Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references.

As the management of dementia is a significant public health concern, efforts to increase access to effective treatments to a greater number of residents with dementia in skilled nursing facilities (SNFs) are warranted. The treatment addressed in this study, non-electronic external memory aids, is an evidence-based practice that has been found to increase positive communicative interactions and decrease negative behavioral problems of residents with dementia in SNFs. Although use of memory aids is recommended, there are significant barriers such as lack of time and resources that inhibit the use of effective treatments in typical clinical settings. To address such barriers to evidence-based practice (EBP) implementation, the Promoting Action on Research in Health Services (PARIHS) framework is available. The PARIHS framework accounts for elements outside of the clinician knowledge base that may impact EBP delivery such as perceptions of the specific EBP and the specific context in which the EBP will be delivered. Organizational variables such as culture, leadership priorities, and resource availability are considered. Although the PARIHS framework has been used to successfully study and support EBP uptake in other areas of health care such as nursing, this framework has not to date been used in the field of Speech-Language Pathology, the clinician group of interest in this study. This study utilized a transformative, mixed-methods design within the PARIHS framework to investigate potential impacts of Speech-Language Pathologists' (SLPs) and Facility Rehabilitation Directors' (FRDs) perceptions of the evidence and organizational context on the use of non-electronic external memory aids in SNFs. The project explored differences between FRDs' and SLPs' perceptions of such variables, as well as the relationship between those variables and the SLPs' reported percentage of use of non-electronic external memory aids. Qualitative methods through semi-structured interviewing of SLPs further provided contextualized and detailed data regarding facilitators and barriers to the use of memory aids in SNFs. Results of the study indicated that there were statistically significant differences between SLP and FRD groups in terms of perceptions of the organizational context in the SNF, with the FRDs viewing the organizational context more favorably. There were no significant quantitative differences between SLPs and FRDs in terms of perception of the evidence for the practice of non-electronic external memory aids. Both groups demonstrated relatively favorable perceptions of the practice (3.8 on a 5-point scale with 5 being strongly favorable). Each additional point regarding favorable perceptions of SLPs in terms of the evidence for non-electronic external memory aids were associated with a 24% increase in percentage of use of the practice. Perceptions of the organizational context in the SNF were not significantly associated with higher percentages of SLP use of the practice; however, issues of organizational context were heavily present in the qualitative data. Analysis of the interview data yielded a total of 318 codes and 191/318 (60%) of those codes addressed issues of organizational context. Qualitatively, the most common codes related to issues of lack of necessary staff to both implement and sustain the use of non-electronic external memory aids. Further, lack of physical materials and time to create memory aids was also a frequently reported barrier in the interview data. There was not mention of local performance data or systems for which to evaluate performance in relationship to non-electronic external memory aid usage in the interview data. Results of this study may contribute to the acceleration of a successful, systematic uptake of non-electronic external memory aids for residents with dementia in SNFs by considering SLPs' perceptions of evidence and by engaging the end organizational context. This project may also serve as a model to contribute to the successful implementation of other EBP for patients with cognitive-communicative impairments.

The quality of care in nursing homes has been evaluated from many varying perspectives, but few studies have analyzed quality in light of complaints made to state survey agencies by residents, their family members, or other individuals interacting with the nursing home. This study analyzed complaints, investigation of complaint allegations, and complaint-related deficiency citations to determine their effect, if any, on the quality of care in nationwide nursing homes. Using the Online Survey Certification and Reporting (OSCAR) survey dataset for facility characteristics and the complaint investigation dataset for outcomes of complaint investigation, analyses conducted included descriptives, correlations, conceptual mapping for complaint-related deficiencies, chi-square tests of independence, t-tests, and generalized estimating equations. At baseline, approximately 66% of nursing homes were for-profit and roughly 53% belonged to a chain membership, while the average percent of residents receiving Medicaid for care reimbursement was 60%. Results indicated that nursing homes differed significantly by profit status and chain membership on whether a complaint was received and whether a deficiency citation was issued following a complaint investigation. Additionally, certain facility and resident-aggregated characteristics, as indicated by odds ratios, were associated with an increase in the likelihood of receiving a complaint or a complaint-related citation. With respect to facility characteristics, for-profit nursing homes and those nursing homes belonging to a chain membership were found to have more complaints and more complaint-related deficiency citations than nonprofit nursing homes and non-chain facilities. Resident-aggregated characteristics, such as a nursing home having more residents restrained, more residents with a catheter, or more residents with a diagnosis of depression, indicated a greater likelihood of receiving a complaint or complaint-related deficiency citation in longitudinal analyses. While additional research could aid in interpreting the effect of complaints on quality of care in nursing homes, study results indicate several facility and resident-aggregated factors that may aid in better understanding of quality of care and improve the training of surveyors and nursing home staff to improve quality of care for residents.

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. / 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.

The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings. The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals. The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness. The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ. The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.

Tobulėjant šiandieninės visuomenės naudojamoms technologijoms, vis didesnis dėmesys skiriamas mokymosi visą gyvenimą procesui. Norėdami gyventi pilnavertiškesnį gyvenimą mokytis turi ir pagyvenę žmonės. Nemaža dalis pagyvenusių žmonių gyvena senelių globos namuose. Šio darbo tikslas - išryškinti vyresniojo amžiaus žmonių mokymosi poreikių tenkinimo galimybes. Tyrimo objektas – pagyvenusių žmonių mokymosi poreikiai ir jų tenkinimo galimybės. / There is a growing attention paid to the process of lifelong learning as the technologies used by nowadays society are improving. The elderly have to learn as well if they want to lead a full-rate way of life. A fair number of the elder people live in nursing homes. The aim of this work is to show up the possibilities of the learning supply of the senior people. The object of the research is learning needs of senior people and the possibilities of their supply.

This study was designed to examine the relationship between job satisfaction, work stress, and work value orientation in a sample of nursing home aides. It was hypothesized that 1) organizational stress would impact job satisfaction in a curvilinear manner in such a way to form an inverted U-shape; 2) job risk, a second element of work stress, would also share the same curvilinear relationship with job satisfaction; 3) work value orientation would be significantly related to job satisfaction. Data were analyzed by conducting Curve Estimations and a bivariate regression. Results did not provide support for the hypotheses. Regressions analyzing work stress did provide support for a linear relationship between work stress and job satisfaction. Implications and limitations of the findings were discussed as were recommendations for future research. / Department of Counseling Psychology and Guidance Services

The assumption underlying this study is that a spatially well planned and appropriately furnished nursing home facility will help the nurses to perform their work more effectively and accordingly lead to more satisfaction for the residents. Research in the forms of a literature review, a movie analysis, and a field study of nursing homes in Germany and the USA, including plan annotations and observational mapping, trace study analyses and survey techniques, was conducted and revealed an unexpected urgent need for nursing home design improvement, especially in the U.S. The research results led to the development of a catalogue of patterns which are useful in the design and planning of a nursing home to improve nurses’ effectiveness in administering care to fulltime residents of nursing homes. With the help of the developed patterns, suggestions for building renovations of two of the researched nursing homes, one American and one German, were given. / Department of Architecture

Syftet med studien var att undersöka inre arbetsmotivation och arbetstillfredsställelse genom att se vilket motivationsbehov och vilken typ av arbetstillfredsställelse som skattades högst. Syftet var även att undersöka vilka motivationsbehov som bäst predicerar inre och yttre arbetstillfredsställelse. Studien genomfördes inom äldreomsorgenen i en mindre kommun i Sverige. 80 personer deltog i studien som genomfördes som en enkätundersökning. Mätinstrumenten som användes var Minnesota Satisfaction Questionnaire (MSQ) och Basic Need of Satisfaction at work Scale (BNS). MSQ mätte inre och yttre arbetstillfredsställelse medan BNS mätte inre arbetsmotivation med utgångspunkt från Self-Determination Theory och de tre komponenterna autonomi, kompetens och samhörighet. Resultatet visade att samhörighet var det behov som skattades högst och det fanns en signifikant skillnad till autonomi och kompetens. Inre arbetstillfredsställelse skattades högre än yttre arbetstillfredsställelse och autonomi och kompetens predicerade inre arbetstillfredsställelse medan kompetens predicerade yttre arbetstillfredsställelse. / The purpose of the study was to examine intrinsic work motivation and work satisfaction by seeing which basic motivation need and which type of work satisfaction that was highest estimated. The purpose was also to examine which basic motivation needs that were the predictors to internal and external work satisfaction. The study was conducted among employees in nursing homes. 80 nurses participated and the study was conducted as a survey. The instrument used in the study was Minnesota Satisfaction Questionnaire (MSQ) and Basic Need of Satisfaction at work Scale (BNS). MSQ measured internal and external work satisfaction while BNS measured intrinsic work motivation based on Self Determination-Theory and the three components autonomy, competence and relatedness. The results showed that relatedness was highest estimated and that there was a significant difference to autonomy and competence. Internal work satisfaction was rated higher than external work satisfaction and autonomy and competence was the predictors of internal work satisfaction while competence predicted external work satisfaction.

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.