The objective of this study is to describe and understand the organizational culture and context in Home Health Nursing (HHNsg) practice. Participants consisted of a Licensed Practical Nurse (LPN), three Registered Nurses (RNs) and three Registered Nurse leaders. Using the methodology of ethnography, data collection methods included participant-observation, documenting fieldnotes, writing reflective memos, conducting individual interviews and examining organizational priorities. Home Health Nurses (HHNs) were observed and subsequently interviewed to illustrate routine practices and discourses that influence everyday HHNsg practice. Nurse leaders shared their perspectives of everyday contexts underpinning HHNsg practice, particularly professional claims of culturally-competent care. Geertz’s theoretical concepts of “thick descriptions and “texts” were applied to the analysis. My concluding discussion demonstrates how participants enacted cost-effective and efficient philosophies of organizing care despite claiming the importance of culturally-competent care with South Asian clients (India, Punjab). / Graduate

Abstract Home Health Care (HHC) is a health care service delivered by sending caregivers such as nurses or personal support workers (PSW) to visit patients in their homes. The assignment of patients to nurses as well as the sequencing of patients for each nurse is called the Home Health Care Scheduling and Routing Problem (HHCSRP). This thesis proposes a heuristic approach to solve HHCSRP to which it is hard and even impossible to obtain an optimal solution for relative larger instances in a reasonable amount of computational time by using an exact algorithm as HHCSRP is NP hard. In the approach, this thesis developed and contributed a heuristic partition method to partition patients into a number of single nurse groups. The computational test result shows that the proposed approach can achieve good solutions which remain within 5% of the commercial solver CPLEX’s best solution using an acceptable solution time on all test instances.

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Thesis advisor: Ruth McRoy / Unmet long term care needs are increasingly filled by immigrant home health workers who are primarily female (88%), racial minorities (85%), and from developing countries including Mexico, Caribbean, Philippines, and Africa. The growing numbers of immigrant home health workers are a result of global factors including economic policies, colonial histories with developing countries, and immigration legislation. In addition to macro factors, personal motivations lead migrant home health workers to immigrate and find jobs in the U.S. Once in the U.S., little is known about migrant home health workers' caregiving experiences and work conditions. This study was designed to address this need and explored the personal experiences and viewpoints of the workers. Additionally information on migration histories and work setting was gathered to contextualize caregiving experiences. The study was guided conceptually by caregiving theory on the commodification and devaluation of "care" which can ultimately result in outsourcing care to immigrant women. Qualitative description methods were used to guide the research design, data collection, and analysis of twenty-three semi-structured interviews of female immigrant home health workers in Massachusetts. Interviews focused on three topics: caregiving experiences, reasons for migrating to the U.S., and work conditions. Findings will add to the knowledge base about immigrant home health workers paying particular attention to how workers themselves describe their experience which will in turn inform future policy and program initiatives on inclusion of a multicultural workforce into the long term care system. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Loosely coupled workgroups are common in the real world, and workers in these groups are autonomous and weakly interdependent. They have patterns of work and collaboration that distinguish them from other types of groups, and groupware systems that are designed to support loose coupling must address these differences. However, they have not been studied in detail in Computer-Supported Cooperative Work (CSCW), and the design process for these groups is currently underspecified. This forces designers to start from scratch each time they develop a system for loosely coupled groups, and they must approach new work settings with little information about how work practices are organized. <br><br> In this dissertation, I present a design framework to improve the groupware design process for loosely coupled workgroups. The framework has three main parts that add a new layer of support to each of the three stages in the general groupware design process: data collection about the target work setting, analysis of the data, and system design based on the analysis results. The framework was developed to provide designers with support during each of these stages so that they can consider important characteristics of loosely coupled work practice while carrying out design for the target group. The design framework is based on information from CSCW and organizational research, and on real-world design experiences with one type of loosely coupled workgrouphome care treatment teams. <br><br> The framework was evaluated using observations, interviews, and field trials that were carried out with multidisciplinary home care treatment teams in Saskatoon Health Region. A series of field observations and interviews were carried out with team members from each of the home care disciplines. The framework was then used to develop Mohoc, a groupware system that supports work in home care. Two field trials were carried out where the system was used by teams to support their daily activities. Results were analyzed to determine how well each part of the design framework performed in the design process. The results suggest that the framework was able to fill its role in specializing the general CSCW design process for loosely coupled groups by adding consideration for work and collaboration patterns that are seen in loosely coupled settings. However, further research is needed to determine whether these findings generalize to other loosely coupled workgroups.

Loosely coupled workgroups are common in the real world, and workers in these groups are autonomous and weakly interdependent. They have patterns of work and collaboration that distinguish them from other types of groups, and groupware systems that are designed to support loose coupling must address these differences. However, they have not been studied in detail in Computer-Supported Cooperative Work (CSCW), and the design process for these groups is currently underspecified. This forces designers to start from scratch each time they develop a system for loosely coupled groups, and they must approach new work settings with little information about how work practices are organized. <br><br> In this dissertation, I present a design framework to improve the groupware design process for loosely coupled workgroups. The framework has three main parts that add a new layer of support to each of the three stages in the general groupware design process: data collection about the target work setting, analysis of the data, and system design based on the analysis results. The framework was developed to provide designers with support during each of these stages so that they can consider important characteristics of loosely coupled work practice while carrying out design for the target group. The design framework is based on information from CSCW and organizational research, and on real-world design experiences with one type of loosely coupled workgrouphome care treatment teams. <br><br> The framework was evaluated using observations, interviews, and field trials that were carried out with multidisciplinary home care treatment teams in Saskatoon Health Region. A series of field observations and interviews were carried out with team members from each of the home care disciplines. The framework was then used to develop Mohoc, a groupware system that supports work in home care. Two field trials were carried out where the system was used by teams to support their daily activities. Results were analyzed to determine how well each part of the design framework performed in the design process. The results suggest that the framework was able to fill its role in specializing the general CSCW design process for loosely coupled groups by adding consideration for work and collaboration patterns that are seen in loosely coupled settings. However, further research is needed to determine whether these findings generalize to other loosely coupled workgroups.

From preschool through the end of high school, accommodation and success rather than self-advocacy and student development are the predominant frameworks for students with physical disabilities. Many students with physical disabilities who use wheelchairs are assisted by their family members with daily life activities such as getting out of bed, showering, eating, dressing, and toileting. For most of these students college is the first time they will have to use his or her own voice. Once in college, the students are responsible for finding their own personal care. Students are challenged with becoming responsible for the process of hiring an attendant for themselves, taking the next step to becoming independent, and being socialized into a new environment. Many factors affect the transition and experiences from high school to college and for students with physical disabilities, that transition may involve attendant care. The purpose of this study was to explore the transitional attendant care issues and experiences of college students with physical disabilities who use wheelchairs. A phenomenological approach grounded in qualitative methodology was used in this study. In a mid-sized public doctoral-granting Midwestern institution, twelve participants were interviewed who were undergraduates with a physical disability using a wheelchair and having attendant care. Seven themes emerged regarding transitional issues for students with attendant care: time management, preparing for attendant care, training attendants, first feelings, accepting responsibility, parental involvement, and financial considerations. Four themes emerged regarding their collegiate experiences: attendant care preferences, relationships with attendants, supportive friends, and characteristics of attendants. Recommendations for future studies, future researchers, student affairs educators, and future college students were provided. While students with disabilities that use wheelchairs and attendant care have similar experiences with many other students, they also have experiences that are completely different than the average college freshman. It is important to understand the unique challenges this subpopulation of college students has, and what they can do, and not do, to meet those challenges. Students with disabilities that use a wheelchair and will use attendant care need to consider the implications of attendant care and plan ahead prior to coming to college. / Department of Educational Studies

Optimized Routing and Scheduling (RS) for mobile caregivers is essential for the efficient management of Home Health Care services. Unexpected events, such as traffic jams and visits lasting longer or shorter than expected, may affect the initial caregiver’s schedule by delaying or accelerating visits. Therefore, the RS should be continuously updated to deliver services that respect the problem constraints, e.g., patients’ and caregivers’ availability, caregivers’ breaks, etc., while minimizing the total costs of services. The services costs include travel, overtime, time exceeding patient time windows, and working time differences among caregivers. In this research, we formulate and solve a mixed-integer linear programming RS model that considers delays and earliness throughout the day. Once delays or earliness arise, we propose a rescheduling approach capable of updating the current schedule to consider the time difference and instantly provide a new optimal outcome. Results show a decrease in total costs in 48% of the cases, with an average saving of 349$ per day when rescheduling patients. 15% of the cases present an increase in total costs by an average of 143$ per day. No change is observed in 37% of the cases. Finally, when applying the rescheduling approach, results show that larger time windows provide more significant savings when delays are observed throughout the day.