The main topic of this thesis concentrates on the adolescents' leaving process from foster families in our Czech territory. The aim of the presented thesis is a deeper exploration of the leaving process preparation from foster families and circumstances connected with it. The theoretical part of this thesis is divided into three chapters. The first of them deals with the adolescence period with its developmental specifics. The second one describes foster care and its partition in the Czech legislative system. The same one also presents available Czech and foreign research. The last chapter focuses on the two topics: the leaving process of adolescents from foster care from a legislative point of view and how it names participants who contribute to this leaving process. At last, it shows some useful Czech social care services for adults. The practical part of the thesis presents a realised qualitative study with three groups who contributed on foster care in the Czech area. These involved groups were adolescents (16+), their foster mothers who share the same household and social workers. This research tried to bring answers for the questions about the adolescents' leaving process from long-term foster care and other similar topics which deal with it. The results of the research were deeply analysed...

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.

This study focused on the psychosocial effects of parental loss on children orphaned by HIV/AIDS. The primary aim of the research was to explore the psychosocial effects of parental loss on children orphaned by HIV/AIDS through the eyes of the caregivers. Five participants were selected for this study using convenience sampling. The data was collected using face-to-face semi-structured interviews. The interviews were analysed using thematic content analysis and themes were extracted and presented. The results of this study indicate that children orphaned by HIV/AIDS living in the children’s home experience many psychosocial problems. Further research on the psychosocial issues specific to orphaned children raised in children’s homes in rural areas is recommended / Psychology / M. A. (Clinical Psychology)

Frailty poses a complex challenge for some people through their experience of ageing. In Wales, devolution requires organisations to use a whole systems approach with a model of partnership to deliver public services. An integrated care approach is offered to meet the service user focus or ‗value demand‘ which impacts on clinical, professional, organisational and policy levels within the system. Therefore, the aim of this study was to explore whether there was a difference between integrated health and social care day services and non- integrated health and social care day services. In doing so, answering the questions, how were these services different, what were the differences as perceived by the participants, why were they different, what could be learned from this study and how could health and social care services integrate in practice? The study utilized Gadamer‘s interpretative hermeneutics with a single intrinsic case study design. Using this approach ensured that the unique voice of the individual lived experience was heard and interpreted within the whole system of the study. The participants were service users, carers and staff in a day hospital, an outpatient clinic, day centre, reablement team and a joint day care facility. The methods included a survey questionnaire (SF12v2 and London Handicap Scale), in-depth interviews, observations; and historical and service documents; and reflective diary. Data collection occurred January 2005 to December 2006. Quantitative and qualitative data were analysed separately. The qualitative data was analysed using Gadamer‘s five stage approach developed by Fleming et al (2003) and Nvivo 7.0. The embedded quantitative data was analysed using SPSS version 13.0. Triangulation was achieved through the use of a meta matrix which merged the qualitative and quantitative data. The difference between integrated and non integrated services is expressed through the four themes, ‗the study participants‘, ‗commissioning and decommissioning integrated services‘, ‗the journey within day services‘, ‗navigating services and orchestrating care‘. The four themes were developed through a strategy used for interpreting the findings, which was to follow the study questions, propositions and ‗emic‘ questions. The differences between the integrated and non integrated services were in the meaning of their purpose, culture, level of integration, team orientation of practice and the model of service user/carer relationship observed within the services. The thesis identified challenges in respect of integrated working such as concept confusion, negative experiences of care for frail or older people, a vertical gap in knowledge transfer between strategic organisation, the operational services and service users. Mapping each service level of integration and team orientation to the model of service user and carer relationship, found that the level of team orientation and integration does not appear to be proportionate to the service user and carer relationship. The thesis concludes that in order to attempt to answer the question as to whether these day services can integrate in the practice, all levels of the system should focus on the service user/carer relationship. We need to understand service user diagnosis, how its characteristics and effect are interpreted by the service user, carer, professional and wider society in relation to independence and autonomy. It argues that knowledge emerges at this micro level (service user and carer relationship) and how we engage with this relationship and manage the knowledge we gain from it (both vertically and horizontally), will lead us to understand how we can ensure that integration occurs and that services in the future are person focussed.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Home-based rehabilitation (HBR) in under-resourced areas in a primary health care context exposes students to the real life situations of clients. The educational experience of HBR, underpinned by the theory of situated learning, promotes experiential and transformative learning. HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. Physiotherapy students and their clients frequently have diverse lingual, socio-economic and cultural backgrounds which may hinder the provision of appropriate treatment to clients in their residences. Increased knowledge of HBR in the physiotherapy context could result in an enhanced experience for both student and client. This study sought to explore the perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. Whether the students felt adequately prepared to perform HBR was also explored. A qualitative research design in the interpretivist paradigm was used. An exploratory case study was performed. Semi-structured interviews were conducted with clients (N=7) living in an under-resourced setting who had received HBR from physiotherapy students. Paired interviews were conducted with final year physiotherapy students (N=6) after their HBR placement. The data were subjected to inductive thematic analysis and themes developed. The findings showed that while clients appreciated the students’ services, there were communication barriers and unmet expectations. Students reported difficulty in adapting to the unfamiliar context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency to assist in communication. Earlier facilitated exposure to under-resourced contexts in the early clinical phase was suggested to reduce culture shock. An awareness of home environments in under-resourced areas influenced the students’ interventions in other contexts. To gain maximum benefit from the learning opportunities available through HBR, students require support for client management and client-centred problem solving in an under-resourced setting. Guided reflection should form part of the HBR placement to facilitate the construction of new knowledge, to promote deep transformative learning and to increase the students’ awareness of their role as change agents. Exposure to real life situations in under-resourced settings in the form of HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they will serve during community service. / AFRIKAANSE OPSOMMING: Tuisgebaseerde rehabilitasie (TBR) in ondervoorsiende gebiede in die primêre gesondheidsorg-konteks stel studente bloot aan die werklike lewensomstandighede van kliënte. Die opvoedkundige ondervinding van TBR, gerugsteun deur die teorie van gesitueerde leer, bevorder ervarings- en transformasionele leer. TBR lei nie net tot akademiese leer en persoonlike ontwikkeling nie, maar bevorder ook insig in maatskaplike verantwoordbaarheid en verantwoordelikheid. Fisioterapie-studente en hul kliënte het dikwels verskillende taal-, sosio-ekonomiese en kulturele agtergronde wat kan verhinder dat die toepaslike behandeling vir kliënte tuis verskaf word. ’n Toename in kennis van TBR in die fisioterapie-konteks kan lei tot ’n beter ondervinding vir beide die student en die kliënt. Die doel van die studie is om die persepsies van die fisioterapie-studente en hul kliënte met betrekking tot TBR, as deel van die kliniese opleiding in omgewings waar daar beperkte hulpbronne is, na te vors. Daar is ook nagegaan of die studente gevoel het dat hulle genoegsaam voorberei is om die TBR toe te pas. ’n Kwalitatiewe navorsingsontwerp in die interpreterende paradigma is gebruik. ’n Verkennende gevalle-studie is gedoen. Semi-gestruktureerde onderhoude is met die kliënte (N=7) wat in ondervoorsiende omstandighede leef en wat TBR van fisioterapie-studente ontvang het, gevoer. Onderhoude is in pare met fisioterapiestudente in hul finale jaar (N=6) gevoer nadat hulle hul TBR-plasing voltooi het. ’n Induktiewe tematiese analise van die data is gedoen en temas is ontwikkel. Die resultate het getoon dat, alhoewel die kliënte waardering gehad het vir die dienste wat deur die studente gelewer is, daar kommunikasiegapings en onvervulde verwagtinge was. Die studente het gerapporteer dat hulle gesukkel het om aan te pas by die onbekende omgewing met die gevolg dat die intervensies nie genoegsaam kliëntgerig was nie. Hulle het ook aangedui dat daar ’n behoefte is om die nodige taalvaardigheid te ontwikkel om kommunikasie te verbeter. Die kultuurskok wat beleef is, kan moontlik in die vroeë kliniese fase reeds gefasiliteer word deur die studente aan ondervoorsiende kontekste bloot te stel. Die kennis van die tuisomgewings in ondervoorsiende areas het ’n invloed gehad op die studente se intervensies in ander kontekste. Studente benodig ondersteuning in kliëntebestuur en kliëntgesentreerde probleemoplossing in ondervoorsiende omgewings ten einde maksimum voordeel te verkry uit leergeleenthede wat beskikbaar is deur TBR. Begeleide refleksie behoort deel te vorm van die TBR-plasing om die opbou van nuwe kennis te fasilliteer, diepgaande transformatiewe leer te bevorder en die student se bewustheid van hul rol om verandering teweeg te bring, op te skerp. TBR voorsien nie net waardevolle, outentieke leergeleenthede ter plaatse nie, maar gee ook die fisioterapie-studente blootstelling aan die werklike situasies waarin mense hulle in ondervoorsiende omgewings bevind. Hierdie ondervinding kan waardevol wees om graduandi voor te berei om die behoeftes aan te spreek van die bevolkingsgroepe wat hulle tydens hul gemeenskapsdiensjaar sal bedien.

This descriptive correlational study describes the relationships among 30 home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care. The self-report data were collected using a Nursing Invasiveness Scale (NIS), Index of Patient Territorial Control Perceptions (IPTCP), and Patient Satisfaction Instrument (PSI). The subjects were males and females, aged 23 to 93 years, who were receiving home care nursing. Analysis of the data suggests that the subjects perceived a low level of invasiveness by home care nurses, "much control" within their homes (their primary territories), and were highly satisfied with their nursing care. There was a significant negative correlation (r = -0.79) between perceptions of nursing invasiveness and satisfaction with nursing care. The relationships between perceptions of nursing invasiveness and territorial control (r = -0.02) and between perceived territorial control and satisfaction with nursing care (r = 0.14) were not significant.

A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Legislation in South Africa pertaining to the care and protection of children is presently being revised and changed. Should alternative care be necessary for a vulnerable child, the Children's Act 38/2005 prioritises a foster care placement over a child and youth care centre of which a Children's Home is a part. Given the steady decline in traditional family living due to, amongst other things HIV/AIDS, poverty and unemployment in South Africa, the dominant view of family care being prioritised may not always be feasible in reality. The study researched this view by hearing the voices of children and their caregivers, in both foster care and in Children's Homes by conducting a qualitative study based on the exploratory and descriptive designs A purposive sampling strategy was used as there were clear criteria for the selection of participants. There were two sample groups. One consisted of child participants and the other consisted of caregivers viz. foster parents and child-care workers. Caregivers were included for the purposes of enhancing reliability, validity and trustworthiness of the study. Data was collected by means of semi-structured in depth interviews with the child participants. Two focus groups were held with the caregivers; one with the foster parents and the other with the child-care workers. Both the in depth interviews as well as the focus group discussions were guided by similar themes that were linked to the main objectives of the study. The findings revealed that children's voices were largely absent in decisions pertaining to their well being; that they preferred to live with families of origin as opposed to alternative care and should they be placed in alternative care, foster care was preferred to Children's Homes. The findings further emphasized the need for infrastructural support such as family preservation programmes, financial and social work support for all poverty stricken families and strengthened human resources for Children's Homes. Recommendations therefore centred around ways in which to capacitate families of origin; ways of including children in decision making and the necessary infrastructural support to ensure optimum care for vulnerable children. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007

Bakgrund: Medellivslängden i Sverige ökar vilket leder till en ökad äldre befolkning. För att kunna bo hemma så länge som möjligt kan de äldre behöva få hjälp från hemvården. Syfte: Att undersöka vilka faktorer som upplevs påverkar de äldres tillfredsställelse av vården samt vad som är viktigt för de personer som får hjälp. Metod: En deskriptiv kvalitativ intervjustudie. Semi-strukturerade intervjuer gjordes med 11 brukare från två olika kommunala hemvårdsområden. Resultat: Personal och Utförande var två huvudkategorier som kom fram av analysen. Informanterna beskrev sina upplevelser och vad som var viktigt för dem inom dessa ramar. Kategorin Personal kunde delas upp i två underkategorier; Yrkeskompetens och Bemötande. Utförande delades in i underkategorierna; Hemtjänsten – ett serviceperspektiv, Självbestämmande, Kontinuitet och Trygghet.   Konklusion: För att man som utförare av hemtjänst skall förbättra vården är det viktigare att fokusera på de processrelaterade faktorerna som har en stor betydelse för hur brukarna upplever hemvården. Genom att lägga stor vikt vid personalens sociala kompetens vid rekrytering samt att involvera brukaren och dennes familj i vården och utformandet av den kan positiva upplevelser av vården skapas. Detta ser ut att kunna skapa ökat välbefinnande hos brukarna. / Background: The average age in Sweden increases which leads to an increased population of old people. In order to live in their own homes as long as possible, elderly people may be in need of help from the community home-services. Aim/objectives:The goal of this study was to examine variables perceived to affect older people’s satisfaction of home care services and what they emphasize important in the care.  Design: Descriptive qualitative study with interviews. Semi-structured interviews are done with 11 clients receiving care from two different community home-service areas. Results: ’Staff’ and ‘Services’ were the main categories of the results. The clients described their experiences and what they assumed as important for them. The category ‘Staff’ were divided into sub-categories: ‘Professional competence’ and ‘attitudes from staff’. ‘Services’ were divided into four other sub-categories: ‘the community home-service- a service perspective’ ‘self-autonomy’, ‘continuity’ and ‘safety’. Conclusions: The health care providers for the home care services should focus on improvements regarding process related factors, because they are important for the client’s experiences of the home care services. When recruiting new persons for a job in the home care services, the focus should be on his or hers social competence. Furthermore, to involve the client and his or hers family in the care may create positive experiences and increase the clients wellbeing.