People with serious mental illness are genetically predisposed to diabetes. Their risk is heightened with the use of atypical antipsychotic medications. Contextual conditions also influence diabetes care and outcomes. There is a lack of research on diabetes care for the mentally ill in residential care facilities. Therefore, there is little understanding of the social relations that contribute to this group’s health disparities. Institutional ethnography was chosen to explore this phenomenon in a group of 26 women in a rural for-profit group home in southern Ontario. Work activities of residents and providers were examined to map out the social organization of health inequities. Interviewees included residents with diabetes, care providers, field workers, and health professionals. Observations and analysis of coordinating texts were further methods used to reveal disjunctures between discourses embedded within diabetes care guidelines and the actualities of living within imposed constraints of group home care. The overarching State interest in cost containment creates rationing that limits the care afforded residents, resulting in poor dietary intake and lack of quality of life opportunities. Further, group home policies regulate systems of safety, reporting, and financial accountability, but do not promote health. The medical and psychiatric divide also contributes to health disparities. Diabetes care provision supports ‘self-care,’ which is challenging for this group, and health providers lack understanding of contextual constraints. Combined, these social circumstances perpetuate disease development and make illness management difficult. These findings warrant the need for State financial support and policy changes that give primacy to illness prevention, health promotion, and medical management so the mentally ill can realize health and wellbeing. A linkage between mental and physical health care is also crucial. Further, health providers are urged to be critical of social ideologies that sustain health inequalities, and to deliver services that are sensitive to unique particularities.

People with serious mental illness are genetically predisposed to diabetes. Their risk is heightened with the use of atypical antipsychotic medications. Contextual conditions also influence diabetes care and outcomes. There is a lack of research on diabetes care for the mentally ill in residential care facilities. Therefore, there is little understanding of the social relations that contribute to this group’s health disparities. Institutional ethnography was chosen to explore this phenomenon in a group of 26 women in a rural for-profit group home in southern Ontario. Work activities of residents and providers were examined to map out the social organization of health inequities. Interviewees included residents with diabetes, care providers, field workers, and health professionals. Observations and analysis of coordinating texts were further methods used to reveal disjunctures between discourses embedded within diabetes care guidelines and the actualities of living within imposed constraints of group home care. The overarching State interest in cost containment creates rationing that limits the care afforded residents, resulting in poor dietary intake and lack of quality of life opportunities. Further, group home policies regulate systems of safety, reporting, and financial accountability, but do not promote health. The medical and psychiatric divide also contributes to health disparities. Diabetes care provision supports ‘self-care,’ which is challenging for this group, and health providers lack understanding of contextual constraints. Combined, these social circumstances perpetuate disease development and make illness management difficult. These findings warrant the need for State financial support and policy changes that give primacy to illness prevention, health promotion, and medical management so the mentally ill can realize health and wellbeing. A linkage between mental and physical health care is also crucial. Further, health providers are urged to be critical of social ideologies that sustain health inequalities, and to deliver services that are sensitive to unique particularities.

Research into adverse events in home care is at a very early stage worldwide. Adverse event research in other health care sectors has demonstrated that patients can and do suffer harm, much of which is preventable, during the receipt of health care services. A stratified, random sample of patients who had received home care nursing service and were discharged in 2004/05 from three Ontario home care programs was studied to develop basic exploratory and descriptive evidence to advance the understanding of AEs in home care. The outcome is an estimate of the incidence of adverse events among patients, description of adverse event types and factors associated with adverse events, and the development of models predictive of home care patients with higher and lower potential for adverse events, and of the location of patients with adverse events. Positive critical indicators were identified in 66.5% of 430 cases. Sixty-one adverse events were identified in 55 (19.2%) of these 286 cases. When adjusted for sampling methodology, the adverse event rate was 13.2 per 100 patients (95%, CI 10.4% - 16.6%, SE 1.6%). Thirty-three percent of the adverse events were rated as having more than a 50% probability of preventability; 1.4% of all patients experienced an adverse event related death. Eight of the 45 factors significantly associated with adverse events formed a single factor model predictive of adverse events. Six two-factor interactions and the absence of one factor were also predictive of the occurrence of adverse events. Five of the 12 critical indicators significantly related to adverse events, as well as 7 critical indicator combinations formed models that reliably located about two-thirds of patients who had, and almost all patients who had not, experienced an adverse event. This study suggests that a significant number of home care patients experience adverse events, two-thirds of which are preventable. Use of adverse event sensitive factors as a screening tool for patients that may benefit from enhanced case management and clinical vigilance, and those unlikely to be placed at increased adverse event risk by maintaining current levels of vigilance, presents an opportunity to improve patient safety. Retrospective critical indicator models identifying home care patients who have experienced an adverse event can be used to estimate adverse event incidence rates and changes in rates over time.

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

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

Bakgrund: Mötet mellan sjuksköterska och patient har beskrivits som grundläggande isjuksköterskearbetet och är mer välstuderat i andra sjukvårdsmiljöer än hemsjukvården,som är basen för Sveriges sjukvård och engagerar ett stort antal behövande som vårdasav många anställda. Hemmet får allt större betydelse som vårdplats och antalet platserpå sjukhusen blir färre.Syftet var att beskriva sjuksköterskan i hemsjukvårdens upplevelse av mötet medpatienten och dennes närstående i deras eget hem (ordinärt boende).Metod: Studien gjordes som en allmän litteraturstudie där vetenskapliga artiklarsystematiskt söktes i olika databaser för att sedan analyseras. Sökningarna resulterade i11 artiklar.Resultatet: Presenteras i tre kategorier som beskriver sjuksköterskans upplevelser:Relationens betydelse i mötet med patient och närstående, förtroende, tillit och respekt imötet samt maktlöshet, frustration och en känsla att inte räcka till.Diskussion: Med kännedom om hur betydelsefull relationen till patienten upplevskänns det angeläget att som sjuksköterska i hemsjukvården arbeta personcentrerat ochatt hela tiden lyssna in patient och närstående och försöka anpassa sig till situationen.7Slutsats: Relationen mellan patient, närstående och sjuksköterska har stor betydelse föroch påverkar alla inblandade parter. Kunskap som är av betydelse för att möta de kravoch förväntningar hemsjukvården kommer ställas inför när allt fler och allt sjukarepersoner kommer behöva hjälp med allt mer avancerade insatser. / Background. The encounter between the nurse and the patient has been described asfundamental in nursing work and are more well-studied in other health care settingsthan home care, wich is the base for the Swedish health care and involves a largenumber of needy cared for by many people. The home is of increasing importance as aplace for care and the number of places in hospitals are becoming fewer.The aim was to describe the experiences nurses in home care have of the encounterwith the patient and his or her relatives in their own home (ordinary housing).Method: the study was conducted as a literature review and articles were searched forsystematically in different databases and then analyzed. The searches resulted in 11articles.The result is presented in three categories that describe nurses´experiences: Thesignificance of the relation in the encounter with patient and relatives, confidence, trustand respect in the encounter and powerlessness, frustration and a feeling of not beeingable to do enough.Discussion: With knowledge of how important the relation to the patient is percieved,it´s of importance to work person-centered and listen to the patient and the relatives andtry to adjust to the situation.Conclusion: The relationship between patient, relatives and nurse is of greatimportance to, and impact on all parties involved. Knowledge that is relevant toconfront the demands and expectations that home care will face when more andincreasingly ill people will need help with more advanced efforts.

Bakgrund: Hemsjukvården är en verksamhet som inbegriper vårdmöten med vårdtagare med invandrarbakgrund. En god kommunikation anses grundläggande för att distriktssköterskor ska kunna ge individanpassad information och förebygga sjukdom samt främja hälsa. Det som anses försvåra kommunikationen är då vårdtagare och distriktssköterskor talar olika språk eller använder skilda kroppspråk. Syfte: Syftet med studien var att undersöka distriktssköterskors erfarenheter av det vårdande mötet med vårdtagare med invandrarbakgrund i hemsjukvården. Metod: En kvantitativ deskriptiv design användes med en enkät som datainsamlingsmetod. Materialet analyserades i SPSS version 20 samt genom inspiration från kvalitativ manifest innehållsanalys. Resultat: Resultatet skildrar distriktssköterskors erfarenheter inom hemsjukvården i ett län i södra Sverige samt hur deras erfarenheter varierar. Denna studie visar att majoriteten av deltagarna har erfarenheter av vårdmöten med vårdtagare med invandrarbakgrund. Det framgår även att det föreligger ett behov av kompetensutveckling särskilt inom interkulturell kommunikation, religionskunskap och kultur. Övervägande delen av deltagarna menar även att vårdmötet försvåras då språkskillnader föreligger. Slutsats: Studien visar att det anses föreligga ett behov av ökade kunskaper inom detta betydelsefulla område, och att studien därför bör upprepas för att erhålla ett större material. Kunskapen skulle kunna erhållas i grundutbildningen till sjuksköterska, i specialistutbildningen eller i form av internutbildning på arbetsplats. Genom mer kunskaper skulle det kunna skapas bättre förutsättningar för ett lyckat vårdmöte samt leda till ett vårdande arbete av god kvalité. / Background: Home health care is an activity that involves care meetings with patients with a migrant background. Good communication is considered essential for district nurses to be able to provide individualized information and prevent disease and promote health. The communication is considered more difficult when patients and district nurses speak different languages or use different body language. Purpose: The aim of the study was to investigate the district nurses experiences of caring meetings with patients with and immigrant background in home health care. Method: A quantitative descriptive design was used based on a questionnaire. The material was analyzed in SPSS version 20, except for the open ended questions that were analysed by inspiration from qualitative content analysis. Results: The results portray district nurses experiences in home helth care in a county in southren Sweden and how their experiences vary. This study shows that the majority of the participants have experience of caring meetings with patients with immigrant background. Participants identified needs for more training and education about intercultural communication, religion and culture. The majority of respondents believe that caring meetings become aggravated by language differences. Conclusion: The study shows that there is a need for increased knowledge in this important field and that the study should be repeated to obtain a larger material. This knowledge could be obtained in basic training for nurses, in specialized training or in-service training at the workplace. More knowledge would be able to create better conditions for a successful care meeting and nursing of good quality.

Syfte: Att undersöka distriktssköterskors erfarenheter av rollen som ledare för omvårdnadsarbetet i kommunal hemsjukvård. Metod: Studien hade en kvalitativ ansats. Tio distriktssköterskor verksamma inom kommunal hemsjukvård i två olika kommuner deltog i studien. Data insamlades via semi-strukturerade intervjuer och analyserades genom kvalitativ innehållsanalys. Resultat: Tre kategorier med åtta subkategorier framkom. De tre kategorierna och dess subkategorier indelades enligt följande: Att leda omvårdnaden är en ansvarsfull uppgift med subkategorierna Ansvar för att organisera omvårdnaden, Ansvar för kompetensutveckling och Att vara sitt eget verktyg. Kategorin Att leda omvårdnaden innebär samarbete med andra med subkategorier Samarbete med kollegor, Samarbete med omvårdnadspersonal och Samarbete med andra professioner. Slutligen framträdde kategorin Att rollens karaktär har förändrats med subkategorierna Ökad omfattning av komplex hemsjukvård, Konsultativt arbetssätt och ökat administrativt arbete.  Slutsats: Studiens resultat indikerar att satsningar inom kommunerna och utbildningar bör göras för att stärka distriktssköterskans roll som ledare för omvårdnadsarbetet inom kommunal hemsjukvård. / Aim: To investigate the district nurses' experiences of their role as leaders of nursing in community home care. Method: The study had a qualitative approach. Ten district nurses working in community home care in two different municipalities participated in the study. Data were collected through semi-structured interviews and analyzed by qualitative content analysis. Results: Three categories with eight subcategories emerged. The three categories and their subcategories were divided as follows: To lead the nursing is a responsible task with subcategories Responsibility for organizing nursing care, Responsibility for professional development and To be her/his own tools. The category To lead the nursing care involves collaboration with others by subcategory Collaboration with colleagues, Collaboration with nursing staff and Collaboration with other professions. Finally the category: The role's character has changed appeared with the subcategories Increased extent of complex home nursing, Consultative approach and increased administrative work. Conclusion: The results of the study indicate that investments in the municipalities and education should be made to strengthen the district nurse's role as leader of the nursing work in community nursing.

In Ontario, access to publicly funded home care services is managed by Community Care Access Centres (CCACs). CCAC case managers are responsible for assessing all potential clients and prioritizing the allocation of services. The objectives of this thesis were to: 1) describe the types of decisions made by CCAC organizations and by individual case managers concerning the allocation of nursing, personal support and homemaking services to long-term adult clients with no mental health issues; and 2) to describe and assess the factors and values that influence these decisions. We conducted two case studies in which qualitative data were collected through 39 semi-structured interviews and a review of relevant documents from an urban and a rural area CCAC. A modified thematic analysis was used to identify themes related to the types of priority setting decisions and the associated factors and values. An internet-based survey was then designed based on these results and answered by 177 case managers from 8 of the 14 CCACs. The survey contained discrete choice experiments to examine the relative importance of client attributes and values to prioritization choices related to personal support and homemaking services, as well as questions that examined case managers’ attitudes towards priority setting. We found that both the rural and the urban CCACs utilized similar forms of priority setting and that case managers made the majority of these decisions during their daily interactions with clients. Numerous client, CCAC, and external factors related to the values of safety, independence and client-focused care were considered by case managers during needs assessment and service plan development. The relative importance of the selected client attributes in defining need for personal support and homemaking services was tested and found to be significantly affected by the location of the case manager (rural or urban area), years of experience in home care, and recent experience providing informal care. Case managers allocated services in the spirit of equal service for equal need and in consideration of operational efficiency. We also identified a number of case manager-related, client-related and external factors that interfered with the achievement of horizontal equity.

Cerebral Palsy (CP) is a childhood-onset neurological disorder caused by a non-progressive lesion in the developing brain. It causes permanent motor and movement disorders, and can sometimes cause secondary cognitive, sensory, and communication conditions. The majority of children with CP will survive into adulthood; however, a relatively small amount of research has been done about adulthood and aging with CP. Using data collected in Ontario with the Resident Assessment Instrument for Home Care (RAI-HC), a retrospective, cross-sectional analysis was performed to create a clinical profile of adults with CP receiving long term home care services in Ontario. Of the 519, 443 people in the sample, 2000 had CP. Persons with CP tended to be younger than comparison groups, had higher scores on functional assessment scales, and were more likely to use assistive devices. They tended to have lower scores on scales meant to predict decline in health or function than the comparison groups, suggesting increased health and functionality stability compared to other Home Care recipients. A second analysis assessed the association between functional assessment scales, demographic variables and clinical indicators and use of physical therapy (PT), occupational therapy (PT) and either PT or OT for persons with CP in this population. Using three logistic regression models, indicators that were found to have positive, significant associations with use of rehabilitative services were: receipt of initial assessment, likelihood of decline in functionality, use of a wheelchair, being married, and CCAC of assessment origin. Living in a private residence compared to living in an assisted living situation had a significant, negative effect on rehabilitative service use. These findings suggest that PT and OT are referred to persons with CP in reaction to risk of health declines, and not in an attempt to improve baseline functionality. Future research on the factors that would indicate likelihood of improvement with PT or OT could identify whether these associations are appropriate for optimum care for persons with CP who receive home care services.