The first purpose of this study was to describe the deaths of fifteen nursing home residents with late-stage dementia. The devastating effect of dementia on a person has been called a ‘living death’ (Woods, 1989). The caring which occurs when someone is going through this process in a nursing home was recorded and analysed. In analysing this act of caring, the second purpose was to look for the origins of the structures and the sources of pressure that shaped the context and therefore helped determine the behaviour of the various groups under observation. These groups were residents and their relatives, the staff of the nursing home and the treating doctors. Before commencing observations and carrying out this study, an understanding needed to be developed of: the condition of dementia as it is perceived by health professionals and presented in the media; the institutions in which the majority of people with dementia end their days; the background and conditions of the staff who nurse in them; the models of care that guide and determine policies; and the conceptions of life and death which underpin relevant laws and moral standpoints. Accordingly, in part 1. chapter 1 the history, causes, pathology and effects of dementing conditions are examined. Relevant medical and lay literature including media influences are examined which pertain to the subject of death and dementia and nursing home care. The history of this institutional care is briefly examined together with the growth of the discipline of gerontological nursing. Chapter 2 discusses some of the effects of this history on present day care and the concept of emotional work being carried out within the present day aged care public policy regulations. The moral arguments surrounding illness and dying in Australian society today are briefly discussed. Chapter 3 describes the conceptual framework for the study, the ethnographic method that has been employed and an outline of critical theory as the basis for analysis. The chapter concludes by recounting the practical steps taken to arrange the field work, secure the consent of participants, record data and gather documents, and outlines the ethical considerations given to the undertaking of the study. Chapter 4 describes the context in which the study took place and the first tentative exploration of the culture from an etic perspective. Part 2 describes the death trajectories observed and raises some questions about alternative strategies that may have been considered within a different paradigm of caring. In chapter 5 the death trajectories of each of the fifteen residents in the study are described, each written with a particular emphasis to illustrate aspects of the culture of care that emerged through thematic analysis. Observations, comments and feelings from staff and family are wound in and around these case studies. Chapter 6 looks more closely at the impact of policy and institutional pressure on the milieu in which these deaths took place. Part 3 draws conclusions from the observations and makes suggestions for emancipatory change as viewed from the author's standpoint of critical ethnographic analysis. In the final chapter an argument is presented for policy change that leads a movement towards palliative care practices for people with late-stage dementia. Approaches to implementation of palliative care will need to take account of any expression by the resident such as an advanced directive, indicating a preferred approach to treatment in the period prior to death; a need for a better understanding of such issues as the significance of body breakdown, the manifestations of pain and electrolyte imbalances; the surrounding ethical complexities and shift in public opinion, and perhaps, most of ail, the culture of the institutions in which this dying will take place. A definition of late-stage dementia which might be used in determining patterns of care is set out. A discussion about changes in practice which relate lo communication with treating doctors, the administering of antibiotics, the relief of pain, the mobilisation of residents and the provision of food and water takes place in light of the evidence found. The discussion of these issues is raised in the form of debate. Each aspect needs more rigorous analysis and information so that evidence-based practice, rather than care which is value-laden and emotional, can be used when treatment decisions are made for people with late-stage dementia.

<p><em><p>I Sverige finns minst 150 000 personer med demens och cirka 20 000 personer insjuknar årligen. Bemötandet av en demenssjuk person har visat sig vara helt avgörande för hur mycket den demenssjuke klarar av och en nära positiv relation mellan demenssjuka och vårdare kan få den sjuke att fungera bättre. Syftet med studien var att belysa vad omvårdnadspersonal på kommunala gruppboenden upplevde som förutsättningar och hinder för att skapa bra bemötande av demenssjuka. Data samlades in via intervjuer och bearbetades med kvalitativ innehållsanalys. De kategorier som framkom var: <em>Medvetenhet</em> <em>om kroppsspråkets betydelse</em> <em>för</em> k<em>ommunikation, Viljan till gott samarbete och flexibelt arbetssätt, Stabil personalgrupp, Inställd på den andres behov, Känsla av otillräcklighet </em>och <em>Resursbrist. </em>Resultatet visade att det som verkade underlättande för bemötandet var framförallt personalens egenskaper såsom att använda sitt kroppsspråk, vara klar och tydlig vid kommunikation. Ett bra samarbete i personalgruppen och liten personalomsättning, att personalen försökte finna den röda tråden och leva sig in i den sjukes verklighet. Faktorer som verkade hindrande var framförallt organisatoriska, såsom att personaltätheten minskade och att ett mindre antal personal skulle vårda allt sjukare människor men även att personalen inte alltid kunde hjälpa den sjuke ur oro och ångest.</p></em></p><p> </p><p> </p>

<p>This essay aims to explore the possibilities for elderly in nursing homes in Örebro municipality toreceive other treatments besides medication in case of depression or anxiety. Issues associated withthe object in this paper and which are discussed are prevalence of drug usage, opportunities forelderlies to receive other treatments, prevalence of other treatments and the elderlies own power orinfluence over the choice of treatment. The survey has been conducted with questionnaires sent outby post to nurses at every nursing home for elderly in Örebro municipality. The results showed thatdrugs are used extensively when treating depression or anxiety among the nursing home residents,and other treatments are never or only occasionally being discussed at more than half of the nursinghomes in this study. The results also show that reminiscence therapy and problem-solving therapyhas been used occasionally, while alternative therapies are used more frequently. It is also unusualfor the elderly to be involved in the choice of treatment, mostly because of cognitive impairmentssuch as dementia.</p> / <p>Denna studie syftar till att undersöka möjligheterna för äldre på särskilda boenden inom Örebrokommun att få annan behandling än medicinering vid depression och ångest. Frågeställningarnasom kopplas till syftet behandlar förekomst av läkemedel, möjligheter till andrabehandlingsmetoder, förekomst av andra behandlingsmetoder samt den äldres inflytande över sinegen behandling. Undersökningen har genomförts med enkäter som skickats ut via post till enomvårdnadsansvarig sjuksköterska på varje särskilt boende i Örebro kommun. Resultaten somframkom visar på att läkemedel används i hög uträckning vid behandling av depression eller ångest,och att diskussion om andra behandlingsmetoder aldrig eller enbart ibland förs vid över hälften avboendena. Resultaten visar även att reminiscensterapi och problemlösningsterapi använts videnstaka tillfällen, medan alternativa behandlingsmetoder används mer frekvent. Det är ocksåovanligt att de äldre får vara med och diskutera valet av den behandling som ska påbörjas, oftast pågrund av kognitiva funktionsnedsättningar som exempelvis demenssjukdom.</p>

<p>The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records.</p><p> The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. </p><p> In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.</p>

The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records. The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.

I Sverige finns minst 150 000 personer med demens och cirka 20 000 personer insjuknar årligen. Bemötandet av en demenssjuk person har visat sig vara helt avgörande för hur mycket den demenssjuke klarar av och en nära positiv relation mellan demenssjuka och vårdare kan få den sjuke att fungera bättre. Syftet med studien var att belysa vad omvårdnadspersonal på kommunala gruppboenden upplevde som förutsättningar och hinder för att skapa bra bemötande av demenssjuka. Data samlades in via intervjuer och bearbetades med kvalitativ innehållsanalys. De kategorier som framkom var: Medvetenhet om kroppsspråkets betydelse för kommunikation, Viljan till gott samarbete och flexibelt arbetssätt, Stabil personalgrupp, Inställd på den andres behov, Känsla av otillräcklighet och Resursbrist. Resultatet visade att det som verkade underlättande för bemötandet var framförallt personalens egenskaper såsom att använda sitt kroppsspråk, vara klar och tydlig vid kommunikation. Ett bra samarbete i personalgruppen och liten personalomsättning, att personalen försökte finna den röda tråden och leva sig in i den sjukes verklighet. Faktorer som verkade hindrande var framförallt organisatoriska, såsom att personaltätheten minskade och att ett mindre antal personal skulle vårda allt sjukare människor men även att personalen inte alltid kunde hjälpa den sjuke ur oro och ångest.

Despite the benefits of physical activity for older adults, many residents living in long-term care homes (LTC) are relatively inactive. Previous research has revealed barriers to physical activity at the resident-level, organizational, and environmental level. However, little attention has been paid to other factors influencing physical activity within the broader institutional complex. The goal of this study was to uncover how the work of personal support workers (PSWs) related to the promotion of physical activity was socially organized. Institutional Ethnography (IE), developed by Dorothy Smith, guided this study. Smith proposed that peoples’ everyday experiences in local settings are organized, often unknowingly, by the actions of people located outside of the local setting and that this organization is textually-mediated. Two LTC homes in Ontario participated in this study. I began data collection by observing PSWs as they went about their work. Next, I interviewed PSWs and other people located inside (e.g. nurses, managers) and outside the LTC homes (e.g. representatives from the Ministry of Health and Long-Term Care (MOHLTC). Lastly, I collected texts that organized the PSWs’ work, such as Ministry standards. The findings revealed that although the MOHLTC standards were viewed as producing something “good” for the residents, some of the standards disrupted the PSWs’ work, which made it challenging for them to support daily physical activity. The promotion of physical activity was seen as an additional program that happened a few times per week and it was parceled out as a professional activity that was socially organized “out” of the PSW role. The findings suggest that local solutions are needed. A good starting point would be to go and talk to PSWs and residents to determine what type of assignments would permit the incorporation of physical activity into daily care. To embed the promotion of physical activity into daily care, a major rethink and reorganization of PSWs work will be needed, including a greater investment in human and material supports for PSWs.

Despite the benefits of physical activity for older adults, many residents living in long-term care homes (LTC) are relatively inactive. Previous research has revealed barriers to physical activity at the resident-level, organizational, and environmental level. However, little attention has been paid to other factors influencing physical activity within the broader institutional complex. The goal of this study was to uncover how the work of personal support workers (PSWs) related to the promotion of physical activity was socially organized. Institutional Ethnography (IE), developed by Dorothy Smith, guided this study. Smith proposed that peoples’ everyday experiences in local settings are organized, often unknowingly, by the actions of people located outside of the local setting and that this organization is textually-mediated. Two LTC homes in Ontario participated in this study. I began data collection by observing PSWs as they went about their work. Next, I interviewed PSWs and other people located inside (e.g. nurses, managers) and outside the LTC homes (e.g. representatives from the Ministry of Health and Long-Term Care (MOHLTC). Lastly, I collected texts that organized the PSWs’ work, such as Ministry standards. The findings revealed that although the MOHLTC standards were viewed as producing something “good” for the residents, some of the standards disrupted the PSWs’ work, which made it challenging for them to support daily physical activity. The promotion of physical activity was seen as an additional program that happened a few times per week and it was parceled out as a professional activity that was socially organized “out” of the PSW role. The findings suggest that local solutions are needed. A good starting point would be to go and talk to PSWs and residents to determine what type of assignments would permit the incorporation of physical activity into daily care. To embed the promotion of physical activity into daily care, a major rethink and reorganization of PSWs work will be needed, including a greater investment in human and material supports for PSWs.

No description available.

The purpose of the present study was to examine the effect of environmental density on the behavior (Disruptive and Nondisruptive) of elderly residents with dementia living on a special care unit. A building project that led to relocation of residents from high density units to units that varied in density (low vs. high) provided a natural context for this study. Disruptive and Nondisruptive behavior are composite variables that together include the full range of behavioral responses. Both are composed of several subvariables. Data were collected using direct behavioral observation using the Environment-Behavior Interaction Code (Stewart & Hiscock, 1992b) and a hand-held computer. The first objective of the study was to examine behavior patterns in relation to density and privacy. This objective was addressed with a quasi-experimental design (Study 1), in which three hypotheses were tested. It was predicted that residents who moved from a high density unit to a low density unit would exhibit a greater reduction in rate of Disruptive behavior (Hypothesis 1) and a greater increase in rate of Nondisruptive behavior (Hypothesis 2), compared to residents in a constant high density condition. It was also predicted that use of Private Time (time spent alone in one's bedroom) would be greater on the low density unit, where residents had private rooms (Hypothesis 3). Results of Study 1 provided support for Hypotheses 1 and 2, in relation to comparisons with the External Comparison Group only. Within subjects analyses provided additional support for Hypothesis 1 (Disruptive behavior). Hypothesis 3 (Private Time) was also supported. The second objective of the study was to explore the perceptions of family and staff caregivers with regard to the effect of the environment on resident behavior. This study was addressed with a qualitative design (Study 2) using the grounded theory method. Participants in Study 2 described the needs of residents with dementia in relation to the physical and social environment, and the outcomes that occurred when these needs were met or not met. (Abstract shortened by UMI.)