M.Cur. / The purpose of the research study is to describe guidelines to counteract unethical behaviour in homes for the aged by auxiliary nurses and care workers. The objectives are to explore and describe the factors related to the unethical behaviour in homes for the aged by auxiliary nurses and care workers by: Exploring and describing the perceptions of the auxiliary nurses and care workers relating to unethical behaviour of auxiliary nurses and care workers in homes for the aged; and Exploring and describing the perceptions of the registered nurses relating to unethical behaviour of auxiliary nurses and care workers in homes for the aged. The point of departure for the research was an uncovering of abuse in homes for the aged by M-Net's Carte Blanche team and the observations of the researcher over a long period of time

<p>Alternate Level of Care, or ALC, is a designation assigned to a patient during an acute care hospital stay when that patient is occupying a bed but no longer requires that intensity of service. A high proportion of beds occupied by patients requiring ALC results in problems in the healthcare system related to patient flow, access, and efficiency. The purpose of this study was to better understand the experience of older patients and family caregivers while the patient is designated as requiring ALC. This study employed the Three-Dimensional Narrative Inquiry Space method of Clandinin and Connelly (2000) to examine the experiences of five patients and four family caregivers. The primary data source for this study was a series of semi-structured interviews with individual participants over time while they were in the midst of the experience of ALC. Data analysis involved a twofold process of restorying all interview transcriptions for a given participant into a single story summarizing his or her experience, and analyzing the content across stories to identify common themes. The major finding of this study was that uncertainty was a significant part of the experience of ALC. This uncertainty was manifest in relation to self-concept, waiting for placement, not knowing about information, not being included in planning, lack of mobility, and lack of meaningful activity. The study findings have implications for strategies to manage uncertainty in the areas of practice, policy, education, and research in order to improve the experience of older patients and their family caregivers.</p> / Master of Science (MSc)

Bakgrund: Senior alert är ett nationellt kvalitetsregister som avser att förebygga trycksår, fall, undernäring, ohälsa i munnen och blåsdysfunktion hos patienter över 65 år. För att identifiera dessa riskområden används olika bedömningsinstrument och sjuksköterskor ansvarar för att registreringarna genomförs och att förebyggande åtgärder sätts in. Syfte: Studiens syfte var att studera sjuksköterskors upplevelse av att arbeta med kvalitetsregistret Senior alert samt hur sjuksköterskorna upplever att arbetet med kvalitetsregistret påverkar vården hos de äldre. Metod: Sex sjuksköterskor verksamma inom Uppsala kommun med erfarenhet av att arbeta med Senior alert intervjuades och en kvalitativ innehållsanalys användes för att bearbeta den insamlade datan.   Resultat: Utifrån den insamlade datan utformades fyra kategorier, Upplevelser av Senior alert som redskap, Senior alert kan förbättras, Tillämpandet av senior alert i praktiken och Arbetet med Senior alert bidrar till ökad vårdprevention och sju underkategorier. Slutsats: Senior alert upplevs som ett bra redskap för att arbeta förebyggande och främja teamarbete, men uppfattas som tidskrävande. Sjuksköterskorna i den här studien anser att vården av de äldre förbättras då identifiering av riskområden sker tidigt och åtgärder sätts in. För att kunna göra resultatet överförbart och veta på vilket sätt vården förbättras behövs ett större urval och frågor som är utformade för att kunna besvara syftet. / Background: Senior Alert is a quality registry which aims to prevent pressure ulcers, falling, malnutrition, bad oral health and urinary incontinence among patients over 65 years. To identify these areas different evaluation tools are used and nurses are responsible for the registrations and making sure preventive actions are made. Aim: The aim of this study was to describe how nurses experience working with the quality registry Senior Alert and how it affects the care of the elderly. Methods: Six nurses working in Uppsala county with experience of working with Senior Alert was interviewed. The interviews were analyzed using a qualitative content analysis. Results: Four categories, Senior Alert as a tool, Senior Alert needs improvement, Working with Senior Alert and Senior Alert contributes to a better health care and seven subcategories were identified. Conclusions: The respondents found Senior Alert to be a helpful tool for preventive work and that it promotes teamwork, but is perceived as time consuming. The nurses in this study think that the care of the elderly improves by early identification and preventive actions, but to do this, study-result transferability and knowing in what way the care will improve it will need a larger target group and more questions to answer the aim of the study.

Bakgrund: Svensk statistik tyder på att antalet multisjuka äldre kommer att öka. Hälso- och sjukvårdslagen stadgar att vården skall vara av god kvalitet och tillgodose patienternas behov av trygghet. I dagens samhälle föreligger en risk att äldre människor utsätts för ålderism, vilken kan påverka vårdens kvalitet och orsaka ett lidande för de äldre patienterna. Syfte: Att beskriva äldre patienters upplevelser av vården på en geriatrisk vårdavdelning i Mellansverige. Metod: Latent kvalitativ innehållsanalys av tolv semistrukturerade intervjuer. Resultat: Resultatet utgörs av två teman och sju subteman. Temat Upplevelser av att få en god vård beskriver att de äldre patienterna upplevde sig få en vårdande miljö samt att vårdpersonalen fungerade som en hälsoresurs vilket kunde gynna patienternas välbefinnande. Temat belyser att ett gott bemötande och att få bli sedd som en person resulterade i positiva känslor samt att delaktighet och självbestämmande var viktiga faktorer. Temat Upplevelser av att få en bristande vård beskriver att upplevelser av en otrygg omgivning och avsaknad av sjukdomshänsyntagande, bristande bemötande och kunskap samt att inte få en personcentrerad vård resulterade i negativa känslor. Slutsatser: Resultatet visar att det förekommer både positiva och negativa upplevelser av vården på avdelningen. Att de äldre patienterna upplever brister i vården uppmärksammar att det finns en risk för att ålderism existerar och påverkar vårdens kvalitet. Examensarbetet kan tillföra kunskap om och förståelse för hur äldre patienter upplever vården, vilket kan bidra till bättre förutsättningar för en god vårdupplevelse. / Background:  Swedish statistics indicate that there will be an increase in the number of elderly with multiple illnesses. The Health Care Act stipulates that the care provided must be of good quality and meet the patients’ needs for security. In today's society there is a risk that older people are subjected to ageism, which can affect the quality of healthcare and expose the older patients to conditions of suffering. Aim: To describe older patients’ experiences of healthcare at a geriatric ward in central Sweden. Methods: A latent qualitative content analysis of twelve semi-structured interviews. Results: The results consist of two themes and seven subthemes. The theme Experiences of getting good health care describes that when older patients experienced a nurturing environment and the caregivers worked as a health resource, it could benefit the patients’ wellbeing. The theme emphasizes that encountering a good reception and being aknowledged as a person resulted in positive emotions, and that participation in the care process and self-determination were key factors. The theme Experiences of receiving a lack of care describes that the experience of an unsafe environment, actual diseases not being taken into account, lack of treatment and knowledge, as well as being denied person-centered care, resulted in negative emotions. Conclusions: The results indicate that both positive and negative resposnses concerning the care at the ward are experienced. The older patients who experience deficiencies in healthcare, recognize that there is a risk that ageism exists, which may affect the quality of care. The thesis provides knowledge and understanding of how older patients experience healthcare which can contribute to better conditions for the patients, in order for them to experience good healthcare.

Introdução: a vulnerabilidade é um conceito que visa ampliar a compreensão da condição de saúde do ser humano. Posto isto, o objetivo geral deste estudo foi analisar a vulnerabilidade individual, social e programática entre idosos que vivem no domicílio e sua associação com os desfechos adversos relacionados aos indicadores da condição de saúde, e mapeá-los espacialmente. Método: trata-se de um estudo epidemiológico de base populacional, do tipo inquérito domiciliar, transversal e observacional, desenvolvido no município de Uberaba (MG). Constituíram a amostra final 701 idosos selecionados por meio da amostragem por conglomerado em múltiplo estágio. Para avaliação do componente individual recorreu-se ao fenótipo de fragilidade; o programático por meio de um indicador de acesso e utilização do serviço de saúde; o social mediante a distribuição espacial dos setores censitários do município deste estudo. Procedeu-se análise descritiva, análise de componentes principais, teste qui-quadrado e modelos de regressão logística, logística multinomial e linear (p<0,05). A análise espacial foi realizada por meio de mapas temáticos. Resultados: constatou-se que 32,0 % dos idosos apresentava as três condições de vulnerabilidade (individual, social e programática) concomitantemente. Evidenciaram-se como fatores associados à condição de fragilidade física: sexo feminino (p=0,015) e faixas etárias de 70 a 79 anos (p=0,013) e 80 anos ou mais (p<0,001). Para condição de elevada/muito elevada vulnerabilidade social predominaram: faixas etárias de 60+ 70 anos (p=0,009) e 70+ 80 anos (p=0,039); ausência de escolaridade (p<0,001) (p<0,001) e 1+4 anos de estudo (p=0,001); e renda mensal < 1 salário mínimo (p=0,007), 1 salário (p=0,013) e 1+3 salários (p=0,027). Já os fatores associados à moderada vulnerabilidade programática foram: faixa etária 70+ 80 anos (p=0,039); não possuir escolaridade (p=0,017), 1+4 anos de estudo (p=0,003) e 4+9 anos de estudo (p=0,029). Na análise de associação entre os componentes da vulnerabilidade, constatou-se menor proporção de idosos frágeis com elevada vulnerabilidade programática quando comparados aos pré-frágeis e não frágeis (p=0,011). Na distribuição espacial dos desfechos adversos de saúde segundo a vulnerabilidade social, houve maior ocorrência de quedas, dependência para AIVD e péssima/má autopercepção de saúde entre idosos residentes em áreas de elevada/muito elevada vulnerabilidade social comparados aos demais. Em relação à associação entre os componentes de vulnerabilidade e os desfechos de saúde, observou-se associação da fragilidade física com todos os desfechos analisados (quedas, hospitalização, dependência para ABVD e AIVD, autopercepção de saúde e número de morbidade). O componente social associou-se à dependência para ABVD e AIVD e à autopercepção de saúde. Já o componente programático permaneceu associado apenas ao maior número de morbidade. Conclusão: os resultados evidenciaram que os idosos estão sujeitos às condições de vulnerabilidade sob as perspectivas biológica, social e no acesso e utilização de serviços de saúde. Infere-se que os componentes individual, social e programático de vulnerabilidade podem influenciar nas condições de saúde de idosos, sendo que a fragilidade física se relacionou a todos os desfechos analisados / Vulnerability is a concept intended to broaden understanding regarding the health condition of people. This study\'s general objective was to analyze the individual, social and programmatic vulnerability of elderly individuals living in the community and its association with adverse outcomes related to health status indicators, in addition to mapping them spatially. Method: This population-based, cross-sectional and observational epidemiological study included a survey conducted in the individuals\' homes in the city of Uberaba, MG, Brazil. The final sample included 701 elderly individuals selected through multistage cluster sampling. The fragility phenotype was used to assess the individual component; the programmatic component was verified through an indicator for access and attendance to health services; and the social component was verified through the spatial distribution of the census sector of the city under study. Descriptive analysis, principal components analysis, and the Chi-square test, in addition to logistic regression models and multinomial logistic regression (p<0.05) were performed. Spatial analysis was conducted using thematic maps. Results: 32.0% of the elderly individuals concomitantly presented three vulnerability conditions (individual, social and programmatic). The factors that appeared associated with a physically frail condition were: being a woman (p=0.015), aged from 70 to 79 years old (p=0.013) or 80 years old or older (p<0.001). The following predominated for conditions of high social vulnerability: aged from 60+ 70 years old (p=0.009) and 70+ 80 years old (p=0.039); no formal education (p<0.001) (p<0.001) and 1+4 years of schooling (p=0.001); and monthly income < 1 times the minimum wage (p=0.007), 1 times the minimum wage (p=0.013) and 1+3 times the minimum wage (p=0.027). The factors associated with moderate programmatic vulnerability were: ages between 70+ 80 (p=0.039); no formal education (p=0.017), 1+4 years of schooling (p=0,003) and 4+9 years of schooling (p=0,029). Analysis of association among vulnerability components revealed a lower proportion of frail elderly individuals with high programmatic vulnerability when compared to their pre-frail and non-frail counterparts (p=0.011). The spatial distribution of adverse health outcomes according to social vulnerability revealed a greater occurrence of falls, dependency for IADLs, and poor/very poor self-perception of health status among those living in areas of high/very high social vulnerability compared to their counterparts. In regard to association among vulnerability components and health outcomes, physical frailty was associated with all outcomes (falls, hospitalization, dependency for ADLs and IADLs, self-perception of health and number of morbidities). The social component was associated with ADL and IADL dependency and self-perception of health. The programmatic component remained associated only with a greater number of morbidities. Conclusion: The results evidenced that elderly individuals are subject to vulnerable conditions from a biological and social perspective also considering access and use of health services. The results suggest that individual, social and programmatic components of vulnerability influence the health conditions of elderly individuals, while physical frailty was related to all the outcomes under study

O Acidente Vascular Cerebral (AVC) é a principal causa de morbimortalidade no mundo, sendo prevalente entre a população idosa. Sofrer AVC é um episódio inesperado com alto potencial para ser vivenciado como estressante, uma vez que representa ameaça ao controle pessoal. Os objetivos do estudo foram caracterizar os idosos com AVC, avaliar o déficit neurológico, a independência funcional, os sintomas depressivos e o estresse percebido deles, assim como a relação entre o déficit neurológico, a independência funcional, sintomas depressivos e o estresse percebido. Trata-se de um estudo analítico e transversal dos idosos com diagnóstico médico de primeiro evento de AVC, atendidos na Unidade de Emergência do Hospital das Clínicas de Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram utilizados os seguintes instrumentos: Roteiro estruturado para caracterização dos idosos, Mini-Exame do Estado Mental (MEEM), Escala de AVC do National Institutes Health (NIHSS), Medida da Independência Funcional (MIF), Escala de Depressão Geriátrica (EGD) e Escala de Estresse Percebido (EEP). A técnica de estatística descritiva foi utilizada para todas as variáveis, incluindo a medida de tendência central (média e mediana) e de dispersão (desvio padrão), para variáveis quantitativas; análise univariada (tabelas de frequência) e bivariada (tabelas de contingência), para variáveis qualitativas. As médias das variáveis categóricas foram analisadas pelo T de Student para comparação entre dois grupos. Já a comparação das médias de mais de dois grupos foi realizada por meio da ANOVA e teste de Bonferroni (post-hoc). A regressão linear múltipla foi utilizada para ajustar as associações entre a variável resposta e as variáveis exploratórias. Do total de 90 idosos com diagnóstico do primeiro AVC, que se caracterizaram pela média de 71,2 anos, 56,7% eram do sexo masculino, 53,3% casados, 55,6% estudaram de 1 a 4 anos, 56,7% com restrição da participação nas atividades, 50% com cuidador familiar, 92,2% com AVC isquêmico, 68,7% com AVC leve, 56,7% com 2 ou 3 comorbidades, 70% com independência modifica ou completa, 26,7% com sintomas depressivos. A média do escore da Escala de Estresse Percebido foi de 14,04 (8,5) [IC 95%: 12,2 - 15,83]. Maior estresse percebido estava associado à presença do cuidador (p < 0,001), a restrição da participação das atividades após AVC (p < 0,001), maior gravidade do AVC (p < 0,001), maior dependência funcional (p < 0,001) e com maior número de sintomas depressivos (p < 0,001). No modelo da regressão linear múltipla, as variáveis presença do cuidador, independência funcional e sintomas depressivos explicaram 63% da variação do escore da escala de estresse, o que foi significante (F3;86 = 51,48; p < 0,001). Os idosos após o AVC parecem vivenciar o retorno para casa de forma estressante, sendo a percepção do estresse influenciada pela dependência funcional e sintomas depressivos apresentados por eles. Estudos longitudinais devem ser conduzidos a fim de identificar os preditores de estresse. Além disso, estudos qualitativos podem aprofundar a análise para a compreensão e significado do estresse vivenciado pelos idosos no retorno para casa após a alta hospitalar. / Stroke is the main cause of morbidity and mortality around the world, and is prevalent in the elderly population. Being a stroke victim is an unexpected episode with great potential to be experienced as a stressful event, as it represents a threat to personal control. The study aims were to characterize elderly stroke victims, to assess their neurological deficit, functional independence, depressive symptoms and perceived stress. An analytic and cross-sectional study was developed among elderly patients medically diagnosed with a first stroke episode and attended at the Emergency Unit of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The following instruments were used: Structured script to characterize the elderly, Mini-Mental State Examination (MMSE), National Institute of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), Geriatric Depression Scale (GDS) and Perceived Stress Scale (PSS). Descriptive statistics were applied to all variables, including central trend (mean and median) and dispersion (standard deviation) for quantitative variables; and univariate (frequency tables) and bivariate analyses (contingency tables) for qualitative variables. Student\'s t-test to compare two groups was used to analyze the means of the categorical variables. To compare the means of more than two groups, ANOVA and Bonferroni\'s test (post-hoc) were used. Multiple linear regression served to adjust associations between the response variable and the exploratory variables. The 90 elderly diagnosed with a first stroke episode were characterized as follows: mean age 71.2 years, 56.7% were male, 53.3% married, 55.6% between 1 and 4 years of education, 56.7% with restricted participation in activities, 50% with family caregiver, 92.2% with ischemic stroke, 68.7% with mild stroke, 56.7% with two or three comorbidities, 70% with modified or complete independence, 26.7% with depressive symptoms. The mean score on the Perceived Stress Scale was 14.04 (8.5) [95% CI: 12.2 - 15.83]. Higher levels of perceived stress were associated with the presence of a caregiver (p < 0.001), restricted participation in activities after the stroke (p < 0.001), more severe stroke (p < 0.001), greater functional dependence (p < 0.001) and a higher number of depressive symptoms (p < 0.001). In the multiple linear regression model, the variables presence of the caregiver, functional independence and depressive symptoms explained 63% of the variation in the stress scale score, which was significant (F3;86 = 51.48; p < 0.001). After the stroke, the elderly seemed to experience their return home as stressful, and the perceived stress was influenced by their functional dependence and depressive symptoms. Longitudinal studies are needed to identify stress predictors. In addition, qualitative studies can deepen the analysis in order to understand and grasp the meaning of the stress elderly patients experience when they return home after discharge.

Introdução: a vulnerabilidade é um conceito que visa ampliar a compreensão da condição de saúde do ser humano. Posto isto, o objetivo geral deste estudo foi analisar a vulnerabilidade individual, social e programática entre idosos que vivem no domicílio e sua associação com os desfechos adversos relacionados aos indicadores da condição de saúde, e mapeá-los espacialmente. Método: trata-se de um estudo epidemiológico de base populacional, do tipo inquérito domiciliar, transversal e observacional, desenvolvido no município de Uberaba (MG). Constituíram a amostra final 701 idosos selecionados por meio da amostragem por conglomerado em múltiplo estágio. Para avaliação do componente individual recorreu-se ao fenótipo de fragilidade; o programático por meio de um indicador de acesso e utilização do serviço de saúde; o social mediante a distribuição espacial dos setores censitários do município deste estudo. Procedeu-se análise descritiva, análise de componentes principais, teste qui-quadrado e modelos de regressão logística, logística multinomial e linear (p<0,05). A análise espacial foi realizada por meio de mapas temáticos. Resultados: constatou-se que 32,0 % dos idosos apresentava as três condições de vulnerabilidade (individual, social e programática) concomitantemente. Evidenciaram-se como fatores associados à condição de fragilidade física: sexo feminino (p=0,015) e faixas etárias de 70 a 79 anos (p=0,013) e 80 anos ou mais (p<0,001). Para condição de elevada/muito elevada vulnerabilidade social predominaram: faixas etárias de 60+ 70 anos (p=0,009) e 70+ 80 anos (p=0,039); ausência de escolaridade (p<0,001) (p<0,001) e 1+4 anos de estudo (p=0,001); e renda mensal < 1 salário mínimo (p=0,007), 1 salário (p=0,013) e 1+3 salários (p=0,027). Já os fatores associados à moderada vulnerabilidade programática foram: faixa etária 70+ 80 anos (p=0,039); não possuir escolaridade (p=0,017), 1+4 anos de estudo (p=0,003) e 4+9 anos de estudo (p=0,029). Na análise de associação entre os componentes da vulnerabilidade, constatou-se menor proporção de idosos frágeis com elevada vulnerabilidade programática quando comparados aos pré-frágeis e não frágeis (p=0,011). Na distribuição espacial dos desfechos adversos de saúde segundo a vulnerabilidade social, houve maior ocorrência de quedas, dependência para AIVD e péssima/má autopercepção de saúde entre idosos residentes em áreas de elevada/muito elevada vulnerabilidade social comparados aos demais. Em relação à associação entre os componentes de vulnerabilidade e os desfechos de saúde, observou-se associação da fragilidade física com todos os desfechos analisados (quedas, hospitalização, dependência para ABVD e AIVD, autopercepção de saúde e número de morbidade). O componente social associou-se à dependência para ABVD e AIVD e à autopercepção de saúde. Já o componente programático permaneceu associado apenas ao maior número de morbidade. Conclusão: os resultados evidenciaram que os idosos estão sujeitos às condições de vulnerabilidade sob as perspectivas biológica, social e no acesso e utilização de serviços de saúde. Infere-se que os componentes individual, social e programático de vulnerabilidade podem influenciar nas condições de saúde de idosos, sendo que a fragilidade física se relacionou a todos os desfechos analisados / Vulnerability is a concept intended to broaden understanding regarding the health condition of people. This study\'s general objective was to analyze the individual, social and programmatic vulnerability of elderly individuals living in the community and its association with adverse outcomes related to health status indicators, in addition to mapping them spatially. Method: This population-based, cross-sectional and observational epidemiological study included a survey conducted in the individuals\' homes in the city of Uberaba, MG, Brazil. The final sample included 701 elderly individuals selected through multistage cluster sampling. The fragility phenotype was used to assess the individual component; the programmatic component was verified through an indicator for access and attendance to health services; and the social component was verified through the spatial distribution of the census sector of the city under study. Descriptive analysis, principal components analysis, and the Chi-square test, in addition to logistic regression models and multinomial logistic regression (p<0.05) were performed. Spatial analysis was conducted using thematic maps. Results: 32.0% of the elderly individuals concomitantly presented three vulnerability conditions (individual, social and programmatic). The factors that appeared associated with a physically frail condition were: being a woman (p=0.015), aged from 70 to 79 years old (p=0.013) or 80 years old or older (p<0.001). The following predominated for conditions of high social vulnerability: aged from 60+ 70 years old (p=0.009) and 70+ 80 years old (p=0.039); no formal education (p<0.001) (p<0.001) and 1+4 years of schooling (p=0.001); and monthly income < 1 times the minimum wage (p=0.007), 1 times the minimum wage (p=0.013) and 1+3 times the minimum wage (p=0.027). The factors associated with moderate programmatic vulnerability were: ages between 70+ 80 (p=0.039); no formal education (p=0.017), 1+4 years of schooling (p=0,003) and 4+9 years of schooling (p=0,029). Analysis of association among vulnerability components revealed a lower proportion of frail elderly individuals with high programmatic vulnerability when compared to their pre-frail and non-frail counterparts (p=0.011). The spatial distribution of adverse health outcomes according to social vulnerability revealed a greater occurrence of falls, dependency for IADLs, and poor/very poor self-perception of health status among those living in areas of high/very high social vulnerability compared to their counterparts. In regard to association among vulnerability components and health outcomes, physical frailty was associated with all outcomes (falls, hospitalization, dependency for ADLs and IADLs, self-perception of health and number of morbidities). The social component was associated with ADL and IADL dependency and self-perception of health. The programmatic component remained associated only with a greater number of morbidities. Conclusion: The results evidenced that elderly individuals are subject to vulnerable conditions from a biological and social perspective also considering access and use of health services. The results suggest that individual, social and programmatic components of vulnerability influence the health conditions of elderly individuals, while physical frailty was related to all the outcomes under study

The purpose of this qualitative pilot study is to explore the patient perspectives about what it is like to receive a bed bath. Examining studies of bath basins versus alternative methods has shown a decrease in the spread of nosocominal infections. However, there is not sufficient evidence evaluating the patient perspectives of assistive bed bathing and interactions with nurses and nursing support staff. This information can provide healthcare providers, especially nurses, with a better understanding of patient perspectives and values. It also supports the national healthcare approach towards patient-centered care.

O Acidente Vascular Cerebral (AVC) é uma doença com início súbito que pode afetar o funcionamento físico, cognitivo e comportamental de uma pessoa. Diante das inúmeras transformações que pode causar, há grande chance de os sobreviventes vivenciarem a ocorrência do AVC como uma experiência estressante. O presente estudo teve como objetivo analisar a trajetória e identificar os preditores do estresse psicológico dos idosos sobreviventes do AVC. Tratou-se de um estudo longitudinal e prospectivo, realizado no Distrito Federal. A amostra foi constituída por 50 idosos sobreviventes do AVC recrutados do setor de Emergência do Hospital de Base do Distrito Federal. A coleta de dados foi realizada em três momentos, a saber: duas semanas (T1), três meses (T2) e seis meses (T3) após a alta hospitalar. O instrumento para coleta de dados foi composto por questões sociodemográficas, clínicas, Mini-Exame do Estado Mental (MEEM), Escala de Estresse Percebido - 10 itens (EEP-10), Escala do AVC do National Institute of Health (NIHSS), Medida da Independência Funcional (MIF), Escala de Depressão Geriátrica - 15 itens (EGD15).A média de idade dos sobreviventes do AVC foi de 70,3 (7,6) anos. Houve predomínio de idosos mais jovens (60 a 79 anos) e sem companheiro (54%). A amostra foi composta por número igualitário de participantes do sexo masculino e feminino. Os sobreviventes estudaram, em média, 4,2 anos, e a maioria recebia de um a dois salários mínimos (70%). O AVC isquêmico foi o tipo do AVC mais prevalente (96%). A média do número de comorbidades foi de 2,36 (DP=0,8), sendo que 78% dos idosos possuíam de duas a três comorbidades. A média da EEP-10 apresentou declínio no decorrer dos seis meses (p<0,001). Houve diferença estatisticamente significativa entre as médias da EEP-10 nos momentos T1 e T2, T1 e T3, sendo mais acentuada entre os momentos T1 e T3 (p<0,001). Entre T1 e T3, a média da EEP-10 dos idosos sobreviventes do AVC apresentou queda de quase seis pontos (p<0,001). Não houve associação entre o estresse psicológico e as variáveis sociodemográficas (sexo, renda, idade, estado civil) no T1, T2, T3. Os idosos com cuidador apresentaram maior média na EEP-10 quando comparados aos idosos sem cuidador no T1 (p=0,003), T2 (p<0,001) e T3 (p=0,02). Os idosos com depressão apresentaram maior média na EEP-10 quando comparados aos idosos sem depressão no T1 (p<0,001), T2 (p<0,001) e T3 (p<0,001). Os sobreviventes com AVC moderado apresentaram maior média na EEP-10 quando comparados aos idosos com AVC leve no T1 ((p=0,001), T2 (p=0,006) e T3 (p<0,001). A redução da média da EEP-10 apresentou relação com o aumento da média da MIF (p=0,04) e a redução da média de EGD-15 (p<0,001). A média da MIF (?=-0,61; p=0,015) e da EGD-15 (?=0,30; p=0,01) no T1 foram preditores da média da EEP-10 no T3. Conclui-se que o estresse psicológico dos idosos sobreviventes do AVC diminui no decorrer dos seis meses após a alta hospitalar para casa. Além disso, menor funcionalidade e maior número de sintomas depressivos duas semanas após a alta prevêem maior nível de estresse psicológico seis meses após a alta / Stroke is a disease with a sudden onset that can affect the physical, cognitive and behavioral functioning of a person. In the face of the many transformations it may cause, there is a great chance that survivors will experience the occurrence of stroke as a stressful experience. This study aimed to analyze the trajectory and to identify the predictors of the psychological stress of the elderly stroke survivors. It was a longitudinal and prospective study, which took place in the Federal District. The sample consisted of 50 elderly stroke survivors, recruited from the Emergency Department of the Base Hospital of the Federal District. Data collection was performed in three moments, namely: two weeks (T1), three months (T2) and six months (T3) after hospital discharge. The instrument for data collection consisted of sociodemographic and clinical questions, Mini Mental State Examination (MMSE), Perceived Stress Scale - 10 items (PSS-10), National Institute of Health Stroke Scale (NIHSS), Measure Independence Functional (MIF), Geriatric Depression Scale - 15 items (GDS-15). The average age of stroke survivors was 70.3 (7.6) years. There was a predominance of younger elderly (60 to 79 years) and those without a companion (54%). The sample consisted of an equal number of male and female participants. The survivors studied, on average, 4.2 years, and the majority received from one to two minimum wages (70%). Ischemic stroke was the most prevalent stroke type (96%). The mean number of comorbidities was 2.36 (SD = 0.8), and 78% of the elderly had from two to three comorbidities. The mean PSS-10 showed a decline over the six months (p<0.001). There was a statistically significant difference between the means of the PSS-10 at moments T1 and T2, T1 and T3, being more pronounced between T1 and T3 moments (p<0.001). Between T1 and T3, mean PSS-10 of stroke survivors presented a drop of almost six points (p<0.001). There was no association between psychological stress and sociodemographic variables (sex, income, age, marital status) in T1, T2 and T3. Elderly with caregivers presented a higher average in the PSS-10 when compared to the untreated elderly in T1 (p=0.003), T2 (p<0.001) and T3 (p=0.02). The elderly with depression presented a higher mean in the PSS-10 when compared to the elderly without depression in T1 (p<0.001), T2 (p<0.001) and T3 (p<0.001). Survivors with moderate stroke presented a higher mean in the PSS-10 when compared to the elderly with mild stroke in T1 (p=0.001), T2 (p=0.006) and T3 (p<0.001). The reduction of the mean PSS-10 was related to the increase in the mean FIM (p = 0.04) and the reduction in the mean GDS-15 (p<0.001). The mean FIM (?=-0.61, p=0.015) and the GDS-15 (?=0.30, p=0.01) in T1 were predictors of mean PSS-10 in T3. It has been concluded that the psychological stress of the elderly stroke survivors decreases during the six months after hospital discharge. In addition, lower functionality and greater number of depressive symptoms, two weeks post-discharge, predict higher level of psychological stress six months after it

The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. / Master of Health Science (Hons)