Seasonal influenza, or the flu, impacts over 3 million people each year. Within the health sector, nosocomial infection and absenteeism are frequently associated with the flu. The Centers for Disease Control and Prevention (CDC) recommend flu vaccination for all eligible individuals, especially health care workers (HCWs). Interventions associated with increased HCW vaccination include educational programs and occupational health campaigns to address misconceptions regarding vaccine safety and efficacy. This project evaluated the impact of a voluntary, web-based education module to encourage registered nurse (RN) vaccination. The logic and health belief models served as the theoretical frameworks. In a nonequivalent group design, an educational program addressing evidence-based barriers to vaccination was delivered at 1 acute-care hospital and was not delivered at a comparison hospital within the health system. A total of 192 surveys (116 at intervention facility) were returned over 3 weeks. Statistically significant differences (x2 = 7.210, p = 0.007) were found for RNs who accepted influenza vaccination after education when compared to the RNs not receiving education. The 15% higher vaccination rate for RNs receiving education (91.1% vs. 76.1%) translates into more than 100 additional vaccinated RNs if applied across both hospitals. This project found that a simple but tailored web-based educational program is effective in converting RNs to vaccination acceptance. Increased vaccination produces societal change by reducing nosocomial and community influenza transmission. Reduced influenza infection improves community health as well as patient safety. Future work should address community-wide HCW education initiatives and evaluate their impact on quality and financial indicators at the hospital and community levels.

There is a worldwide shortage of direct care workers who help older adults in their own homes. The purpose of this multiple case study was to explore strategies that owners of home health care businesses can use to retain adequate direct care workers for their businesses. Five home care agency owners from Wake County, North Carolina, participated. Each owner had successfully implemented strategies to ensure adequate caregivers to sustain the business. Human relations theory was used to address the business problem. Data collection involved interviewing the 5 owners of home care agency businesses in their offices. Through a process of methodological triangulation, observations and documentary evidence supplemented data collected through semistructured interviews. Deductive and inductive coding were used to arrange and identify 3 emergent themes: company reputation, training and career development, and the role of government. The results of this study may contribute to social change because home care agency owners and other business owners can use the findings to improve on their treatment of low income workers which may help eradicate discrimination to ethnic minorities.

Le polyhandicap est consécutif à une lésion sur un cerveau immature, il associe déficience mentale profonde, déficit moteur, restriction de l’autonomie. Objectifs 1) décrire les caractéristiques médicales, la prise en charge du PLH et son adéquation, 2) évaluer l’impact du polyhandicap sur le vécu des aidants. Méthodologie : étude de cohorte. Sept centres (SSR et médico sociaux) ont participés. Patients inclus: répondant à la définition du PLH, pour chaque patient sont inclus aidants professionnels et familiaux. Données recueillies : patient :médicales, modalités de prise en charge, aidants: sociodémographiques et vécu. Résultats : 875 patients ont été inclus, âge moyen 24 ans, enfants 45.8%, adultes 54.2, principales comorbidités :infections pulmonaires, troubles orthopédiques, épilepsie. L’adéquation objective de la prise en charge en SSR est de 60% au regard de la sévérité du PLH. Le polyhandicap de l’enfant a un retentissement considérable sur le vécu des parents et des soignants. / Polyhandicap (PLH) is a chronic affliction occurring in an immature brain, leading to the combination of profound mental retardation and serious motor deficit. The French health system allows care management in specialized rehabilitation centers (SRC), residential facilities (RF), and home care. The aims of this study were i) To describe PLH patients ‘health status and to estimate the adequacy of care management ii) To assess the QoL of parents and health-care workers.Method: inclusions: PLH patients, parents and institutional HCWs of each included patients. Data collection: socio demographic, clinical, modalities of care management, caregivers' QOL. Results: 875 PLH patients were included: main comorbidities were pulmonary infections, orthopedic and epilepsy. Global objective adequacy was higher for patients cared for in SRC.The QoL scores of all dimensions were significantly lower for parents and health care workers than for controls.

Thesis (D. Min.)--Gordon-Conwell Theological Seminary, Charlotte, NC, 2002. / Abstract and vita. Includes bibliographical references (leaves 117-123).

The purpose of this case study is to gain a deepened understanding of how employees within the home care sector experience their work in general and their working conditions in particular based on which emotions they experience and how the employees handle these emotions. In order to answer the purpose and questions raised in the study, five semistructured interviews were held with home care workers. The study subjects were asked questions aiming to get them to share their knowledge and experiences regarding their working situation. The gathered empirical material was then analyzed with the help of emotional sociological theories and concepts as well as with parts of Goffman´s dramaturgical perspective. The results of the study show that employees working within the home care sector experience a wide range of emotions, where stress is one of the most frequently experienced emotions. Stress is experienced mainly due to the subjects experiencing their work as high demanding and that they lack control over their work. The results also showed that the employees use a mixed approach to their work. On the one hand, the study subjects experience that their identities are closely linked to their work and that close relationships are formed with the home care recipients. On the other hand, the subjects emphasize the importance of separating their individual personal from their professional role as caregivers in order to avoid emotional strains. In their relationship with the home care recipients, the employees must take in to account various emotional rules and the social exchange is characterized by an imbalance in the relationship between home care recipients and workers. Another key aspect of the home care employees working situation emerging from this study is a certain lack of the posterior region which appears during the subject’s lunch breaks. During the lunch break work related topics are discussed and the care giver might have to finish their lunch break early in order to assist a colleague or care recipient.

本研究試圖探究走過家庭照顧歷程決定成為照顧服務員這群女性勞動者，從這群女性勞動者的生命圖象中，分析這兩種角色之差異性，並進一步探討研究對象對於這兩種角色轉換之轉換歷程與因應策略。 本研究使用質性取向的研究方法，以半結構式的深度訪談進行資料蒐集，有效受訪對象共訪談8位曾有家庭照顧經驗之照顧服務員，年齡介於44歲～63歲之間，教育程度則以高中職為主。婚姻狀況單身3名、單親2名、已婚育有子女3名。照顧關係中女兒照顧者與媳婦照顧者各半。家庭照顧期間從1年到16年皆有，照顧服務員工作年資則從2年到13年不等。 本研究首先歸納整理女性成為主要照顧者的原因，並整理當照顧情境改變時家庭照顧者重返勞動市場之考量因素。研究發現，家庭照顧者在成為照顧服務員的過程當中，受服務經驗扮演相當重要的中介角色，受服務經驗是這群中年婦女在求職過程的一個重要催化劑，轉而投入照顧服務工作。接著耙梳照顧服務員在職場的工作困境，研究發現照顧服務員所面臨到的工作困境相當多元，本研究分從個人面、互動面、實務面及制度面四個層面加以說明。 研究最後統整了兩種照顧經驗之比較，研究發現家庭照顧者成為照顧服務員之後，因照顧對象的不同，隸屬於不同的關係中，佔據不同的位置，扮演不同的角色，並依循此角色之責任義務規範行事。兩種照顧經驗的差異展現在照顧角色轉換的經驗感受、照顧基礎的差異以及照顧過程中照顧者的自主性三個面向上。同樣的照顧工作，一是無酬一是有酬，一是親屬關係一是專業服務關係，一是基於責任一是基於契約提供照顧，一是在家庭成員共識認可下照顧，一是依循科層組織規章在契約的規範下照顧，兩者在不同的面向上呈現相當不同的景象。然而，具有家庭照顧經驗的照顧服務員，對日後的照顧工作是有影響的，其關連性主要包括在下列三個部分：照顧的知識技巧、同理以及情感轉移上。其照顧與互動的技巧是可以透過反覆的實作而熟能生巧，照顧技巧的經驗累積可以視為是一種延續。 私領域的家庭照顧者與公領域的照顧服務員間之兩種照顧經驗，在照顧的任務（care for）上其實大致相同，但在照顧者對他人個感受（care about）上卻大相逕庭。因為照顧關係與照顧基礎的不同，親屬關係的家庭照顧承載著較多的感受狀態，家庭照顧者需時時刻刻、盡己所能地回應失能者所有需求，關注受照顧者的福祉，也因此照顧者會感受到較大的照顧壓力。反觀照顧服務員的照顧本質，對於情感的指涉相對較低，關係建立僅是互動的基礎，互動的時間也多在服務的時數範圍內，對受照顧者而言，更多的關注是在照顧任務是否精確完善的被執行。因此，一樣照顧兩樣情，相似的照顧工作，在不同的照顧場域中，照顧技巧的經驗會延續，但照顧歷程的差異感受卻是呈現相當多元的樣貌。 / This research aims to investigate female laborers who decide to become care workers owing to the experience of being family caregivers. It analyzes the difference between the two roles as well as the transformation and strategies that are taken. With the qualitative approach, the data were collected by semi-structural in-depth interviews.There are 8 valid once-family-caregiver interviewees who are now care workers aged 44 to 66, with the educational background of senior or vocational high schools. Among these interviewees, three are single, 2 are single mothers and 3 are married and have children. Four of whose family roles are daughters, four daughters- in- law. They have 1-16 years of experience of being family caregivers respectively and 2-13 years of being care workers. The study starts with a generalization of reasons that makes females as main caregivers and factors of their returning to the labor market when care-taking conditions change. It discovers that the experience of having been taken care of plays a crucial role in the transformation—from family caregivers to domestic ones. The experience serves as an important catalyst for these middle-aged women to become care workers. The study, then, scrutinizes the predicament these care workers encounter, followed by an analysis of their mutiple predicament derived from four respectives: personal conditions, interactive relationship with their patients, care-taking practice and public system. The study wraps up with a comparison-- after becoming care workers, these once-family-caregivers make adjustments according to different relationship and roles. The diversity between the two experience presents upon three dimensions: relationship with patients, different care-taking basis and autonomy of patients. Although both family caregivers and domestic ones are responsible for taking care of patients, the formers are unpaid; doing the job out of familial affection and obligations with the consensus of other family members, while the latters are paid workers, looking after their patients on the basis of profession and contracts under relevant regulations. Each unfolds quite disparate views in front of us. As divergent as they are, the experience of family care-taking has impact on the domestic caregiving work in terms of relevant knowledge and skills, compassion and communication abilities. The accumulation of similar experience can be extended and easily applied. The mission of 'caring for' patients is generally identical for both private-domain family cargivers and public-domain care workers, nevertheless, the extent of “caring about” patients varies. Family caregivers carry more affection and emotions; they have to do their best all all times to respond every need and well-being of the disables, which generates much stress. Care workers, however, are less affection-expected; their relationship with the patients is contract-based and they serve their patients in work hours. Instead of emotionally dependent, patients focus more on whether and how the tasks are being done. Two different perspectives are revealed which give us more lights on the care-taking work.

This study focused on two factors, auspice and job satisfaction, which have been shown to impact on the quality of child care programs. However, while research has indicated that auspice, job satisfaction, and program quality are intertwined, there is a lack of research which explores these factors qualitatively. There is also a dearth of research which has considered auspice from the caregivers' perspectives. Hence, the purpose of this study was to explore the meaning that caregivers give to auspice in their work in nonprofit and for-profit child care centers. As well, this study sought to examine the relationship between auspice and job satisfaction from the caregiver's point of view, paying close attention to differences in job satisfaction that existed between staff employed in nonprofit centers and staff who worked in private or for-profit centers. A series of qualitative, in-depth interviews were conducted with eight child care workers from the Vancouver Metropolitan area. Four of the participants were employed in or owned private centers and four of the participants worked in nonprofit centers. Positive and negative perceptions of both nonprofit and private auspice emerged. In particular, the nonprofit participants believed that child care should be operated as a service and not a business. They perceived that the motive to make a profit in child care lead for-profit centers to sacrifice quality in order to cut costs and maximize profits. On the other hand, the for- profit participants perceived that their centers provided high quality care and were dedicated to putting the needs of children and staff first. In general, the participants'' perceptions of factors that influenced their job satisfaction were similar across auspices. The nature of child care work and supportive relationships with co-workers were factors which positively influenced job satisfaction while the perceived lack of status in the eyes of society negatively affected satisfaction. Differences in job satisfaction according to auspice were found on several factors, such as government policies and a perceived lack of enough time to accomplish job duties.

Thesis (D. Min.)--Gordon-Conwell Theological Seminary, Charlotte, NC, 2002. / Abstract and vita. Includes bibliographical references (leaves 117-123).

Thesis (D. Min.)--Gordon-Conwell Theological Seminary, Charlotte, NC, 2002. / Abstract and vita. Includes bibliographical references (leaves 117-123).

This study sought to explore the views of healthcare workers regarding paediatric anti-retroviral therapy (ART) adherence in Nigeria. An exploratory descriptive qualitative research design was used to identify and describe healthcare workers’ views in Kano and Lagos, Nigeria. Three focus group discussions were held. The transcribed data was analysed using the framework approach of data analysis. Healthcare providers perceived poverty, illiteracy, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing ART adherence. Recommendations for enhancing paediatric ART adherence levels in Nigeria included: mainstreaming adherence counselling in paediatric ART and adopting a comprehensive family centred care approach were identified as measures for improving paediatric ART adherence. Other measures included free ART services, quality improvement in paediatric ART services, parental empowerment and stigma and discrimination reduction programmes. / Health Studies / M.A. (Public Health)