Thesis (M.Soc.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.

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Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Home-based rehabilitation (HBR) in under-resourced areas in a primary health care context exposes students to the real life situations of clients. The educational experience of HBR, underpinned by the theory of situated learning, promotes experiential and transformative learning. HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. Physiotherapy students and their clients frequently have diverse lingual, socio-economic and cultural backgrounds which may hinder the provision of appropriate treatment to clients in their residences. Increased knowledge of HBR in the physiotherapy context could result in an enhanced experience for both student and client. This study sought to explore the perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. Whether the students felt adequately prepared to perform HBR was also explored. A qualitative research design in the interpretivist paradigm was used. An exploratory case study was performed. Semi-structured interviews were conducted with clients (N=7) living in an under-resourced setting who had received HBR from physiotherapy students. Paired interviews were conducted with final year physiotherapy students (N=6) after their HBR placement. The data were subjected to inductive thematic analysis and themes developed. The findings showed that while clients appreciated the students’ services, there were communication barriers and unmet expectations. Students reported difficulty in adapting to the unfamiliar context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency to assist in communication. Earlier facilitated exposure to under-resourced contexts in the early clinical phase was suggested to reduce culture shock. An awareness of home environments in under-resourced areas influenced the students’ interventions in other contexts. To gain maximum benefit from the learning opportunities available through HBR, students require support for client management and client-centred problem solving in an under-resourced setting. Guided reflection should form part of the HBR placement to facilitate the construction of new knowledge, to promote deep transformative learning and to increase the students’ awareness of their role as change agents. Exposure to real life situations in under-resourced settings in the form of HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they will serve during community service. / AFRIKAANSE OPSOMMING: Tuisgebaseerde rehabilitasie (TBR) in ondervoorsiende gebiede in die primêre gesondheidsorg-konteks stel studente bloot aan die werklike lewensomstandighede van kliënte. Die opvoedkundige ondervinding van TBR, gerugsteun deur die teorie van gesitueerde leer, bevorder ervarings- en transformasionele leer. TBR lei nie net tot akademiese leer en persoonlike ontwikkeling nie, maar bevorder ook insig in maatskaplike verantwoordbaarheid en verantwoordelikheid. Fisioterapie-studente en hul kliënte het dikwels verskillende taal-, sosio-ekonomiese en kulturele agtergronde wat kan verhinder dat die toepaslike behandeling vir kliënte tuis verskaf word. ’n Toename in kennis van TBR in die fisioterapie-konteks kan lei tot ’n beter ondervinding vir beide die student en die kliënt. Die doel van die studie is om die persepsies van die fisioterapie-studente en hul kliënte met betrekking tot TBR, as deel van die kliniese opleiding in omgewings waar daar beperkte hulpbronne is, na te vors. Daar is ook nagegaan of die studente gevoel het dat hulle genoegsaam voorberei is om die TBR toe te pas. ’n Kwalitatiewe navorsingsontwerp in die interpreterende paradigma is gebruik. ’n Verkennende gevalle-studie is gedoen. Semi-gestruktureerde onderhoude is met die kliënte (N=7) wat in ondervoorsiende omstandighede leef en wat TBR van fisioterapie-studente ontvang het, gevoer. Onderhoude is in pare met fisioterapiestudente in hul finale jaar (N=6) gevoer nadat hulle hul TBR-plasing voltooi het. ’n Induktiewe tematiese analise van die data is gedoen en temas is ontwikkel. Die resultate het getoon dat, alhoewel die kliënte waardering gehad het vir die dienste wat deur die studente gelewer is, daar kommunikasiegapings en onvervulde verwagtinge was. Die studente het gerapporteer dat hulle gesukkel het om aan te pas by die onbekende omgewing met die gevolg dat die intervensies nie genoegsaam kliëntgerig was nie. Hulle het ook aangedui dat daar ’n behoefte is om die nodige taalvaardigheid te ontwikkel om kommunikasie te verbeter. Die kultuurskok wat beleef is, kan moontlik in die vroeë kliniese fase reeds gefasiliteer word deur die studente aan ondervoorsiende kontekste bloot te stel. Die kennis van die tuisomgewings in ondervoorsiende areas het ’n invloed gehad op die studente se intervensies in ander kontekste. Studente benodig ondersteuning in kliëntebestuur en kliëntgesentreerde probleemoplossing in ondervoorsiende omgewings ten einde maksimum voordeel te verkry uit leergeleenthede wat beskikbaar is deur TBR. Begeleide refleksie behoort deel te vorm van die TBR-plasing om die opbou van nuwe kennis te fasilliteer, diepgaande transformatiewe leer te bevorder en die student se bewustheid van hul rol om verandering teweeg te bring, op te skerp. TBR voorsien nie net waardevolle, outentieke leergeleenthede ter plaatse nie, maar gee ook die fisioterapie-studente blootstelling aan die werklike situasies waarin mense hulle in ondervoorsiende omgewings bevind. Hierdie ondervinding kan waardevol wees om graduandi voor te berei om die behoeftes aan te spreek van die bevolkingsgroepe wat hulle tydens hul gemeenskapsdiensjaar sal bedien.

This descriptive correlational study describes the relationships among 30 home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care. The self-report data were collected using a Nursing Invasiveness Scale (NIS), Index of Patient Territorial Control Perceptions (IPTCP), and Patient Satisfaction Instrument (PSI). The subjects were males and females, aged 23 to 93 years, who were receiving home care nursing. Analysis of the data suggests that the subjects perceived a low level of invasiveness by home care nurses, "much control" within their homes (their primary territories), and were highly satisfied with their nursing care. There was a significant negative correlation (r = -0.79) between perceptions of nursing invasiveness and satisfaction with nursing care. The relationships between perceptions of nursing invasiveness and territorial control (r = -0.02) and between perceived territorial control and satisfaction with nursing care (r = 0.14) were not significant.

A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Bakgrund: Medellivslängden i Sverige ökar vilket leder till en ökad äldre befolkning. För att kunna bo hemma så länge som möjligt kan de äldre behöva få hjälp från hemvården. Syfte: Att undersöka vilka faktorer som upplevs påverkar de äldres tillfredsställelse av vården samt vad som är viktigt för de personer som får hjälp. Metod: En deskriptiv kvalitativ intervjustudie. Semi-strukturerade intervjuer gjordes med 11 brukare från två olika kommunala hemvårdsområden. Resultat: Personal och Utförande var två huvudkategorier som kom fram av analysen. Informanterna beskrev sina upplevelser och vad som var viktigt för dem inom dessa ramar. Kategorin Personal kunde delas upp i två underkategorier; Yrkeskompetens och Bemötande. Utförande delades in i underkategorierna; Hemtjänsten – ett serviceperspektiv, Självbestämmande, Kontinuitet och Trygghet.   Konklusion: För att man som utförare av hemtjänst skall förbättra vården är det viktigare att fokusera på de processrelaterade faktorerna som har en stor betydelse för hur brukarna upplever hemvården. Genom att lägga stor vikt vid personalens sociala kompetens vid rekrytering samt att involvera brukaren och dennes familj i vården och utformandet av den kan positiva upplevelser av vården skapas. Detta ser ut att kunna skapa ökat välbefinnande hos brukarna. / Background: The average age in Sweden increases which leads to an increased population of old people. In order to live in their own homes as long as possible, elderly people may be in need of help from the community home-services. Aim/objectives:The goal of this study was to examine variables perceived to affect older people’s satisfaction of home care services and what they emphasize important in the care.  Design: Descriptive qualitative study with interviews. Semi-structured interviews are done with 11 clients receiving care from two different community home-service areas. Results: ’Staff’ and ‘Services’ were the main categories of the results. The clients described their experiences and what they assumed as important for them. The category ‘Staff’ were divided into sub-categories: ‘Professional competence’ and ‘attitudes from staff’. ‘Services’ were divided into four other sub-categories: ‘the community home-service- a service perspective’ ‘self-autonomy’, ‘continuity’ and ‘safety’. Conclusions: The health care providers for the home care services should focus on improvements regarding process related factors, because they are important for the client’s experiences of the home care services. When recruiting new persons for a job in the home care services, the focus should be on his or hers social competence. Furthermore, to involve the client and his or hers family in the care may create positive experiences and increase the clients wellbeing.

La thèse interroge la possibilité d'une régulation unique du secteur des services à la personne tel qu'il a été institutionnellement délimité par le Plan Borloo de 2005. Nous y défendons l'idée que, si le Plan Borloo n'a pas permis de générer un secteur unifié, (au sens que lui donne les approches en termes de régulation sectorielle), les dispositifs visant la construction d'un marché des services à la personne, qu'il a introduit, sont mobilisés à la fois par les nouveaux entrants et par les acteurs historiques du champ, mais de façon non homogène et différente de ce que le Plan anticipait.Il en résulte une situation de double crise (crise des enseignes et crises des associations autorisées) que les conclusions de la thèse permettent d'éclairer. / My thesis tests the existence of a unique sectorial-based regulation for lifestyle and domiciliary care services as it was institutionally delimited and thought by the French Plan Borloo (2005). I defend the idea that the Plan Borloo has not generated a unified sector configuration (as defined by sectorial-based regulation approaches). The Plan Borloo has introduced institutional arrangements that aim to constructing a market for lifestyle and home care services. Theses arrangements are mobilised both by new players and by historical suppliers but non-homogenously and differently than expected by the Plan. The consequence is a double crisis (crisis of the new player “brand names” and crisis of the historical third sector actors) that my conclusion explains.

With the increasing demands of rising medical costs in combination with a boom in elderly patients in need of quality patient care medical practices are being stressed. Patient to nurse ratios are increasing and government spending in the medical domain is at an all-time high threatening the futures of government medical programs such as Medicare and Medicaid. In this thesis we propose a framework for the monitoring of a patient's vital statistics in a home-based setting using a mobile smart device. We believe that in taking advantage of the wireless sensor technology which is readily available today we can provide a solution that is both economically and socially viable offering a solid quality of healthcare in a comfortable and familiar environment. Our framework exposes both 802.11 and Bluetooth wireless protocol transmitting medical sensor devices using an Android platform device as a monitoring hub. / by Mark Conaster. / Thesis (M.S.C.S.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

A atenção domiciliar (AD) é uma modalidade de atenção à saúde que visa reorganizar o processo de trabalho das equipes de diferentes serviços, reduzir a demanda por atendimento hospitalar, ampliar a autonomia dos usuários e de seus familiares, além de proporcionar a integralidade da atenção. No âmbito do sistema único de saúde, a AD é operacionalizada, na atenção primária, por meio da Estratégia de Saúde da Família (ESF) e do programa Agentes Comunitários de Saúde (PACS) e pelo programa Melhor em Casa que organiza os Serviços de Atenção Domiciliar (SAD). O estudo teve como objetivo caracterizar os indivíduos assistidos pela equipe multiprofissional de atenção domiciliar (EMAD) do município de Ribeirão Preto, SP. Trata-se de um estudo epidemiológico descritivo que utilizou um formulário e o domínio motor da Medida de Independência Funcional (MIF) para obter o perfil e a incapacidade funcional, respectivamente. Participaram do estudo 58 indivíduos maiores de 18 anos, residentes na área de abrangência e cadastrados na EMAD entre o período 1 de janeiro à 12 de agosto de 2013. Para a realização da análise dos dados, utilizou-se o aplicativo Stata 9.0. Além da análise descritiva, realizou-se o teste de comparação de médias entre os grupos por meio do teste t de Student e ANOVA one way. Os indivíduos caracterizam-se pelo discreto predomínio do sexo masculino (51%), idosos (79,4%), sendo que 91,4% estão inseridos na modalidade de atenção domiciliar AD2 e 87,9% receberam a visita domiciliar do enfermeiro. Houve o predomínio do acesso à atenção domiciliar por demanda espontânea (48,2%) e 41,4% dos participantes realizavam fisioterapia, no momento da entrevista, no SUS (79,2%). Além disso, 37,6% necessitavam usar fraldas e equipamentos (91,4%), sendo este a cadeira de rodas (39,6%) e a maioria foi adquirido por meio do SUS (51%). Quanto aos diagnósticos, os mais frequentes são o acidente vascular encefálico (11%) e a doença pulmonar obstrutiva crônica (11%). Em relação aos cuidadores, 80,4% são do sexo feminino, idosos (41%), com o grau de parentesco esposa (37,6%). Entre aqueles que cuidam de indivíduos que fazem ou fizeram fisioterapia, 90% receberam orientações. No que tange à MIF, a média do domínio motor foi de 50,5 pontos. A maior categoria foi alimentação, sendo que 43,1% apresentaram independência completa, e a menor foi escadas, com 58,6% de indivíduos que necessitaram de ajuda total. O perfil dos indivíduos assistidos pela EMAD e a utilização de uma ferramenta que avalia a incapacidade funcional dos mesmos evidenciaram aspectos propositivos para potencializar o planejamento e a operacionalização da assistência e do processo de trabalho da EMAD. / Home care (AD) is a type of health care that aims to reorganize the work process of the different services teams, reduce the demand for hospital attendance, increase the autonomy of the users and of their family members, in addition to providing comprehensive care. Within the framework of the public health system, AD is operationalized, in the primary care, by means of the Family Health Strategy (ESF), of the Community Health Agents (PACS) program and by the Better Home program which organizes the Homecare Services (SAD). The study aimed at characterizing the individuals assisted by the multidisciplinary team of home care in the city of Ribeirão Preto, Brazil. This is a descriptive epidemiological study which made use of a form and of the motor domain included in the Functional Independence Measure (MIF) to get the profile and the functional disability, respectively. The study included 58 patients over 18 years old living in the area covered and enrolled in the EMAD in the period between January 1 to August 12, 2013. For carrying out the data analysis, Stata 9.0 application was used. In addition to the descriptive analysis two variables or more were compared using the t Student and ANOVA one way test. Individuals are characterized by a slight predominance of males (51%), elderly (79.4%), and 91.4% are inserted into the modality of home care AD2 and 87.9% received home visits of the nurse. There was a predominance of access to home care by spontaneous demand (48.2%) and 41.4% of the participants performed physical therapy at the time of interview, in the SUS (79.2%). Furthermore, 37.6% needed to wear diapers and equipment (91.4%), these being the wheelchair (39.6%) and most had been obtained through the SUS (51%). With regard to diagnosis, the most frequent are the stroke (11%) and the chronic obstructive pulmonary disease (11%). Regarding caregivers, 80.4% are female, elderly (41%), with the degree of relationship wife (37.6%). Among those who took care of individuals who are undergoing or underwent physical therapy, 90% received guidance. Concerning the MIF, the average of motor domain was of 50.5 points. The largest category was feeding, and 43.1% had complete independence, and the lowest was stairs, with 58.6% of individuals requiring total assistance. The profile of the individuals assisted by the EMAD and the use of a tool that evaluates their functional disability highlighted propositive aspects so as to enhance the planning and the operationalization of the assistance and of the EMAD working process.