The past two decades have witnessed transition from in-patient hospital settings to Community and Home Based Care in Zimbabwe. This is because of an increase in the number of people developing chronic health conditions such as diabetes, hypertension and cancers, and thus needing longer treatment durations. The increase in chronic conditions has mainly been attributed to the increase in incidence and prevalence of Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome in Sub-Saharan Africa. Many Governments, including that of Zimbabwe, endorsed and promoted community and home based care to provide a continuum of care to the chronically ill. Despite the implementation of Community and Home Based Care programmes, no studies known to the researcher have been done to investigate the congruency of service users’ needs and the programme goals. Purpose: The purpose of the study is twofold; firstly to explore whether Community and Home Based Care interventions provide services that effectively meet users’ goals in a dynamic social environment and secondly, to develop guidelines for enhancing care provision as well as congruency of service users’ needs and programme goals. Methods: A mixed-method approach combining qualitative and quantitative data collection and analysis was used. Concurrent collection of data with equal status was placed on both qualitative and quantitative data. For qualitative data interviews and focus groups were used with home based care service users, family care givers, and health providers. Structured questionnaires were used for the quantitative data. Framework: Imogene King’s Interacting Systems Framework and Theory of Goal Attainment were adopted to guide the study. These were utilised because of the assumption that mutual agreement on goals for effective care can be achieved through nurse-client interactions and communication Research findings: Community and Home Based Care programme in Zimbabwe does not comprehensively meet the needs of its service users. Service users have diverse needs and goals depending on the specific condition and symptoms they experience. They perceive access to medication for symptom management and pain control, food and financial stability, as priority needs. The study found that nursing services provided in Community and Home Based Care generally align with the physical needs of service users and was deficient in addressing the socio-economic and psycho-social needs of service users. Conclusion: No single sector can achieve the users’ and the programme`s goals of quality health on its own. The goals may only be realised when other stakeholders and relevant sectors contribute to the Community and Home Based Care programme, which requires diverse resources. Guidelines to enhance integration of Community and Home Based Care with social services were developed. / Health Studies / D.Litt. et Phil. (Health Studies)

The development of palliative care in Indonesia has been slow due to the absence of palliative care guide lines and standards. This results in the limited provision of palliative care where it can only be found available in 14 hospitals in the whole country with a population over 260 million, and the palliative care is basically directed to adult patients. In the paediatric medicine field, the palliative care services in Indonesia is still in its infancy and currently palliative care is served by only one non-profit organization in Jakarta. With around 1,5 million people in Jakarta associated with living in poverty, this organization is focusing on providing free palliative care to children from marginalized communities. The questions that are raised out of these circumstances are how paediatric palliative care is practiced in Jakarta and what the rewarding and challenging parts of the job are. The aim of the study is to describe nurses' perspectives and experiences in giving home-based palliative care to children living with cancer and HIV from marginalized communities in Jakarta. A qualitative study design with content analysis was considered to be the method that fitted the goal of the study best. Semi structured interview was used as data collection method and there were seven nurses who participated in the interviews. The result is described by two main categories; the first category contains different topics that functioned as encouragements to the nurses, and the second category consists of various subjects that contribute to challenges that nurses encounter in their work. Lack of palliative education that lead to certain attitudes in the referral process, misperceptions about pain management and nurses’ stress management are discussed as some challenges encountered in the implementation of palliative care.

<p>In many developing countries including South Africa, there is an overwhelming number of people infected with HIV/AIDS in the hospitals, which the health care workers are unable to cope with. Therefore, an urgent need to develop alternative community based activities such as support groups, home based care programs and placement of&nbsp / orphans, for the provision of social health care services to the HIV client, arises. However, a deeper understanding of the challenges facing community organizations when&nbsp / providing home based care is crucial and necessary in order to formulate effective and relevant care services. The aim of the study was to explore the challenges faced by Umtha&nbsp / elanga Community Organization (UWCO) in the provision of HIV/AIDS home based care. The objectives of the study were to assess the current home based care of the UWCO and to explore the challenges that community based organizations have to face when providing care services to people being infected and affected by HIV/AIDS. The research design undertaken was the case study of UWCO. The qualitative approach with in-depth interviews with the&nbsp / management staff and home based caregivers was utilized. Data analysis began immediately after the interviews by transcribing and translating the audio-taped data. Thematic analysis was used in which data was coded and categorized. The findings of the research&nbsp / indicated that the home based care programme assists PLWHA clients in their natural home setting. All home based carers work voluntary and get supported by the organization as&nbsp / ell as by the department of social development and health such as the social workers. Finances appear to be, both for the organization and the home based carers, a huge&nbsp / hindrance. Research indicated that the organization experiences various challenges to provide the service to their community. It is recommended that Government must ensure that&nbsp / home based care workers get recognition, credit and support for their valuable contribution. Training for HBC employers needs to be extended to expose and add more skills. This&nbsp / will ensure that they are equipped for their tasks. Home based care workers must become registered and paid better salaries by the government.</p>

Syftet med denna uppsats var att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelse av mötet med kunderna utifrån aspekterna kvalitet, tid och makt. Vi har genomfört en kvalitativ intervjustudie med sex personer som arbetar inom hemtjänstverksamheten. Studiens resultat har analyserats och tolkats utifrån teorierna socialkonstruktionism och roll­teori samt begreppet relationell makt. Resultaten visar att tiden är central i mötet mellan hem­tjänstpersonal och kunder då den inverkar på när och hur länge insatserna ska utföras. Lyhörd­het och att utgå från kundens behov och önskemål definieras som god omsorgskvalitet medan maktförhållandet växlar mellan hemtjänstpersonal och kund utifrån varje unikt om­sorgs­möte. För att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelser av mötet med kunderna behöver aspekterna kvalitet, tid och makt belysas och analyseras i en och samma kontext. Resultaten visar att de tre aspekterna samverkar i mötet och analysen med­verkar till att nå en djupare förståelse för hemtjänstpersonalens upplevelser. / The purpose of this study was to gain a deeper understanding and knowledge of home based care giver´s experiences of the encounter with clients from three perspectives: quality, time and power. We conducted a qualitative interview study with six people working in home based care. Our results have been analyzed and interpreted by the theories social construc­tionism and role theory and the concept of relational power. The results of the study demon­strate that time is central for the encounter between home care giver´s and clients affecting both when and how long the care should be performed. Responsiveness and putting the client´s needs in focus are defined as good quality of care, while the power relationship between home care givers and clients changes between each unique encounter. To get a deeper understanding and knowledge of home care givers experiences of the encounter with clients the three aspects: quality, time and power, needs to be highlighted and studied in the same context. The results demonstrate that the three aspects interact in the encounter and analyzing these together creates a deeper understanding of home care giver´s experience of the encounter.

<p>In many developing countries including South Africa, there is an overwhelming number of people infected with HIV/AIDS in the hospitals, which the health care workers are unable to cope with. Therefore, an urgent need to develop alternative community based activities such as support groups, home based care programs and placement of&nbsp / orphans, for the provision of social health care services to the HIV client, arises. However, a deeper understanding of the challenges facing community organizations when&nbsp / providing home based care is crucial and necessary in order to formulate effective and relevant care services. The aim of the study was to explore the challenges faced by Umtha&nbsp / elanga Community Organization (UWCO) in the provision of HIV/AIDS home based care. The objectives of the study were to assess the current home based care of the UWCO and to explore the challenges that community based organizations have to face when providing care services to people being infected and affected by HIV/AIDS. The research design undertaken was the case study of UWCO. The qualitative approach with in-depth interviews with the&nbsp / management staff and home based caregivers was utilized. Data analysis began immediately after the interviews by transcribing and translating the audio-taped data. Thematic analysis was used in which data was coded and categorized. The findings of the research&nbsp / indicated that the home based care programme assists PLWHA clients in their natural home setting. All home based carers work voluntary and get supported by the organization as&nbsp / ell as by the department of social development and health such as the social workers. Finances appear to be, both for the organization and the home based carers, a huge&nbsp / hindrance. Research indicated that the organization experiences various challenges to provide the service to their community. It is recommended that Government must ensure that&nbsp / home based care workers get recognition, credit and support for their valuable contribution. Training for HBC employers needs to be extended to expose and add more skills. This&nbsp / will ensure that they are equipped for their tasks. Home based care workers must become registered and paid better salaries by the government.</p>

This thesis describes and analyses in three substudies how home-based measures for children are expanding and why an open care idea are established as part of the Swedish child welfare. The first substudy describes the national increment of what today can be considered as a treatment policy – non-institutional care in child welfare. The results are analysed with Kingdon's agenda setting theory and shows that the factors of what Kingdon describes as problems-, politics- and policyflow influenced the national increment. Significant mechanisms have primarily been, the profession, the society's concerns for socially disadvantaged children, negative experiences of institutionalisation and a political position to deinstitutionalise all care. The second substudy focuses on how knowledge and research contributes to ideological, professional, and organizational change in child welfare by analysis of Research &amp; Developments reports and articles from the professional journal Socionomen. Based on the neo-institutional concepts of organisational fields and isoformism the study's results shows that a consequence of adaptation strategies and "rationalized myths" are a number of similarities in how home-based measures are organized and which measures that are used. The third substudy, a case study, analyses how we can understand a local development of ideas in social services for children with concepts from neo institutional theory. Interviews and municipal documents are analysed and shows that the local translation of an open care idea is characterized by discretion, personal preferences and action and affects the choice of method and organization. The study also shows a political mistrust of institutional care while there is at the same time political confidence in the individual social worker's ability to find solutions that allow non-institutional measures to be an alternative to institutional care. An overall conclusion of the thesis is that there is now a treatment policy in social services for the children, which involves extensive efforts at home and it has led to that more children receive support from social services. One result of non-institutional care increment is that it led to increased costs for municipalities for intervention for children and young people when out-of-home care has not decreased. Another general conclusion is that translation and adaptation of ideas to local contexts is something that generally fits street-level bureaucrats need for discretion.

Bakgrund: Venösa bensår är ingen sjukdom utan ett symtom som orsakas av bakomliggande faktorer. Det är framförallt äldre personer som har en ökad risk för sårbildning. Sjuksköterskan är ansvarig för att utföra en bedömning av såret inför val av behandling. Syfte: Att beskriva sjuksköterskors bedömning av venösa bensår hos patienter inom hemsjukvården. Metod: Studien är en kvalitativ intervjustudie med induktiv ansats. Data samlades in genom sex semistrukturerade intervjuer. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: Sjuksköterskans tillvägagångssätt vid bedömning, sjuksköterskan och patienten tillsammans i en bedömning, sjuksköterskans behov av erfarenhet, stöd och utveckling i bedömning. Sårets egenskaper och fastställande av bakomliggande orsak var av stor betydelse. Likaså poängterades vikten av att göra en helhetsbedömning av patienten, vilket visade sig både ha positiva och negativa sidor relaterat till patientens hemmiljö. Kontinuerlig utbildning och stöd från kollegor ansågs vara till stor hjälp vid bedömning av patienter med venösa bensår. Slutsats: Det konstaterades att bedömningen av venösa bensår upplevs svår, innehåller flera moment samt att praktiken inte alltid stämmer överens med teorin. För att försäkra att patienten får de bästa förutsättningarna till en god sårläkning bör sjuksköterskan se till hela människan och varje patients enskilda behov. / Titel: Nurse's assessment of venous leg ulcers in home based care Background: Venous leg ulcers is not an illness, but a symptom caused by underlying factors. It is mostly elderly people which have an increased risk for ulceration. The nurse is responsible for making the assessment of the ulcer, before choice of treatment. Aim: To describe nurse's assessment of venous leg ulcers in patients within home based care. Method: The study is qualitative interview study with an inductive approach. Data was collected through six semi- structured interviews. The material was analysed with qualitative content analysis. Results: The analysis resulted in three categories: Nurses approach to assessment, the nurse and the patient together in an assessment, nurses needs for experience, support and development in assessment. The ulcer's characteristics and determination of underlying cause were of great importance. Similarly, the importance of making a comprehensive assessment of the patient was emphasized, which proved to have both positive and negative sides related to the patient's home environment. Continuous education and support from colleagues were of great help in assessing patients with venous ulcers. Conclusion: It was confirmed that the assessment of venous leg ulcers is experienced complex, containing several moments, and that practice and theory are not always consistent. To ensure that the patient gets the best prerequisites for good wound healing, the nurse should look after the entire person and patient's individual needs.

Magister Human Ecology - MHE / In many developing countries including South Africa, there is an overwhelming number of people infected with HIV/AIDS in the hospitals, which the health care workers are unable to cope with. Therefore, an urgent need to develop alternative community based activities such as support groups, home based care programs and placement of orphans, for the provision of social health care services to the HIV client, arises. However, a deeper understanding of the challenges facing community organizations when providing home based care is crucial and necessary in order to formulate effective and relevant care services. The aim of the study was to explore the challenges faced by Umtha elanga Community Organization (UWCO) in the provision of HIV/AIDS home based care. The objectives of the study were to assess the current home based care of the UWCO and to explore the challenges that community based organizations have to face when providing care services to people being infected and affected by HIV/AIDS. The research design undertaken was the case study of UWCO. The qualitative approach with in-depth interviews with the management staff and home based caregivers was utilized. Data analysis began immediately after the interviews by transcribing and translating the audio-taped data. Thematic analysis was used in which data was coded and categorized. The findings of the research indicated that the home based care programme assists PLWHA clients in their natural home setting. All home based carers work voluntary and get supported by the organization as ell as by the department of social development and health such as the social workers. Finances appear to be, both for the organization and the home based carers, a huge hindrance. Research indicated that the organization experiences various challenges to provide the service to their community. It is recommended that Government must ensure that home based care workers get recognition, credit and support for their valuable contribution. Training for HBC employers needs to be extended to expose and add more skills. This will ensure that they are equipped for their tasks. Home based care workers must become registered and paid better salaries by the government. / South Africa

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

This dissertation studies factors that predict use of public eldercare, informal care, and purchase of private services in relation to an individual’s needs, social network characteristics, and sociodemographic factors. A further purpose is to examine whether use of public eldercare is correlated to receipt of informal care and purchase of private services in the Swedish welfare state. The dissertation is based on the Kungsholmen Study, a population-based longitudinal study. Studies I–III used cross-sectional data from community-dwelling people aged 81-100 and examined (I) gender, (II) marital and parental status, and (III) dementia and depressive symptoms as predictors of use of home help. Study IV analyzed factors related to moving into institutional care and receipt of home help from 1994/96 to 2000. The majority of support provided to elders living in the community comes from informal sources, even among people living alone. There was considerable overlap between home help and informal care. When all sources of care were considered, childless individuals had comparatively lower odds of receiving care. Factors predicting use of public eldercare and informal care differed depending on whether or not elders coresided. No gender differences in use of formal and informal care were found when controlling for household composition. Living alone, dementia, need of help with household chores, and walking limitations increased the likelihood of using public eldercare. Coresidence, informal care from outside the household, and use of private services decreased the likelihood. Depressive symptoms increased the likelihood of receiving home help and institutionalization when using longitudinal data, but not in the cross-sectional studies. Educational level was of importance and interacted with several factors; persons with higher levels of education were advantaged. Very few people moved into institutional care without previously having received home help services. Essentially the same factors that predicted receipt of home help services also predicted institutionalization.