ln 1998, the Florida state legislature mandated the privatization of child welfare services. The decision to contract child welfare services to non-profit organizations was done as an effort to attain lower costs, effectiveness, and quality in service delivery. The 1998 initiative came to be known as "Community-Based Care" and was based on the idea that local communities would have incentives to be more accountable for children than the state. The federal government requires that safety be the paramount goal for all children in the child welfare system. The purpose of this study was to assess if Community-Based Care was indeed effective in this principal objective with the use of the researcher's own developed definition of "safety" and three safety performance measures relative to her definition taken from the Florida Department of Children and Families online performance dashboard application. This research focused on the Community-Based Care initiative in district 7 (Orange, Osceola, Seminole, and Brevard counties) and drew attention to the question, are district 7 's children safer now since the privatization of child welfare services? From a public management perspective, this study showed that privatized child welfare services are both capable and incapable of keeping children safe due to various factors. The findings from this study are important as they can give national, regional, and local public managers a significant and unique view on privatized child welfare services along with associated benefits and shortcomings in ensuring children's safety.

Bakgrund: Distriktssköterskor i hemsjukvården arbetar självständigt i ett växande arbetsfält med allt sjukare patienter och mer avancerad vård. Teamarbete, samverkan och arbetsledning ställer höga krav på distriktssköterskans arbete vilket har väckt uppmärksamhet och forskning kring arbetssituationer som ställer så pass höga krav på distriktssköterskan att det inverkar negativt på distriktssköterskans hälsa och riskerar patientsäkerheten. Syfte: Att undersöka distriktssköterskors erfarenhet av svåra situationer i hemsjukvården. Metod: Studien har en kvalitativ ansats. Tolv distriktssköterskor verksamma inom kommunal hemsjukvård har deltagit i studien och med hjälp av semistrukturerade intervjuer har data insamlats. Därefter har data analyserats genom induktiv innehållsanalys. Resultat: Distriktssköterskor i hemsjukvården erfar svåra situationer i en bristande arbetsmiljö, i svårigheter i rollen som omvårdnadsledare, i bristande samsyn inom vårdorganisationen samt svårigheter i relationen med anhöriga och patient. För varje kategori finns underkategorier såsom hot och våld, ensamarbetets baksida, tidsbrist, svårt att leda arbetet när personalen brister i sin yrkesutövning, baspersonal som bedömer patienten ur ett annat perspektiv, stöttande av personal i svåra situationer, samverkan med andra professioner, svårt att få kontakt med läkare, anhörigas behov av bekräftelse och försummande av egenvårdsansvaret. Konklusion: Distriktssköterskorna erfor flera svåra situationer inom den kommunala hemsjukvården. För att säkerställa distriktssköterskors hälsa och trygga patientsäkerheten behöver dessa situationer synliggöras och åtgärdas. / Background: District nurses in home care work independently in a growing field of work with increasingly ill patients and more advanced care. Teamwork, collaboration and staff management demand high quality in the district nurse performance, which has drawn attention and research to work situations demanding so much that the district nurse health and patient safety are adversely affected. Purpose: To investigate the district nurses' experience of difficult situations in home caring. Method: The study has a qualitative approach. Twelve district nurses working in municipal home care participated in the study and data was collected through semi-structured interviews. Data has been analyzed through an inductive content analysis. Results: District nurses in home care experience difficult situations in a lacking work environment, difficulties in the role as nursing leader in a lacking consensus in the caring organization, as well as difficulties in the relation between dependent and patient. Each area is divided in sub categories, such as threat and violence, working alone, time constraints, difficulties in management when personnel is lacking in performing nursing care, collaboration with other profession, supporting personnel, difficulties of getting in touch with doctors, caring staff assessing patients in another perspective, dependents’ need of confirmation and patients lacking in self-care. Conclusion: District nurses experience difficult situations in nursing homecare. To ensure the district nurses´ health and ensure patients safety requires these situations have to be made visible and addressed.

<p>This thesis deals with a very important issue in South African society, i.e. the provision of financial and non-cash support to older persons. Older persons in South Africa can be described as a sizeable but vulnerable group requiring specific protection. Section 27 of the South African Constitution of 1996 obliges the state to take reasonable legislative and other measures within available resources to progressively realise the right of access to social security. Hence, the steps taken by the state to promote older persons&rsquo / right of access to social security and to protect their right to dignity need to be evaluated. The legislative framework for the provision of financial and non-cash support to older persons currently is fragmented into various statutes dealing with retirement income, state grants to older persons and care and support services for older persons. Therefore, the current legislation lacks an integrated approach to the provision of support and care to older persons, as well as a central principle on which to base future legislation concerning older persons. One such principle that could potentially be adopted is intergenerational solidarity, which can be described as the solidarity between the active working-age population, as one generation, from which benefits flow to older persons as the other. This thesis evaluates whether intergenerational solidarity should form the basis of South African legislation on the provision of retirement income and the provision of care and support to older persons, and if so, whether it in fact does. If the answer to the latter is in the negative, the thesis further examines whether the current process to reform the retirement income system and related legislation in South Africa would be a suitable platform to introduce the concept of intergenerational solidarity to legislation concerning older persons.</p>

According to the statistics from Department of Health, Executive Yuan, in 2007,brain attack has been listed as the third of the top ten reasons for death. In Taiwan, the occurrence rate of brain attack on population above 35-year-old is 3/1000. And the total amount of population above 35-year-old is nearly 10,000,000. Then the latest number of occurrence of brain attack is approximately 30,000¡COnce the stroke happens, under such a circumstance, not only the expense of acute care increases but also the long-term medical care expense, the family and social cost will become larger. In view of that, the long-term care plan for stroke patient has been in urgent need. This research, ¡¨Long-distance Community Health Care Nursing Service for Stroke Patients¡¨, which is originated from a plan conducted by a medical center in Southern Taiwan. Based on Andersen¡¦s¡]1968¡^health behavior model as the theoretical structure¡Awe studied 102 patients who had a stroke (including high stroke risk patients)within one year in Kaohsiung. In this study, we applied JMP V6.0¡]SAS Institute, Cary, NC, USA¡^to analyzing case characters¡Aconducting univariate analysis by £q2 analysis and ANOVA. Then we applied multivariate logistic regression analyses to significant variables. We hope to find out the predisposition, enabling factors and need factor from those important predictor variables in ¡§Long-distance Community Health Care and Nursing Service¡¨. We research the differences of stroke patients¡¦ behaviors, providing those research results as the reference materials for related business promotional strategy in future, hoping to advance the quality of long-term care and nursing for stroke patients. In this study, total 102 copies of the questionnaire were sent out and returned, with a return rate of 100%, and 100 copies of questionnaire were effective. The research results show that: 1. Predisposition¡GThere are significant differences on these items--¡§Number of Children¡¨(Demography), ¡§Buddhist¡¨(Religion) and ¡§Those who have a health check within nearly one year¡¨(Health Concept). 2.Enabling factors¡GThere are significant differences on these items--¡¨Monthly Family Income¡¨(Economical factor),¡¨Monthly Balance of Payment¡¨(Economical factor) and ¡§Commercial Insurance¡¨(Insurance resource). 3.Need factors¡GPeople (those who think their health state stay at the average level), Health State (¡§High Blood Pressure and Heart Attack¡¨,¡¨Eye Diseases¡¨, ¡¨Cancer¡¨,¡¨Bone and Muscle¡¨,¡¨Asthma¡¨,¡¨Ears Disease¡¨and ¡¨Neural Diseases¡¨are involved. The behavior research includes ¡§Number of Accepting Medical Treatment per month¡¨(1 to 2 times), ¡§Activity in Daily Life ¡¨¡]ADL¡BIADL-Shopping Ability¡^and ¡§Functional Behaviors¡¨. 4. To sum up, the predisposition, enabling and need factors in this research could partially influence using behaviors¡Ain accordance with Andersen¡¦s inference in health behavior model. In conclusion¡G1.¡¨Long-term Community Health Care and Nursing¡¨ can be applied to stroke patients, which can help patients to build up effective self-management and advance life quality; 2. This service combines Medical Service Chain established by Information-Telegraphic Technology. Currently, blood pressure checking and telephone consultation are most popular service among interviewees, and other kinds of service are under development; 3. Stroke patients with different demographical characters show a great difference on using behaviors; 4. To speak briefly, this service can meet the ideal long-term care and nursing standard for local aging population.

<p>This thesis deals with a very important issue in South African society, i.e. the provision of financial and non-cash support to older persons. Older persons in South Africa can be described as a sizeable but vulnerable group requiring specific protection. Section 27 of the South African Constitution of 1996 obliges the state to take reasonable legislative and other measures within available resources to progressively realise the right of access to social security. Hence, the steps taken by the state to promote older persons&rsquo / right of access to social security and to protect their right to dignity need to be evaluated. The legislative framework for the provision of financial and non-cash support to older persons currently is fragmented into various statutes dealing with retirement income, state grants to older persons and care and support services for older persons. Therefore, the current legislation lacks an integrated approach to the provision of support and care to older persons, as well as a central principle on which to base future legislation concerning older persons. One such principle that could potentially be adopted is intergenerational solidarity, which can be described as the solidarity between the active working-age population, as one generation, from which benefits flow to older persons as the other. This thesis evaluates whether intergenerational solidarity should form the basis of South African legislation on the provision of retirement income and the provision of care and support to older persons, and if so, whether it in fact does. If the answer to the latter is in the negative, the thesis further examines whether the current process to reform the retirement income system and related legislation in South Africa would be a suitable platform to introduce the concept of intergenerational solidarity to legislation concerning older persons.</p>

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2008. / Title from first page of PDF document. Includes bibliographical references (p.66-68).

Doctor Legum - LLD / This thesis deals with a very important issue in South African society, i.e. the provision of financial and non-cash support to older persons. Older persons in South Africa can be described as a sizeable but vulnerable group requiring specific protection. Section 27 of the South African Constitution of 1996 obliges the state to take reasonable legislative and other measures within available resources to progressively realise the right of access to social security. Hence, the steps taken by the state to promote older persons&rsquo; right of access to social security and to protect their right to dignity need to be evaluated. The legislative framework for the provision of financial and non-cash support to older persons currently is fragmented into various statutes dealing with retirement income, state grants to older persons and care and support services for older persons. Therefore, the current legislation lacks an integrated approach to the provision of support and care to older persons, as well as a central principle on which to base future legislation concerning older persons. One such principle that could potentially be adopted is intergenerational solidarity, which can be described as the solidarity between the active working-age population, as one generation, from which benefits flow to older persons as the other. This thesis evaluates whether intergenerational solidarity should form the basis of South African legislation on the provision of retirement income and the provision of care and support to older persons, and if so, whether it in fact does. If the answer to the latter is in the negative, the thesis further examines whether the current process to reform the retirement income system and related legislation in South Africa would be a suitable platform to introduce the concept of intergenerational solidarity to legislation concerning older persons. / South Africa

Bakgrund: Svårläkta sår är ett globalt problem och innebär ökade kostnader för samhället. Sårvård är en stor del av distriktssköterskans arbete och innebär samverkan med patient och andra yrkeskategorier. Syfte: Att beskriva distriktssköterskans erfarenheter av samverkan vid vård av patienter med svårläkta sår i hemsjukvård. Metod: Metoden som användes var kvalitativ innehållsanalys med induktiv ansats. Datainsamling skedde genom elva kvalitativa, semi-strukturerade intervjuer med distriktssköterskor som har arbetat med sår inom kommunal hälso- och sjukvård. Resultat: Resultatet visar att distriktssköterskans upplevelse av samverkan vid sårvård kan liknas vid ett lagspel, där det finns möjligheter och hinder under spelets gång. Samverkan vid sårvård påverkas av olika spelregler, vilka som deltar och i vilken grad de tar sitt ansvar. Distriktssköterskornas kunskap skapar möjlighet till utveckling. Slutsats: Vilka möjligheter och hinder som distriktssköterskan stöter på under samverkan kring sårvård är avgörande för hur utgången blir för patienten med såret. Hinder kan vara både prövande och tidskrävande processer. Möjligheter skapas genom kunskap och kännedom om varandra som personer bakom vår yrkesroll. / Background: Wound Care is a global problem and involves increased costs for society. Wound care is a major part of the district nurse's work in the home care setting and involves collaboration with patients and other occupational categories. Aim: To describe the district nurse's experiences of collaboration in the care of patients with difficult-to-heal wounds in home health care. Method: A qualitative method was used in the study and the result was analyzed according to meaning analysis. Eleven district nurses were interviewed. The thesis used qualitative content analysis. Results: The result shows that the district nurse's experience of cooperation in wound care can be compared to a team game, where there are opportunities and obstacles during the course of the game. Collaboration in wound care is influenced by different rules of play, who participate and the degree to which they take their responsibility. The district nurses' knowledge creates opportunities for development. Conclusion: The opportunities and obstacles that the district nurse encounters during collaboration on wound care are decisive for how the outcome will be for the patient with the wound. Obstacles can be both trying and time-consuming processes. Opportunities are created through knowledge and knowledge of each other as people behind our professional role.

Aim: To evaluate Home-based interventions to lower neonatal mortality rates in developing countries. Background: A developing country is a country that is lacking in the services and facilities enjoyed by people in developed countries, such as personally owned automobiles and homes with indoor plumbing and water-carried sewage disposal systems. The difference in resources compared to developed regions, has been evident to the correlation of the increase neonatal mortality rates. Method: An electronic, systematic review of four databases were used to retrieve 209 articles initially, later filtered to 42 articles utilized in this review. The following databases used are as listed: CINAHL Plus with Full Text; APA PsycInfo; Cochrane Database of Systematic Reviews; and MEDLINE. Articles had to solely refer to developing regions and neonatal mortality. Key Issues: Developing countries continue to report the highest neonatal mortality rates. The leading etiologies for increased neonatal mortality rates (NMR) differ in these regions compared to developed countries. Causes and factors must be understood to allow for the appropriate interventions to be implemented in the plan of care. Conclusions: Home-based interventions and community care have shown to significantly aid in the reduction of neonatal mortality rates in developing countries. Evidence based studies have also concluded that interventions are often presented in packages. Packages targeting individual households with home-based intervention; packages improving communities with health workers; and packages aiming to strengthen the trust between facilities and communities via referrals and recommendations.

Prenatal care (PNC) is an essential health service that can reduce adverse health and social outcomes through prevention, detection and treatment of abnormalities of pregnancy. It offers an opportunity to mitigate the impact of the Social Determinants of Health (SDoH) on individual patients through advocacy and referral to social services. Despite a publicly funded health care system in Canada, disparities in access to PNC persist. Much is known about the barriers to PNC and client experiences of inadequate PNC (IPNC). Very little is known about care provider perspectives of IPNC, what should be done about it and are the barriers to doing it. The goal of this project was to address this gap in knowledge to inform the development of novel care delivery models that could reduce disparities in access to PNC in Hamilton. Using a Critical Theory lens, I conducted an interpretive descriptive study using individual interviews and focus groups with health and social service providers in Hamilton to explore their understandings of IPNC. Participants viewed IPNC as a small but important phenomenon disproportionately impacting people who are marginalized. The experience of IPNC is chaotic, worrisome and joyful for providers. An interdisciplinary, midwifery-led outreach PNC model would better meet the needs of the client population and providers alike. A Community Centred Care model of PNC embodies and enhances participant suggestions for addressing IPNC. Access to abortion, postpartum care and newborn apprehension require special attention. Peer participation and the impacts of patriarchy and racism must be addressed in the development of future PNC models. The ways in which participants described and proposed intervening in IPNC revealed an individualized understanding of the SDoH that is paralleled in existing research on IPNC. This conceptualization of the problem obscures the root causes of disparities in access and warrants future consideration. / Thesis / Master of Science (MSc) / Prenatal care (PNC) can help to reduce complications of pregnancy and birth and connect expecting families with other support services. Even though health care is free in Canada, people who are marginalized struggle to access enough PNC. We know the complexities of people’s lives and their negative experiences with the health care system prevent them from getting PNC. We know little about what PNC for people who don’t access it is like for the providers or why they can’t make their care easier to access. Mindful of systems of power, the goal of this research is to explore how health and social service providers understand inadequate PNC (IPNC), to inform accessible PNC models. Participants proposed an interdisciplinary outreach PNC model responsive to needs of the community. The Social Determinants of Health were an important part of how participants understood IPNC which shaped the way that they proposed to address it.