The purpose of this study was to focus on the Omnibus Budget Reconciliation Act of 1987 and the amendments of 1989 and 1990. Nursing assistants were placed in cluster groups of 300-hours, 120-hours, and 0-hours. Each subject's job performance of nursing care was observed using the Francis's Task Performance Rating Scale. The purpose of the analysis was to determine (1) if there was a significant difference in job performance of patient care between program completers and the challengers, (2) if there was a significant difference in the job performance of patient care between 300-hour and 120-hour, and (3) if there was a significant difference between the content required in OBRA mandated nursing assistant programs and actual job performance skills needed in patient care. It was determined that program completers' job performance of patient care was significantly different from the challengers.

Orientador: Aparecida Mari Iguti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T23:59:29Z (GMT). No. of bitstreams: 1 Mioto_OdilamarLopes_D.pdf: 2456129 bytes, checksum: 8425f82de3bd9084dfd488150ea99202 (MD5) Previous issue date: 2011 / Resumo: A tese tem como foco uma experiência local que, pela vertente social da profissão enfermagem, visa identificar os olhares dos profissionais da saúde, de nível superior, sobre o trabalho desenvolvido pelos técnicos de enfermagem da Atenção Básica na cidade de Americana/SP. Busca caracterizar o perfil destes trabalhadores, conhecer o processo de trabalho desenvolvido em oito Unidades Básicas e Pronto Atendimentos do município, bem como analisar sua identidade social e profissional no interior de um coletivo profissional. Utiliza-se de abordagem qualitativa que, por meio de entrevistas semi-estruturadas, enseja compreender a realidade que emerge da percepção, relato e experiência de quinze técnicos de enfermagem. As dinâmicas relacionais e sociais a que estão inseridos são retratadas nos depoimentos de nove enfermeiros que os supervisionam nos diferentes locais e cinco profissionais médicos que integram as equipes de saúde. A observação participante localiza o pesquisador no contexto escolhido e permite entender os sujeitos sociais no interior das equipes, bem como as relações hierárquicas de saber e poder. A pesquisa revela a importância do trabalho desenvolvido pelos técnicos de enfermagem como construtores do vínculo, do acolhimento, pela escuta e a responsabilidade declarada pelo primeiro contato dos indivíduos, famílias e a comunidade adscrita com os serviços de saúde.Como um dos estratos componentes da profissão enfermagem, propõe-se neste estudo uma reflexão sobre os olhares dos profissionais da saúde, especificamente o enfermeiro e o médico, que conduz à "invisibilidade funcional" induzida pela não valorização e reconhecimento do trabalho desenvolvido pelos técnicos de enfermagem no processo contínuo da atenção e do cuidado. Distingue-se neste estudo local a utilização e apropriação, pelos profissionais de nível superior, das práticas destes trabalhadores objetivando provocar uma reflexão que possibilite a construção de novas relações e a valorização dos técnicos de enfermagem como produtores de ações de saúde no cotidiano / Abstract: This thesis focuses on a local experiment which, through the social aspects of the nursing profession, seeks to identify the views of graduated health professionals, on the work undertaken by staff of the Primary Health Care Nursing in the city of Americana/SP.Its specific objectives are to characterize the profile of these workers, identifying the labor process in eight Basic Units (BU) and Primary Care (PC), and to analyze their social and professional identities within a professional group. It aims to characterise the profile of these workers, get to know the work processes developed in the eight Basic Units of the city as well as analyse their social and professional identity within a professional community. The method makes use of a qualitative approach, using semi-structured interviews, aiming to understand the reality that emerges from the perception, reports and experience of fifteen nursing assistants. The relational and social dynamics where they are inserted are portrayed in the testimonies of nine nurses who supervise them in the various sites and five physicians that integrate health teams. The Participant observation locates the researcher in the chosen context and helps to understand the social subjects within teams as well as the hierarchical relationships of knowledge and power. The research reveals the importance of the work done by technical nurses as builders of bonds, welcoming treatment, by listening and also the responsibility stated by the first contact of individuals, families and the community enrolled in the health service. As a component of the nursing profession, this study proposes a reflection on the perspective of the health professionals, specially the nurse and the physician, which leads to "functional invisibility" induced by the non-recognition and appreciation of the work done by nurse assistants in the continuum process of care and concern. Distinct in this study is the use and appropriation by gradute professionals of the practices of these technical nurses in the local municipality of Americana / SP aiming to generate a reflection that enables the construction of new relationships as well as the upgrading of nurse assistants as producers of health actions / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

After careful review of English for Specific Purposes (ESP) and English for Medical Purposes (EMP) literature, I assisted in the development of a curriculum for an ESP Certified Nursing Assistant (CNA) Preparation course. The course participants were non-native English speaking employees of Utah Valley Regional Medical Center (UVRMC), currently working in the department of housekeeping, wanting to further their employment opportunities. The ESP CNA Preparation course was 12 weeks duration, three days per week, 5:30 pm – 7:00 pm. My contribution to the curriculum was the development of teaching materials and methods and I used two guiding questions to assist in the development of the materials: • What form should effective materials take for an ESP CNA preparation course? • How effective were these materials? From all the ESP / EMP related literature that I reviewed, I found three studies (Orr, 2002; Bosher & Smallkowski, 2002; Dias, 1999) that had a strong emphasis, closely related to our curriculum, on different aspects of materials development. The literature provided a basis for the outline of materials to be developed for the ESP CNA Preparation course. An in-depth needs and situational analysis, close observation of the CNA course and ongoing Teaching English to Speakers of Other Languages (TESOL) coursework, added to the basis established from the review of literature. The CNA course gave the project team opportunities to observe what English skills a non-native English speaker (NNES) would need to participate appropriately, and with different people observing we gathered different perspectives. The materials development process reviews the types (e.g., lesson plans, activities, worksheets, audio etc) and purpose of materials developed. After two week increments of the ESP CNA Preparation course, I critically reviewed the things that I learned from the use of my materials (e.g., lesson plan format, time allocations, teaching methodology, materials that did not enhance language skills etc). My materials went through a refining process. Three things I learned from this project are: • To teach an effective ESP curriculum, an ESL and a content expert are required. • Materials developed for an ESP course come from a variety of sources. • The development of materials is a progressional process.

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Det övergripande syftet med denna studie var att beskriva, tolka och förstå vårdlärares upplevelse av att arbeta med distansundervisning på vård- och omsorgsprogrammets vuxenutbildning. Studien genomfördes som en kvalitativ intervjuundersökning med hermeneutiskt perspektiv. I resultatet framkom nio metaforer som konkretiserar vårdlärarnas upplevelse av arbetet. Metaforerna gestaltar distansformens betydelse för vårdlärarna och visade att vårdlärarna upplevde den egna erfarenheten som ett oumbärligt didaktiskt verktyg. Vårdlärarnas personliga egenskaper var av större betydelse än de tekniska hjälpmedlen. Vikten av att etablera en personlig relation med den studerande och att stötta och stärka den studerandes självkänsla förstods som centralt i vårdlärarnas arbete. Både det webbaserade samtalet och det fysiska mötet samt snabb återkoppling bidrog till att etablera en personlig relation, vilket främjar lärandet. Svagheter med distansformen var när språket inte räckte till, när den studerande hade begränsad studievana, brist på erfarenhet av vård- och omsorgsarbete samt tidsbrist. De flesta av vårdlärarna hade genomfört sina egna vårdlärarstudier på distans. Vårdlärarnas förförståelse, kompetens i flera ämnen med lång och bred yrkeserfarenhet, ett tydligt mål i form av en hög vård- och omsorgskvalitet, samt ett starkt intresse för att den studerande skulle lyckas, gjorde arbetet som distanslärare meningsfullt och betydelsefullt för de studerandes kunskapsutveckling. / The overall aim of this study was to describe, interpret and understand nursing assistant teachers’ experience of working with distance learning for adult students within health and social care education. The study was conducted as qualitative interviews with hermeneutic theoretical perspective. The result indicated nine metaphors that concretize nursing assistant teachers’ perception of their work. The metaphors show the meaning of the distance learning for the teachers and that they regarded their own experience as an indispensable didactic tool. Nursing assistant teachers’ personal characteristics were more important than the technical aids. The importance of establishing a personal relationship with the student, to support and enhance the student's self-esteem were understood as central to the teachers work. Both the web-based conversation and the physical meeting along with rapid feedback helped establish a personal relationship, which promotes learning. Weaknesses in the distance form was when the language was insufficient, when students had limited study habits, lack of experience of care work and lack of time. Most of the nursing assistant teachers had themselves experience of distance learning from their own studies. Nursing assistant teachers’ pre-understanding, expertise in several subjects with extensive professional experience, a distinct aim to higher health-care quality, as well as a strong interest to see the students succeed, made the distance teacher role meaningful and important for the development of the students’ knowledge.

Over the last decade, long-term care facilities have transitioned from institutional care models that focus on person-centered care, in which the resident is the center of the care. The purpose of this study is to explore the nurse and certified nursing assistant perception of the person-centered care services they deliver. Jean Watson's theory of human caring is the theoretical framework that guided this study. The theory focusing on the human caring experiences and person-centered care is being characterized as a caring feeling. The carative factors of Watson's theory, the fundamental concept of caring, has been associated with improved outcomes for the resident and the caregiver. Using a phenomenology research design, 3 focus groups of 15 nurses and 10 certified nursing assistants (CNA), working in a long-term care facility, were asked questions to describe their perception of person-centered care. The responses from the 25 participants were stored and organized using Nvivo. The thematic analysis revealed that the nurses and CNAs perceived person-centered care to include the caring and compassionate approach taken when care is being delivered. The participants also shared that person-centered care included involving the resident in decision making through communicating openly and developing relationships. The discussions revealed that 8 carative factors influenced their understanding, with the main factor being the creative problem-solving method for decision making. The �ndings from this study have the potential to impact positive social change at the organizational level, influencing the delivery of care within long-term care settings.

Significant costs are associated with the turnover rate of certified nursing assistants (CNAs) in skilled nursing facilities (SNFs), and turnover impacts the quality of care for residents of the SNFs through disruption of care. The purpose of this quantitative cross-sectional study was to identify the leadership characteristics of supervisors most associated with the job satisfaction (JS) of CNAs in SNFs. Herzberg's dual factor theory was used as the theoretical framework to explain the relationship between the leadership characteristics and the associated JS. The research question was used to examine the independent variables of trust, teamwork, supportive supervision, leader-follower relationships, and empowerment of supervisors in SNFs that help predict the dependent variable, JS of CNAs. A random sampling of the population of CNAs from 120-bed SNFs located in Florida completed online surveys that included the Organizational Trust Inventory, the Conditions for Work Effectiveness Questionnaire II, and the Benjamin Rose Nurse Assistant Job Satisfaction Scale. Multiple linear regression was used to analyze data to determine the effects of the leadership characteristics on the JS of CNAs in SNFs. Results indicated that the increased levels of trust negatively impact the JS of the CNAs, whereas increased levels of empowerment increase JS. Implementing strategies to address the needs of CNAs positively impacts society by improving the lives of the workers and increasing CNA retention, thus improving the lives of vulnerable members of society through enhanced quality of care.

Syftet med denna studie är att belysa hur upplevelsen gällande dokumentation bland personal inom hemvården ser ut. Detta gjordes genom en kvalitativ studie med sex slumpmässigt utvalda ur personalen på tre arbetsplatser inom en medelstor stad i Sverige. Den huvudsakliga faktorn som formar upplevelsen gällande dokumentationen bland personal tenderer att vara hur arbetstiden är fördelad, då ingen specifik tid till detta finns utsatt i deras schema. Detta verkar vara ett stressmoment bland personalen. Vikten av kunskap, både gällande möjligheten till att använda de redskap som finns tillgängliga inom arbetsplatsen samt tillräckliga språkkunskaper för att ordentligt kunna dokumentera har även nämnts som viktiga faktorer. Tillgängligheten av verktyg, främst datorer visade sig ha en stor inverkan på personalens upplevelser gällande tiden. En annan faktor som pekades ut var arbetsklimatet, som var påverkat av det stöd som erbjöds från personalgrupp och enhetschef vid problem gällande dokumentationen. Den sista större faktorn gällande upplevelsen av dokumentationen visade sig vara att den ger en trygghet, något som skyddar både personal och brukare. För att vidare belysa resultaten av denna studie, användes två teorier, KASAM (Känsla av sammanhang) och systemteorin. / The purpose of this study is to shed some light regarding the experiences among personnel within home care services about documentation as a work activity. This is done by a quality study with six randomly selected personnel for an interview from three workplaces within a medium sized city in Sweden. The result of this study shows a pattern among the participants in certain areas. The primary factor that shapes the experience regarding documentation among personnel tend to be how the working time is distributed, since no specific time set aside for documentation only in the schedule. This tends to be a stress factor amongst the personnel. The importance of knowledge, both regarding the ability to use the tools available within the workplace and the language skill needed to properly document has been mentioned as important factors. The accessibility of tools, primary computers has a major impact on the experience of time amongst the personnel. Another factor that was pointed out was the working climate, which was affected by the support offered by both other personnel and head of unit should problems regarding documentation arise. And lastly a major factor regarding the experience about documentation turned out to be the safety it gives regarding the rule of law, which protected both the personnel and patients. To further shed light regarding the results of this study, two theories were applied, “sense of coherence” and systems theory.

Ce mémoire porte sur l’évolution de la profession de puéricultrice au Québec entre 1925 et 1985. Il cherche plus spécifiquement à éclairer les raisons de la disparition de cette profession. Celle-ci prend racine dans le contexte de la lutte contre la mortalité infantile et de la médicalisation croissante de la maternité, ce dernier phénomène connaissant de profondes modifications au cours du XXe siècle. En parallèle, les systèmes de santé et d’éducation québécois connaissent d’importants bouleversements. Comment la profession de puéricultrice évolue-t-elle devant ces changements ? Comment tentera-t-elle de faire sa place dans le monde des spécialistes des soins et de l’enfance ? Par ailleurs, quelle place la société, plus spécifiquement le monde médical et l’État, lui réservera-t-elle au fil du temps et pour quelles raisons ? Qu’est-ce qui explique sa disparition ? Voilà les questions auxquelles ce mémoire cherche à répondre. Afin de bien ancrer les origines de la profession, notre analyse s’est d’abord penchée sur les raisons de la création des premières formations en puériculture et des stratégies de professionnalisation des puéricultrices. Notre recherche s’est ensuite intéressée aux discours des acteurs s’étant prononcés sur le sort des puéricultrices à la suite des grandes réformes des années 1960-1970 ainsi qu’au discours des puéricultrices qui cherchent à s’inscrire dans ce nouveau système de santé étatisé. Nous émettons l’hypothèse que la profession de puéricultrice a été victime de plusieurs facteurs dont les multiples réorganisations du système de santé ainsi que de la compétition entre les professions de la santé, mais plus profondément d’une conception de la maternité qui se modifie considérablement au cours de la période étudiée. / This memoir examines the evolution of the occupation called “baby nurse” (puéricultrice in French), in Québec, between 1925 and 1985. It aims more specifically at shedding light on the reasons why this occupation disappeared. This occupation builds on the fight against child mortality and the growing medicalization of maternity, the latter phenomenon undergoing considerable modifications throughout the XXth century. Simultaneously, the health care and education systems in Québec experience significant upheavals. How does the baby nurse occupation evolve in light of these changes? How will it try to establish itself in this world of child care specialists? Furthermore, what place will society, more specifically the medical community and the government, leave for it throughout time, and for what reasons? How can we explain it disappearance? Those are the questions this memoir will try to answer. To ensure that the origins of this occupation are well anchored, our analysis examined the reasons why the first baby nurse programmes were created and strategies were developed for this occupation’s professionalization. Then, our research focused on the messages being conveyed by the actors involved following the major reforms that occurred in 1960-1970, and that of the baby nurse trying to get included this new government-owned health care system. We make the assumption that the baby nurse occupation was a victim of several factors, including the multiple reorganisations of the health care system, and the competition between health care occupations, but more deeply of a conception of maternity that will be greatly modified during the studied period.

Numerous research on the development of knowledge and skills within health and social care has been undertaken; however, it can be argued that there is a need to understand the connection between inclusion and the development in knowledge and experience.  The purpose of this dissertation is to explore students’ experiences of the health and social care adult- education program, and participation and learning processes it represents.  The program is considered the formal route to acquire a position as a nursing assistant or health care assistant. Furthermore, the program can be seen as a combination of vocational training, and a measure to reduce unemployment. This empirical study is based on 15 in- depth interviews with students in the health and social care adult-education. These interviews are using a hermeneutic interpretation method, and draw on Lave and Wenger`s theory of learning. In addition to sociocultural theory according to Säljö. Findings indicate that the adult-education program in health and social care is not only a training process, but also a participation process. For the students, it is about gaining participation in the professional community, in Swedish society, and also about an existential safety in a social context. In order to gain participation, intellectual and physical artifacts, as well as personal qualities, are a prerequisite. Despite these requirements, and the challenges students face, the findings reveal that most students continue their studies. This finding leads to the idea that health and social care can be understood a discipline of inclusion. These findings assist the health and social care field in understanding the connection between said artifacts for inclusion in working life and society; in addition, that such programs should be understood from a wider perspective and viewed in relation to the tension between three educational projects: the students` individual project, the program organizer’s project and the national, societal education project.