Att befinna sig i ett terminalt skede i livet kan innebära en känsla av oro och ångest inför sjukdomen och döden. Möjligheten att då få tillbringa sin sista tid i hemmiljö med nära och kära kring sig genererar för många en trygghet. Syftet med denna uppsats är att belysa vuxna människors erfarenheter av att i livets slutskede vårdas av anhöriga i hemmiljö. Metoden som använts är systematisk litteraturstudie där aktuell forskning inom området sammanställts. Databaser som använts för sökningen var PsycINFO, Medline, Cinahl, Elin@kalmar och SweMed+. Artiklar som syftade till problemformuleringen kvalitetsgranskades och resultatet bygger på tio vetenskapliga artiklar. Resultatet visade att sociala relationer och stöd från familjen genererar livskvalitet och trygghet hos människan som vårdas i livets slutskede. Delaktighet i sin vård och känsla av att inte förlora kontrollen över sina symtom gjorde att människan kände hopp och att de klarade av situationen. Slutsatserna var att möjligheten att få bo kvar hemma ansågs mycket betydelsefullt. Sociala relationer bidrog till att människor hemma kände en lägre grad av symtom. Den sjuke uppskattade stödet från familjen men ville inte bli en börda för anhöriga. Information om stöd och en realistisk planering samt insikt i situationens allvar bidrog till att hon kände delaktighet och bättre kunde hantera situationen.

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Background: In Havana, Cuba, they have established a great availability of health centers that work close to the patients and their families, both geographically and socially. Family-centered nursing is something that is sought within the health care in the Western world. Numerous studies have shown that family-centered nursing increases patient safety and patient satisfaction and to provide psychological support to family members has shown to contribute to a better well-being to both them and the patient. Aim: To describe nurses’ experiences of involving family members in home-based care provided through consultorios in Havana, Cuba. Method: A qualitative study was completed with semi-structured interviews with five nurses that was currently working or had been working at consultorios in Havana, Cuba. Analysis was done according to qualitative content analysis based on the approach presented by Graneheim and Lundman. Results: The data resulted in two main-themes. The family members were presented as informants to the nurses, psychological support to the patients and as an asset to the nurse. The nurses further explained the importance of seeing the whole picture of their patient’s situation, how they educate family members to be involved in the care and how they support the family members psychologically. Discussion: The nurses’ experience of family members' role and their work to involve them was discussed in relation to previous research and the concept of family-centered care as presented by Benzein, Hagberg and Saveman. / Bakgrund: I Havanna, Kuba, har de upprättat en stor tillgänglighet av sjukvårdsinstanser och hälsocenter som arbetar nära patienterna och deras familjer, både geografiskt och socialt, så kallade consultorios. Familjecentrerad omvårdnad är något som eftersträvas inom sjukvård i västvärlden. Ett flertal studier har visat att familjecentrerad omvårdnad ökat patientsäkerheten och patientens tillfredställelse av vården och att psykologiskt stöd för anhöriga bidrar till en bättre hälsa både för dem och patienten. Syfte: Att beskriva sjuksköterskors erfarenheter av att involvera familjemedlemmar i hemsjukvård som bedrivs utifrån consultorios i Havanna, Kuba. Metod: En kvalitativ studie med semistrukturerade intervjuer genomfördes och fem sjuksköterskor som arbetade eller har arbetat på consultorios i Havanna, Kuba, deltog. Resultatet bearbetades utifrån kvalitativ innehållsanalys baserad på den strategi som beskrivits av Graneheim och Lundman. Resultat: I resultatet framkom två huvudteman. Familjemedlemmarna presenterades dels som informanter men också som en tillgång i sjuksköterskans arbete samt som ett psykologiskt stöd till patienterna. Vidare berättade sjuksköterskorna vikten av att se hela bilden av deras patienters situation, hur de utbildar familjemedlemmar i omvårdnaden och hur de stödjer familjemedlemmar psykologiskt. Diskussion: Sjuksköterskornas upplevelse av familjemedlemmars roll och deras arbete med att involvera dessa diskuterades i relation till tidigare forskning och begreppet familjecentrerad omvårdnad som det beskrivits av Benzein, Hagberg och Saveman.

Health system restructuring combined with the preferences of palliative care recipients to be cared for at home has lead to a shift in the delivery of care from the hospital to the home setting. An analysis was conducted on five main home-based palliative care health service components: home-based nurse visits, home personal support worker visits, home-based physician visits, ambulatory physician visits, and other ambulatory and home-based visits. First, we assessed the proportion of total cost associated with the main services at different time points over the palliative care trajectory. Second we examined the socio-demographic and clinical factors that predict the propensity and intensity of service use, using a two-part model. The results suggest that the greatest contributor to the total cost of home-based palliative care was personal support worker visits, followed by nurse visits. The regression analysis revealed that patient age as well as functional status most often predicted health service use.

Health system restructuring combined with the preferences of palliative care recipients to be cared for at home has lead to a shift in the delivery of care from the hospital to the home setting. An analysis was conducted on five main home-based palliative care health service components: home-based nurse visits, home personal support worker visits, home-based physician visits, ambulatory physician visits, and other ambulatory and home-based visits. First, we assessed the proportion of total cost associated with the main services at different time points over the palliative care trajectory. Second we examined the socio-demographic and clinical factors that predict the propensity and intensity of service use, using a two-part model. The results suggest that the greatest contributor to the total cost of home-based palliative care was personal support worker visits, followed by nurse visits. The regression analysis revealed that patient age as well as functional status most often predicted health service use.

<p>Att befinna sig i ett terminalt skede i livet kan innebära en känsla av oro och ångest inför sjukdomen och döden. Möjligheten att då få tillbringa sin sista tid i hemmiljö med nära och kära kring sig genererar för många en trygghet. Syftet med denna uppsats är att belysa vuxna människors erfarenheter av att i livets slutskede vårdas av anhöriga i hemmiljö. Metoden som använts är systematisk litteraturstudie där aktuell forskning inom området sammanställts. Databaser som använts för sökningen var PsycINFO, Medline, Cinahl, Elin@kalmar och SweMed+. Artiklar som syftade till problemformuleringen kvalitetsgranskades och resultatet bygger på tio vetenskapliga artiklar. Resultatet visade att sociala relationer och stöd från familjen genererar livskvalitet och trygghet hos människan som vårdas i livets slutskede. Delaktighet i sin vård och känsla av att inte förlora kontrollen över sina symtom gjorde att människan kände hopp och att de klarade av situationen. Slutsatserna var att möjligheten att få bo kvar hemma ansågs mycket betydelsefullt. Sociala relationer bidrog till att människor hemma kände en lägre grad av symtom. Den sjuke uppskattade stödet från familjen men ville inte bli en börda för anhöriga. Information om stöd och en realistisk planering samt insikt i situationens allvar bidrog till att hon kände delaktighet och bättre kunde hantera situationen.</p>

Magister Curationis - MCur / The purpose of the study will be to explore the discharge referral pathway for patients that have been discharged from hospital to home in the Western Cape Province. A mix of quantitative and qualitative research, using a descriptive design will be undertaken. Quantitatively, following the patient paper trail from Tertiary Hospital to grassroots level. Qualitatively, to identify whether the referral pathway was user friendly. Records of discharged patients from the Tertiary Hospital will be used as the study population. Patient information will be accessed from patient files at the hospital. Interviews will be conducted with the relevant discharge liaison officers at the Tertiary Hospital, and Primary Health Care level. Relevant staff members within the non–governmental –organisations (NGOs), will also be interviewed in order to determine their perception of the discharge referral pathway. The findings of the study will be used to inform policy guidelines. Challenges encountered by staff members in referring patients for continuum of care, and the perception of consumers will also be described and documented.

This thesis, 'Living with HIV/AIDS: An ethnography of care in Western Kenya', is based upon 18 months of ethnographic fieldwork carried out in Central Nyanza, Kenya, between 2005-2007. It studies practices of care against the backdrop of the HIV/AIDS epidemic, which has impacted the region severely. The thesis explores how home and hospital are established as domains of care through practice. It draws upon ethnographic material collected from within a District Hospital, a Community-Based Organisation and people's homes. The thesis follows practices of care across divergent domains of social life to consider how practices of care within Luo networks of kinship and relatedness intersect with governmental interventions to manage HIV/AIDS. The thesis describes two governmental projects introduced to administer HIV/AIDS care in this region. It considers Home-Based Care, an HIV/AIDS response in which Community Health Workers are trained to support particular aspects of care at home, focusing on the practices of care employed by Community Health Workers as they visit sick people at home and attend organisational meetings. The thesis also describes the landscape of HIV care in the District Hospital, including the delivery of antiretroviral therapy. The focus here is on the relationships between caring practices in the hospital and at home, and the divergent responsibilities to care experienced by hospital staff and family members. The main argument of the thesis is that care is a particularly useful analytical tool for anthropology because practices of care take place across many different domains of social life, cutting across the boundaries that have formed the traditional focus of anthropological study. Studying practices of care illuminates the production of bounded domains of social life whilst simultaneously drawing attention to similarities of practice across different domains. Care provides a way of understanding the complex social landscape that has developed as people in Western Kenya endeavour to live with HIV/AIDS.

Background: The past two decades have witnessed transition from in-patient hospital settings to Community and Home Based Care in Zimbabwe. This is because of an increase in the number of people developing chronic health conditions such as diabetes, hypertension and cancers, and thus needing longer treatment durations. The increase in chronic conditions has mainly been attributed to the increase in incidence and prevalence of Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome in Sub-Saharan Africa. Many Governments, including that of Zimbabwe, endorsed and promoted community and home based care to provide a continuum of care to the chronically ill. Despite the implementation of Community and Home Based Care programmes, no studies known to the researcher have been done to investigate the congruency of service users’ needs and the programme goals. Purpose: The purpose of the study is twofold; firstly to explore whether Community and Home Based Care interventions provide services that effectively meet users’ goals in a dynamic social environment and secondly, to develop guidelines for enhancing care provision as well as congruency of service users’ needs and programme goals. Methods: A mixed-method approach combining qualitative and quantitative data collection and analysis was used. Concurrent collection of data with equal status was placed on both qualitative and quantitative data. For qualitative data interviews and focus groups were used with home based care service users, family care givers, and health providers. Structured questionnaires were used for the quantitative data. Framework: Imogene King’s Interacting Systems Framework and Theory of Goal Attainment were adopted to guide the study. These were utilised because of the assumption that mutual agreement on goals for effective care can be achieved through nurse-client interactions and communication Research findings: Community and Home Based Care programme in Zimbabwe does not comprehensively meet the needs of its service users. Service users have diverse needs and goals depending on the specific condition and symptoms they experience. They perceive access to medication for symptom management and pain control, food and financial stability, as priority needs. The study found that nursing services provided in Community and Home Based Care generally align with the physical needs of service users and was deficient in addressing the socio-economic and psycho-social needs of service users. Conclusion: No single sector can achieve the users’ and the programme`s goals of quality health on its own. The goals may only be realised when other stakeholders and relevant sectors contribute to the Community and Home Based Care programme, which requires diverse resources. Guidelines to enhance integration of Community and Home Based Care with social services were developed. / Health Studies / D.Litt. et Phil. (Health Studies)

Thesis (M.A. Education (Community and Continuing Education)) -- University of Limpopo, 2015 / This report describes the research conducted at Kgotlelelang Basadi Home-based Care centre, in the Capricorn District Limpopo Province of South Africa. The centre serves four villages: Ngwanamago, Makata, Matobole and Thaba. Statement of the problem It seems the home-based caregivers of chronic patients at Kgotlelelang Basadi HBC centre do not have the necessary qualifications, knowledge, skills, and health care and protective resources such as gloves, thermometers and masks. It looks like the homebased caregivers are not adequately and continuously trained as there are always new discoveries and developments with regard to the treatment of diseases. It apprears they perform their duties without sufficient support by relevant institutions like clinics and hospitals. Furthermore, it appears the home-based caregivers are not recognised, and are also undermined. The aim of the study is to explore the educational needs and assets of home-based caregivers for homebound chronic patients at Kgotlelelang Basadi Home-based Care centre. After establishing the educational needs and assets of home-based caregivers I recommended the formulation of possible relevant educational programmes. In an attempt to achieve the said aims, the following research questions were formulated and put forward in chapter 1. Objectives  To establish the existing qualifications of home-based caregivers for home-bound chronic patients at Kgotlelelang Basadi HBC Centre.  To determine the relevancy of the existing educational programmes of home-based caregivers for home-bound chronic patients.  To contribute towards formulating relevant educational programmes of home-based caregivers for home-bound chronic patients.