Résumé : L’administration de la médication en centre d’hébergement (CH) constitue une activité qui amène l’infirmière à résoudre des problèmes complexes dans un contexte d’incertitude. Elle exige un raisonnement clinique rigoureux pour lequel il n’existe pas d’instrument de mesure valide et fidèle. Le but de cette étude était d’élaborer un test de concordance de script (TCS) pour mesurer le raisonnement clinique infirmier relatif à l’usage optimal des médicaments en CH et pour documenter sa validité et sa fidélité. Après l’optimisation, le TCS comprenait 55 items répartis dans 20 vignettes cliniques. Il a été mis à l’essai auprès d’étudiantes en sciences infirmières (n=76) et d’infirmières expertes (n=10). Le test a été rempli une seconde fois (test-retest) par 35 étudiantes. La moyenne des scores obtenue par les étudiantes novices est de 55,6 ± 7,7 tandis que celle obtenue par les infirmières expertes est de 63,7 ± 8,0. Les tests statistiques appliqués ont démontré une différence significative dans la moyenne des deux groupes (p < 0,02). La valeur du coefficient alpha de Cronbach de l’ensemble du TCS est de 0,65. Un coefficient de corrélation intraclasse (CCI) a été calculé pour évaluer la stabilité temporelle de l’instrument de mesure. Son résultat est de 0,618 (p = 0,000). Le TCS conçu dans le cadre de cette étude a besoin d’être modifié afin d’obtenir un meilleur indice de fidélité. Les autres résultats statistiques démontrent que le TCS est capable de distinguer les niveaux d’expertise. Cette étude vient s’ajouter aux autres études ayant évalué le raisonnement clinique et confirme l’importance de suivre les directives fondées sur les données probantes pour développer un TCS. / Abstract : The administration of prescribed medication in long-term care facilities is a task that requires the nurse to solve complex problems in a context of uncertainty. It demands a rigorous clinical reasoning for which there is no valid and reliable measurement tool. The purpose of this study was to develop a script concordance test (SCT) to measure nursing clinical reasoning regarding the optimal use of medication in long-term care facilities and to document its validity and reliability. After optimization, the SCT was made up of 55 items divided in 20 clinical vignettes. It has been tested on nursing students (n = 76) and expert nurses (n = 10). The test was completed a second time (test re-test) by 35 students. The mean score obtained by the novice students is 55.6 ± 7.7 while the one obtained by the expert nurses is 63.7 ± 8.0. The applied statistical tests showed a significant difference in the average of the two groups (p < 0.02). The Cronbach alpha coefficient for the entire SCT is 0.65. An inter-class correlation coefficient (ICC) was calculated to assess the temporal stability of the measuring tool. The result is 0.618 (p = 0.000). The SCT developed as part of this study needs to be modified in order for it to be more reliable. The other statistical results demonstrate that the SCT is able to differentiate between levels of expertise. This study adds to previous studies that evaluated clinical reasoning and confirms the importance of following guidelines that rely on evidence-based data to develop a SCT.

The social environment has been recognised as one of the key aspects in determining the quality of life throughout the human lifespan. Human behaviour, thoughts, feelings and attitudes are socially constructed and can only be understood when viewed from the perspective of social interaction. Older individuals, who live in residential facilities experience a diminished quality of life due to factors such as loss of independence, reduced social networks, functional dependence, and contextual changes. Depression, loneliness and social isolation are an integral part of these individuals’ lives. People develop specific styles of relating, also referred to as interpersonal styles. The systems theory is used to explain the circular processes of the interaction between people. In particular the Self-Interactional Group Theory (SIGT) is proposed as theoretical framework to explore the relational qualities of older people in a residential care facility. SIGT views the interaction between people on three levels, namely the intra-personal level, the interpersonal level and the group level, which operate interdependently in the interaction between people. The interpersonal level of analysis consists of the definition of the relationship, relational qualities, motivation to engage with people to address needs and needs satisfaction as well as the circular processes of which the interaction consists of. The interactions between people always take place in an interpersonal context, embedded in broader environments. A qualitative and exploratory research design was selected to explore the relational qualities in interactions between older individuals living in a residential care facility. This study is based on data collected during a primary research study at a residential care facility for older individuals in 2013. The purpose of study was to explore the quality of life of older individuals residing in a residential care facility in Gauteng, South Africa. The data-gathering process in the primary research study involved the Mmogo-Method, a visual projective data-gathering method, the World Café method and person-centred interviews to gain insight into the participants’ life experiences at the residential care facility. For the purpose of this research, only the person-centred interviews were used for the secondary analysis of the data. Twelve purposely-selected individuals (aged 80 to 95; 3 men and 9 women) from the residential care facility participated voluntarily in the person-centered interviews, which were audio recorded. The collected data were transcribed verbatim and subjected to two different methods of analyses. First, data were analysed thematically by adopting an inductive approach. The themes identified in this first phase were next subjected to a deductive content analysis. The themes were categorised according to the relational variables in accordance with the Interactional Pattern Analysis (IPA), thereby contributing to the trustworthiness of the findings. The findings revealed that the interactions between older individuals take place in a broader environment that advocate the active participation of people. Active participation takes place both in and outside the facility and older people reported that this contributed to their quality of life. The relational qualities that could be described as enhancing interpersonal connectivity and satisfying older people’s needs for confirmation were identified as empathy, unconditional acceptance of others, confirmation and interpersonal flexibility. This research, however, highlighted relational qualities that restrained quality of life of older people, namely confusing self-presentation, ineffective expression on needs and withdrawal due to physical immobility. Needs were expressed in a very unspecific, blaming or manipulative manner, and consequently needs were not satisfied, but provoked, instead, feelings of frustration, pain and guilt. This research highlighted the predicament that older people find themselves in. Their decreased physical abilities and limited emotional repertoire to move towards others and the environment also limit their needs satisfaction. The presenting problem of social isolation can be explained by the combination of limited physical mobility and relational qualities that restrain quality of life for older people. This research study thus holds important implications for relationship-focused approaches in residential facilities for older individuals in order to empower and enable them to enhance their quality of life. Specific recommendations include interventions to assist older people to express their needs more effectively and to use opportunities in interaction to confirm them as autonomous functioning older people. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

This research provides a feminist perspective on the lowest paid sector of the United States long-term care industry, Certified Nursing Assistants. This research adds to current feminist scholarship on the modern professional caregiving industry by focusing on the perspective of the workers. As the population of older adults requiring care is expected to increase over the coming decades, the demand for paid caregivers will increase as well. Historically, care work was an expected duty done freely by the women of the family, but today much of the vital intimate caring labor is relegated to paid caregivers. I examine how alternative social, political and economic frameworks can transform United States society’s attitude towards the increasingly relevant issue of caring labor. I argue that incorporating a feminist perspective will be helpful in developing a sustainable model for caring labor that acknowledges the dignity of both patients and their caregivers. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

INTRODUÇÃO: A despeito de todos os avanços no tratamento cirúrgico do câncer, ainda existem fatores complicadores para a adequada evolução no pós-operatório. Realizou-se estudo retrospectivo em uma população de pacientes submetidos a tratamento cirúrgico oncológico eletivo para o câncer retal, a fim de caracterizá-los epidemiologicamente e determinar quais variáveis estão associadas a maior morbimortalidade tais como aumento de permanência hospitalar, utilização de unidade de terapia intensiva, reoperações, óbito em 30 dias e custos hospitalares totais. MÉTODO: Foram selecionados todos os pacientes submetidos a cirurgias retais eletivas para o tratamento oncológico no período de 01 de outubro de 2008 a 31 de dezembro de 2012, resultando numa amostra de 405 pacientes de idade adulta e ambos os sexos. Realizou-se análise univariada para cada desfecho e análise multivariada através de regressão logística com ajustamento para as seguintes variáveis: sexo, idade, índice massa corpórea, estadiamento TNM, procedimento realizado, escore ASA, via de acesso, realização de QRT neoadjuvante, intervalo entre a neoadjuvância e a cirurgia e tempo cirúrgico, com validação interna através da técnica de bootstrap. RESULTADOS: Foram identificados como fatores de risco para aumento de permanência hospitalar a obesidade classe II e III (OR 15,44; IC95% 1,05 - 227,52; p = 0,05) e anestesia combinada - regional associada à geral (OR 5,38; IC95% 1,08 - 29,95; p = 0,04); amputação abdominoperineal foi fator de risco para reoperação em 30 dias (OR 4,54; IC95% 1,15 - 17,90; p = 0,03); amputação abdominoperineal (OR 5,38; IC95% 1,21 - 23,73; p = 0,03) e exenteração pélvica (OR 19,98; IC95% 0,99 - 401,32; p = 0,05) foram fatores de risco para utilização de UTI; idade acima de 79 anos (OR 13,99; IC95% 1,51 - 128,95; p = 0,02) foi fator de risco para complicação pós-operatória; idade acima de 79 anos (OR 0,07; IC95% 0,01 - 0,39; p = 0,01) foi fator de proteção para tempo cirúrgico elevado, obesidade classe II e III (OR 12,87; IC95% 1,54 - 107,67; p = 0,02) e via de acesso laparoscópica com transição para aberta (OR 8,7; IC95% 2,67 - 28,36; p < 0,001) foram fatores de risco para tempo cirúrgico elevado. CONCLUSÕES: Obesidade classe II e III e anestesia combinada são fatores de risco para tempo de permanência hospitalar prolongado para pacientes submetidos a cirurgia para tratamento de câncer retal. Outros estudos se fazem necessários para entender quais são os mecanismos que levam a anestesia combinada, eventualmente, a este aumento de permanência hospitalar / INTRODUCTION: Despite all the developments in the surgical treatment of cancer, there are still complicating factors for a correct postoperative evolution. There were conducted a retrospective study in a population of patients submitted to surgical rectal cancer treatment to characterize them epidemiologically and determine which variables are associated with increased morbimortality such as increased hospital length of stay, use of intensive care unit, reoperations, 30-day mortality and total hospital costs. METHOD: All patients submitted to colorectal surgery treatment for cancer during the period October 1st, 2008 to December 31th, 2012, resulting in a sample of 405 patients of both genders. Univariate analysis was conducted for each outcome and multivariate analysis through logistic regression with adjustment for the following variables: sex, age, body mass index, TNM stage, procedure performed, ASA score, laparoscopic or open surgery, neoadjuvant treatment, interval between the neoadjuvant therapy and the surgery, and operative time, with internal validation by the bootstrap technique. RESULTS: there were identified as risk factors for increased hospital stay, the obesity class II and III (OR 15.44; 95% CI 1.05-227.52; p = 0.05) and combined anesthesia - regional and general (OR 5.38; 95% CI 1.08-29.95; p = 0.04); abdominoperineal amputation was a risk factor for 30-day reoperation (OR 4.54; 1.15 95% CI-17.90; p = 0.03); abdominoperineal amputation (OR 5.38; 95% CI 1.21-23.73; p = 0.03) and pelvic exenteration (OR 19.98; 95% CI 0.99-401.32; p = 0.05) were risk factors for ICU use; age over 79 years (OR 13.99; CI 1.51-128.95; p = 0.02) was a risk factor for postoperative complication; age over 79 years (OR 0.07; CI 0.01-0.39; p = 0.01) was protective factor to prolonged operative time , obesity class II and III (OR 12.87; CI 1.54-107.67; p = 0.02) and laparoscopic approach with transition to open (OR 8.7; CI 2.67-28.36; p 0.001) were risk factors to prolonged operative time. CONCLUSIONS: Obese class II and III and combined anesthesia are risk factors for prolonged hospital stay for patients undergoing surgery for rectal cancer treatment. Further studies are needed to understand the mechanisms that lead combined anesthesia to increase hospital stay

Submitted by William Justo Figueiro (williamjf) on 2015-06-27T13:17:10Z No. of bitstreams: 1 48.pdf: 277933 bytes, checksum: 5da9fa29ec0ef22c87f14da81485d37c (MD5) / Made available in DSpace on 2015-06-27T13:17:10Z (GMT). No. of bitstreams: 1 48.pdf: 277933 bytes, checksum: 5da9fa29ec0ef22c87f14da81485d37c (MD5) Previous issue date: 2011-12-06 / Nenhuma / Este estudo consistiu na avaliação, por um grupo de usuários, de um serviço de assistência especializada em HIV/AIDS em Porto Alegre, RS, relacionando as percepções do grupo com as dimensões do questionário eletrônico de avaliação do Departamento de DST/AIDS e Hepatites Virais - QUALIAIDS, na perspectiva da integralidade e da humanização. Para tratamento dos dados utilizou-se a técnica de grupo focal e análise temática. Nos resultados, evidenciou-se a importância dos elementos acolhimento e acesso na avaliação do serviço feita pelos usuários, influenciando o estabelecimento de vínculo, a adesão ao tratamento e a preferência pelo serviço. Foi constatada a satisfação do usuário no uso do serviço. A pressão da crescente demanda interfere negativamente na relação usuárioserviço. A organização de práticas em saúde, bem como estudos aprofundados sobre o tema, são necessários para atenuar o preconceito de pessoas vivendo com HIV/AIDS. Este trabalho mostra a pertinência de considerar a participação do usuário nas avaliações de serviços de saúde para a qualificação da assistência. / This study was the assessment by a group of users, a service facility specializing in HIV / AIDS in Porto Alegre, RS, relating the perceptions of the group with the dimensions of the electronic questionnaire for the assessment of STD / AIDS and Viral Hepatitis - Qualiaids from the perspective of integrality and humanization. For data processing we used the technique of focus groups and thematic analysis. The results, revealed the importance of host and access elements in the assessment made by users of the service, influencing the establishment of a rapport, adherence to treatment and preference for the service. Has been found the user satisfaction in using the service. The pressure of growing demand negatively interferes with the user-service relationship. The organization of health practices, as well as detailed studies on the subject, are needed to mitigate the prejudice of people living with HIV / AIDS. This work shows the relevance of considering the user's participation in evaluations of health services to qualify for assistance.

The purpose of this research was to examine specific coping methods used by the elderly as they adjust to the environment of a long-term care facility, and to examine the correlations between these coping methods and levels of depressive symptomatology.

本文係針對台灣地區各縣市1999至2008年之老人安養機構設立之床位數進行分析，利用雙因子固定效果模型（two-factor fixed effects model）探討台灣地區各縣市老人安養機構設立之重要影響變數，以及這些變數對於老人安養機構設立床位數影響程度之強弱。本文首先將文獻之檢閱做整理介紹，先概述至今國內外討論老人安養機構設立及使用之相關文章重要觀點，了解這些文章作者的研究時間與空間範圍、所使用分析方法、論點及其變數設定，在最後與本研究之結論相互比較，觀察文獻與本研究之間是否具有一致性。 由於本論文重視各地區變數之影響，故本研究使用具地域性之各縣市數據資料作為變數，經由資料蒐集，將合適之變數納入研究考量，參閱文獻資料，加上能夠取得之數據資料為考量。本文將討論下列變數：台灣地區實質薪資、各縣市老年人口數、各縣市人口密度、各縣市教育程度為大專及以上人口之比率、各縣市失業率、各縣市女性勞動參與率、各縣市15歲以上人口婚姻狀況有偶人數比率、各縣市出生率、各縣市外籍與大陸配偶人數、各縣市社福外籍勞工人數以及各縣市每萬老人接受居家服務人次等十一個變數。對於老人安養機構設立數之關係，觀察其影響程度，了解各地區差異，期能對政府提供具體的政策建議，並對未來各縣市公私立老人安養機構之設立提供參考。 / This study analyses the number of the beds established of the long-term care (LTC) facilities of each city and county in Taiwan between 1999 and 2008, using “two-factor fixed effects model” to explore some of the important influential variables of the long-term care facilities of each city and county, and the strength of the relation of these variables of the hospital beds. This article firstly introduces and reviews some articles and studies that are basically related, and overview the important points of view of the establishment of the long-term care facilities, to understand the analytical methods and the arguments of these articles and authors. As the importance of this thesis, the effect of regional variables, the study uses cities and counties level variables. Through data collection, using the variables in the study that are considered appropriate. Refer to the literature, adding with data obtained for the considerations. This article will discuss the following variables: the real wage of Taiwan each year, the number of counties and cities in the elderly population, the population density, the population with tertiary education level, the unemployment rate, the female labor force participation rate, the population over the age 15 that have marital status, the proportion of birth rate, the number of foreign and mainland spouses, the number of the welfare of foreign workers per 10,000 of the elderly receiving home care people, totally 11 variables. To establish the relationship between the number of observed effect level of long-term care facilities of each city and county, to understand the regional differences, to provide the government on specific policy recommendations. In the future, we expect to provide the public and private sectors the reference establishment of nursing agencies of each city and county.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

The social environment has been recognised as one of the key aspects in determining the quality of life throughout the human lifespan. Human behaviour, thoughts, feelings and attitudes are socially constructed and can only be understood when viewed from the perspective of social interaction. Older individuals, who live in residential facilities experience a diminished quality of life due to factors such as loss of independence, reduced social networks, functional dependence, and contextual changes. Depression, loneliness and social isolation are an integral part of these individuals’ lives. People develop specific styles of relating, also referred to as interpersonal styles. The systems theory is used to explain the circular processes of the interaction between people. In particular the Self-Interactional Group Theory (SIGT) is proposed as theoretical framework to explore the relational qualities of older people in a residential care facility. SIGT views the interaction between people on three levels, namely the intra-personal level, the interpersonal level and the group level, which operate interdependently in the interaction between people. The interpersonal level of analysis consists of the definition of the relationship, relational qualities, motivation to engage with people to address needs and needs satisfaction as well as the circular processes of which the interaction consists of. The interactions between people always take place in an interpersonal context, embedded in broader environments. A qualitative and exploratory research design was selected to explore the relational qualities in interactions between older individuals living in a residential care facility. This study is based on data collected during a primary research study at a residential care facility for older individuals in 2013. The purpose of study was to explore the quality of life of older individuals residing in a residential care facility in Gauteng, South Africa. The data-gathering process in the primary research study involved the Mmogo-Method, a visual projective data-gathering method, the World Café method and person-centred interviews to gain insight into the participants’ life experiences at the residential care facility. For the purpose of this research, only the person-centred interviews were used for the secondary analysis of the data. Twelve purposely-selected individuals (aged 80 to 95; 3 men and 9 women) from the residential care facility participated voluntarily in the person-centered interviews, which were audio recorded. The collected data were transcribed verbatim and subjected to two different methods of analyses. First, data were analysed thematically by adopting an inductive approach. The themes identified in this first phase were next subjected to a deductive content analysis. The themes were categorised according to the relational variables in accordance with the Interactional Pattern Analysis (IPA), thereby contributing to the trustworthiness of the findings. The findings revealed that the interactions between older individuals take place in a broader environment that advocate the active participation of people. Active participation takes place both in and outside the facility and older people reported that this contributed to their quality of life. The relational qualities that could be described as enhancing interpersonal connectivity and satisfying older people’s needs for confirmation were identified as empathy, unconditional acceptance of others, confirmation and interpersonal flexibility. This research, however, highlighted relational qualities that restrained quality of life of older people, namely confusing self-presentation, ineffective expression on needs and withdrawal due to physical immobility. Needs were expressed in a very unspecific, blaming or manipulative manner, and consequently needs were not satisfied, but provoked, instead, feelings of frustration, pain and guilt. This research highlighted the predicament that older people find themselves in. Their decreased physical abilities and limited emotional repertoire to move towards others and the environment also limit their needs satisfaction. The presenting problem of social isolation can be explained by the combination of limited physical mobility and relational qualities that restrain quality of life for older people. This research study thus holds important implications for relationship-focused approaches in residential facilities for older individuals in order to empower and enable them to enhance their quality of life. Specific recommendations include interventions to assist older people to express their needs more effectively and to use opportunities in interaction to confirm them as autonomous functioning older people. / MA (Psychology), North-West University, Potchefstroom Campus, 2014