No / INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

This research provides a feminist perspective on the lowest paid sector of the United States long-term care industry, Certified Nursing Assistants. This research adds to current feminist scholarship on the modern professional caregiving industry by focusing on the perspective of the workers. As the population of older adults requiring care is expected to increase over the coming decades, the demand for paid caregivers will increase as well. Historically, care work was an expected duty done freely by the women of the family, but today much of the vital intimate caring labor is relegated to paid caregivers. I examine how alternative social, political and economic frameworks can transform United States society’s attitude towards the increasingly relevant issue of caring labor. I argue that incorporating a feminist perspective will be helpful in developing a sustainable model for caring labor that acknowledges the dignity of both patients and their caregivers. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Master's project identifies, describes, analyses and provides sugestions of solving ethical problems whom social worker is dealing with when working and looking after clients in terminal phase of their life. Master's project is divided into 4 chapters. First chapter is focusing on explanation of terms like dying, aging, nursing home and social worker. Second chapter is about explanation of chosen ethical terms with whom social worker is often dealing with. Third chapter is focusing on each of all areas where problems may occur for social worker during his work, for example moving clients to the hospital, keeping their privacy during stay in a double bed room and optimizing daily schedules of dying patient. Last area of interest is divided into providing tasks like feeding, hygiene and spiritual care. Last chapter is conclusion of those problems with ideas and examples how to solve them. Moving clients in terminal stadium of their life is within competences of a nurse, however, it would be better if nursing homes would have their own doctors, who could examine and analyse each patient individualy. Dying in a double bed room with presence of another patient is uncomfortable and displeasing moment, that could be solved with spare room, where this roommate could stay during last moments of that dying patient. Food is served in accordance with schedule, which could be good to adjust to clients individual needs. Same adjustments would be good in schedule of staff, to ensure 24 hour care. Spiritual care is insufficient, and social worker is responsible for this situation and should fix it along with coopreation of various churches.

Made available in DSpace on 2016-08-03T16:34:39Z (GMT). No. of bitstreams: 1 SAMANTHA RIBEIRO ULTRAMARI1.pdf: 1584078 bytes, checksum: 011cbc9e75c666c83cef25c8d4ba5163 (MD5) Previous issue date: 2007-03-21 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This research verifies through drawing the children’s opinion on the Long Stay Home for the Elderly, before and after ludic contact with the resident elderly. So as to better characterize the elderly population, a neuropsychological profile is outlined. This work was developed with 21 resident elderly and 61 children aged between 7 and 12, from public Primary and Secondary schools. It begins with verification trough drawing of the children’s opinion on Home for the Elderly. Then a ludic intervention with the participation of children and the elderly takes place: there are 10 encounters with symbolic games and rule games. Afterwards, the children’s opinion is re-evaluated and a neuropsychological evaluation of the elderly is done, making use of the Mini Mental State Exam, of the Scale of Geriatric Depression, of the Short-Form Health Survey (SF-36) and of the Katz Rate. In order to verify the children’s opinion expressed through drawing, the open title “Home for the Elderly is…” is suggested to be completed. The drawings are analysed based on the projective, based on the projective House-Tree-Person (HTP) test. The results show that from one application of the test to the other there was a change in the opinion of 67% of the children, manifested a more positive opinion, perceiving the elderly as more interactive and the Home for Elderly as more humanised, as expressed in more colourful drawings of houses with doors and windows, people smiling and moving, and affectionate messages. The negative aspects found consist of an increased number of bars and people drawn faceless, which way 0,19, on a scale of 0 to 1, on which the maximum positive value is 1. On the neuropsychological evaluation of the elderly, during MMSE, 50% have showed cognitive preservation. The other instruments indicate that most of the subjects present no depressive symptoms, emit positive opinions on their on health, take part of ludic activities and are dependant. This study, however, points out that the particularities of the researched institution, together with the realization of ludic activities, may have favoured the changes on children’s opinions after their contact with the home for the elderly. The study indicates the need of new research on the interaction of children and elderly people resident at nursing homes / Esta pesquisa verifica a opinião da criança por meio do desenho sobre o Lar de Longa Permanência para Idosos, antes e depois de contato lúdico com idosos institucionalizados. Para melhor caracterizar a população idosa, traça seu perfil neuropsicológico. Desenvolve-se junto a 21 idosos institucionalizados e 61 crianças com idades entre 7 e 12 anos, do Ensino Fundamental público. Inicia-se por verificar a opinião destas crianças sobre Asilo, por meio de desenho. Em seguida, realiza intervenção lúdica com crianças e idosos, de 10 encontros com brincadeiras simbólicas e jogos de regras. A seguir, reavalia a opinião das crianças e faz avaliação neuropsicológica dos idosos, por meio de Mini-Exame do Estado Mental, da Escala de Depressão Geriátrica, do Short-Form Health Survey (SF-36) e do Índice de Katz. Para verificar a opinião das crianças expressa por meio do desenho, utiliza de um título em aberto “Asilo é...”, a ser completado. Eles são analisados com subsídios do teste projetivo House-Tree-Person (HTP). Os resultados demonstram que houve, de uma aplicação para outra, alteração na opinião de 67% das crianças, que manifestaram opinião mais positiva relativa a perceber os idosos mais interativos e o Asilo mais humanizado, por meio de desenhos mais coloridas, de casas com portas e janelas, de pessoas sorrindo e em movimento e de mensagens afetuosas. Como aspectos negativos, encontram-se maior número de grades e de pessoas desenhadas sem face, o que pode representar a percepção da criança da dificuldade de contato do idoso com o mundo externo. Na análise estatística, encontrou-se média geral de 0,34 e desvio padrão de 0,16, no primeiro desenho e, no segundo, média de 0,42 e desvio padrão de 0,19, com médias obtidas numa escala de 0 a 1, em que se considera positivo o valor próximo a 1. Na avaliação neuropsicológica dos idosos, no MEEM, 50% demonstram preservação cognitiva. Os demais instrumentos indicam que a maior parte deles não apresenta sintomas depressivos, emite opinião positiva com relação à própria saúde, participa das atividades lúdicas e é dependente. Este estudo ressalta contudo que as características da instituição pesquisada, juntamente com a realização de atividades lúdicas, podem ter favorecido a opinião das crianças após seu contato com o Asilo. O estudo indica a necessidade de novas pesquisas sobre interação criança-idoso institucionalizado

In the limited qualitative research about families who have placed a family member in a nursing home, conflict is identified as a significant problem (Lashewicz & Keating, 2009; Lashewicz et al., 2007). Whether it is related to absence of filial responsibility on the part of adult children, (Ganong & Coleman, 2005; Piercy, 1998), adult child ambivalence (Bengtson et al., 2002; Lüscher & Pillemer, 1998), female and male gender caregiving roles (Spitze & Trent, 2006; Dayton-Ingersoll, 2003; Aronson, 1992), differences in levels of commitment on the part of adult children to assist older parents (Silverstein et al., 2008), adult children being overly assertive - exercising undue influence - when caring for an older parent (Lashewicz & Keating, 2009; Hall, 2005; Soden, 2005), family history (Brody, 1998; Merrill, 1997; Leder, 1993; Bedford, 1992; Matthews & Tarler-Rossner, 1988), family size and/or sibling composition (Davey & Szinovacz, 2008; Matthews, 2002; Wolf et al., 1997) or the geographical proximity of adult children to an aging parent (Dillman et al., 2012; Pillemer & Suitor, 2006; Roff et al., 2007; Stern, 1995) situational caregiving factors leading up to, during, and after nursing home placement can be the source of considerable family conflict. Utilizing modified transcendental phenomenology (Cooper, 2010; Lindseth & Norberg, 2004; Pollio et al., 1997), this research is based on fifteen-structured interviews (Rubin & Rubin, 2012; van den Hoonard, 2012; Bernard & Ryan, 2010; Berg, 2009; Esterberg, 2002) with adult women who live in central and northwestern New Brunswick, Canada who have experienced interpersonal conflict in their family prior to, during, and after placing a family member in a nursing home. The three questions that guide this study are: How does conflict occur within families who have placed a family member in a nursing home? Utilizing modified transcendental phenomenology, how can we better understand conflict in families who have placed a family member in a nursing home? What kind of conflict resolution practices and social policies can be put into place to assist families should they experience conflict as a result of nursing home placement? The findings of this study can be explained through the application of developmental theory where sociological factors are said to be significant in connection with family development (Rodgers & White, 1993; Hill, 1964; Duvall, 1957), life span theory where life-span psychology, biology, and sociology facilitates changes in the family unit (Heckhausen, 2010; Bengtson & Allen, 1993; Aldous, 1990), social psychological equity theory where conflict occurs, typically, but not exclusively, in families where there is more than one adult child, because of a perceived existing inequity in caring for an older parent both prior to, during, and after nursing home placement (Dayton-Ingersoll, 2002; Walster et al., 1978; Adams, 1965), intersectionality theory where various dimensions of many categories define the social reality of caregivers (McCall, 2005), and multi-level family conflict theory (Canary & Canary, 2013) where four interconnected levels, ranging from the micro level to the macro level describe family conflict. Interpersonal family conflict can damage relationships when interpersonal communication breaks down (Katz et al. 2011; Koerner & Fitzpatrick, 2006). Interpersonal communication is significant as it is "...the process by which people interactively create, sustain, and manage meaning..." (Dainton & Zelley,1994, p. 2). Interpersonal conflict theory argues "... that interpersonal conflict is related to lower levels of relational functioning ..." (Roloff & Chiles, 2011, p. 429). With the application of these six theories, we must then determine what kind of conflict resolution practices and social policies can be put into place to best assist families should they experience conflict in connection with nursing home placement.

Dans les milieux de soins, il importe d’assurer la qualité de l’ensemble des services offerts, incluant lors de la fin de vie. À cet effet, un rôle clé des infirmières et infirmiers oeuvrant en centre d’hébergement (CHSLD) est de favoriser l’implication des proches dans les soins de fin de vie, ce qui peut contribuer, entre autres, au soulagement d’une possible souffrance pour eux ou les personnes âgées. Selon Andershed et Ternestedt (2001), l’implication des proches prend plusieurs formes : recevoir de l’information (savoir), être présent (être) et effectuer des tâches ou soins (faire). Cependant, peu d’études sur la fin de vie en CHSLD abordent l’implication des proches dans d’autres contextes que la planification des soins et la prise de décisions. Considérant ce manque de connaissances, le but de l’étude était d’explorer les perceptions de proches, en plus d’infirmières ou d’infirmiers, sur l’implication des proches dans les soins de fin de vie d’une personne âgée vivant en CHSLD. Pour répondre à ce but, une étude de cas qualitative instrumentale a été réalisée. Les données ont été collectées auprès de 4 infirmières ou infirmiers et 3 proches, par l’entremise d’entrevues semi-structurées individuelles, ainsi qu’un journal de bord et la documentation du milieu. L’analyse thématique présente l’étendue de l’implication des proches, les souhaits d’implication des proches et quelques stratégies favorisant cette implication. Ces résultats peuvent servir de pistes d’amélioration dans les pratiques en CHSLD, en plus de sensibiliser les professionnels de la santé aux réalités des proches lors de la fin de vie. / In health care settings, it’s imperative that quality of all services is ensured, including end-of-life (EoL) care. A key role of nurses working in long-term care homes (LTCH) is to promote the involvement of relatives in EoL care to, among others, help relieve a possible suffering of relatives or older adults. Based on Andershed and Ternestedt’s (2001) theory, relatives’ involvement can be described in three categories: their knowledge (to know), their presence (to be) and their participation in tasks or care (to do). However, few studies address relatives’ involvement in LTCH in other aspects than decision-making and care planning. Considering this knowledge gap, we conducted a qualitative case study exploring relatives’ and nurses’ perceptions of relatives’ involvement in this context. Data was collected from a sample of 4 nurses and 3 relatives using individual semi-structured interviews, a reflexive journal and relevant documents from the LTCH. Applying thematic analysis, results showed the scope of relatives’ involvement during the EoL, how relatives wished to be involved, and facilitating strategies to involve relatives in care. These results can guide improvement in LTCH practices and raise awareness in health care professionals of the experience of relatives during the agony phase.

Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes. This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011). From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer. This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.

L’objectif général de la thèse était d’une part d’étudier le rôle de l’impact des politiques menées en matière de respect du droit aux choix et aux risques dans les EHPAD/EHPA sur l’émergence des libertés des résidents et d’autre part sur le choix de leur mode de vie.La première partie de la thèse visait à étudier l’état du vieillissement, le statut des personnes âgées en France et l’influence de nos représentations sociales sur leurs comportements. L’hypothèse d’une association entre les préjugés que porte la société sur les personnes âgées et la réduction de leur autonomie a été induite.La deuxième partie de la thèse visait à mieux comprendre les possibilités d’expression des résidents en EHPAD/EHPA et quels étaient les facteurs qui permettaient leur émergence dans des lieux normalisés. Nous avons fait l’hypothèse que, quel que soit le niveau de dépendance d’une personne (physique et/ou psychique), celle-ci possédera toujours des marges de liberté dont l’expression est déterminée par des facteurs externes et internes à elle.La troisième partie de la thèse s’est intéressée aux politiques de respect du droit aux choix et aux risques des personnes âgées et aux enjeux éthiques, médicaux et sociaux que cette notion soulève. L’hypothèse d’une association entre l’application de ces politiques et un contexte organisationnel a été soulevée.Enfin, dans la dernière partie de la thèse, nous avons étudié l’impact des politiques de respect du droit aux choix et aux risques des résidents sur la perception de leur qualité de vie. Pour cela, nous avons coproduit une grille d’indicateurs nous permettant de distinguer les institutions respectueuses des droits et des risques des personnes âgées avec des résidents. Les résultats que nous avons obtenus montrent l’importance de prendre en compte le respect et la dignité des personnes âgées tant au niveau individuel que contextuel dans l’étude des facteurs protecteurs de la qualité de vie. / The aim of this thesis was first to study how the liberty of the residents in nursing homes for elderly has been impacted by the policies led regarding the respect of the right to choose and to take risks. Secondly, we studied the impact they had on the way of living chosen by the elderly.The first part of the thesis aims at studying the state of the aging process and the status of the elderly in France and the influence of our own social representations, on their behavior. The hypothesis of a link between our Society’s prejudices on the elderly and the decrease in their autonomy is implicit.The second part of the thesis aims at better understanding the nursing homes residents’ expression possibilities. We also focused on the factors which would allow their emergence in standard places at all levels of social life.Our main hypothesis is that the dependency level of a person (physical and/or psychological) is no impediment to his or her capacity to bear in mind their liberty margin, which expression is determined by external and internal personal factors.The third part of the thesis tackles the policies put in place to respect the elderly rights to choose and take risks within their caring homes, as well as the ethical, medical and social stakes raised by this notion.The hypothesis of the link between the setting up of these policies and a certain organizational context has been emphasized.Finally, in the last part, we studied the impact the policies applied on the respect to choose and take risks had on the residents’ perception of their quality of life.An indicator grid has been co-produced to distinguish the institutions respect of their residents’ rights and risks.The results we obtained highlights the significance of taking into account the respect and the dignity of the elderly in the study of the protective factors of the quality of life, both at the individual and contextual level.

No description available.

Under början av 1990-talet infördes reformer som än idag påverkar svensk äldreomsorg. Dessa reformer föranledde till stora förändringar i den offentliga sektorn, där privatiseringen av offentliga tjänster är en del av resultatet. I nästan tre decennier har resultatet av dessa reformer varit väl omdiskuterade i både politiska sammanhang och samhället, där äldreomsorgen är en av de stora reformerna som diskuteras. Föreliggande studie jämför och analyserar tillförlitlig kvalitet på given vård i äldreomsorgen mellan den offentliga och privata sektorn eftersom den privata sektorn ibland har ett vinstintresse, vilket den offentliga sektorn saknar. Syftet med studien var att jämföra och analysera hur chefer uppfattar möjligheten att ge tillförlitlig kvalitet i verksamheten. Arbetet i den dagliga verksamheten utförs av chefer och medarbetare tillsammans, vilket föranledde att det i studien intervjuades åtta chefer på äldreboenden i Sverige, där fyra chefer från respektive offentlig eller privat given äldrevård utgjorde studiens empiriska material. Intervjufrågorna var konstruerade utifrån studiens analysmodell som bygger på karaktäristiska egenskaper för organisationer med hög tillförlitlighet. Föreliggande studie visar att cheferna i både den offentliga och privata sektorn uppfattar, utifrån de förutsättningar som finns i äldreomsorgen, möjlighet till tillförlitlig kvalitet. Dock visar resultatet av studien att det finns brister i den tillförlitliga kvaliteten. Studiens vetenskapliga bidrag visar på kvaliteten utifrån de förutsättningar som chefer har att ge en tillförlitlig kvalitet i äldreomsorgen. / During the start of the 1990´s reforms were introduced that to this day affect Swedish elderly care. These reforms brought forth large alterations in the public sector where in multiple, previously public services were privatized. In the following three decades have these reforms been regularly discussed in both political contexts and society, where the reforms of the elderly care have been prominent. This study compares and analyze reliable quality of administrated care of elderly between the public and private sectors, because of the private sector´s common profit orientation, which the public sector does not have. The purpose of this study was to compare and analyze how management perceive the opportunity to give reliable quality within the organization. Operational labor is performed by both management and coworkers together which resulted in eight managers within the Swedish elderly care being interviewed wherein four worked in the public sector and private, respectively. These interviews became the empirical basis for the study. The interview questions were constructed using the studies analytical model which is based on characteristic properties within organization with high reliability. The result of this study shows that managers in both the public and private sectors perceive the possibility of reliable quality based on the conditions that exist in elderly care. However, the results of the study show that there are shortcomings in the reliable quality. The study´s scientific contribution indicates the quality based on the conditions that managers have to provide a reliable quality in elderly care.