importance of internal phosphorus circulation, where plants probably take phosphorus from the underlying clay. Hence, vegetation could possibly increase the total phosphorus content in the wetland. The composition of phosphorus in the sediment was analysed using sequential fractionation. The dominating form of phosphorus in the sediment was iron-bound phosphorus (29 %). In total, 48 % of the phosphorus was stable, i.e. tightly bound in the sediment, and 35 % was relatively stable. The bioavailable fraction, which could cause eutrophication in downstream waters, was 17 % of the total phosphorus content, or 41 kg ha-1. The amount of total phosphorus was significantly higher near the inlet, compared to the outlet, which is explained by rapid sedimentation of particulate phosphorus entering the wetland. The phosphorus amount near the inlet represented 80 % of the total phosphorus load – which indicates the importance of internal circulation of phosphorus, both biological and geochemical.

Syftet med denna litteraturstudie var att beskriva hur människor med fibromyalgi upplever att leva med långvarig smärta, hur denna hanteras i det dagliga livet samt vilka omvårdnadshandlingar som upplevs betydelsefulla av fibromyalgidrabbade. Litteratursökningen genomfördes via Högskolan Dalarnas databaser ELIN, Blackwell Synergy och EBSCO HOST med hjälp av sökord i olika kombinationer. Tre artiklar söktes manuellt. Inklusionskriterierna var att artiklarna skulle vara vetenskapliga och skrivna på engelska, svenska, norska eller danska samt vara publicerade mellan 1997-2007. Artiklarna (n=16) kvalitetsgranskades med hjälp av granskningsmallar och de artiklar som var av hög eller medelhög kvalitet inkluderades. I resultatet framkom att den långvariga smärtan vid fibromyalgi upplevdes dominera medvetandet vilket kunde leda till känslor av ilska, hjälplöshet, frustration, irritation, desperation och utmattning. Flera delar av, eller i vissa fall hela kroppen, engagerades av smärtan. Exempel på strategier för att hantera smärtan var att använda sig av fysiska aktiviteter, avslappningsövningar, självdistrahering, alternativmedicinska behandlingar och att ha en positiv attityd. Den viktigaste formen av psykologiskt stöd var att bli lyssnad till och att få uttrycka sig utan att känna sig dömd. Vidare var praktiskt stöd, såsom assistans med hushållssysslor av stor betydelse. Att erhålla adekvat information om sjukdomstillståndet och prognosen upplevdes vara viktigt av fibromyalgidrabbade.

The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups. The majority of LPNs expressed that it was easy to respond to the questions (56%), while nine percent considered it as difficult. Eleven comments were given about questions that were perceived to be unclear, complicated or contained difficult words. In the RN group only 30 percent considered that the questions were easy to respond to. One third of the RNs considered that part of the questions were unclear, and six RNs expressed also which questions they experienced as unclear. In general, the questions in the ACT were perceived as relevant. The instrument's relevance as a tool to measure contextual factors that influence the implementation of evidence based nursing can also be considered to be determined. By modifying the content in the questionnaire in accordance with what appeared in this survey and to implement yet another test, the instrument should be considered to be relevant for use within Swedish municipality care of the elderly. ACT can be used both as a tool in the work on improvement of clinical practice and as a tool for further research about implementation of evidence based nursing.