Thesis (Ph.D.)--University of Nebraska-Lincoln, 2006. / Title from title screen (site viewed on August 28, 2006). PDF text of dissertation: 206 p. : ill. ; 1.54Mb. UMI publication number: AAT 3208077. Includes bibliographical references. Also available in microfilm, microfiche and paper format.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

The purpose of this study was to explore the impact of training and employment as a health care aide on the personal and public lives of nine immigrants, eight of whom were women. These individuals had successfully completed a combined skills and ESL training program for Home Support or Home Support/Resident Care Attendant at an immigrant settlement agency on the west coast of Canada approximately one to two years prior to the study. The program trained the individuals to work as care aides in private homes or long term care facilities as well as provided training in English skills. A qualitative approach was chosen in order to explore the issues and themes that were relevant to the participants, from their own perspectives, with regard to the impact of training and employment as a health care aide on their lives. The findings revealed that participation in a training program had a significant impact on the individuals' lives. Acquiring an occupational skill for the health professions gave some of the individuals an occupational identity as well as personal fulfillment. For others, this training helped them to find meaningful employment and facilitated their integration into Canadian society. However, finding full-time employment proved to be a challenge for most of the participants. They encountered many barriers to employment for example, the need to work on-call and the resultant lack of a stable income; conflicts between domestic responsibilities and work outside the home; transportation limitations; and personal barriers, such as age, work experience, and education. On the positive side, participation in the training program helped the individuals to improve their English skills which increased their confidence, independence, autonomy, and self-esteem. Improvement in English skills also facilitated the individuals' settlement and integration into Canadian society. In addition, knowledge of health care had a positive impact on the individuals' ability to care for their family members. Overall, participation in a skills and language training program had a significant impact on the individuals' identity, family life, and settlement in Canada.

The purpose of this study was to explore the impact of training and employment as a health care aide on the personal and public lives of nine immigrants, eight of whom were women. These individuals had successfully completed a combined skills and ESL training program for Home Support or Home Support/Resident Care Attendant at an immigrant settlement agency on the west coast of Canada approximately one to two years prior to the study. The program trained the individuals to work as care aides in private homes or long term care facilities as well as provided training in English skills. A qualitative approach was chosen in order to explore the issues and themes that were relevant to the participants, from their own perspectives, with regard to the impact of training and employment as a health care aide on their lives. The findings revealed that participation in a training program had a significant impact on the individuals' lives. Acquiring an occupational skill for the health professions gave some of the individuals an occupational identity as well as personal fulfillment. For others, this training helped them to find meaningful employment and facilitated their integration into Canadian society. However, finding full-time employment proved to be a challenge for most of the participants. They encountered many barriers to employment for example, the need to work on-call and the resultant lack of a stable income; conflicts between domestic responsibilities and work outside the home; transportation limitations; and personal barriers, such as age, work experience, and education. On the positive side, participation in the training program helped the individuals to improve their English skills which increased their confidence, independence, autonomy, and self-esteem. Improvement in English skills also facilitated the individuals' settlement and integration into Canadian society. In addition, knowledge of health care had a positive impact on the individuals' ability to care for their family members. Overall, participation in a skills and language training program had a significant impact on the individuals' identity, family life, and settlement in Canada. / Education, Faculty of / Language and Literacy Education (LLED), Department of / Graduate

Home health aides' performance can help home health clients achieve quality of life. This quantitative, cross-sectional study examined which work-related factors of home health aides influence home health clients' quality of life. A socioecological perspective was used to understand influences on behaviors. Participants in this study were 400 home health clients who received services from home health agencies. A binary logistic model was used to determine the predictor variables of home health aides that contributed to home health clients' quality of life. Findings indicated that psychosocial skills were among the most predicted work-related performance of home health aides that lead to quality of life for home health clients. All independent variables (professional care; teaching clients about medication management, pain, and home safety; and social and communication skills) showed significance (p < .05). The implications of this study for positive social change include contributing evidence to support improving home health practices and informing policies, which might increase the quality of life for home health clients.

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

<p>Syftet med studien har varit att undersöka hur arbetsterapeuter går till väga för att genomföra en informationsöverföring till alla personliga assistenter hos en brukare samt hur arbetsterapeuter anser att informationsöverföringen till personliga assistenter fungerar. En kvalitativ ansats valdes och informationen inhämtades via intervjuer med 9 arbetsterapeuter i öppenvården i Västmanlands och Gävleborgs län. Resultatet visar att: det är få av arbetsterapeuterna som tycker att informationsöverföringen fungerar riktigt bra. Flertalet anser att det är lättare att nå fram och få en bra kommunikation med de personliga assistenterna om de är intresserade och insatta i sitt arbete. Arbetsterapeuterna beskriver att informationsöverföringen sker utifrån varje enskilt fall och hur många som är närvarande beror på vad som arbetsterapeuten vill informera om. Valet av tillvägagångssätt och hur många som man träffar inom gruppen beror mycket på vad ärendet handlar om och vilken kompetensnivå som de personliga assistenterna har. Att nå fram till alla i gruppen med information är svårt, eftersom de personliga assistenterna oftast jobbar på olika tider. Det är också svårt att veta vilka som tar eller får del av informationen då det inom vissa grupper ofta byts personal. Det är nästan uteslutande arbetsterapeuten som tar initiativ till uppföljning genom att ringa och fråga hur det har gått. Författarna kan konstatera att arbetsterapeuterna är flexibla, arbetar med både offensiv och defensiv informationsöverföring beroende på de personliga assistenternas kunskapsnivå. I sitt informationsgivande förhållande till de personliga assistenterna använder sig de flesta arbetsterapeuterna av den induktiva principen (Christensen och Jensen 2004) genom att utgå ifrån det enskilda ärendet i informationsöverföringsstillfället. Vid framtida studier av ämnet bör även de personliga assistenternas bild av informationsöverföringsprocessen delges för att ge en bredare bild av processen.</p>

Thesis (M.A.)--Memorial University of Newfoundland, 2005. / Bibliography: leaves 125-142.

Syftet med studien har varit att undersöka hur arbetsterapeuter går till väga för att genomföra en informationsöverföring till alla personliga assistenter hos en brukare samt hur arbetsterapeuter anser att informationsöverföringen till personliga assistenter fungerar. En kvalitativ ansats valdes och informationen inhämtades via intervjuer med 9 arbetsterapeuter i öppenvården i Västmanlands och Gävleborgs län. Resultatet visar att: det är få av arbetsterapeuterna som tycker att informationsöverföringen fungerar riktigt bra. Flertalet anser att det är lättare att nå fram och få en bra kommunikation med de personliga assistenterna om de är intresserade och insatta i sitt arbete. Arbetsterapeuterna beskriver att informationsöverföringen sker utifrån varje enskilt fall och hur många som är närvarande beror på vad som arbetsterapeuten vill informera om. Valet av tillvägagångssätt och hur många som man träffar inom gruppen beror mycket på vad ärendet handlar om och vilken kompetensnivå som de personliga assistenterna har. Att nå fram till alla i gruppen med information är svårt, eftersom de personliga assistenterna oftast jobbar på olika tider. Det är också svårt att veta vilka som tar eller får del av informationen då det inom vissa grupper ofta byts personal. Det är nästan uteslutande arbetsterapeuten som tar initiativ till uppföljning genom att ringa och fråga hur det har gått. Författarna kan konstatera att arbetsterapeuterna är flexibla, arbetar med både offensiv och defensiv informationsöverföring beroende på de personliga assistenternas kunskapsnivå. I sitt informationsgivande förhållande till de personliga assistenterna använder sig de flesta arbetsterapeuterna av den induktiva principen (Christensen och Jensen 2004) genom att utgå ifrån det enskilda ärendet i informationsöverföringsstillfället. Vid framtida studier av ämnet bör även de personliga assistenternas bild av informationsöverföringsprocessen delges för att ge en bredare bild av processen.

Background: Approximately 5 million older adults receive home healthcare (HHC) annually in the United Sates, and nearly 90% of HHC recipients are 65 years or older. HHC encompasses in-home interdisciplinary services such as skilled nursing, social work, and physical, speech, and occupational therapy. One in every five patients is hospitalized during their time in HHC. Researchers have explored machine learning models that use data in the electronic health record (EHR) to aid clinicians in identifying patients at high risk for hospitalization and emergency department (ED) visits. Failure to consider social risk factors can exacerbate health inequities. Some studies suggest that including social risk factors in machine learning models can help to mitigate bias in model performance among individuals from racial and ethnic minority groups. Prior literature has reported that a majority of social information is documented in clinical notes. In the HHC setting, there is a gap in understanding how social risk factors are documented in clinical notes and whether adding social risk factors in machine learning models can improve model performance. Thus, this dissertation aims to: 1) summarize the literature on machine learning conducted in the HHC setting, 2) extract social risk factors documented in HHC clinical notes, and 3) examine how social risk factors influence machine learning model performance. Methods: The data from this dissertation is from one HHC agency in New York, New York, including approximately 65,000 unique patients and 2.3 million clinical notes. The Biopsychosocial Model guided this study by providing a framework to report the features included in the machine learning models. To address the first aim, a scoping review was conducted to summarize the literature on machine learning applied to EHR data in the HHC setting. To address the second aim, a natural language processing system was developed to extract social risk factors from HHC clinical notes. Then, logistic regression was utilized to examine the association between the social risk factors documented in clinical notes and hospitalization and ED visits. Finally, to address the third aim, social risk factors were included in four machine learning models to predict hospitalization and ED visit risk in HHC. A sub-analysis was conducted to explore the utility of social risk factors in machine learning models across individuals from different racial and ethnic groups. Results: The results from all three aims suggest that there has been a rise in machine learning applied in HHC, but few studies have incorporated clinical notes. There are gaps in implementing machine learning models in practice and standardizing social risk factors in documentation. HHC clinicians are documenting the following social risk factors in 4% of their clinical notes: Social Environment, Physical Environment, Education and Literacy, Food Insecurity, and Access to Care. These social risk factors are significantly associated with hospitalization and ED visits; however, their contribution showed minimal differences in machine learning model performance. Conclusion: This dissertation study demonstrates the feasibility and utility of leveraging HHC clinicians’ clinical notes to understand social risk factors. Further exploration is needed to tease out the nuances in how HHC clinicians perceive, assess, and document social risk factors in the EHR. Stakeholders are encouraged to standardize social risk factors and develop informatics tools tailored to the HHC setting to improve the identification of patients at risk for hospitalization and ED visits.