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This study is a descriptive qualitative analysis of the values and traits of rehabilitation counselor life care planners. Using the theoretical foundation of the Person-Environment fit theory, it reviews the available literature on rehabilitation counselor life care planners and fills in a missing sub-category of research on Person-Group fit within the private rehabilitation field and life care planning. It contains a review of rehabilitation counselor identity in order to provide context to how rehabilitation counselor life care planners view themselves as practitioners, particularly the role of income in career fit given ethical concerns surrounding money in the practice of life care planning. The primary traits resulting from this study are emotional differentiation, counselor as educator/performer, desiring intellectual excellence, detail oriented, and financial awareness. The primary values resulting from this study are recognition of humanity, integrity, objectivity, freedom in work, and social and financial responsibility. These results are discussed within the social culture of rehabilitation counseling to better understand their development.

No description available.

Thesis (M.S.) --University of Texas Graduate School of Biomedical Sciences at San Antonio, 2008. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin, School of Nursing. / eContent provider-neutral record in process. Description based on print version record.

Advance care planning for adults is a process of consideration, discussion and decisions about care at the end of life. There is evidence that advance care planning improves outcomes such as the achievement of preferred place of death and the quality of dying. However, the uptake of advance care planning is variable. There are calls for more research to understand what influences people to carry it out to plan services and improve the quality of life of patients and their families. This dissertation reports on a qualitative, video interview study of 15 adult hospice patients. The study was interpretative influenced by the narrative approach with data driven thematic analysis and a video aide memoir. Coding was carried out using the Computer Assisted Qualitative Data Software programme Transana. The rigour and credibility of the study was viewed through the lens of trustworthiness which included the development of a Continuous Conversation Framework. The aim of the study was to investigate what would influence hospice patients to discuss their advance care planning to develop future education programmes based upon the perspectives of people at the end of their life: 1. What influences hospice patients in their advance care planning? 2. What communication skills do hospice patients find helpful when clinicians discuss advance care planning? Three findings are reported. These suggest that the influences on advance care planning activity and conversations is the less reported relationship of the personal context of a person's life (as well as services, diagnosis and prognosis considerations). First, the findings highlight the relevance of how people with an incurable illness live with and talk about their dying within the individual context of their daily lives. Secondly, differences are illustrated between how people prepare (for themselves) and plan (for others) in their dying. Thirdly, clinician communication behaviours such as empathy (through mutual connection and visible behaviours), tailored conversations (through accessible and selective honesty) and the design and use of space empower people to carry out conversations which support them as they live with, prepare and plan for dying. The three findings contribute to the perspective which supports the complexity of advance care planning that should focus on the context of person's life as well as the paperwork, prognosis or diagnosis. A contribution to person-centred care is suggested through a model of relational advance care planning.

Older adults with dementia are at increased risk of becoming incapable of making their own decisions and may therefore benefit from planning for care at the end-of-life. Advance care planning (ACP) is a complex, multifaceted process by which people can express their wishes about care at the end-of-life in case they become incompetent to make decisions for themselves. However, we have little understanding of the ACP process among people with dementia and their families. This study addressed three questions: 1) when and how to cognitively impaired older adults and their families receive information about ACP; 2) in which aspects of the ACP process do families of cognitively impaired older adults engage, and why (and does this fit within the framework of the transtheoretical model of behaviour change [TTM]); and 3) how ACP relates to the way in which family members perceive the quality of death of their loved one. 22 family members of deceased older adults with dementia were interviewed and data was analyzed using interpretive description qualitative methods. Participants reported that information about ACP is provided in a haphazard and often incomplete manner, leading to difficulty engaging in the ACP process. Older adults were in various stages of readiness to engage in ACP behaviours, with most only engaging in a subset of ACP behaviours. Although ACP was viewed as beneficial by participants, several barriers were identified that prevented people with dementia from dying in a way that was aligned with previously-expressed wishes. Implications for the practice of clinical neuropsychology and implications for policy on ACP are discussed. / Graduate

Advance care planning (ACP) is a process of discussing the patient’s wishes and preferences for future health care. ACP allows for the patient to retain their autonomy and involves informing the patient about their illness, prognosis, and their health care options. Despite the known advantages of completion of ACP forms, ACP discussions are minimal during primary care visits. The purpose of this DNP project was to identify primary care providers (PCP) beliefs and attitudes regarding barriers to addressing ACP with patients with a chronic illness in the primary care setting at one family practice clinic in Tucson, Arizona, and to determine if providing educational information will increase the PCPs intent to address ACP within clinical practice. A pre-survey, educational handout, and post-survey containing Likert-type scale questions and one ranking format question was created and sent via email to potential participants within the family practice clinic. The pre-survey requested demographic characteristics, and both the pre and post surveys assessed the PCPs beliefs and attitudes towards barriers to addressing ACP. 42 potential PCPs were asked to participate in the online surveys, eight (19%) completed the pre-survey, and four (9.5%) completed the post-survey. The data obtain from the surveys indicate lack of time, discomfort with the subject, and communication barriers as the most frequently reported perceived barriers to addressing ACP in the primary care setting. The results from this project can be used to understand PCPs beliefs and attitudes towards addressing ACP in the primary care setting and how this can affect future care of the patient when a serious illness occurs.

This thesis uses an ethnographic study to interrogate the policy discourse of capturing ‘child voice’ specifically in relation to a ‘looked after’ child. In recent years, attempts have been made to involve children who are ‘looked after’ in discussions and decisions about their care arrangements to ensure that their voice is heard. To ensure this happens, children ‘in care’ are asked about their care placement regularly as part of the care planning review process and their views are incorporated into decisions about their care plan. This study focuses on the lived experiences of a seven-year old female child, who I have referred to as ‘Keeva’, who is ‘in care’ under a Kinship Care arrangement. Over a period of a year, I was based in Keeva’s home one afternoon a week to gain insights about her lived experience as a ‘looked after’ child and how she represented herself. I also observed three care planning review meetings to see how her voice was captured by those charged with her care and how she was represented. I relate Keeva’s experience through seven narrative episodes to capture the rich complexity of the social world she inhabits. I explore aspects of her home and family, her interactions with others and her experience of exploring physical spaces both inside and outside the home. I suggest that these experiences underpin her sense of self and how she relates to others. Drawing on the ideas of Bourdieu, I suggest these experiences and her sense of place in the social order write themselves ‘onto her’ through her habitus and dispositions. Using a Foucauldian lens, I problematise the notion of voice as I contest that the child I observed engaged fully in the statutory processes that surround her. I suggest Keeva, a child who is ‘looked after’, will neither have nor feel she has the agentive properties to influence the care planning process. Instead, as her voice is irrevocably bound up in a bureaucratic process that is uncritically accepted as representative of her, she is obscured as a consequence. I also examine the multivocity in representations of Keeva highlighting the competing discourses of safeguarding, child protection and the ’rights-based’ agenda. I conclude that Keeva was not well represented in care planning reviews and had very little influence in decision-making about her care plan. Despite believing the opposite, those charged with her care failed to hear her or take note of what she said. Furthermore, there was an absence of criticality in representations of Keeva allowing Keeva to be constructed by those professionals involved with her care, in an unchallenged way. As a consequence she was silenced and less visible than the process itself.

Primary nursing is a system of delivering nursing care when one nurse is responsible and accountable for the assessment of the patient's needs as well as the planning, implementing and evaluating of the nursing care throughout the patient's hospitalization. These activities are done in collaboration with the patient and other members of the health team. This system is a relatively recent development in the field of nursing. There has been little research done to either describe or evaluate primary nursing, particularly in the area of psychiatry. This study was an attempt to include both patients and nurses in such an evaluation. A validated and reliable questionnaire was developed by the author to obtain data related to patients' and nurses’ perceptions of the occurrence, importance and satisfaction of specific primary nursing behaviours. The questionnaire was administered to twenty-nine patients and their primary nurses during the last week of the patient's hospitalization. Nurses and patients reported that primary nursing behaviours related to discharge had a low occurrence rate. However, they attributed a high degree of importance to these same behaviours. Both groups reported a low occurrence and importance score for primary nursing behaviours related to family involvement with the primary nurse and the patient's treatment program. Both nurses and patients agreed on the occurrence and importance of most of the primary nursing behaviours. There was less agreement in the area of satisfaction. / Applied Science, Faculty of / Nursing, School of / Graduate