Depuis le début des années 90, le réseau de la santé au Québec est soumis à une vaste restructuration qui a eu des conséquences négatives sur la qualité de vie au travail (QVT) des infirmières et infirmiers. Les hommes se retrouvent en nombre croissant dans toutes les sphères de la pratique infirmière, mais les études existantes ne font malheureusement pas mention de la qualité de vie au travail de ceux-ci. Alors, il apparaît pertinent de s’attarder au phénomène de la qualité de vie au travail des hommes infirmiers dans la profession infirmière, et ce, plus précisément en CSSS mission CLSC. Le but de cette étude phénoménologique consiste à décrire et à comprendre la signification de la qualité de vie au travail pour des infirmiers œuvrant en CSSS mission CLSC. L’essence du phénomène, les huit thèmes et les 35 sous-thèmes qui se dégagent directement des entrevues énoncent que la signification de la qualité de vie au travail pour des infirmiers œuvrant en centre de santé et des services sociaux (CSSS), mission CLSC et déclarant avoir une qualité de vie positive au travail, signifie « un climat empreint de caring qui favorise l'épanouissement de l'infirmier en CLSC en œuvrant pour le maintien de l'harmonie entre les sphères professionnelle et familiale ». Si certains résultats corroborent ceux d’études antérieures, d’autres apportent des éléments nouveaux favorisant la santé des infirmiers par le biais de la qualité de vie au travail. Enfin, des avenues concrètes visant la mise en place de programmes d’optimisation de la qualité de vie au travail, sont proposées. / In the 1990s, health care organizations in Québec underwent sweeping reforms that disrupted the work climate and practices of nurses (Bourbonnais et al., 2000; Pérodeau et al., 2002). These reforms had a negative impact on nurses’ quality of working life (QWL), leading decision makers and researchers to investigate the QWL phenomenon from several perspectives (Delmas, 1999; 2001; Gascon, 2001; O’Brien-Pallas & Baumann, 1992). Most of the studies of this phenomenon were conducted in hospital settings and were based on paradigms of psychological distress (Bourbonnais et al., 1998, 2000) or burn-out (a pathogenic perspective) (Duquette et al., 1995) rather than a health paradigm (a salutogenic perspective) (Gascon, 2001). A salutogenic perspective represents a positive vision of an approach to health (Antonovsky, 1996; Delmas, 2001, Duquette & Delmas, 2002). The scientific literature (Brooks et al., 1996; Ekstrom, 1999; Evans, 2001) suggests that, in addition to living through the same upheavals as their female colleagues, some male nurses also have negative feelings related to sex discrimination, feelings of isolation, and the conflict between masculine values (strength, aggressiveness) and the feminine values (gentleness, flexibility) of the nursing profession. These feelings can only hamper nurses’ QWL, yet they are not mentioned in studies of male nurses (Boughn, 2001; Ekstrom, 1999; Evans, 1997, 2001). The aim of the study, using Giorgi’s (1985, 1997a) descriptive phenomenology as a method, is to describe and understand the significance of phenomena through people’s experiences. The findings were derived from semi-structured individual interviews of 60 to 90 minutes with five male nurses who reported a positive quality of life at work. Data analysis consisted of: collecting the data, reading and rereading the results, dividing the data into meaningful units, organizing and stating the raw data in the language of the discipline and, finally, synthesizing the findings and letting the essence of the phenomena emerge. Watson’s (1988, 2005) human caring philosophy served as a backdrop for the entire process. The analysis of verbatim transcripts revealed eight themes that defined the significance of the quality of working life for male nurses practising in community settings: 1) autonomy in their professional practice; 2) job satisfaction; 3) a healthy workplace setting; 4) relations with the administration characterized by support and respect; 5) caring relationships with other members of the interdisciplinary team; 6) working in partnership with female peers; 7) commitment to clients and their families; and 8) professional work-life balance. The essence of the phenomenon stems directly from the themes that emerged during the interviews; it states that for male nurses working in health and social service centres (CSSSs), as part of CLSCs, working life means “a caring climate that fosters the vitality of male CLSC nurses by trying to maintain a balance between their professional and family lives.” If some of the findings confirm what has been reported in other studies, others have added new information on how to promote the health of male nurses by targeting quality of working life. Concrete avenues are proposed for implementing quality of working life optimization programs.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

Contexte: Les centres de jour offrent des interventions de groupe à des personnes âgées qui présentent des incapacités, dans le but de favoriser leur maintien à domicile. Des études récentes tendent à démontrer qu’une utilisation régulière du service serait nécessaire pour induire des effets bénéfiques. Objectifs: Cette recherche visait à documenter l’utilisation des centres de jour par des personnes âgées qui présentent des incapacités. Elle comportait trois principaux objectifs: 1) Caractériser les utilisateurs de centre de jour et ce qui les distingue des non-utilisateurs et analyser les déterminants de l’utilisation du centre de jour. 2) Explorer l’adéquation entre les activités offertes par les centres de jour et les caractéristiques d’autonomie et de santé des utilisateurs. 3) Définir les facteurs associés à la régularité de la participation. Méthodes: Cette recherche s’appuie sur une analyse secondaire de données recueillies auprès de 723 personnes âgées qui ont participé au projet de démonstration SIPA (Services intégrés pour personnes âgées) implanté dans deux CLSC de la région de Montréal. L’utilisation du centre de jour a été documentée pendant une période de six mois, auprès des cinq centres de jour existant sur ce même territoire. Des informations sur le fonctionnement des centres de jour ont été obtenues par des entrevues et des rencontres de groupe auprès de coordonnateurs de ces centres. Les données ont été analysées à l’aide de statistiques descriptives, d’analyses en regroupement et d’analyses de régression logistique et multiple. Résultats: Les résultats sont présentés dans trois articles, soit un pour chacun des objectifs. Article 1: La proportion d’utilisateurs de centre de jour est de 18,8% (IC-0,95: 16,0 à 21,7%). Les facteurs suivants augmentent la probabilité d’utiliser le centre de jour: être plus jeune (RC: 1,12; IC-0,95: 1,06 à 1,19); ne pas avoir une éducation universitaire (RC: 1,92; IC-0,95: 1,04 à 3,57); recevoir l’aide du CLSC pour les activités de vie quotidienne plus d’une fois par semaine (RC: 1,73 et 2,48 pour aide de deux à cinq fois par semaine et aide de six à sept fois par semaine respectivement; IC-0,95: 1,06 à 2,80 et 1,22 à 5,06); faire partie du bassin de desserte d’un centre de jour dont les coûts sont moins élevés (RC: 1,054 ; IC-0,95: 1,001 à 1,108 pour chaque augmentation de 1$); et pour les hommes seulement, avoir déjà subi un accident vasculaire cérébral et présenter davantage d’incapacités fonctionnelles (interaction entre le sexe et la présence d’un AVC: RC: 0,298; IC-0,95: 0,108 à 0,825; interaction entre le sexe et les capacités fonctionnelles mesurées à l’OARS: RC: 1,096; IC-0,95: 1,019 à 1,178). De plus, on observe une plus grande probabilité d’utiliser le centre de jour chez les personnes qui cohabitent avec une personne de soutien. Toutefois, cette relation ne s’observe que chez les personnes nées au Canada (interaction entre la cohabitation avec la personne de soutien et le pays de naissance: RC: 0,417; IC-0,95: 0,185 à 0,938). Article 2: Des analyses en regroupement ont permis de distinguer quatre profils de participants ayant des caractéristiques similaires: 1) les personnes fragilisées par un âge avancé et un grand nombre de problèmes de santé; 2) les participants plus jeunes et plus autonomes que la moyenne, qui semblent des utilisateurs précoces; 3) les personnes qui présentent des incapacités d’origine cognitive; et 4) celles qui présentent des incapacités d’origine motrice. Les activités de groupe des centres de jour ont été regroupées en huit catégories: exercices physiques; groupe spécifique pour un diagnostic ou un problème fonctionnel commun; activités fonctionnelles; stimulation cognitive; activités musicales ou de réminiscence; sports et jeux physiques; intégration sociale; prévention et promotion de la santé. Les activités les plus fréquentes sont les exercices physiques et les activités d’intégration sociale auxquelles ont participé plus de 90% des utilisateurs de centre de jour, et ce en moyenne à respectivement 78% (±23%) et 72% (±24%) de leurs présences au centre de jour. Les autres catégories d’activités rejoignent de 45% à 77% des participants, et ce en moyenne à 35% (±15%) à 46% (±33%) de leurs présences. La participation aux diverses catégories d’activités a été étudiée pour chaque profil d’utilisateurs et comparée aux activités recommandées pour divers types de clientèle. On observe une concordance partielle entre les activités offertes et les besoins des utilisateurs. Cette concordance apparaît plus grande pour les participants qui présentent des problèmes de santé physique ou des incapacités d’origine motrice et plus faible pour ceux qui présentent des symptômes dépressifs ou des atteintes cognitives. Article 3: Les participants au centre de jour y sont inscrits en moyenne à raison de 1,56 (±0,74) jours par semaine mais sont réellement présents à 68,1% des jours attendus. Les facteurs suivants sont associés à une participation plus régulière au centre de jour en termes de taux de présences réelles / présences attendues: ne pas avoir travaillé dans le domaine de la santé (b: ,209; IC-0,95: ,037 à ,382); recevoir de l’aide du CLSC les jours de fréquentation du centre de jour (b: ,124; IC-0,95: ,019 à ,230); être inscrit pour la journée plutôt que la demi-journée (b: ,209: IC-0,95: ,018 à ,399); lors de ses présences au centre de jour, avoir une moins grande proportion d’activités de prévention et promotion de la santé (b: ,223; IC-0,95: ,044 à ,402); et enfin, avoir un aidant qui présente un fardeau moins élevé pour les personnes avec une atteinte cognitive et un fardeau plus élevé pour les personnes sans atteinte cognitive (interaction entre la présence d’atteinte cognitive et le fardeau de l’aidant: b: -,008; IC-0,95: -,014 à -,044). Conclusion: Conformément à leur mission, les centres de jour rejoignent une bonne proportion des personnes âgées qui présentent des incapacités. Cette étude fait ressortir les caractéristiques des personnes les plus susceptibles d’y participer. Elle suggère la nécessité de revoir la planification des activités pour assurer une offre de services qui tienne davantage compte des besoins des participants, en particulier de ceux qui présentent des atteintes cognitives et des symptômes de dépression. Elle démontre aussi que l’intensité d’exposition au service semble faible, ce qui soulève la question des seuils d’exposition nécessaires pour induire des effets favorables sur le maintien à domicile et sur la qualité de vie de la clientèle cible. / Background: Adult Day Centers (ADC) offer group-based interventions to older, community-dwelling individuals with functional limitations, with the aim of helping them remain in the community for as long as possible. Recent studies seem to indicate that regular use is needed for positive effects on participants and their caregivers. Objectives: The purpose of this study was to document the use of ADCs by seniors with functional limitations. There were three main objectives: 1) To identify the characteristics of ADC users versus non-users and to identify the determinants of use. 2) To explore how well ADC program activities matched the different needs of participants with various health and functional characteristics profile. 3) To examine the factors related to regularity of ADC attendance. Methods: This study was based on a secondary analysis of data collected from 723 seniors participating in the Services intégrés pour personnes âgées (SIPA) demonstration project implemented in two CLSCs in Montreal. ADC use data were obtained for a six month period, from the five ADCs serving the same catchment area. To better understand the ADC program characteristics, individual interviews and focus groups were carried out with ADC coordinators. Data were analysed with descriptive statistics, cluster analysis, and logistic and multiple regression analysis. Results: The results are presented in three articles, one for each main objective. Article 1: The proportion of ADC users was 18.8% (CI-0.95: 16.0 – 21.7%). The following factors increased the probability of ADC use: being younger (OR: 1.12; CI-0.95: 1.06 – 1.19); not having a university degree (OR: 1.92; CI-0.95: 1.04 – 3.57); receiving help from the CLSC for daily living activities more than once a week (OR: 1.73 and 2.48 for help two to five times per week and six to seven times per week respectively; CI-0.95: 1.06 - 2.80 and 1.22 - 5.06); being in the catchment population of an ADC with a lower daily fee (OR: 1.054; C-I0.95: 1.001 - 1.108 for each 1$ fee increase); and for men only, having had a stroke or presenting with more functional incapacities (interaction between gender and presence of a stroke: OR: 0.298; CI-0.95: 0.108 - 0.825; interaction between gender and functional capacity as measured by OARS: OR: 1.096; CI-0.95: 1.019 - 1.178). In addition, the probability of ADC use was higher among individuals who live with the person identified as their caregiver. However, this association was found only among persons born in Canada (interaction between whether they lived with caregiver and country of birth: OR: 0.417; CI-0.95: 0.185 - 0.938). Article 2: Four different participant profile groups were identified using cluster analysis: 1) frail seniors of advanced age who had a large number of health problems; 2) individuals who were younger and more independent than the average participants who appeared early users of ADC; 3) individuals with functional impairment related to cognitive problems; and 4) those with movement disorders which affected their independence. Classification of program activities by a panel of experts distinguished eight categories of activities: physical exercise; groups for those with common diagnoses or functional problems; functional activities; cognitive stimulation; music or reminiscence activities; sports and physical games; social skills and interaction; disease prevention and health promotion activities. The most frequent activities were physical exercise, and social skills and interaction activities in which more of 90% of ADC users participated, respectively at a mean of 78% (± 23%) and 72% (± 24%) of their attendances at the ADC program. Other categories of activities were provided to 45 to 77% of participants, and at a mean of 35% (± 15%) to 46% (± 33%) of their ADC attendances. Participation in these activities categories was examined for each profile group, and compared to the recommended activities for such client group. Partial correspondence was found between program activities and participants’ needs. Concordance seemed higher for individuals with physical health problems or mobility impairments and weaker for those presenting with depressive symptoms or cognitive impairments. Article 3: ADC participants were registered with their program for a mean of 1.56 (±0.74) days per week, but were actually present 68.1% of the scheduled days. More regular attendance (higher proportion of scheduled days attended) was associated with: a previous profession of ADC participant or spouse in a sector other than health care (b: .209; CI-0.95: .037 − .382); the individual receiving formal help for activities of daily living on days of expected ADC participation (b: .124; CI-0.95: .019 − .230); enrolment for the whole day rather than half a day (b: .209 : CI-0.95: .018 − .399); lower participation rates in prevention and health promotion activities (b: .223; CI-0.95: .044 − .402); and among participants with cognitive impairment, lower caregiver burden, and among persons without cognitive impairment, higher caregiver burden (interaction between cognitive impairment and caregiver burden: b: -.008; CI-0.95: -.014 − -.044). Conclusion: In keeping with their mission, adult day centres attract a large portion of seniors with disabilities. This study has identified the characteristics of the clientele who are most likely to participate in centre activities. Results also suggest a need to review the planning of activity program components to ensure that the services offered best respond to client needs, particularly clients presenting with depressive symptoms or cognitive impairments. It has also demonstrated that the intensity of exposure to this service tends to be low overall, which raises the question of the level of exposure needed to have a positive influence on the quality of life and ability to remain in the community among this population.

Contexte: Les centres de jour offrent des interventions de groupe à des personnes âgées qui présentent des incapacités, dans le but de favoriser leur maintien à domicile. Des études récentes tendent à démontrer qu’une utilisation régulière du service serait nécessaire pour induire des effets bénéfiques. Objectifs: Cette recherche visait à documenter l’utilisation des centres de jour par des personnes âgées qui présentent des incapacités. Elle comportait trois principaux objectifs: 1) Caractériser les utilisateurs de centre de jour et ce qui les distingue des non-utilisateurs et analyser les déterminants de l’utilisation du centre de jour. 2) Explorer l’adéquation entre les activités offertes par les centres de jour et les caractéristiques d’autonomie et de santé des utilisateurs. 3) Définir les facteurs associés à la régularité de la participation. Méthodes: Cette recherche s’appuie sur une analyse secondaire de données recueillies auprès de 723 personnes âgées qui ont participé au projet de démonstration SIPA (Services intégrés pour personnes âgées) implanté dans deux CLSC de la région de Montréal. L’utilisation du centre de jour a été documentée pendant une période de six mois, auprès des cinq centres de jour existant sur ce même territoire. Des informations sur le fonctionnement des centres de jour ont été obtenues par des entrevues et des rencontres de groupe auprès de coordonnateurs de ces centres. Les données ont été analysées à l’aide de statistiques descriptives, d’analyses en regroupement et d’analyses de régression logistique et multiple. Résultats: Les résultats sont présentés dans trois articles, soit un pour chacun des objectifs. Article 1: La proportion d’utilisateurs de centre de jour est de 18,8% (IC-0,95: 16,0 à 21,7%). Les facteurs suivants augmentent la probabilité d’utiliser le centre de jour: être plus jeune (RC: 1,12; IC-0,95: 1,06 à 1,19); ne pas avoir une éducation universitaire (RC: 1,92; IC-0,95: 1,04 à 3,57); recevoir l’aide du CLSC pour les activités de vie quotidienne plus d’une fois par semaine (RC: 1,73 et 2,48 pour aide de deux à cinq fois par semaine et aide de six à sept fois par semaine respectivement; IC-0,95: 1,06 à 2,80 et 1,22 à 5,06); faire partie du bassin de desserte d’un centre de jour dont les coûts sont moins élevés (RC: 1,054 ; IC-0,95: 1,001 à 1,108 pour chaque augmentation de 1$); et pour les hommes seulement, avoir déjà subi un accident vasculaire cérébral et présenter davantage d’incapacités fonctionnelles (interaction entre le sexe et la présence d’un AVC: RC: 0,298; IC-0,95: 0,108 à 0,825; interaction entre le sexe et les capacités fonctionnelles mesurées à l’OARS: RC: 1,096; IC-0,95: 1,019 à 1,178). De plus, on observe une plus grande probabilité d’utiliser le centre de jour chez les personnes qui cohabitent avec une personne de soutien. Toutefois, cette relation ne s’observe que chez les personnes nées au Canada (interaction entre la cohabitation avec la personne de soutien et le pays de naissance: RC: 0,417; IC-0,95: 0,185 à 0,938). Article 2: Des analyses en regroupement ont permis de distinguer quatre profils de participants ayant des caractéristiques similaires: 1) les personnes fragilisées par un âge avancé et un grand nombre de problèmes de santé; 2) les participants plus jeunes et plus autonomes que la moyenne, qui semblent des utilisateurs précoces; 3) les personnes qui présentent des incapacités d’origine cognitive; et 4) celles qui présentent des incapacités d’origine motrice. Les activités de groupe des centres de jour ont été regroupées en huit catégories: exercices physiques; groupe spécifique pour un diagnostic ou un problème fonctionnel commun; activités fonctionnelles; stimulation cognitive; activités musicales ou de réminiscence; sports et jeux physiques; intégration sociale; prévention et promotion de la santé. Les activités les plus fréquentes sont les exercices physiques et les activités d’intégration sociale auxquelles ont participé plus de 90% des utilisateurs de centre de jour, et ce en moyenne à respectivement 78% (±23%) et 72% (±24%) de leurs présences au centre de jour. Les autres catégories d’activités rejoignent de 45% à 77% des participants, et ce en moyenne à 35% (±15%) à 46% (±33%) de leurs présences. La participation aux diverses catégories d’activités a été étudiée pour chaque profil d’utilisateurs et comparée aux activités recommandées pour divers types de clientèle. On observe une concordance partielle entre les activités offertes et les besoins des utilisateurs. Cette concordance apparaît plus grande pour les participants qui présentent des problèmes de santé physique ou des incapacités d’origine motrice et plus faible pour ceux qui présentent des symptômes dépressifs ou des atteintes cognitives. Article 3: Les participants au centre de jour y sont inscrits en moyenne à raison de 1,56 (±0,74) jours par semaine mais sont réellement présents à 68,1% des jours attendus. Les facteurs suivants sont associés à une participation plus régulière au centre de jour en termes de taux de présences réelles / présences attendues: ne pas avoir travaillé dans le domaine de la santé (b: ,209; IC-0,95: ,037 à ,382); recevoir de l’aide du CLSC les jours de fréquentation du centre de jour (b: ,124; IC-0,95: ,019 à ,230); être inscrit pour la journée plutôt que la demi-journée (b: ,209: IC-0,95: ,018 à ,399); lors de ses présences au centre de jour, avoir une moins grande proportion d’activités de prévention et promotion de la santé (b: ,223; IC-0,95: ,044 à ,402); et enfin, avoir un aidant qui présente un fardeau moins élevé pour les personnes avec une atteinte cognitive et un fardeau plus élevé pour les personnes sans atteinte cognitive (interaction entre la présence d’atteinte cognitive et le fardeau de l’aidant: b: -,008; IC-0,95: -,014 à -,044). Conclusion: Conformément à leur mission, les centres de jour rejoignent une bonne proportion des personnes âgées qui présentent des incapacités. Cette étude fait ressortir les caractéristiques des personnes les plus susceptibles d’y participer. Elle suggère la nécessité de revoir la planification des activités pour assurer une offre de services qui tienne davantage compte des besoins des participants, en particulier de ceux qui présentent des atteintes cognitives et des symptômes de dépression. Elle démontre aussi que l’intensité d’exposition au service semble faible, ce qui soulève la question des seuils d’exposition nécessaires pour induire des effets favorables sur le maintien à domicile et sur la qualité de vie de la clientèle cible. / Background: Adult Day Centers (ADC) offer group-based interventions to older, community-dwelling individuals with functional limitations, with the aim of helping them remain in the community for as long as possible. Recent studies seem to indicate that regular use is needed for positive effects on participants and their caregivers. Objectives: The purpose of this study was to document the use of ADCs by seniors with functional limitations. There were three main objectives: 1) To identify the characteristics of ADC users versus non-users and to identify the determinants of use. 2) To explore how well ADC program activities matched the different needs of participants with various health and functional characteristics profile. 3) To examine the factors related to regularity of ADC attendance. Methods: This study was based on a secondary analysis of data collected from 723 seniors participating in the Services intégrés pour personnes âgées (SIPA) demonstration project implemented in two CLSCs in Montreal. ADC use data were obtained for a six month period, from the five ADCs serving the same catchment area. To better understand the ADC program characteristics, individual interviews and focus groups were carried out with ADC coordinators. Data were analysed with descriptive statistics, cluster analysis, and logistic and multiple regression analysis. Results: The results are presented in three articles, one for each main objective. Article 1: The proportion of ADC users was 18.8% (CI-0.95: 16.0 – 21.7%). The following factors increased the probability of ADC use: being younger (OR: 1.12; CI-0.95: 1.06 – 1.19); not having a university degree (OR: 1.92; CI-0.95: 1.04 – 3.57); receiving help from the CLSC for daily living activities more than once a week (OR: 1.73 and 2.48 for help two to five times per week and six to seven times per week respectively; CI-0.95: 1.06 - 2.80 and 1.22 - 5.06); being in the catchment population of an ADC with a lower daily fee (OR: 1.054; C-I0.95: 1.001 - 1.108 for each 1$ fee increase); and for men only, having had a stroke or presenting with more functional incapacities (interaction between gender and presence of a stroke: OR: 0.298; CI-0.95: 0.108 - 0.825; interaction between gender and functional capacity as measured by OARS: OR: 1.096; CI-0.95: 1.019 - 1.178). In addition, the probability of ADC use was higher among individuals who live with the person identified as their caregiver. However, this association was found only among persons born in Canada (interaction between whether they lived with caregiver and country of birth: OR: 0.417; CI-0.95: 0.185 - 0.938). Article 2: Four different participant profile groups were identified using cluster analysis: 1) frail seniors of advanced age who had a large number of health problems; 2) individuals who were younger and more independent than the average participants who appeared early users of ADC; 3) individuals with functional impairment related to cognitive problems; and 4) those with movement disorders which affected their independence. Classification of program activities by a panel of experts distinguished eight categories of activities: physical exercise; groups for those with common diagnoses or functional problems; functional activities; cognitive stimulation; music or reminiscence activities; sports and physical games; social skills and interaction; disease prevention and health promotion activities. The most frequent activities were physical exercise, and social skills and interaction activities in which more of 90% of ADC users participated, respectively at a mean of 78% (± 23%) and 72% (± 24%) of their attendances at the ADC program. Other categories of activities were provided to 45 to 77% of participants, and at a mean of 35% (± 15%) to 46% (± 33%) of their ADC attendances. Participation in these activities categories was examined for each profile group, and compared to the recommended activities for such client group. Partial correspondence was found between program activities and participants’ needs. Concordance seemed higher for individuals with physical health problems or mobility impairments and weaker for those presenting with depressive symptoms or cognitive impairments. Article 3: ADC participants were registered with their program for a mean of 1.56 (±0.74) days per week, but were actually present 68.1% of the scheduled days. More regular attendance (higher proportion of scheduled days attended) was associated with: a previous profession of ADC participant or spouse in a sector other than health care (b: .209; CI-0.95: .037 − .382); the individual receiving formal help for activities of daily living on days of expected ADC participation (b: .124; CI-0.95: .019 − .230); enrolment for the whole day rather than half a day (b: .209 : CI-0.95: .018 − .399); lower participation rates in prevention and health promotion activities (b: .223; CI-0.95: .044 − .402); and among participants with cognitive impairment, lower caregiver burden, and among persons without cognitive impairment, higher caregiver burden (interaction between cognitive impairment and caregiver burden: b: -.008; CI-0.95: -.014 − -.044). Conclusion: In keeping with their mission, adult day centres attract a large portion of seniors with disabilities. This study has identified the characteristics of the clientele who are most likely to participate in centre activities. Results also suggest a need to review the planning of activity program components to ensure that the services offered best respond to client needs, particularly clients presenting with depressive symptoms or cognitive impairments. It has also demonstrated that the intensity of exposure to this service tends to be low overall, which raises the question of the level of exposure needed to have a positive influence on the quality of life and ability to remain in the community among this population.

The research focused on employee wellness and explored and described the role of spirituality in the wellbeing of CHCWs of HIV/AIDS patients. It was important to determine how CHCWs dealt with the stress of caregiving, due to the increasing number of HIV infections and burden on government resources. The approach was a phenomenological qualitative study using faceto- face interviews to collect data from a purposive sample of eight CHCWs from a population of 250 at Temba. The audio-recorded interviews were transcribed verbatim and analysed for emerging themes using thematic analyses. The research findings provided evidence that spirituality impacted positively on the wellbeing of the CHCWs by providing the coping mechanism to deal with stress. The conclusions drawn were that personal and organisational wellbeing operated at an optimal level due to the influence of spirituality. Recommendations were that formalised spiritual programmes were offered as a tool to equip CHCWs in their duties. / Industrial and Organisational Psychology / M. Com.

No description available.

The master thesis deals with the applicability of the model of therapeutic community in the work with youth at risk. The aim of the thesis is to provide information about possible connection of these two phenomena based on theory and Czech practice. The thesis has a theoretical and an empirical part. The chapters of the theoretical part describe target groups from the view of adulthood development, the model of therapeutic community and its possible application in various diagnostic circles. The last chapter of the theoretical part describes the employment of the model of therapeutic community in the work with youth at risk in a historical perspective. Next, it suggests that the model of therapeutic community is compatible with the attainment of developmental goals during maturing. The empirical part maps the usage of elements of therapeutic community model in selected facilities which work with youth at risk. It informs whether these elements occur and if so, what shape they take in practice.

Focusing on the rights of children who are deprived of their family environment and remain in child-headed households in the context of the HIV epidemic in Africa cannot be more relevant at present as the continent faces a significant increase in the number of children who are left to fend for themselves due to the impact of the epidemic. The impact of the epidemic is so severe that it is likened to an armed conflict. In sub-Saharan Africa, an estimated 22.4 million people are living with HIV, and in 2008 alone, 2 million people died of AIDS-related illnesses. Such massive loss of human lives is itself a tragedy. However, the repercussions of the epidemic suffered by children may be less visible, yet are just as far-reaching, and in all likelihood longer lasting in their effects. Initially, it appeared that children were only marginally affected by the epidemic. Unfortunately, it is now clear that children are at the heart of the epidemic. In sub-Saharan Africa, an estimated 14 million children lost their parents to AIDS-related illnesses and an unimaginable number of children consequently find themselves in deepened poverty. Traditionally, children who are deprived of their family environment in Africa have been cared for by extended families. However, the HIV epidemic has dramatically affected the demography of many African societies. As the epidemic continues to deplete resources of the affected families and communities, extended families and communities find it more and more difficult to provide adequate care to the increasing number of children who are deprived of parental care. As a result, more and more children are taking care of themselves in child-headed households. The foremost responsibility of states with regards to children who are deprived of parental care is to support families and communities so that they are able to provide adequate care to children in need of care, thereby preventing children from being deprived of their family environment. While strengthening families and communities, as required by articles 20 of the Convention of the Rights of the Child and 25 of the African Charter on the Rights and Welfare of the Child, as well as other international guidelines such as the 2009 UN Guidelines for the Alternative Care of Children, states also have the responsibility to provide ‘special protection and assistance’ to children who are already deprived of their family environment and are living in child-headed households. The important question is how to interpret the right to alternative care, and special protection and assistance, with respect to children in child-headed households. The study examines the international standards and norms regarding children who are deprived of their family environment including children in child-headed households and explores the ways those children are supported and protected in South Africa, against the background of related developments in a number of different African countries, including Namibia, Southern Sudan and Uganda. In 2002, the South African Law Reform Commission made the important recommendation that child-headed households should be legally recognised. The Children’s Amendment Act (No 41 of 2007), which amended the comprehensive Children’s Act (No 38 of 2005) gave effect to this recommendation by legally recognising child-headed households under prescribed conditions. It is a bold step to strengthen the protection and assistance given to children in child-headed households. However, child-headed households should not be legally recognised unless all the necessary protection and assistance measures are effectively put in place. In order to design and implement the measures of protection and assistance to children in child-headed households, a holistic children’s rights-based approach should be a guiding light. A rights-based approach, which articulates justiciable rights, establishes a link between the entitlement of children as rights-holders and legal obligations of states as duty-bearers. States have the primary responsibility to provide appropriate protection and assistance to children who are deprived of their family environment. This is a legal obligation of states, not a charitable action. A rights-based approach is further important in that it ensures that both the process of mitigation strategies and the outcome of such efforts are firmly based on human rights standards. The study argues that legal recognition should be given to child-headed household only after a careful evaluation based on the international standards with regard to children deprived of their family environment. It further argues that measures of ‘special protection and assistance’ should be devised and implemented using a rights-based approach respecting, among others, children’s rights to non-discrimination, to participation and to have their best interests given a priority. / Thesis (LLD)--University of Pretoria, 2009. / Centre for Human Rights / unrestricted