Thesis (M.Arch.(Prof.))--University of Pretoria, 2005. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Unhealthy eating and physical activity behaviours are common among nurses. As nurses spend a substantial proportion of their waking hours at work, interest in delivering interventions in the workplace to improve this populations' eating and physical activity behaviours is growing. This programme of research aimed to systematically develop evidence-based and theory-informed recommendations for a workplace intervention to change nurses' eating and physical activity behaviours. Methods: A systematic literature review of published randomised controlled trials was undertaken. Factors that behavioural theories suggest may influence nurses' eating and physical activity behaviours were identified through theoretical domains framework-informed qualitative interviews and a survey of nurses. Intervention recommendations were specified in terms of (i) intervention functions and policy categories using a Behaviour Change Wheel and (ii) theory-informed behaviour change techniques using a behaviour change technique taxonomy. Evidence related to the parameters of effectiveness for each technique was also taken into account during this intervention specification process. The selected techniques were then combined into a conceptual overview of a potential workplace intervention. Results: Data from 13 randomised controlled trials indicate workplace-based behaviour change interventions targeted to this population are effective in decreasing body weight. The evidence base is, however, limited in quantity and quality. Nurses' beliefs about important determinants of eating and physical activity behaviour change were identifed across 16 qualitative interviews and 245 survey responses and key determinants included: environmental context and resources; behavioural regulation; emotion; beliefs about consequences; knowledge and optimism. Based on this behavioural diagnosis, 24 behaviour change techniques suitable for targeting the identified determinants were chosen and combined into a potential workplace intervention. Conclusions: This thesis illustrates the utility of the Theoretical Domains Framework, the Behaviour Change Wheel and the behaviour change technique taxonomy for developing workplace intervention recommendations. The proposed recommendations address a gap in the current evidence base. Such an intervention, if implemented, has the potential to improve nurses' eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

nÃo hà / A AvaliaÃÃo Multidimensional RÃpida da Pessoa Idosa (AMRPI) à um instrumento que pode ser utilizado para identificar problemas de saÃde condicionantes de declÃnio funcional em pessoas idosas. Indica, quando necessÃrio, a utilizaÃÃo de outros instrumentos mais complexos: cartÃo de Jaeger; Escala de AvaliaÃÃo de Medida de IndependÃncia Funcional; Escala de Katz; Escala de Lawton; APGAR; Escala de DepressÃo GeriÃtrica; ECOMAPA; Mini exame do estado mental; e Escala de AvaliaÃÃo do EquilÃbrio e da Marcha de Tinneti. Este estudo objetivou avaliar a aplicabilidade do instrumento AvaliaÃÃo multidimensional rÃpida da pessoa idosa, na consulta de Enfermagem no contexto da EstratÃgia SaÃde da FamÃlia; e como objetivos especÃficos, verificar a concordÃncia dos especialistas acerca da aplicabilidade do instrumento AMPI na atenÃÃo bÃsica e considerar os aspectos do instrumento que foram consensuais entre os especialistas para propor as adequaÃÃes necessÃrias. Pesquisa metodolÃgica do tipo intencional. A populaÃÃo do estudo constituiu-se de enfermeiros, experts ou especialistas, do Brasil que possuÃsse conhecimento na Ãrea da saÃde do idoso com no mÃnimo cinco anos de experiÃncia. A coleta de dados foi realizada de fevereiro a abril de 2012, via correio eletrÃnico, utilizando o mÃtodo "Delphi" com duas rodadas. Para avaliaÃÃo do instrumento, foram utilizados os critÃrios da psicometria propostos por Pasquali (1999): comportamental, simplicidade, clareza e relevÃncia atribuido uma nota (-1,0 e +1). A concordÃncia esperada foi de 80%. Os dados foram agrupados e analisados estatisticamente, por meio do programa Statistical Package for the Social Sciences, versÃo 18.0, e software Excel. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme protocolo n.302/11. Os participantes foram do sexo feminino e a mÃdia de idade de 45 anos. Atuava na regiÃo Nordeste (36,3%), seguidas da regiÃo Sudeste (22,7%). Quanto à Ãrea de especialidade, 72,7% tinham formaÃÃo em gerantologia. Referente à titulaÃÃo mÃxima, 54,5 % concluÃram doutorado e 36,3% mestrado; com tempo de atuaÃÃo na Ãrea de 5 a 15 anos (50%) e mais de 16 anos (49,9 %), com mÃdia do tempo de 21,13 anos. Na Ãrea de atuaÃÃo profissional, atuavam no ensino (45,4%) e na assistÃncia na EstratÃgia SaÃde da FamÃlia (36,3%). Na primeira rodada, com exceÃÃo do item atividade sexual, todos alcanÃaram concordÃncia, com proporÃÃes estatisticamente significativas. Na segunda rodada, apÃs revisÃo do item âatividade sexualâ, obteve-se concordÃncia estatisticamente significativa. Conforme os resultados apresentados, o instrumento AvaliaÃÃo multidimensional rÃpida da pessoa idosa constitui ferramenta importante na consulta de Enfermagem no contexto da EstratÃgia SaÃde da FamÃlia, na busca pelo envelhecimento ativo.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O presente estudo apresenta como temÃtica o luto vivido por famÃlias cujos entes queridos foram doadores de ÃrgÃos. Discute-se a necessidade de os profissionais de saÃde conhecer as etapas do luto e a sutileza em percebÃ-las nos momentos de aproximaÃÃo com a famÃlia, instrumento valioso no processo de cuidar, em especial no enfrentamento da morte. Teve como objetivos, assistir a famÃlia no processo do luto apÃs doaÃÃo de ÃrgÃos; descrever as histÃrias das famÃlias de doadores de ÃrgÃos, focando nas experiÃncias de perda e no processo de doaÃÃo, analisar o processo de enfrentamento do luto da famÃlia apÃs doaÃÃo de ÃrgÃos e analisar a visita domiciliÃria como estratÃgia de promoÃÃo da saÃde de famÃlias em luto. Pesquisa qualitativa, utilizou a HistÃria TÃpica de vida. O local do estudo foi a Zona norte do estado do CearÃ, Brasil, onde foram identificados 39 doadores de mÃltiplos ÃrgÃos no perÃodo de 2009 a 2011, sendo a visita domiciliar a estratÃgia de cuidado e coleta de dados com oito famÃlias. Foram descritas as HistÃrias tÃpicas das famÃlias e analisados os seus lutos: identificou-se a estrutura familiar, o desenvolvimento e a sua funcionalidade, pelo Modelo Calgary de AvaliaÃÃo Familiar. Este estudo fornece contribuiÃÃes para os profissionais da saÃde, principalmente para enfermeiros, em relaÃÃo à importÃncia do cuidado à pessoa em processo de luto, sendo necessÃria a revisÃo de prÃticas que inibem a exposiÃÃo dos sentimentos, as polÃticas de acolhimento familiar em InstituiÃÃes e a prÃtica efetiva de visitas domiciliarias como metodologia de cuidado familiar. AlÃm disso, essa aproximaÃÃo entre famÃlia e equipe à uma oportunidade de os profissionais reverem suas prÃticas, nas suas fragilidades e possibilidades terapÃuticas. Esse processo proporcionaria a elaboraÃÃo constante do cuidado compartilhado. Essa pesquisa evidencia a necessidade, ainda, de estudos para sistematizaÃÃo de prÃticas de profissionais em especial de enfermeiros com a visÃo da promoÃÃo da saÃde mental de familiares em luto, visto que para o sofrimento da perda, o abraÃo cuidador à o ponto de partida. / The present study has as its central theme of discussion grief experienced by families whose loved ones were organ donors. It discusses the need for health professionals to know the stages of grief and subtlety to perceive them approaching in moments with family, valuable tool in the care process, especially in the face of death. This research aimed to assist the family in the grieving process after organ donation. Specifically, the objective is also to describe the stories of the families of organ donors, focusing on the experiences of loss and the donation process, analyze the coping process of grieving family after organ donation and analyze how the home visit strategy to promote the health of families in mourning. It is a qualitative research and used the Topical History of life. The site was the area north of the state of CearÃ, where 39 were identified multiple organ donors in the period from 2009 to 2011, being the home visit strategy and careful data collection with eight families who agreed to participate. Were described topical stories of families and analyzed their grief: identified the family structure, development and its functionality at Calgary Family Assessment Model. This study provides contributions for health professionals, mainly nurses about the importance of care for the person grieving process, necessitating a revision of practices that inhibit the exposure of feelings, policies foster care in institutions and effective practice home visits as a method of family care. Moreover, this approach between family and staff is an opportunity for professionals to review their practices, their weaknesses and therapeutic possibilities. This process would provide the constant construction of shared care. In this sense, it signals the need also to work with the vision of promoting the mental health of families in mourning, as for the pain of loss, the embrace caregiver is the starting point.

No description available.

Māori are the indigenous people of New Zealand. As a population group Māori have on average the poorest health status of any ethnic group in New Zealand (Ministry of Health, 2007). Much of this disproportionate ill-health is linked to manageable and/or preventable conditions. Given this, there is much scope for effective Māori health promotion in particular, as the Māori population is relatively young. The primary objective of the case study research was to determine the organisational pre-requisites necessary to fund, implement and sustain Māori health promotion within a primary care setting. Secondary aims were to; identify how health promotion is perceived within a ‘Māori’ primary health care setting, identify existing health promotion practice, and test the feasibility of implementing a current Māori health promotion framework. The case study research was informed by 19 key informant interviews and two focus group sessions. A literature review including an organisational document review was also undertaken. Findings indicated that many of the pre-requisites necessary for effective Māori health promotion implementation sat outside the scope of the organisation and needed to come from a variety of sources including the Ministry of Health, District Health Board’s (DHB’s), community organisations and health providers, whānau (family), hapū (sub tribe) and iwi (tribe), including support from other sectors. The research also found a number of underlying issues that impacted greatly on the health of the Māori population within the PHO. These issues need to be addressed at a number of levels and given high New Zealand priority. In testing the feasibility of a current Māori health promotion model (Kia Uruuru Mai a Hauora) it was considered by participants to fit well with the goals, principles and values of the case study site and within primary health care in general, complementing critical health care service delivery components that already exist. The study’s conclusion found that there was much scope for Māori health promotion that was fully supported, recognised, and adequately and appropriately resourced by the New Zealand Government, Ministry of Health and DHB’s in order to provide long term cost effective and sustainable health benefits.

<p>  </p> <p>Lack of physical activity is considered a public health crisis, with only 21% of women meeting current physical activity guidelines. Inactivity places individuals at higher risk for heart disease, type 2 diabetes, depression, cancer, and premature death. Affect, or one’s mood and emotions, is often related to both health outcomes and health behaviors. Positive affect is associated with a lower risk of mortality, healthy eating habits, and decreased alcohol consumption, while negative affect is associated with premature mortality, lower medication adherence, and riskier sexual behaviors. Fredrickson’s broaden and build theory of positive emotions (BABT) supports the relationship of how positive emotions can lead to enhanced health. This dissertation aims to examine the relationship between positive affect of married women, positive affect of their husbands and wives’ physical activity, guided by the BABT. </p> <p><br></p> <p>The three hypotheses for this investigation are: A) on days when wives have indicated higher positive affect, they will have higher levels of same day moderate to vigorous physical activity (MVPA), B) on days when wives have higher positive affect, they will have higher levels of next day MVPA, and C) husbands’ positive affect will be associated with wives’ same day MVPA beyond the impact of wives’ own daily positive affect. To examine these relationships, a secondary data analysis of the Health and Relationships Project (HARP) data set using population average models was done. The HARP is a 10 day, online, daily diary study (including a baseline questionnaire) of couples that aimed to examine how individuals in long-term relationships manage situations/contexts that impact their health. </p> <p><br></p> <p>Independent variables assessing daily positive affect of calm and happy were used. The dependent variable of daily moderate-to-vigorous physical activity (MVPA) was created as a sum of minutes of reported moderate and vigorous activity over the last 24 hours. Covariates in the model included age, baseline moderate activity frequency, baseline vigorous activity frequency, education level, marital quality, and race/ethnicity. This analysis included 115 heterosexual couples. There is partial support for the hypotheses. Results for hypothesis A showed only happiness (β = 0.15; <em>p</em> < 0.01) to be associated with same day MVPA. For hypothesis B neither happiness (β = 0.11; <em>p</em> = 0.06) nor calmness (β = 0.01; <em>p</em> =0.90) were significantly associated with wives’ next day MVPA. Findings for the two-partner model (hypothesis C) showed husbands’ affect did not significantly contribute to wives’ MVPA, while wives’ positive affect remained significantly associated with their own same day MVPA (happy β = 0.15; <em>p</em> < 0.01).</p> <p><br></p> <p>Wives’ positive affect being significantly associated with same day MVPA supports the tenets of Fredrickson’s BABT and previous work surrounding affect and health behaviors.  While husbands’ positive affect was not significant in this analysis, husbands could be contributing to their wives’ MVPA in other ways such as increasing her overall happiness level or increasing her marital satisfaction. Additionally, other indicators of social support (e.g., close friends or other family members) could be impacting wives’ MVPA behaviors and should be considered in future studies. The results from this study support further investigation of the affect-physical activity relationship.</p>

Cardiovascular disease (CVD) represents a large portion of the burden of illness for industrial nations, and biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive and population health promoting strategies to reduce this burden of illness. The present research is part of a larger research program, the Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study designed to investigate and strengthen community-based heart health activities in both the formal and informal public health systems. This study builds upon CHHIOP's qualitative findings to examine how community relationships and community development approaches play out in local contexts to shape the reality of (heart) health promotion practice. Although community development is a central concept in heart health policy there has been no analysis of its understanding, support or use among community health stakeholders. In order to address these questions thirty key informant interviews were conducted with community heart health stakeholders from eight of the 42 health unit areas across Ontario. The findings reveal that three patterns of community heart health practice appeared across the communities, illustrating a continuum of collaboration. These patterns are typfied by different community atmospheres for collaboration, the divergent nature of agency inter-relations, and distinct composites in the use of community (development) approaches. Central themes across communities illustrated the importance of local community contexts, the lack of a common understanding of community development, and the emergence of a shift in health agencies' ways of doing business. Local perspectives and the dynamics of intra-community relations were allowed to emerge and highlight the need for place-sensitive implementation of health promotion strategies at the community level. / Thesis / Master of Arts (MA)

The health service provides a Child Health Programme (CHP) to all children to help them attain their health and development potential. Core elements include screening, immunisations, growth and development surveillance, health promotion advice, and parenting support. The surveillance/advice/support components (known as Child Health Surveillance CHS) are delivered through a series of universally offered child health reviews mainly provided by Health Visitors (HVs) supplemented by additional support as required. Scottish policy issued in 2005 led to considerable changes to the CHP. The number of CHS reviews was substantially reduced to enable more intensive support of children who required it. A three category indicator of need was introduced at the same time to facilitate the identification of children requiring enhanced support. This thesis aims to explore the shift to more targeted provision of CHS that occurred from 2005 onwards, and to examine the impact of this on the preventive health care provided to pre-school children. The specific objectives are: · To describe the development of professional guidance on the CHP and how this has been adopted into Scottish policy. · To compare the CHP provided in Scotland to that offered in other high income countries. · To examine the impact of the changes to CHS on the coverage of universally offered child health reviews. · To explore, following the changes to CHS, which factors are associated with children being identified as in need of enhanced CHP support. · To assess the impact of the changes to CHS on the totality of preventive care provided to pre-school children by HVs and General Practitioners (GPs). The key methods used are literature review, policy analysis, and analysis of routine health data. Selected findings include the following: · All the high income countries studied provide the same basic elements as the Scottish CHP but the detail of the different programmes varies considerably. Some of the variation may reflect the different needs of different populations, but much seems to reflect different approaches to evidence interpretation and policy making in different settings. · Not all children offered ‘universal’ child health reviews actually receive them. Children from deprived areas are less likely to receive their reviews. Inequalities in review coverage have remained unchanged after the changes to CHS. · Many factors, including those reflecting infant and maternal health and family social risk, are associated with being identified by HVs as needing enhanced CHP support. The threshold at which children are identified as needing enhanced support varies between areas across Scotland. · GP provision of child health reviews has reduced after the changes to CHS as would be expected. Recorded GP provision of other preventive care consultations is uncommon and has not changed. Currently available routine data do not allow trends in the totality of HV provided care to be examined. In summary, the Child Health Programme makes an important contribution to supporting young children and their families but it is a complex service and considerable uncertainty about aspects of its content and delivery remain.

I mötet med patienter i livets slut övergår sjuksköterskans handlingar från botande till lindrande. Bakgrunden beskriver begreppet hälsa som ett flerdefinierbart begrepp och sjuksköterskans roll i vården. Den palliativa vårdens förhållningssätt och de sex S:en beskriver att sjuksköterskan ska utgå från patientens livsvärld för att få kunskap om hur livskvalité och hälsa kan främjas i livets slut. I problemformuleringen beskrivs vikten av att se patienters behov och önskningar, det är deras berättelser som bör ligga till grund för sjuksköterskans agerande. Syftet var att belysa vad patienter upplever som hälsobefrämjande omvårdnad vid livets slut. Metoden som använts är litteraturstudie och resultatet är funnet i åtta vårdvetenskapliga artiklar. Resultatet redovisades i tre teman som uppfattades som viktiga för att uppleva välbefinnande och hälsa i livets slut. Hälsofrämjande relationer beskriver närståendes betydelse och sjuksköterskans förmåga att ha både en professionell och personlig roll. Möjliggöra delaktighet, genom god kommunikation och att patienten har kontroll skapas delaktighet i vården. Möjliggöra ett gott liv, genom symtomkontroll och att bevara det vanliga, främjas en känsla av värdighet för patienter i livets slut. Betydelsen av sjuksköterskans roller framkom i diskussionen, vikten av att vara både personlig och professionell. Medvetenhet krävs hos sjuksköterskan för att se patientens verkliga behov. Det visade sig att närstående inte enbart var något positivt för patienterna, de känner ett ansvar för sina närståendes välmående och det kan innebära ytterligare en påfrestning för den som är sjuk.