With the initiation of national health insurance, the ecology of medicine and organization of hospitals in Taiwan underwent rapid change. The beginning of a global budget aggravated the impact of hospitals, especially the district hospitals which were already facing most of the pressure. Over half (51.61 %) of the above district hospitals chose to focus on long term care, nursing homes making up the great majority. This research evaluates the efficiency of two district hospital-based nursing homes by Data Envelopment Analysis (DEA). The purpose of this research includes: First, evaluate the efficiency of two district hospital-based nursing homes, including overall efficiency, purely technological efficiency and scale efficiency. Second, assess the relative efficiency relationships of the two nursing homes. Third, probe the differences between relatively efficient and relatively inefficient groups in input variable and output variable. Fourth, with the analysis results, suggest adjustments of input and output to every relative inefficiency groups, as the health care manager's reference. The research approach is to consult relevant documents and the purpose of this study is to choose input and output variables. These variables are screened by Pearson analysis for isotonicity relation. Process the study by DEA for relatively efficient analysis, then direct against the relatively inefficient groups for discussion of efficiency reference set and slack variable analysis. The result of study shows: First, overall efficiency: There are 6 relatively inefficient groups (37.5%) in the first nursing home; There are 8 groups relatively inefficiently attended to (50%) in the second nursing home; There are 18 groups relatively inefficient (56.25%) in the combined first and second nursing home groups. Second, purely technological efficiency: There are 4 groups relatively inefficiently attended to (25.0%) in the first nursing home; There are 5 groups relatively inefficiently attended to (31.25%) in the second nursing home; There are 15 groups relatively inefficient (46.9%) in the combined first and second nursing home groups. Third, scale efficiency: There are 6 groups relatively inefficiently attended to (37.5%) in the first nursing home; There are 8 groups relatively inefficiently attended to (50%) in the second nursing home; There are 18 groups relatively inefficient (56.25%) in the combined first and second nursing home groups. Fourth, the slack variable analysis: the input items that must improve are foreign caretaker labor hours, nurse assist labor hours and nurse labor hours into sequentially, the output one is most important in increasing the income range. In this research, nursing staff and attendants' labor hour can only represent the workforce attending to the unit, but besides personnel figures, personnel quality is a very important factor, too; as regards nursing efficiency, it is not only the number attending to the quantity of service, but also the quality: For example, the incidence of pressure sores, unexpected accidents, patient satisfaction, or staff members' satisfaction, etc. These will all influence the overall efficiency in DEA and remaining research to analyse further in the future. We hope the parameters, such as the make up of resident people in different areas, severity of disease, etc., could continue relevant research to influence the efficiency of nursing homes in the future.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2001. / Includes bibliographical references.

The Baby-boom generation, a major contributor to an unprecedented increase in older-aged people, is known for its zest for life and autonomy. Boomers are predicted to enter nursing homes in record numbers with multiple chronic illnesses and person-centered health care expectations. The purpose of this work was to describe current chronic illness management practices in nursing homes focused on person-centered (resident-directed) care and involvement of residents in health-related decision-making and self-care activities. Four projects were undertaken to accomplish this objective: (1) a systematic review of the quantitative literature regarding the management of type 2 diabetes, an exemplar chronic illness; (2) a synthesis of the qualitative literature describing chronically ill, older-aged adults' perceptions of chronic illness care decision-making; (3) an ethnographic pilot study describing the meaning of having type 2 diabetes to nursing home residents; and (4) a qualitative descriptive study of secondary data describing nursing home stakeholder perceptions of opportunities for resident involvement in chronic illness decision-making and self-care activities. Wagner's Chronic Care Model, modified for the nursing home, was the sensitizing framework for this research. Twenty studies met criteria for the systematic review, which described a lack of adherence to clinical practice guidelines and rare inclusion of the resident and family in management practices. The synthesis of 7 qualitative studies revealed 4 themes: (1) Being recognized because I matter; (2) Awareness of importance; (3) Empower through connections and opportunities; and (4) Time is precious. Cognitively capable older-aged adults described benefits from involvement in health care decisions and harm from non-involvement. They perceived inadequate time spent with health care providers as a major determinant of involvement. The pilot ethnography included 3 residents. Findings revealed a perception of few diabetes management choices but many unspoken resident preferences. The qualitative descriptive secondary analysis study included 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Stakeholders perceived many opportunities for resident involvement in decision-making and self-care, but described as many limitations. Findings indicated a shortage of health care providers and differing stakeholder ideas of purpose and goals restricted resident involvement. Clinical, research, and policy implications were discussed. / text

Sammanfattning Bakgrund: På grund av att människor lever längre så kommer antal personer med demens också att öka. Med stigande ålder och ökad närvaro av kroniska sjukdomar så som demenssjukdom, blir det även en ökning av undernäringsproblematik hos den äldre befolkningen.   Syftet: Föreliggande litteraturstudies syfte var att beskriva hinder och möjligheter för att sjuksköterskan ska kunna uppmärksamma, förhindra och minimera undernäring hos äldre dementa på äldreboenden. Syftet var också att granska artiklarnas kvalitét utifrån den metodologiska aspekten urval. Metod: En litteraturstudie med deskriptiv ansats genomfördes baserat på 16 vetenskapliga artiklar som söktes i databaserna Pubmed, Chinal och Scopus. Resultat: Studien visar att demenssjukdomens tre stadier orsakar nutritionsproblem. Bristande kommunikation och interaktion, utebliven måltidsträning och biverkningar av vissa läkemedel påverkade dementa äldres nutrition på ett negativt sett. Uteblivna bedömningar och bristande utbildning/kunskap hindrar sjuksköterskan att uppmärksamma undernäringar. Sjuksköterskan kan använda sig av mätinstrument till hjälp för att upptäcka undernäring och de med risk för undernäring. Sjuksköterskan kan ändra i miljön samt sätta in hjälpinsatser så som näringsdrycker, så det ska gynna nutritionen bättre. Måltidsträning har visat sig hjälpa personer med demens att minska sina ätsvårigheter och öka i vikt. Näringskunskapen visade sig vara högre bland dem med högre utbildning. Slutsats: Sjuksköterskor som arbetar på äldreboenden för dementa äldre, har ett ansvar att se till att näringsbehoven blir uppfyllda. Nutritionsvård är ett teamarbete. I en del av sjuksköterskans arbetsområde ingår rollen som ledare, vilket innebär att utbilda och informera övrig vårdpersonal i nutritionsvård. Det finns mycket forskning kring demens och undernäring, men få studier har genomförts utifrån den dementa personens perspektiv. Därför är ytterligare forskning baserat på intervjuer med dementa personer relevant. / Abstract. Background: Because people live longer the number of people with dementia will also increase. With old age and increasing presence of chronic diseases such as dementia, it will also be an increase in the malnutrition problem in the elderly population. Aim: The present study’s aim was to describe the obstacles and opportunities for the nurse to pay attention to, prevent and minimize malnutrition in elderly demented in geriatric care. The aim was also to scrutinize the quality of the articles based on the methodological aspect selection. Method: A literature review with a descriptive approach was conducted based on 16 research articles that were searched in PubMed, Scopus and Chinal. Results: The study shows that the three stages of dementia causes nutritional problems. Lack of communication and interaction in the eating environment, lack of mealtime training and side effects of certain drugs affected the nutrition of people with dementia negatively. Lack of assessments and the lack of education / knowledge hinders the nurse to detect malnutrition. The nurse can use instruments to help to detect malnutrition and those at risk of malnutrition. The nurse may also change in the environment and put into relief efforts such as nutritional beverages, so that it benefits the nutrition better. Mealtime training has been shown to help people with dementia to reduce their eating difficulties and gain weight. Nutritional knowledge was found to be higher among those with higher education Conclusion: Nurses, who work in nursing homes for older people with dementia, have a responsibility to ensure that nutritional needs are met. Nutritional care is a team work. Parts of the nurse’s work include the role of being a leader, which means to educate and inform other healthcare professionals in nutritional care. There is extensive research on dementia and malnutrition, but few studies have been conducted using the demented person's perspective. Therefore, further research based on interviews with people with dementia is relevant.

Thesis (Ph.D.) -- La Trobe University, 2004. / "A thesis submitted in total fulfillment of the requirements for the degree of Doctor of Philosophy, School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora." Research. Includes bibliographical references (leaves 343-362). Also available via the World Wide Web.

Thesis (Ph. D.)--University of Iowa, 2008. / Thesis supervisor: Janet K. Specht. Includes bibliographical references (leaves 190-211).

Thesis (Ph. D.)--University of Iowa, 2008. / Includes bibliographical references (leaves 190-211). Also available online.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (Ph. D.)--University of Rhode Island, 2004. / Typescript. Includes bibliographical references (leaves 156-167).

Thesis (M.S.)--University of Michigan, 1986.