The diploma thesis deals with the issue of falls among the elderly placed in residential social care facilities. The author mainly focuses on the issue whether the falls can be viewed as a quality indicator of the offered care. The author deals with the issue of falls both on the general level (legislation, standards of quality) and also on the level of a specific residential social care provider represented by home for the elderly Sue Ryder in Prague. Further, the author deals with the issue of falls in inpatient healthcare facilities, as this issue is viewed as an important indicator in terms of comparing quality of care between social care and health care facilities. The key issue of the thesis are the ways to prevent falls of the elderly, so that their basic rights (especially the right to have their own choice), independence and self- sufficiency can be maintained, and also the intervention procedures in these cases. The aim of the thesis is to provide its readers with suggestions on how to improve quality of healthcare in terms of dealing with falls. These suggestions are based on the author's thorough examination of the relevant theoretical and legislative materials. The suggestions are further based on analyzing the fall records, covering a period of 18 months, provided by Sue Ryder...

Pain is the most prevalent medical problem that elderly persons experience in a long-term care home. Nurses play an essential role in managing their pain. The purpose of this study was to explore nurses’ pain management practices in Ontario long-term care homes facilities. The ultimate aim was to recommend measures for effective pain management in aged people. The setting for this study was a selected long-term care home in Ontario, Canada, a 160-bed nursing home for aged people offering various medical care services. Semi-structured focus group interviews, averaging approximately one hour, were conducted. The population of this study was 45 nurses. The researcher used a purposive sampling method to select a sample of 25 nurses. Open-ended questions were used to explore pain management practices and to find barriers to effective pain management. Qualitative data analysis was used to review the data to identify common issues that recurred, and they were summarised in a narrative form. This study demonstrated the importance of recognising and overcoming barriers to the effective management of pain and reinforcing good practices in long-term care homes. Therefore, improved pain management practices are required to manage pain in a long-term care home effectively. / Health Studies / M.A. (Nursing Sciences)

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

No description available.

Thesis (Ph.D. (Nursing Science)) -- University of Limpopo, 2017 / The aim of this study was to develop a model to ensure the integration of Tuberculosis (TB) and Human Immune Deficiency Virus (HIV) services in the Primary Health Care (PHC) facilities of Limpopo Province. An explanatory sequential mixed method was used in this study to develop a model for ensuring the integration of TB and HIV services in the PHC facilities of the Limpopo Province. The researcher collected quantitative data followed by qualitative data. Quantitative data was collected through administration of questionnaires to 450 PHC nurses in the five districts of Limpopo Province. The qualitative data was collected by conducting focus group discussions to five groups of Community Home Based Carers (CHBCs) and five groups of TB/HIV co-infected patients in the five districts of Limpopo Province. Audiotape and field notes were used to capture verbal and non-verbal cues. The Statistical Package for Social Sciences (SPSS) computer programme version 22.0 was used for capturing and analysis of the quantitative data. Content analysis was used to analyse the qualitative data from the CHBCs and the TB and HIV co-infected patients’ focus group discussions. The study revealed lack of knowledge and skills on TB and HIV management due to insufficient training of PHC nurses about TB and HIV management. Staff shortage of PHC nurses in the facilities was also indicated by PHC nurses. Furthermore, TB and HIV coinfected patients are faced with challenges in the PHC facilities and in the community. Challenges that are faced by CHBCs and the TB and HIV co-infected patients include negative attitudes of some clinic staff members towards them. The patients’ families also have some negative attitudes towards the CHBCs as they leave the patients to them without assisting them in the caring duties. The community members also has negative attitudes as they do not accept the CHBCs in their homes to support the patients. Based on the results, a model was developed to ensure the integration of TB and HIV services. The model was validated by PHC nurses and the experts in research and model development. The validation results showed that the model was clear and simple to be used in the PHC facilities for integration of TB and HIV services. The study recommends that the model should be used by PHC facilities for integration of TB and HIV services. The PHC nurses should attend TB and HIV capacity-building courses.

No / To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

The purpose of this study was to evaluate the recreational activities provided in special care units located in the Inland Empire. The population that this study sought to assist was patients diagnosed with Alzheimer's disease and living in an Alzheimer's special care unit.

Les défis associés au phénomène du vieillissement démographique de la population se manifestent sous plusieurs formes et à de nombreux égards. Il y a des questions générales comme celles qui touchent l’économique et d’autres, plus spécifiques et situées, comme celles des modalités assurant des services et des soins adéquats aux personnes vulnérables. Par exemple, le colloque « La qualité de l’expérience des usagers et des proches : vers la personnalisation des soins et des services sociaux », programmé dans le cadre des Entretiens Jacques Cartier à l’automne 2014, s’était donné comme objectif d’examiner l’expérience personnelle des usagers relativement aux prestations de soins de santé et à l’organisation des services sociaux. L’origine de ces réflexions réside dans la nécessité de trouver un meilleur équilibre des pouvoirs dans les relations d’aide ou la prestation de soin. Cette problématique sous-entend l’idée de rendre les usagers capables d’un certain contrôle par l’adoption d’approches permettant aux professionnels de faire des ajustements personnalisés. Cette thèse de doctorat s’inscrit directement dans le prolongement de cette problématique. La recherche vise à examiner les conditions en mesure de rendre possible, dans les Centres d’hébergement et de soins de longue durée (CHSLD), un rapport au monde catégorisé par ce que le sociologue Laurent Thévenot nomme le régime de la familiarité. Le régime de la familiarité fait référence aux réalités où l’engagement des personnes se déploie dans l’aisance. Autrement dit, ce régime d’engagement correspond à un rapport au milieu où la personne est en mesure de déployer ses habitudes, d’habiter le moment et de se sentir chez elle. Comme le montre Thévenot, ce type d’engagement commande la conception d’un monde qui offre aux personnes la possibilité d’articuler les modalités de leurs actions sur des repères qui font sens personnellement pour eux. Ainsi, l’objet de la recherche consiste à mieux comprendre la participation du design à la conception d’un milieu d’hébergement capable d’accueillir ce type d’engagement pragmatique. Les orientations associées à la conception de milieux d’hébergement capables de satisfaire de telles exigences correspondent largement aux ambitions qui accompagnent le développement des approches du design centrées sur l’usager, du design d’expériences et plus récemment du design empathique. Cela dit, malgré les efforts investis en ce sens, les capacités d’appropriation des usagers restent un problème pour lequel les réponses sont précaires. La thèse interroge ainsi le fait que les développements des approches de design, qui ont fait de l’expérience des usagers une préoccupation de premier plan, sont trop souvent restreints par des questions de méthodes et de procédures. Le développement de ces connaissances se serait fait au détriment de l’examen précis des savoir-être également nécessaires pour rendre les designers capables de prendre au sérieux les enjeux associés aux aspirations de ces approches. Plus spécifiquement, la recherche précise les qualités de l’expérience des établissements dont le design permet l’engagement en familiarité. L’enquête s’appuie sur une analyse des jugements posés par des équipes d’évaluation de la qualité du milieu de vie des CHSLD présents sur le territoire Montréalais. L’analyse a mené à la caractérisation de cinq qualités : l’accueillance, la convivialité, la flexibilité, la prévenance et la stabilité. Finalement, sous la forme d’un essai réflexif, un tableau de savoir-être est suggéré comme manière de rendre les designers capables de mettre en œuvre des milieux d’hébergement présentant les qualités identifiées. Cet essai est également l’occasion du développement d’un outil réflexif pour une pédagogie et une pratique vertueuse du design. / The phenomenon of an aging population brings with it a whole host of diverse challenges. Some of these challenges are of a general nature, such as those related to economics, while others are much more specific, such as the conditions and procedures needed to ensure that vulnerable individuals receive adequate care and services. For instance, a symposium entitled “Providing a quality experience for users and loved ones: personalization of care and social services,” held during the fall 2014 Entretiens Jacques-Cartier, aimed to examine personal user experiences pertaining to the delivery of health care services and the organization of social services. This meeting’s initial hypothesis underscored the need for a more balanced power dynamic with caregivers or in the delivery of care. This hypothesis is based on the concept of user capabilities, achieved through the adoption of practices which enable professionals to provide personalized care. Further exploration of this particular issue is at the core of this doctoral thesis. This research aims to examine the conditions which would allow people living in long-term care facilities to engage with their environment in a way the sociologist Laurent Thévenot categorized as “familiar engagement.” Familiar engagement refers to realities in which people are able to rest on an accustomed dependency with the things and people that surround them. In other words, this type of engagement refers to a relationship with one’s environment which allows individuals to take part in their usual habits, and where they feel at home and at ease in their surroundings. As Thévenot’s analysis shows, this type of engagement requires the conception of a world which allows people to frame their actions around reference points which are personally relevant to them. Thus, this research aims to better understand the role of designers in the conception of nursing homes where this type of pragmatic engagement is made possible. The guidelines for the development of residential facilities able to satisfy these criteria are largely in line with the expectations surrounding the development of user-centered design, experience design, and empathic design. That being said, despite the efforts put forth towards this initiative, self-identification with one’s environment remains an unresolved problem. Our hypothesis is that the evolution of user-centered design is too often restricted by methodological or procedural issues. Development in this direction has been done to the detriment of the precise examination of the virtues needed by designers in order to be able to seriously take on the issues associated with the goals of this design approach. More specifically, this research identifies the qualities of long-term care facilities’ experience whose design allows for familiar engagement. For our study, we analyzed the findings and judgments of living environment evaluation teams concerning the quality of living environments of the long-term care facilities in the Montreal area. Through this survey, five qualities have been identified: welcomeness, conviviality, flexibility, thoughtfulness and stability. Finally, as a reflective essay, a portrait of virtues is suggested as a way for designers to implement facilities that share those qualities. The dissertation also presented a reflexive tool for a virtuous design practice and pedagogy.

Annotation: The purpose of this Master's thesis is to describe objectively topic of medical social workers' communication in centers of post-acute care, to highlight importance and difficulty of social work with senior citizens and to propose eventual changes leading to eventual communication improvement. Social work here is complicated because senior citizens are often lonely or may have problematic family relationships or may suffer from dementia and quite often are polymorbid patients. For the thesis were used statistics from The Centre of Postacute Care - Motol University Hospital, then method of questionnaire realized with medical social workers from centers of post-acute care in Czech Republic, and method of structured interview with patients in Center of Postacute Care - Motol University Hospital.

Yes / This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.