Thesis (M.S.)--University of Wisconsin-Madison, 1989. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-81).

Thesis (M.S.)--University of Michigan, 1988.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 126-132).

D.Cur. / Like in many countries, Namibia is experiencing social and economic health care problems related to care provision at state health facilities. The Namibian State has acknowledged that it can no more afford to provide care for all the sick people alone, especially at its health facilities. It is now calling upon the society to take up the responsibility of caring for their sick people at home. Although this call is genuine and necessary, one cannot help to always wonder about the expectations of stakeholders involved in home care provision in rural Namibia. The purpose of the study was to develop and describe a model for capacity building to facilitate quality home care in rural Namibia. To achieve this the following specific objectives were formulated: 1) to explore and describe the expectations of the stakeholders involved in home care situation in rural Northern Namibia; 2) to assess the status of available resources in relation to quality home care; 3) to analyse the concept capacity as a management process and conceptualise the whole study into existing theoretical frameworks to facilitate home care in rural Namibia and 4) to develop and describe practical guidelines for the implementation of the model. A qualitative case study design was used to carry out the study. Explorative, descriptive, theory generative and inductive strategies were utilised. Face to face interviews were conducted with thirty stakeholders in home care using an interview guide. Purposive and Snowballing/networking sampling were used to identify the stakeholders involved with home care. Observations were also made with regard to the status of the resources, its availability and accessibility to the stakeholders. From the empirical phase, various expectations were expressed related to resources, namely, physical structures, knowledgeable human resources, financial and logistics, information, safe water supply, transport and communication means, support systems and mechanisms at home and community levels, food and nutrition. It was clear that resources were lacking as well as the support systems for home care.

Det blir allt vanligare med människor som vårdas palliativt i hemmet. I och med det blir det vanligare att närstående är en del av vårdprocessen. Närstående ställs då inför en helt ny roll gentemot den anhörige. De upplever svårigheter med att bibehålla ett normalt familjeliv då hemmet mer och mer börjar likna ett sjukhus, samtidigt som de vet att de inte skulle klara sig utan hjälpmedlen. Upplevelsen för närstående att ha en döende familjemedlem är påfrestande. Den närstående är inte längre bara en familjemedlem eller vän utan någon som den sjuke är beroende av. För att kunna axla denna roll behöver den närstående stöttning från sjuksköterskan, vänner och familj.   För att sjuksköterskan ska kunna ge det stöd närstående behöver är det viktigt att få en uppfattning om den närståendes upplevelse av den palliativa vården i hemmet. För att ta reda på detta valdes en litteraturstudie till examensarbetet. 12 kvalitativa artiklar analyserades till resultatet vilket mynnade ut i tre teman, att ta ansvar i vårdandet, att ha behov av stöd och att möta döden.  Resultatet visar att de närstående känner ett ansvar i vårdandet. Vissa uttrycker att de inte har något val, de sätter sig själva åt sidan för att kunna uppfylla löftet att vårda den sjuke. Andra känner att det är en självklarhet. De tycker att det är en naturlig del av livet och en möjlighet att få vara nära sin älskade på slutet. Det är viktigt med stöd från sjukvårdspersonal, vänner och familj för de närstående. Brist på stöd gör att närstående känner sig övergivna. Det är lätt att den närstående blir isolerad och bunden till hemmet under vårdtiden och för att klara av det krävs det stöd från utomstående. Närstående tycker att det var svårt att prata om döden, speciellt med den sjuke. De upplever att det är lättare att diskutera döden och sjukdomen med sjuksköterskan för att inte oroa den sjuke i onödan. De känner sig ständigt konfronterande med döden men de uppskattar att de kan vara närvarande och där för den sjuke på slutet. / Background: In recent years, it has become increasingly common for patients to choose to end their life at home. Relatives often wants to fulfill the wishes of the sick person, but are often poorly prepared to act as caregivers and experience lack of continuity, insufficient information and poor treatment. The experience of relatives having a dying family member is stressful. Aim: The aim of this study was to describe the experiences of relatives in palliative homecare.  Method: A literature based study with 12 qualitative articles were performed using the Friberg method of analysis. Results: The result showed that some relatives felt that taking care of their family member where a matter of course and others felt that they had no choice. It was important for the relatives to have support from healthcare professionals, family and friends. Lack of support made them feel abandoned. It was difficult to talk about death with the dying family member and relatives expressed that it was easier to talk to the nurse about it.  Conclusion: Death was constantly present, despite that death was hard to talk about with the sick person. It was also hard for the relative to be responsible for someone else and they felt that they were isolated in their own home. The relatives felt therefore the need to be supported by the nurse. They needed to be able to talk to the nurse and feel safe to fulfill the feeling of support.

This study surveyed the self perceptions of thirty individuals over sixty-five years of age, who lived in the Vancouver Quadra electoral district, in order to gather information about their needs. The study was designed to answer three questions. Do the elderly living at home in a specific geographical area of Vancouver perceive themselves as having needs in the need areas defined by the literature, namely housing, health, independent living, employment, economic security and interpersonal relations? Do the elderly in the selected sample perceive their needs as being met? Do the elderly in the selected sample perceive nurses as involved in helping them meet their needs? A semi-structured interview schedule was used to obtain information relevant to the research problem. The results of this study indicated that more than half the respondents, or 53 per cent, perceived needs in the need areas defined by the literature. The majority of perceived needs, or 76 per cent, were not met. None of the elderly whose needs were met perceived nurses as involved in helping them meet these needs. Moreover, the majority of the study sample, or 87 per cent, did not perceive nurses as potentially helpful in assisting them to meet their needs. The study recommends that nurses extend their current role and become actively involved in assessing and meeting the needs of the elderly living at home. / Applied Science, Faculty of / Nursing, School of / Graduate

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.

Background: Increasing numbers of older people are requiring residential care and there are high levels of depression in such settings. Existing literature suggests that social support can help maintain psychological wellbeing. This study aimed to examine perceived changes in social support following a move into residential care. The key theories drawn upon were socioemotional selectivity theory (Carstensen et al., 1999) and the convoy model (Kahn & Antonucci, 1980). Method: Forty care home residents were interviewed using a structured interview. A hierarchical network mapping technique was used to measure perceptions of total network, inner network and peripheral network size. Functional support from a key significant other was measured using the Significant Others Scale. Contact with network members, depression and demographic information were also examined. Retrospective ratings were obtained by asking participants to think back to before they moved into care. Current and retrospective ratings on all measures were compared using Wilcoxon signed rank tests. Results: Total network size was perceived to have decreased following a move into residential care. There was no significant difference between current and retrospective ratings of inner network size. Peripheral network size decreased but this difference was not statistically significant. There was no perceived change in emotional and practical social support received from a key significant other following the move. Discussion: The results suggest that an individual‟s social network is compacted following a move into care but that membership of the inner network remains stable. These findings are discussed in terms of socioemotional selectivity theory (Carstensen et al., 1999) and the convoy model (Kahn & Antonucci, 1980). Strengths and weaknesses of the study are discussed and clinical implications of the findings explored.

More than 6 million people are currently involved in the provision of informal care in the UK, with demand expected to rise exponentially over the next decades. The aim of this thesis is twofold.  First, to estimate and compare informal care time valuations using a number of methods, and second, to estimate econometrically the determinants of informal care provision.  The first aim is addressed using both new and existing secondary data, with comparison of values across opportunity cost, market replacement cost, compensating income variation, contingent valuation and discrete choice experiments methods.  The second aim is addressed using existing secondary data, where methods of dynamic panel estimation are employed to assess the influence of various socio-economic and demographic characteristics on the decision to provide care and on the level of provision. This is the first study that estimates and compares informal care time valuations using preference-based techniques for the UK and also it is the first time that the determinants of informal care are assessed using dynamic two-part data models. Findings suggest per hour valuations from £8.5 to £14 for most of the methods with the exception of the choice experiment (with values less than £1).  A great deal of heterogeneity can be found in the valuation, especially according to type of care provided.  Informal care is found to be a complement and/or a substitute for formal care, depending on the task in question, while at the same time it competes with other time intensive activities for the allocation of time.

Bakgrund:   Allt fler människor vårdas i sina hem och det anses ofta vara en betydelsefull plats för både sjuka och anhöriga. När sjukdom drabbar en person spelar de anhöriga en viktig roll. De får ta ett stort ansvar gentemot den sjuke och för vården i hemmet. Det är trots detta fortfarande sjuksköterskans uppgift att främja patientens och familjens upplevelse av livskvalitet och välbefinnande. Allas behov behöver tillgodoses för att vården i hemmet ska vara adekvat. Syfte: Att beskriva anhörigas upplevelse av att vårda en sjuk familjemedlem i hemmet. Metod: Denna litteraturöversikt baserades på tio vetenskapliga artiklar. Dessa hämtades från databaserna CINAHL plus with Full text och PubMed. Familjefokuserad omvårdnad var den teoretiska referensram som kom att diskuteras utifrån litteraturöversiktens resultat. Den handlar om familjens betydelse för patientens upplevelse av hälsa och sjukdom. Även de vårdvetenskapliga konsensusbegreppen behandlades. Resultat: Det framkom fyra områden i resultatet. Det första var känslomässig påverkan på den informella vårdaren, vilket berörde de tankar och känslor som uppkom när någon tog sig an vårdarrollen. Det andra var social påverkan, som handlade om hur de anhörigas sociala liv påverkades när de tog sig an den informella vårdarrollen. Det tredje var förändringar, vilket berörde kontrasterna mellan hur livet var innan sjukdom drabbade familjen och hur livet blev efter sjukdomen inträdde. Det sista området var information och stöd som omfattade det som familjen ansåg sig behöva hjälp med.                                                                                          Diskussion: De två områdena känslomässig påverkan på den informella vårdaren och social påverkan diskuterades utifrån den familjefokuserade omvårdnaden och de vårdvetenskapliga konsensusbegreppen. / Background: Nowadays more people are being cared for in the home which is often considered an important place for both the patient and relatives. When illness hits one family member the relatives plays an essential role. They have to take responsibility for their sick family member and for the home nursing. Nevertheless, it is still the nurse´ task to ensure that the patient and the family experience quality of life and wellbeing. Aim: To describe the family experience of caring for a sick family member at home. Method: This literature review was based on ten scientific articles. These were taken from the databases CINAHL Plus with Full Text and PubMed. Family focused nursing was the theoretical framework that the literature review was proceeded from. Family focused nursing is about the family importance to the patient experience of health and illness. The consensus concepts of caring science were also discussed.   Results: Four themes appeared in the result. The first one was emotional impact on the informal caregiver. That theme includes thoughts and feelings that arise when someone takes on the caregiving role. The second one was social impact which is about the family members' social lives and how the informal caregiving role affects them. The third one was changes and that theme is about the contrast between what life was like before the illness struck their family and how life became after the disease entered. The final theme was information and support which included the areas where the family required more help. Discussions:  Emotional impact on the informal caregiver and social impacts were discussed on the basis of family focused nursing and the consensus concepts of caring science.