This thesis is about a Non Government Organisation (NGO) whose main focus is on professional and home care services. The ``Alice{\crqq}, which is part of the Czech Red Cross in České Budějovice, has been supplying these services since 1994. The aim of this thesis is to analyse the historical development of ``Alice{\crqq}, looking closely at the quality of the service it offers. The next aim is to ``compare clients{\crqq} requirements against the potential the organization and to suggest certain improvements that can be made in the services, which would lead to higher quality and greater efficiency.

Trata-se de um estudo exploratório-descritivo, de abordagem quantitativa, cujo objetivo foi avaliar a prática assistencial da intubação gástrica para nutrição enteral dos usuários em Programa de Assistência Domiciliar (PAD), no Hospital Universitário da Universidade de São Paulo. A população foi composta por 37 sujeitos admitidos no PAD, portadores de intubação gástrica para nutrição enteral. A coleta de dados ocorreu no período 15 de abril a 15 de agosto de 2010 por meio de dois formulários. Os dados foram analisados em função da estatística descritiva e inferencial e aplicados testes estatísticos com significância de 5%. Na caracterização dos usuários, constatou- se que 51,4% pertenciam ao sexo feminino e 67,6% apresentavam idade a 60 anos. Em relação ao diagnóstico principal, houve o predomínio de 67,6% dos portadores de doenças neurológicas e a média de permanência no PAD foi de 10,3 meses (dp+12,2). Quanto aos cuidadores, a maioria (89,2%) pertencia ao sexo feminino, e a média de idade foi de 50,6 anos (dp+13,4), 97,3% mantinham vínculo familiar com o usuário e 35,1% não completaram o ensino fundamental. No que diz respeito à via de intubação gástrica, 51,4% utilizaram a gastrostomia, o tipo de dieta predominante 51,4% foi a semi-artesanal. A sonda gástrica foi substituída 29 vezes e o tempo médio de permanência foi de 3,8 meses. Na classificação das extubações, considerando 100 dias, obteve- se a taxa de incidência geral de 1,08, sendo 0,26 de extubações planejadas e 0,82 de não planejadas. As principais circunstâncias envolvidas nas extubações foram: na planejada, a substituição eletiva da sonda; na não planejada, o rompimento do balão da sonda de gastrostomia, com diferença estatística significante (p=0,009). Na comparabilidade entre os grupos de usuários pediátrico e adulto/idoso, houve diferença estatística para o tempo de permanência no PAD e média de idade do cuidador (p=0,00). A taxa incidência de extubação não planejada, no grupo pediátrico, foi de 1,05 e no adulto/idoso de 0,73, não havendo diferença estatística significante (p=0,28). Conclusão: o perfil de usuários do PAD foi constituído, na sua maioria, por usuários idosos, do sexo feminino, tendo como diagnóstico de admissão as doenças neurológicas e com intubação gástrica via gastrostomia; o cuidador era do tipo informal, membro da família, representado pela figura feminina. No que tange às extubações gástricas mensuradas por meio dos indicadores de resultado e pela identificação das circunstâncias envolvidas, verificou-se que os achados permitiram conhecer a realidade dos portadores de intubação gástrica para aporte nutricional no programa, fornecendo subsídios para o estabelecimento de metas assistenciais e gerenciais para a melhoria contínua da qualidade e as reformulações necessárias dos processos de trabalho no âmbito da assistência domiciliar. / This is an exploratory-descriptive study, with a quantitative approach, aiming to evaluate health care practice of gastrointestinal intubation for enteral feeding for users of the Home Care Program (HCP), at the University Hospital of the University of São Paulo. The population consisted of 37 subjects enrolled in the HCP, with gastrointestinal intubation for enteral feeding. Data collection was performed by means of two forms and collected between April 15 to August 15, 2010. Data were analyzed according to descriptive and inferential statistics and statistical tests with significance of 5% were applied. In the characterization of users, 51.4% were female and 67.6% were aged 60 years. In relation to primary diagnosis, there was predominance of 67.6% of patients with neurological diseases and the mean stay in the HCP was 10.3 months (sd +12.2). Regarding caregivers, the majority (89.2%) was female, mean age of 50.6 years (sd +13.4), 97.3% had family ties with the user and 35.1% did not finish elementary school. Regarding the route of gastrointestinal intubation, 51.4% used the gastrostomy, the predominant type of diet was 51.4% semiartisan. The gastrostomy feeding tube was replaced 29 times and the mean time of stay was 3.8 months. In the classification of extubations, considering 100 days, we obtained the overall incidence rate of 1.08, of which 0.26 of planned extubations and 0.82 of unplanned. The main circumstances involved in extubations were : in the planned, elective replacement of the tube; in the unplanned, balloon rupture of the gastrostomy tube, with a statistically significant difference (p = 0.009). When comparing the pediatric with the adult / elderly group, no statistical difference regarding stay in HCP and mean age of the caregiver (p = 0.00) were observed. The incidence rate of unplanned extubation in the pediatric group was 1.05 and in the adult / elderly group was 0.73, with no statistically significant difference (p = 0.28). Conclusion: The user´s profile of HCP consisted mostly of elderly female patients, with an admission diagnosis of neurological diseases and gastrointestinal intubation via gastrostomy; the caregiver was a casual and family member represented by the female figure. Regarding gastrointestinal extubations measured through result indicators and by identifying the involved circumstances found that the findings helped to understand the reality of patients with gastrointestinal intubation for nutritional support in the program, providing subsidies to establish the assistance and managerial goals for the continuous improvement of quality and for the necessary changes in work processes in the home care area.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-09-29T17:24:02Z No. of bitstreams: 1 anadelledesouzateixeiralima.pdf: 4735372 bytes, checksum: 8658fd1c44af350af74986abc77f663e (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-10-09T19:43:33Z (GMT) No. of bitstreams: 1 anadelledesouzateixeiralima.pdf: 4735372 bytes, checksum: 8658fd1c44af350af74986abc77f663e (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-10-09T19:44:53Z (GMT) No. of bitstreams: 1 anadelledesouzateixeiralima.pdf: 4735372 bytes, checksum: 8658fd1c44af350af74986abc77f663e (MD5) / Made available in DSpace on 2017-10-09T19:44:53Z (GMT). No. of bitstreams: 1 anadelledesouzateixeiralima.pdf: 4735372 bytes, checksum: 8658fd1c44af350af74986abc77f663e (MD5) Previous issue date: 2017-08-29 / O objeto desta investigação foi o custo familiar de idoso dependente pela doença de Alzheimer na Atenção Domiciliar. Com o processo de envelhecimento populacional e como consequência deste, há um aumento da incidência das doenças crônico degenerativas, entre elas destacam-se as demências. A Doença de Alzheimer (DA) é considerada a demência de maior prevalência e incidência na população idosa, tornando-se um importante problema de saúde pública, tendo em vista a sua complexidade, já que acarreta dependência total em fases mais avançadas e exigindo cuidados cada vez mais complexos, além da necessidade de aporte emocional e financeiro por parte da família. Objetiva-se, portanto, desenvolver uma análise teórica substantiva sobre o custo familiar com idoso dependente pela doença de Alzheimer. Realizou-se uma investigação qualitativa com a abordagem da Teoria Fundamentada nos Dados. A pesquisa foi operacionalizada em duas etapas. A primeira, de natureza exploratória, no cenário do Serviço de Atenção Domiciliar, foi realizado o levantamento dos idosos cadastrados no período de abril de 2016 a março de 2017. A segunda, de acordo e por meio de inquérito domiciliar objetivou-se: a identificação do perfil sóciodemográfico e econômico dos participantes, avaliou-se o estadiamento da doença, como também buscou-se a compreensão dos custos familiares do idoso dependente da DA. Os participantes foram distribuídos em 3 grupos amostrais. O primeiro composto por dois participantes visto a necessidade de lançar mão de novas perguntas para pesquisa, conformou-se um segundo grupo amostral, constituído por oito participantes. O terceiro grupo amostral, constituído por seis participantes, possibilitou a validação do modelo teórico substantivo, a partir dos achados desta pesquisa. A análise dos dados da primeira etapa foram organizados em uma planilha do programa Microsoft Excel e analisados por estatística descritiva. A análise dos dados da segunda etapa realizou-se mediante três tipos de codificação: codificação aberta, axial e seletiva; utilizando-se o programa OpenLogos® versão 2.0 para realizar a edição textual dos dados empíricos e a codificação aberta. Emergiram dos dados as seguintes categorias: a Doença de Alzheimer: o impacto do cuidado domiciliar na família; entendendo o cuidado domiciliar como melhor opção, mas vivenciando as consequências; estando cadastrado no SAD: atenuando as implicações do cuidado no domicílio; gerenciando o cuidado domiciliar: utilizando de sentimentos para amenizar a sobrecarga; as repercussões do SAD: reflexões para os custos familiares e compreendendo os custos domiciliares com a DA: implicações para a família, sendo esta a última a categoria central do estudo. Conclui-se que as principais repercussões relacionadas aos custos familiares diretos, indiretos e intangíveis, com o cuidado do idoso dependente pela DA no domicílio, estão relacionadas á gravidade desta patologia e não ao acompanhamento pelo Serviço de Atenção Domiciliar (SAD) que se mostrou como facilitador no processo do cuidar em domicílio. Como também, o SAD, no contexto do envelhecimento populacional, surge como alternativa assistencial para cuidado prolongado de forma integral promovendo uma assistência mais qualificada a usuários com dependência funcional, tais como os idosos com Alzheimer. / The objective of this investigation was the family cost of elderly dependent on Alzheimer's disease in Home Care. With the process of population aging and as a consequence of this, there is an increase in the incidence of chronic degenerative diseases, among them the dementias are highlighted. Alzheimer's disease (AD) is considered the most prevalent and incident dementia in the elderly population, becoming an important public health problem, due to its complexity, since it entails total dependence in later stages and requires more complex, in addition to the need for emotional and financial support from the family. It is therefore intended to develop a substantive theoretical analysis on the cost of family care for the elderly dependent on Alzheimer's disease. A qualitative investigation was carried out using the Data Based Theory approach. The research was operationalized in two stages. The first, of an exploratory nature, in the scenario of the Home Care Service, was carried out the survey of the elderly enrolled in the period from April 2016 to March 2017. The second, according to a household survey, was to identify the socio-demographic and economic profile of the participants, the staging of the disease was evaluated, as well as an understanding of the family costs of the elderly dependent on AD. Participants were divided into 3 sample groups. The first one composed of two participants, considering the need to use new research questions, conformed a second sample group, composed of eight participants. The third sample group, made up of six participants, allowed the validation of the substantive theoretical model, based on the findings of this research. The analysis of the data of the first stage were organized in a spreadsheet of the program Microsoft Excel and analyzed by descriptive statistics. The analysis of the data of the second stage was carried out through three types of codification: open, axial and selective coding; using the OpenLogos® version 2.0 program to perform the textual editing of empirical data and open coding. The following categories emerged from the data: Alzheimer's disease: the impact of home care on the family; understanding home care as the best option, but experiencing the consequences; being enrolled in HCS: attenuating the implications of home care; managing home care: using feelings to ease the burden; the repercussions of HCS: reflections on family costs and understanding household costs with AD: implications for the family, the latter being the central category of the study. It is concluded that the main repercussions related to the direct, indirect and intangible family costs, with the care of the elderly dependent on AD at home, are related to the severity of this pathology and not to the follow-up by the Home Care Service (HCS) facilitator in the process of home care. In addition, HCS, in the context of population aging, appears as an assistance alternative for long-term care in an integral manner, promoting a more qualified assistance to users with functional dependence, such as the elderly with Alzheimer's.

Le « knotworking » représente une forme innovante d’organisation du travail dans laquelle la collaboration prend place sous la forme d’épisodes en fonction des besoins de la situation. Cela implique de multiples défis pour soutenir la collaboration, dus à la nature épisodique, improvisée et inter-organisationnelle de cette collaboration. Notre objectif dans cette thèse est de relever ces défis, au travers d’un cas d’étude sur les pratiques collaboratives d’un groupe de professionnels de santé libéraux prenant en charge des patients à domicile. Nos résultats montrent : 1) La centralité des artefacts de coordination ; 2) comment la focalisation sur la qualité de vie des patients amène les acteurs de la prise en charge à traiter de problèmes au-delà du périmètre médical ; 3) que les acteurs de santé passent par différents rythmes de collaboration en fonction de l’évolution de la situation de leur patient. Ces résultats nous ont permis de définir des principes de conception et de développer l’application CARE (Classeur pour une Approche en Réseau Efficace), accessible sur une tablette et restant au domicile du patient. Les retours montrent le rôle potentiel des technologies pour motiver la participation de nouveaux acteurs de santé, et pour la mise en place d’un espace partagé pour les différents participants de la prise en charge. Notre travail contribue à la recherche en TCAO en mettant l’accent sur un nouveau modèle d’organisation du travail (knotworking) et en proposant la première étude de cas de conception d’un outil pour assister la collaboration dans ce contexte / The development of new modes of working raises new challenges for supporting collaboration. Knotworking represents an innovative way of organizing work where collaboration occurs in episodes depending on the requirement of the current situation. Supporting collaboration in knotworking presents multiple challenges due to the episodic, improvised, and cross-boundary nature of the collaboration. Our objective in this thesis is to tackle these challenges. Thus, we conducted a design case study investigating the collaborative practices of a group of self-employed care professionals organized as an association which take care of patients at home. The results show: 1) the centrality of the coordinative artifacts for sharing information and coordinating the work; 2) how focusing on patients’ quality of life leads care actors to address issues beyond the medical scope; 3) how the care actors experience different rhythms of collaboration depending on the patient’s situation. Based on these results, we defined some implications for design and developed the CARE application (Classeur pour une Approche en Réseau Efficace), which is accessible via a tablet and stays at the home of the patient. Feedback reveals the potential role of technologies in motivating the participation of new care actors, and in the creation of a shared place for diverse participants. Our work contributes to CSCW by bringing to focus a new model of organizing work named knotworking and by providing a first design case study aiming at supporting collaboration in this context

The Home and Community Based Care (HCBC) and Support programme has been established as a cost effective response for communities to tackle HIV and AIDS and many other chronic conditions and vulnerabilities which are faced by individuals, families and communities. In terms of the Framework for Home and Community Based Care and Support Programme (2012: 4) HCBCs create an enabling platform for “individuals, families and communities to have access to holistic and comprehensive services nearest to home, which encourages participations by people, responds to the needs of the people, encourages traditional community life and strengthens mutual support opportunity and social responsibility”. Victor Khanye Local Municipality, IDP (2010-2011: 116) states that VKLM is faced with: a high incidence of HIV and AIDS due to poverty, ignorance and a lack of proper entertainment facilities; shortage of clinics and professional staff members, which makes it difficult for patients to access treatment and maximum care and support; and an increase in the number of OVCs which results in a lack of parental care and guidance, poverty, illiteracy, lack of access to medical care, school drop-outs and ultimately an increase in criminal activity and the further spread of HIV and AIDS. The research will assess the effectiveness of Home Community Based Care programmes (HCBCs) on orphaned and vulnerable children with specific reference to the Victor Khanye sub-district in Nkangala District, Mpumalanga Province. The research was conducted in Delmas and its surrounding farming areas. Victor Khanye sub-District has nine wards, most of which are predominantly farming rural areas. The field research took place during June and August 2013 and represents observations recorded at the field interviews, the local AIDS committee and one-on-one interviews with beneficiaries The study is concluded with conclusions drawn from the field study and recommendations.

No description available.

Bakgrund: Önskan att få vårdas hemma vid livets slut ökar bland palliativa patienter. Den välbekanta hemmiljön och möjligheten att få vård av kompetent personal skapar trygghet samtidigt som att brister i personalens kunskap och kommunikation skapar otrygghet hos både patienter och anhöriga. Syfte: Syftet är att beskriva distriktssköterskors erfarenheter av att ge omvårdnad till palliativa patienter i hemsjukvård. Metod: En empirisk kvalitativ intervjustudie med induktiv ansats. Resultat: Distriktssköterskorna beskrev att det är fantastiskt att få vara delaktig i vården så nära patienten samtidigt som de ofta möter svåra och känslomässigt tunga situationer. Vidare beskrevs vikten av att verkligen se den individuella patienten och anhöriga, att anpassa sig efter önskningar och påminna sig om att de är gäster i deras hem. Det framkom även att distriktssköterskorna tycker att kunskapen om palliativ omvårdnad är bristande, både hos distriktssköterskor och hemtjänst. De gav förslag på områden där mer kompetens behövs samt önskemål om handledningstillfällen, både under vårdtiden och efter dödsfall. Slutsats: Slutsatsen är att distriktssköterskor efterfrågar utbildning, stöd och handledning inom palliativ hemsjukvård. Ökad kunskap kan bidra till en bättre och mer kvalificerad personcentrerad vård. / Background: The desire to be cared for at home at the end of life is increasing among palliative patients. The familiar home environment and the possibility of receiving care from competent staff create security while deficiencies in the staff's knowledge and communication create insecurity in both patients and relatives. Aim: The aim of the study is to describe district nurses´ experiences of providing care to palliative patients in home care. Method: An empirical qualitative interview study with inductive approach. Result: District nurses´ described that it is fantastic to be able to be involved in care so close to the patient and at the same time they meet difficult and emotionally heavy situations. Further they described the importance of seeing the individual patient and the relatives, adjusting to their wishes and reminding that they are guests in their homes. It also appeared that the district nurses´ think that knowledge of palliative care is lacking, both in district nurses´ and in home care personal. They proposed in areas where more expertise is needed och they also request for counselling opportunities, both during the care period and after death. Conclusion: The conclusion is that district nurses´ demand education, support and guidance in palliative home care. Increased knowledge can contribute to better and more qualified personcentered care

Bakgrund: Palliativ vård omfattar inte bara vård av patienten utan innefattar även stöd till närstående, både under vårdtiden och efter dödens faktiska inträffande. Ett efterlevandesamtal är en möjlighet för distriktssköterskan att följa upp hur de närstående mår en tid efter dödsfallet och hur de upplevde vården under sjukdomstiden. Syfte: Att beskriva distriktssköterskors och sjuksköterskors erfarenheter av efterlevandesamtal inom kommunal hemsjukvård. Metod: Studien hade en kvalitativ deskriptiv design med en induktiv ansats. Åtta individuella semi-strukturerade intervjuer genomfördes via videomöte. Insamlat material analyserades genom en kvalitativ innehållsanalys med fokus på det manifesta innehållet. Resultat: I resultatet framkom att efterlevandesamtal erbjöds efter alla dödsfall. Arbetsuppgiften beskrevs vara värdefull och mångsidig samt något som distriktssköterskan fått lära sig på egen hand. Efterlevandesamtalet hade en avslutande funktion från både distriktssköterskans och de närståendes perspektiv. Efterlevandesamtalets syfte ansågs vara att identifiera de närstående som var i behov av stöd samt ta emot synpunkter ifrån de närstående och reda ut eventuella frågor. Synpunkterna ansågs viktiga att ta vara på för att kunna kvalitetsutveckla vården. Slutsats: Betydelsen av efterlevandesamtalet var utifrån distriktssköterskornas perspektiv viktig för både distriktssköterskorna och de närstående. Distriktssköterskornas inställning till att genomföra efterlevandesamtal varierade. Framförallt ansågs det vara en värdefull arbetsuppgift men beskrevs även kunna vara svår och krävande. Vår studie skulle kunna hjälpa distriktssköterskor som känner en oro inför efterlevandesamtalet att se på det ur ett annat perspektiv. / Background: Palliative care includes not only the care of the patient, but also support for family members, both during the period of care and after the actual occurrence of death. A bereavement follow-up is an opportunity for the community health nurse to follow up on how the family members feel some time after the death and how they experienced the care during the illness. Aim: To describe the community health nurses experiences of bereavement follow-up in home care services. Method: The study had a qualitative descriptive design with an inductive approach. Eight individual semi-structured interviews were conducted via video meeting. The collected material was analyzed through a qualitative content analysis with a focus on the manifested content. Findings: The results revealed that bereavement follow-up are offered after all deaths. The task was perceived to be valuable and versatile, as well as something that the community health nurse had to learn on their own. The bereavement follow-up had an ending function from both the community health nurses and the family members perspective. The purpose of the bereavement follow-up was to identify the family members in need of support and to receive comments from the family members and sort out any issues. The comments were considered important to take advantage of to improve the quality of the care. Conclusion: From the perspective of the community health nurses the bereavement follow-up was important for both community health nurses and family members. Among the community health nurses the attitude to have bereavement follow-up varied. Above all, it was considered a valuable task but could also be difficult and demanding. Our study could be helpful to those who are anxious about the bereavement follow-up, to look at it from a different perspective.

A program evaluation of the Homemaker Service of Lane County, through use of the Homemaker Opinion Survey and the Former Clientele Satisfaction Survey was implemented because of the interest expressed by the program director to evaluate the program. The master report of the evaluation was submitted to the Homemaker Service of Lane County under the title "Report of the Homemaker and Former Clientele Evaluation of the Homemaker Service of Lane County, 1979." Chapter IV (Findings) of this report, "Homemaker and Former Clientele Evaluation of the Homemaker Service of Lane County," is a condensed version of that found in the master report. The reader is referred to the master for more detailed descriptive tables found in that report.

Bakgrund: Tidigare forskning utförd inom särskilda boenden har visat att det är ett förekommande problem att äldre utsätts för vanvård och försummelse utförd av personal. Forskning om vanvård och försummelse inom ordinärt boende i svensk kontext är bristfällig. Syfte: Syftet med undersökningen var att undersöka och förstå hur omsorgspersonal och enhetschefer inom ordinärt boende resonerar kring vanvård och försummelse i komplexa omsorgssituationer av äldre personer. Metod: Undersökningen är en metodkombination med tvärsnittsdesign som genom en vinjettbaserad enkät avsåg utforska respondenternas resonemang kring komplexa omsorgssituationer. Resultat: Respondenternas resonemang visar på en tendens av bristande kunskap kring våld i form av vanvård och försummelse. Det kunde även urskiljas en ambivalens mellan att se risker och kritisera ageranden samtidigt som man rättfärdigade handlingarna. Respondenternas resonemang visade på svårigheter kring att identifiera våldshandlingar och benämna dem i termer av våld. / Background: Previous research carried out in nursing homes has shown that it is a common problem that the elderly people are exposed to neglect carried out by staff. Research on neglect within home care services in the Swedish context is lacking. Purpose: The purpose of the survey was to investigate and understand how staff and managers within home care survices reason about neglect in complex care situations of elderly people. Method: The survey is a mixed methods with a cross-sectional design that trough a vignette-based survey aimed to explore the respondents' reasoning regarding complex care situations. Results: The respondents' reasoning shows a tendency of a lack of knowledge about violence in the form of neglect. One could also discern an ambivalence between seeing risks and criticizing actions while justifying this acts. The respondents' reasoning showed difficulties in identifying acts of violence and naming them in terms of violence.