This work is a study of the day to day experiences of older people in receipt of in-home care, the experiences of their family carers, and of their careworkers, resulting in a hypothesis about the structure of the lifecycle towards the end of life, and a consideration of both structured transition and individual transitions to and within this life stage. It has taken off from Laslett�s (1989,1996) seminal work on age divisions, into Third and Fourth Ages. Through an initial examination of secondary sources, I have hypothesized that the older people in this care bracket are in fact in a new life stage, between that of the independent Third Age and the dependent Fourth Age. I call this life stage the stage of 'Supported Independence'. Further references to the secondary sources, and references to the data, have supported this hypothesis, and have shown that there is a structured transition from the stage of independence to that of supported independence. The value of building such a life stage lies in the ability we then have to emphasize the situation of in-home care, bringing to prominence the experiences of the three stakeholders in this care environment. I have used the rites of passage concept to make known the issues involving the move from independence to dependence and those issues predominant in receiving in-home care, in being the carer at such a time, and in being the careworker within the invisibility of home. This has shown a formalized separation from the independent identity, and a prolonged stage of liminality because of an often uncertain form of service delivery. In this liminal stage also are revealed the emotions of living at home with a disability and with care, the improvisatory practices, the passivity and the assertiveness of this time of ageing. By applying this concept also to the family carers, I show the movement of families into and through the caring role, the joy of caring and the difficulties of taking responsibility without authority. I have shown carers� own improvisatory practices, and their determination to maintain the care recipient at home as long as possible. For the careworker, the rites of passage concept shows how she (and the careworker participants in this study are all women), can act to either maintain the liminal position of the recipients or assist in their reconnection to greater autonomy. Exploring the careworkers� own positions by means of the rites of passage concept highlights their inter-structural position between the public and private sectors, and highlights too, the care industry�s position, between that of a time managed industry and a recipient-directed industry. Whether this can be regarded as liminal depends on the philosophies of care adopted by the industry. In summary, the study examines the significance of the place of care, challenging the dominant ideology that home is best, and putting forward for consideration principles of care for other models of service delivery.

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This work is a study of the day to day experiences of older people in receipt of in-home care, the experiences of their family carers, and of their careworkers, resulting in a hypothesis about the structure of the lifecycle towards the end of life, and a consideration of both structured transition and individual transitions to and within this life stage. It has taken off from Laslett�s (1989,1996) seminal work on age divisions, into Third and Fourth Ages. Through an initial examination of secondary sources, I have hypothesized that the older people in this care bracket are in fact in a new life stage, between that of the independent Third Age and the dependent Fourth Age. I call this life stage the stage of 'Supported Independence'. Further references to the secondary sources, and references to the data, have supported this hypothesis, and have shown that there is a structured transition from the stage of independence to that of supported independence. The value of building such a life stage lies in the ability we then have to emphasize the situation of in-home care, bringing to prominence the experiences of the three stakeholders in this care environment. I have used the rites of passage concept to make known the issues involving the move from independence to dependence and those issues predominant in receiving in-home care, in being the carer at such a time, and in being the careworker within the invisibility of home. This has shown a formalized separation from the independent identity, and a prolonged stage of liminality because of an often uncertain form of service delivery. In this liminal stage also are revealed the emotions of living at home with a disability and with care, the improvisatory practices, the passivity and the assertiveness of this time of ageing. By applying this concept also to the family carers, I show the movement of families into and through the caring role, the joy of caring and the difficulties of taking responsibility without authority. I have shown carers� own improvisatory practices, and their determination to maintain the care recipient at home as long as possible. For the careworker, the rites of passage concept shows how she (and the careworker participants in this study are all women), can act to either maintain the liminal position of the recipients or assist in their reconnection to greater autonomy. Exploring the careworkers� own positions by means of the rites of passage concept highlights their inter-structural position between the public and private sectors, and highlights too, the care industry�s position, between that of a time managed industry and a recipient-directed industry. Whether this can be regarded as liminal depends on the philosophies of care adopted by the industry. In summary, the study examines the significance of the place of care, challenging the dominant ideology that home is best, and putting forward for consideration principles of care for other models of service delivery.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

The aim of this thesis is to inform in detail about the latest clinical and nursing practice trends concerning the needs of patients in vegetative state and their carers. It also deals with relations in the system of long-term nursing care, providing medical and social services and rehabilitation. It also tries to point out the most pressing problems of the current situation of patients in vegetative state and their families, especially in terms of patient discharge to home care and availability of services specified for this target group. The latest findings and proven methods will be summarized in a simple and understandable form, which will serve as a guide both for health professionals and caregivers.For this thesis the Review and synthesis method will be used. The overview of current knowledge and studies in the field of care for patients in vegetative state will be synthesized and focused on home care with recommendations for practice and indications of weak spots.Long-term follow-up nursing and rehabilitative care is necessary for these patients. A special chapter is focused on the specific needs of patients in vegetative state and appropriate nursing care, rehabilitation and release issues. The fundamental part is the consistency of formal and informal care, caregiver preparation for their future role and related socio-economic issues. In conclusion the legal and ethical aspects of the whole field are mentioned regarding medical and nursing care of patients in vegetative state.In line with the objective of this thesis a manual will be created for potential informal carers on how to care for their loved ones, where to go in the case of emergency and what steps to take during the intermediate stage of institutional and home care. The results can be used for further exploration and as an additional source of information for health professionals.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2012. / Home-Based Healthcare (HBHC) is an important aspect of South Africa's healthcare system. HBHC is the provision of care services to patients by trained or semi-trained caregivers at home. In South Africa HBHC was introduced in 2001 to address many problems with traditional healthcare such as overcrowding in public health facilities. South Africa has one of the highest HIV/AIDS infection rates in the world, which is often accompanied by opportunistic infections such as tuberculosis. HBHC is envisaged to address these challenges, thus relieving the burden on primary healthcare. HBHC is itself faced with many problems which include poor information or data management, unclear information flows, and insufficient information storage. It is also not clear how caregivers use data elements and there is no coherent indigenous knowledge base for the capturing, implementation and utilisation of data elements in local HBHC providers. This is particularly important to caregivers who rely on frameworks of indigenous knowledge in interpreting and making decisions on how to provide a care service to patients. In reality, caregivers operate in indigenous environments requiring the utilisation of local knowledge. This study explores the relationships between, and approaches to, data elements in different HBHC providers and communities. Three interpretive case studies in the Eastern and Western Cape Provinces of South Africa were conducted. Semistructured interviews, focus groups, participant observation and document analysis were used for data collection. The primary research question was: What happens when caregivers from various communities interact with data elements when providing a care service? Caregivers' indigenous knowledge and use of data elements was then harnessed in a knowledge base. The results from this study can be used by HBHC managers to develop their forms and training materials as the initial set of data elements used in HBHC has been identified. Caregivers from different communities can also learn how these data elements are used in other communities.

Face às transições demográfica e epidemiológica observadas no Brasil nas últimas décadas, muitos autores têm discutido as alterações nos perfis saúde-doença das populações. Assim como vêm crescendo o número de idosos, graças aos ganhos obtidos com os avanços tecnológicos na área da saúde e o controle das doenças infecto-contagiosas, verifica-se um importante aumento do número de pessoas com doenças crônico-degenerativas, que muitas vezes carreiam consigo incapacidades e dependência. Numa cidade como São Paulo também é digno de nota o expressivo incremento da violência urbana, expressão das desigualdades impostas pela vigência do sistema capitalista e das políticas de ajuste neoliberal em nosso país. Os que sobrevivem aos acidentes por armas de fogo ou de trânsito, não raro apresentam mutilações ou deficiências físicas com limitações importantes, para os quais os cuidados domiciliários podem representar uma importante estratégia para que se garanta a equidade prevista pelo Sistema Único de Saúde. Pautada pela determinação social do processo saúde-doença, buscou-se compreender as desigualdades sociais e de saúde associadas à distribuição da população em atendimento domiciliário por equipes de Saúde da Família do MSP à luz do Atlas da Exclusão Social no Brasil. Para tanto foi feito o levantamento, por meio de dados secundários, do perfil das pessoas com perdas funcionais e dependência atendidas por 111 (60%) de 185 Unidades de Saúde da Família presentes em 25 das 31 Subprefeituras do MSP em agosto de 2003, abrangendo 45 (66%) dos 96 distritos administrativos da capital, resultando numa amostra de 7.160 pessoas. Utilizando os softwares SPSS® 13.0 e EPI-INFO 2000 versão 3.3.2, os distritos administrativos pesquisados foram agrupados, por meio de uma análise de cluster, tendo por variável base o Índice de Exclusão Social. Em seguida, procedeu-se a descrição estatística das variáveis sexo, idade, grau de incapacidade, patologia, uso de oxigenoterapia, uso de sonda, presença de úlcera por pressão e uso de traqueostomia, cruzando-as entre si e comparando-as nos quatro grupos resultantes da análise de cluster. Efetuou-se o cálculo da correlação entre variáveis e o Índice de Exclusão (Iex) e os indicadores de vida digna, escolaridade e violência. Verificou-se prevalência de idosos (75%), com incapacidade leve (32%) e pouca ou nenhuma complexidade de cuidado (92%), sendo o acidente vascular cerebral (AVC) a doença precursora do atendimento (18%). Apesar de as mulheres serem maioria (60%), quanto maior a exclusão social, maior a proporção de homens com menos de 60 anos e crianças com severa incapacidade e maior complexidade de cuidado. Nos grupos com maior exclusão há proporcionalmente mais homens não idosos com severa incapacidade e maior complexidade de cuidado, sendo o AVC a doença predominante. Já nos grupos de menor exclusão há mais mulheres idosas com incapacidade leve e moderada e menor complexidade de cuidado, sendo o AVC e a hipertensão as doenças principais. Foram encontradas correlações negativas significativas entre o Iex e uso de sonda e traqueostomia, AVC não especificado, fratura de outros ossos dos membros neoplasia de laringe e outros efeitos de causas externas, e positivas entre aquele índice e linfoma não Hodgkin. Observaram-se diferenças no perfil dos distritos estudados de acordo com a exclusão social. Os achados estatísticos vasculharam diferenças nos perfis de saúde-doença de certos grupos sociais, permitindo levantar suspeitas sobre quem são as pessoas que precisam ser assistidas em suas casas. Aquelas em maior exclusão social, além de serem mais numerosas que as outras, apresentaram maior gravidade e complexidade de cuidado. O sentido desses seus achados merece ser investigado com mais substrato teórico, com amostras representativas da população, valendo-se de instrumentos que captem todas as dimensões do processo saúde doença. Faz-se necessário não só discutir a dificuldade de as pessoas acessarem os serviços, mas a potência do PSF em atingi-las, potencializando a diminuição da exclusão sócio-espacial, principalmente se, além de excluída, essa pessoas são portadora de necessidades especiais que demandam assistência no próprio domicílio / In the view of the demographic and epidemiologic transitions observed in Brazil during the last decades, many authors have been discussing the changes in the health-illness profile of the populations. As the number of elderly people has been increasing, mainly due to the technological advances in the health field and to the control of the infecto-contagious diseases, it is also possible to verify a great increase in the number of people with chronic-degenerative diseases, which most of the times bring along disabilities and dependency. In a city like São Paulo it is also important to note the expressive growing of the urban violence, which are the expression of the inequalities imposed by the capitalist system and by the neoliberal policies settings in our country. The individuals who survive the firearms or traffic accidents normally present mutilations or physical disabilities with serious limitations. For these people primary home care may represent an important strategy in order to guarantee the equality foreseen by the Sistema Único de Saúde. Grounded by the social determination of the health-illness process, we tried to understand the social and health inequalities associated to the distribution of the population being attended at home by parties of the Family Health in São Paulo through the light of the Atlas of Social Exclusion in Brazil. Therefore, using secondary data, a survey of the profile of the people who are attended and who bare functional disabilities and dependency was carried out by 111 (60%) of the 185 Units of Family Health de in the 25 of the 31 administrative subdistricts of MSP in August, 2003, embracing 45 (66%) of the 96 administrative districts of the capital, resulting in a sample consisting of 7.160 people. Using SPSS® 13.0 e EPI-INFO 2000 version 3.3.2 as the main softwares, the administrative districts researched were grouped together by means of a cluster analyses, in which the base variable was the Social Exclusion Index. After that, we wrote the statistical description of the following variables, sex, age, disability level, pathology, oxigenotherapy use, catheter use, presence of ulcer due to pressure and tracheostomy use, intercrossing and comparing the variables in the four resulting cluster analyses groups. Then, we calculated de correlation among the variables, the Social Exclusion Index (Iex) and the indicators of condign life, educational level and violence. The results verified are prevalence of elderly (75%), with low disability (32%) and few or none complexity care (92%), being the cerebral vascular accident (AVC) the precursor disease (18%). Although the women represent the majority (60%), the bigger the social exclusion, the bigger the proportion of men who are less than 60 years old and children with severe disability and greater complexity of care. In the groups with greater exclusion there is proportionally more non-elderly men with severe disability and greater complexityof care, being AVC the main disease. In the groups with less exclusion there are more elderly women with low and medium disability and less complexity of care, being AVC and high blood pressure the main diseases. We found significant negative correlation among the Iex, catheter and tracheostomy use, non-specified AVC, fracture of other bones, larynx neoplasy and other effects of external causes, and positives between that index and non Hodgkin lymphoma. We noticed differences in the profile of the studied districts according to social exclusion. The statistical data found searched for differences in the profile of health-illness of certain social groups, allowing us to suspect who are the people that need to be assisted in their homes. Those suffering the higher social exclusion, besides being in greater number than others, presented greater gravity and complexity of care. The meaning of these results deserve to be investigated with better theoretical substrate, with representative samples of the population, making use of tools capable of analyzing every dimension of the health-illness process. It is not only necessary to discuss about the difficulties people encounter when accessing the services, but also the potency of the PSF in reaching them, increasing the lesser of socio-spatial exclusion, principally if, besides being excluded, these people have special needs which demand assistance in their own homes

Many mid-life daughters are primary caregivers to their elderly mothers. However, in most research studies daughters have been grouped with other caregivers; thus, the daughters' experiences have not been specifically identified. Without this information nurses will be unable to adequately assist mid-life caregiving daughters to attain their optimal levels of health. The phenomenological research method was the methodology used to elicit the experiences of the mid-life daughters. The phenomenological method was congruent with the feminist perspective -- the conceptual framework -- which guided the study. The feminist perspective elucidated the importance of eliciting not only the visible caregiving experiences of the mid-life daughters, but also their internal experiences -- their feelings -- and the meanings they gave to their experiences. The researcher recruited subjects for the study through a daughters-of-aging-parents program which was held at the Women's Resource Centre in Vancouver, British Columbia. In order to collect the data, the researcher interviewed the subjects. Congruent with the phenomenological method, data collection and data analysis ran concurrently throughout the study. The conclusions that the researcher drew from the findings of this study include the following: at the start of a caregiving daughter-mother relationship, a daughter is very responsive to the needs of her mother; when a daughter realizes that she is self-sacrificing herself in order to care for her mother, she becomes less responsive to her mother's needs and focuses, instead, on caring for herself; a daughter who is able to identify her own needs and then act on them Is able to care for her mother and herself in a manner that meets both their needs; a daughter experiences a number of emotions while providing care for her mother; a daughter uses the logical process of working towards healthy differentiation in order to counterbalance her emotional reactivity, and a daughter who successfully counterbalances her emotions with logic discovers her basic self and becomes an entity distinct from, yet interdependent with, her mother. / Applied Science, Faculty of / Nursing, School of / Graduate

Introduktion: Antalet svårt sjuka som vårdas under kommunal hälso- sjukvård ökar, vilket ställer krav på ett fungerande vårdteam kring patienten. Distriktssköterskan har fördjupade kunskaper i att samverka med det multiprofessionella teamet och ses som en betydelsefull komponent. Syfte: Syftet var att beskriva distriktssköterskors upplevelser av sin roll i vårdteamet inom kommunal hälso- och sjukvård. Metod: En systematisk litteraturstudie som grundades på tolv vetenskapliga artiklar som söktes fram i de elektroniska databaserna PubMed och Cinahl. Artiklarna analyserades enligt Graneheim och Lundmans (2004) metod för kvalitativ innehållsanalys. Resultat: Resultatet utmynnade i fyra kategorier; Funktionen av att ge och ta emot stöd, Funktionen av att förmedla och utbyta kunskap, Funktionen av att leda och koordinera omvårdnadsarbetet samt Omständigheter som försvårar rollen.  Konklusion: Sjuksköterskans roll i vårdteamet upplevs flerdimensionell. Sjuksköterskan stödjer patient, anhöriga och teammedlemmar, samt tar emot stöd från vårdteamet. Rollen består likaledes av att utbyta kunskap, undervisa i egenvård samt leda och koordinera omvårdnadsarbetet. Det finns även omständigheter som kan leda till att rollen blir svår att utföra, vilket är brist på kommunikation, brist på arbetsledning samt ökad arbetsbelastning. / Introduction: The number of seriously ill people who are cared for during municipal health care is increasing, which places demands on a functioning care team around the patient. The district nurse has an in-depth knowledge of collaborating with the multi-professional team and is seen as an important component. Aim: The aim was to describe the district nurse’s experience of her role in the multidisciplinary care team within home nursing. Method: A systematic literature review based upon twelve scientific articles that were identified through electronic searches within databases of PubMed and Cinahl. The articles were analyzed according to Graneheim and Lundman’s (2004) method of qualitative content analysis. Result: The study resulted in four categories; The function of giving and receiving support, The function of conveying and exchanging knowledge, The function of leading and coordinating the nursing work and Circumstances that complicate the role. Conclusion: The nurse's role in the care team is perceived as multidimensional. The nurse supports patients, relatives and team members, and receives support from the care team. The role also consists of exchanging knowledge, teaching self-care and leading and coordinating nursing work. There are also circumstances that can lead to the role becoming difficult to perform, which is a lack of communication, lack of work management and increased workload.

Psykisk ohälsa är ett växande samhällsproblem, både globalt och i Sverige och risken att drabbas ökar med stigande ålder. Depression hos en äldre person kan vara svårt att uppmärksamma. Äldre som utsätts för en ökad psykisk belastning, som till exempel i samband med sjukdom, förluster av närstående och ensamhetskänslor, riskerar att utveckla depressiva symtom. Dessa symtom utsätter den äldre för ett stort lidande, ökar risken att dö i förtid samt utgör en stor samhällskostnad. Syftet var att studera distriktssköterskans erfarenheter när det gäller att uppmärksamma och förbättra depressiva symtom hos äldre inom kommunal hemsjukvård. Metoden var kvalitativ och hade en induktiv ansats. Åtta distriktssköterskor i fem olika kommuner i södra Sverige intervjuades i 30-60 minuter. Med hjälp av en intervjuguide delgav distriktssköterskorna fritt sina erfarenheter. Innehållsanalysen var kvalitativ och innebar att meningsbärande enheter identifierades och processades till underkategorier samt abstraherades till kategorier. I resultatet framkom att distriktssköterskan använde sin intuitiva förmåga samt förlitade sig på sin erfarenhet, då han/hon i mötet och samtalet med den äldre uppmärksammat depressiva symtom. Mötet och samtalet med den äldre visade sig även vara viktiga redskap för att förbättra dessa symtom. Skattningsinstrument nyttjades inte i någon av kommunerna. Distriktssköterskan i hemsjukvården har en unik möjlighet att på ett tidigt stadium uppmärksamma depressiva symtom samt genom olika omvårdnadshandlingar förbättra dessa symtom. Genom att stå upp för den äldres rättighet till den vård och behandling han/hon är i behov av, får distriktssköterskan en nyckelfunktion i rollen som den äldres företrädare. / Mental illness is a growing problem in society, both global and in Sweden and the risk of suffering from depressive symptoms (DS) increases with ageing. It can be difficult to identify DS in an older person. Elderly people are sometimes at a higher risk of mental pressure, when at the same time dealing with sickness, loss of close relationships and loneliness, which often lead to DS. These symptoms cause the elderly person a great suffering, increases the risk of dying prematurely and is a big cost for the society. The aim was to study district nurses experiences when it comes to identify and improve DS by elderly people in municipal home nursing. The method was qualitative and had an inductive approach. Eight district nurses from five different municipalities in southern Sweden were interviewed for 30-60 minutes. The analysis was qualitative which means that parts with meaning contents were identified and processed into categories and subcategories. The result showed that district nurses used their intuitive ability and leaned on their experience, when in an encounter and in a conversation with an elderly person identified DS. The encounter and the conversation with an elderly person turned out to be an important instrument even when it came to improve these symptoms. A valuation scale was not used in any of the municipalities. The district nurse in home nursing has and unique possibility to, in an early stage, identify DS and by different caring actions improve these symptoms. By standing up for the elderly person's right to get the care and treatment he/she is in need of, the district nurse has a key function in the role as the elderly person’s representative.