Cerebral Palsy (CP) is a childhood-onset neurological disorder caused by a non-progressive lesion in the developing brain. It causes permanent motor and movement disorders, and can sometimes cause secondary cognitive, sensory, and communication conditions. The majority of children with CP will survive into adulthood; however, a relatively small amount of research has been done about adulthood and aging with CP. Using data collected in Ontario with the Resident Assessment Instrument for Home Care (RAI-HC), a retrospective, cross-sectional analysis was performed to create a clinical profile of adults with CP receiving long term home care services in Ontario. Of the 519, 443 people in the sample, 2000 had CP. Persons with CP tended to be younger than comparison groups, had higher scores on functional assessment scales, and were more likely to use assistive devices. They tended to have lower scores on scales meant to predict decline in health or function than the comparison groups, suggesting increased health and functionality stability compared to other Home Care recipients. A second analysis assessed the association between functional assessment scales, demographic variables and clinical indicators and use of physical therapy (PT), occupational therapy (PT) and either PT or OT for persons with CP in this population. Using three logistic regression models, indicators that were found to have positive, significant associations with use of rehabilitative services were: receipt of initial assessment, likelihood of decline in functionality, use of a wheelchair, being married, and CCAC of assessment origin. Living in a private residence compared to living in an assisted living situation had a significant, negative effect on rehabilitative service use. These findings suggest that PT and OT are referred to persons with CP in reaction to risk of health declines, and not in an attempt to improve baseline functionality. Future research on the factors that would indicate likelihood of improvement with PT or OT could identify whether these associations are appropriate for optimum care for persons with CP who receive home care services.

Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.

Utvecklingen inom äldreomsorgen har under de senaste decennierna lett till en mer marknadsanpassad äldreomsorg. Den äldre ska efter att ha fått sitt biståndsbeslut välja vilken utförare som ska tillhandahålla den beviljade insatsen. Valfrihetssystem blir allt vanligare i samhället och valfrihet i sig har länge varit ett politiskt mål. Syftet med denna uppsats var att undersöka äldre personers erfarenheter av att välja hemtjänst. Frågor som har tagits upp är hur man väljer, vad som påverkar hur man väljer, om valet anses vara lätt och om man generellt är nöjd med det system som finns. Metoden som har använts är strukturerade intervjuer där respondenternas svar har kodats i SPSS. Åtta av intervjuerna spelades in och transkriberades. Uppsatsen har ett brukarfokus och utgår från de äldres perspektiv och syftar till att lyfta fram deras åsikter och erfarenheter om valfrihetssystemet inom hemtjänsten. Materialet har analyserats med hjälp av Hirschmans teori om exit, voice och loyalty samt med en deskriptiv beslutsteori, prospektteori. Uppsatsen kommer fram till att systemet idag inte är verksamt i den mening det var tänkt. Alla äldre väljer inte hemtjänst, fysiska och psykiska hinder står i vägen och få väljer att utnyttja sin rätt att byta utförare. Generellt är de äldre nöjda med den hjälp de får och valet av hemtjänstutförare är inte det primära för de äldre. / Elin Örberg

Syfte: Att beskriva hur distriktssköterskor inom hemsjukvården upple­ver sitt arbete och sin arbetsmiljö ur ett fysiskt, psykiskt och socialt perspektiv. Metod: Studien hade en beskrivande design med kvalitativ ansats. Åtta distriktssköterskor verksamma inom hem­sjukvård i tätort eller på landsbygd i Mellansverige deltog i studien. Data samlades in via semi-strukturerade intervjuer och analyserades genom kvalitativ innehållsanalys. Resultat: Temat ”Att arbeta för patientens bästa, en utmaning för distriktssköterskan i hemsjuk­vård” bildades ur fyra kategorier. Utmaningar som distriktssköterskorna i studien beskrev som den fysiska arbetsmiljön i patienternas hem, att ha ett professionellt förhållningssätt, att hålla sig uppdaterade, prioritera och planera sitt arbete. Utmaningarna fanns också i kra­ven ställda från olika håll och strävan efter ett gott samarbete med många olika instanser och yrkeskategorier, allt för patientens bästa. Temat bildades ur kategorierna ”Ditt hem är min arbetsplats – att vara nära men ändå ha distans”, ”Att känna sig som en admi­nistratör men prioritera patientkontakten”, ”Att uppleva stöd och sträva efter samar­bete” samt ”Ambitioner och förväntningar inför framtidens hemsjukvård”. Slutsats: Distriktssköterskorna inom hemsjukvården upplevde många utmaningar i sin strävan efter att arbeta för patientens bästa. Distriktssköterskornas upplevelser gav ett helhetsperspektiv på arbetet inom hemsjukvården och kunskap om detta är ett viktigt redskap för att optimera hemsjukvår­dens framtida kvalitet. / Aim: To describe how district nurses in home care experience their work and their working environment from a physical, psychological and social perspective. Method: The study had a descriptive design with qualitative approach. Eight district nurses working in home care in urban or rural areas in central Sweden participated in the study. Data were collected through semi-structured interviews and analyzed by qualitative content analysis. Results: The theme "Working for the patient's best, a challenge for the district nurse in home care " was formed out of four categories. Challenges that district nurses in the study described as the physical environment in the patients’ home, having a professional approach, to stay updated, prioritize and plan their work. Challenges were also in the requirements asked from various quarters and the quest for a good cooperation with many different instances and professions, all for the patient's best. The theme was formed from the categories "Your home is my workplace - to be close but still have a distance", "To feel as an administrator but prioritize the patient contact", "To experience support and strive for cooperation" and "Ambitions and expectations for the future of home care". Conclusion: District nurses in home care experienced many challenges in their efforts to work for the patient's best. District nurses experiences gave an overall perspective of the work in home care and knowledge of this is an important tool to optimize future home care quality.

Syftet med studien är att granska personalens erfarenheter av tidmätning och IT-baserad planering inom en enhet i hemtjänsten i en storstadskommun. Mina frågeställningar är som följer.  Hur upplever personalen IT-planerad schemaläggning och tidsregistrering i sitt arbete?  Hur påverkas hemtjänstens personalgrupper? Utifrån ett semistrukturerat frågeformulär har hemtjänstpersonal under intervjuer berättat om sina erfarenheter om IT-baserad arbetsplanering och tidmätning. Intervjuresultatet har jag analyserat med hjälp av Ingrid Nilsson Motevasels (2002) idealtyper, kollektivisten och den autonome samt Harry Bravermans (1977) redogörelse av Taylors principer om scientific management. Personalens upplevelse efter införandet av IT-planering och tidmätning av utförd hjälp i hemmet beskrivs ur ett personalperspektiv. Det framkommer utifrån intervjuerna ett tydligt särskiljande av planering och utförande av arbetsuppgifterna, vilket påverkar personalens möjlighet att möta de dagliga skiftande behoven hos hjälpmottagarna. Istället för att planera sin egen dag och att utifrån dagsbehovet beräkna hur mycket tid den ena eller den andra behöver, är tiderna förbestämda oavhängigt dagsbehovet. Detta sätt att planera kan ibland binda upp personalen och en del av flexibiliteten går förlorad. Hur hjälpmottagarna bor, i servicehus eller utspridda i vanliga kvarter har också betydelse för arbetets planering och tidmätning. Personalen upplever sig mer separerad från arbetsledning än tidigare. De upplever sig kontrollerade under sin arbetstid, mindre tid för gruppen, uteblivna kafferaster och ibland kortare luncher än vad som planerats in är några av resultaten enligt informanterna. Det framkommer i mina intervjuer att personalens erfarenheter inte riktigt får gehör hos ledning och planerare.

In this study, I study the relationship between the use of the child home care allowance and second and third births among women aged 19-44 in Finland. I use register data from the Finnish Census Panel (FCP) on 254 465 women who had a second or third child during 1993 to 2007. I apply discrete-time event-history analysis to examine whether women using the child home care allowance while their previous child was under the age of three have a higher risk to proceed to subsequent childbearing – second and third births – than those not using the allowance while their previous child was under the age of three. The analysis is conducted separately for second and third births. The results show that the use of the child home care allowance has an effect on the risk of subsequent child, and that women using the child home care allowance have a higher risk of having a second and a third child than women not using the allowance. Also, the risk of having a second child is found to be higher than having a third child. According to the findings, timing matters. There are differences in how soon women get their subsequent child, and not only whether they get a second and third child or not. These differences are not explained by the control variables. However, the analysis does not demonstrate any causality between the use of the allowance and subsequent childbearing. The impact of the use of the allowance on childbearing may be due to selection effects.

Background: The need for palliative care at home hasincreased in recent years as more people wish to die in their own homes. Toperform good palliative care by addressing patients' needs and desires of lifecare requires a better understanding of how nurses experience palliative careat home.   Aim: The aim of the study was todescribe nurses experiences of caring for patients in palliative care in homecare.   Method: The method was asystematic literature review and the article search resulted in elevenqualitative articles. An inductive qualitative approach was used where nursesdifferent experiences was identified.   Results: Our results are reportedunder two themes:Opportunities and Barriers. Palliative carein home care experiencedby nurses in variousways in which personalgrowth, experience, guidance,trustful communication, cooperation and self-knowledgewas opportunies thatemerged. Barriers experienced by nurseswas ineffective communication,lack of time and abuseof power in palliative care at home. A trusting relationship betweennurses, patients andrelatives, continuous mentoring and reflectionwas considered by nurses to be equippedto carry out worthy of-life care.   Conclusion: This literature review shows the need for knowledgeabout how societynurses perceive opportunitiesand barriers inpalliative care in order toeventually be able to develop and assure the quality of care.

ABSTRACT As the population ages and family structure changes quickly, the demand for long-term care services from elderly people increased rapidly. In the aboriginal villages, due to insufficient medical sources, weak economic condition, and lack of young manpower in family, the need of aboriginal elderly people for health care is much more than urban residents. The study field located in Pingtung County is because it is the territory has the most indigenous townships in Taiwan. The study mainly adopts qualitative methodology with small amount of questionnaires to conduct quantitative analysis, it is expected to draw different dynamic result to generate useful outcome. Based on the findings and conclusion after collected and analyzed, the research could provide reference for the development of long-term care project in aboriginal area and long-term caring insurance in future. The research found that the county government and execution organization- NPO both built positive partnership, but the administration of indigenous people and local township office are not involved much. In additional, the provisions of caring health elder in community between Ministry of the interior and Council of indigenous people are duplicated. The users decreased significantly after implementation of users¡¦ pay concept for additional service hours, and it also caused aboriginal women who work as caregiver lost their jobs. In terms of service utilization, the top three services are body clean, house service and mental support, and the result of questionnaires presents great satisfaction. However, considering of weak economic condition, the elderly cannot accept self-afford service yet. Conclusion: 1. Government should adjust different users¡¦ pay level for isle and indigenous township. 2. It should integrate duplicated resources of community-base for health elderly people. 3. Home caregiver can play role of a propagator for welfare and health care policy in village. 4. To develop an integrated long-term care information system to improve the efficiency of case management and service resource.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, August, 2001. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 131-144).