Thesis (M.S.)--University of Michigan, 1979.

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The focus of this study was to determine what types of information and support families wanted at the time they admitted a relative to a long-term care facility. Twenty families were interviewed by telephone, including both the primary caregiver and, where appropriate caregiving family members. It was found that half of the families felt they wanted no additional information or support than they had received, and that they were basically satisfied with the facility's admission process. The majority of the families felt that the institution also encouraged their continued involvement with their relatives after admission. The results suggest that researchers and practitioners need to be aware, however, that the admission process if often a stressful time, and that family members may be so involved in making long-term care arrangements that they do not focus on their own needs, but only on those of the elderly patient. Support services and information should be provided on an individual basis, considering such factors as whether the caregiver is employed full-time and the distance the caregiver lives from the facility. / Master of Science

This study investigated, responses, of older married persons to questions concerning anticipated availability of help and anticipated sources of help for seven in-home service areas: personal care, nursing care, physical therapy, continuous supervision, household chores, and meal preparation. Variables such as age, gender, level of impairment, proximity of nearest family member, and social resources served as independent variables for this study. Anticipated availability of, help and anticipated sources of help, specifically spouse, other family member, friend-neighbor, agency, or other, served as dependent variables. The investigator's interest was to determine what variables influenced the choice of spouse versus other choices in, anticipated sources of help, and to examine gender differences in anticipated assistance. Use of chi square analysis determined the independence of variables characterizing older married respondents and their anticipated sources of help. Respondents most frequently chose spouse as the anticipated source of help for all in-home services except physical therapy, where agency was the most frequently chosen source of help. Men anticipated help from spouse significantly more than did women. Women anticipated help from sources other than spouse more frequently than men. / Master of Science

Through development of a conceptual model and an index measure based on actual performance, this dissertation focused on clarifying what is "very good" (and "very bad") in nursing home quality. The model expanded on the traditional narrow image of nursing home quality of care, and specified four major dimensions of this broader view of quality. The dimensions (staff intervention, nutrition/food service, physical environment, and community relations) were each reduced further to two subdimensions. Factors influencing quality were also delineated. The new model was then used to tie specific measurable indicators to the overall quality construct. Quality indicators derived from standardized assessments of Medicaid residents were employed in a study of 135 intermediate care facilities in Virginia. Process variables, such as use of physical restraints, catheters, and receipt of various therapies, were analysed for 12,327 residents. Outcome variables (weight loss, increased dependencies in activities of daily living, new pressure sores) were determined through longitudinal analysis for residents with an appropriate preceding assessment (n = 9,006). Assessments were aggregated in each home to calculate a mean (percentage incidence) for each of the 14 quality indicators. A scaling system was used to clearly identify industry"norms" for each variable. Quintiles based on relative incidence were employed to assign homes to five levels of performance. Scale scores were summed to obtain a facility index measure of relative quality. Reliability and validity were evaluated. Relationships of case-mix and selected structural variables (size, ownership, location, percent Medicaid, staff ratios) to the quality measure were analysed. Results suggested better performance by non-profit and smaller homes, but proprietary and non-prof it facilities were about evenly represented among the top tenth percentile of homes. Presence of a skilled care unit appeared to negatively influence quality. Possible interactions and explanations for this finding were considered. Most significantly, the study demonstrated that resident assessments can serve as excellent information sources about what goes on in nursing homes. However, additional variables must be incorporated to make a comprehensive quality measure, based on the model. Recommendations and policy implications were discussed. / Doctor of Philosophy

No / This paper reports on the evaluation of the Enriched Opportunities Programme in improving well-being, diversity of activity, health, and staff practice in for people with dementia. Participants were 127 residents with a diagnosis of dementia or enduring mental health problems in three specialist nursing homes in the UK. A repeated measures within-subjects design was employed, collecting quantitative and qualitative data at three points over a twelve-month period in each facility with follow-up 7 to 14 months later. Two-way ANOVAs revealed a statistically significant increase in levels of observed well-being and in diversity of activity following the intervention. There was a statistically significant increase in the number of positive staff interventions but no change in the number of negative staff interventions overall. There was a significant reduction in levels of depression. No significant changes in anxiety, health status, hospitalisations, or psychotropic medication usage were observed. The Enriched Opportunities Programme demonstrated a positive impact on the lives of people with dementia in nursing homes already offering a relatively good standard of care, in a short period of time. The refined programme requires further evaluation to establish its portability.

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs. The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care plans are communication plans with the addition of autobiographical information. Twenty residents and ten CNAs from two nursing homes participated in the study. Once CCPs were created, CNA participants in one facility received support each day. Following two weeks, CNAs participated in a semi-structured interview. Interviews were transcribed and analyzed using open, axial and selective coding. Findings revealed a core category, meeting resident’s needs through professional support and communication, which describes the progressive process these CNAs underwent to effectively communicate with residents in nursing homes using CCPs. Evolution of this process occurred as CNA participants became familiar with residents. An underlying component facilitating this familiarity was support during CCP implementation. Initially, these CNAs had negative views about nursing home care because they were unsure how to communicate with residents and received little support from higher levels of nursing authority. Over time and with application of CCPs, CNAs became familiar with residents and their communication behaviors. Application of specific communication strategies on CCPs required ongoing support from the investigator/speech-language pathologist which was evident by the comments between CNA participants from each facility. Participants from both facilities reported positive experiences during application of the autobiographical information on the CCPs. This personal information coupled with increased knowledge about resident’s specific communication abilities fostered the formation of a relationship between residents and CNAs. In summary, support during application of CCPs supplements CNAs’ abilities to meet residents’ needs.

Hjärtsvikt är en av Sveriges största folksjukdomar och en vanlig orsak till sjukhusvistelse. Kvalificerad professionell vård i hemmet kan minska antalet inneliggande vårddygn för den hjärtsviktssjuke. Lyfts inte hjärtsviktssjuka personers behov av stödjande insatser fram finns risk för att professionella vårdare i hemmet inte uppmärksammar den sjukes behov av psykosocialt stöd. Syftet med litteraturstudien var att beskriva behovet av psykosocialt stöd för den hjärtsviktssjuke personen som vårdas i hemmet. Systematisk litteraturstudie valdes där 19 artiklar analyserades genom kvalitativ innehållsanalys. Det framkom två huvudkategorier; professionella stödet och det informella stödet. Resultatet beskriver behovet av stödjande insatser i form av psykosocialt stöd den hjärtsviktssjuke erfar i hemmet. Då den professionella vården gjorde en helhetsbedömning av den hjärtsviktssjuke uppmärksammades psykosociala behov hos den sjuke. Genom att stärka den inneboende förmågan med stödjande insatser kunde den sjuke hantera de psykiska symtom som hjärtsvikt medförde. För det professionella stödet var delaktighet av största vikt, delaktighet ökade känslan av att bemästra sjukdomssituationen och stärkte värdigheten hos den sjuke. Litterturstudien riktar sig främst till distriktsköterskor i kommunal hemsjukvård och är överförbar på personer med andra palliativa sjukdomar. Vidare forskning för att få en helhetsbild av den hjärtsviktssjukes vård i hemmet skulle vara att undersöka hur atienternas copingförmåga påverkar deras psykosociala välbefinnande. / Heart failure is one of the most common diseases and a major cause of hospitalization in Sweden. Professional health care provided at home might decrease the number of days of hospitalization for the heart failure patient. If not the heart failure patient´s need for support takes into consideration, there is a risk that professional caregivers in the home do not pay attention to the patient`s need of psychosocial support. The purpose of this study was to describe the heart failure patient's need for psychosocial support while being cared for in the home. A systematic literature review was chosen, 19 articles where selected and analyzed by qualitative content analysis. Two main categories revealed: professional support and informal support. Results of the study describe the supportive services in the form of psychosocial support on heart failure patient experience in the home. The professional care made a holistic assessment of the patient and they noticed psycho-social needs. By enhancing the inherent ability with supportive services, the patient could cope with the mental symptoms of heart failure. For the professional support the involvement of the supporting effort was of paramount importance. If the heart failure patient felt participating in the care, the patients feeling of mastering the disease situation and strengthening of the dignity increased. The literature study caters mainly to district nurses in municipal home care and is transferable to persons with other palliative diseases. Further research is needed to gain an overall picture of the heart failure patient's home care would be to examine how patients' coping, affect their psychosocial well-being.