Thesis (M.Nursing)--Montana State University--Bozeman, 2005. / Typescript. Chairperson, Graduate Committee: Vonna Branam. Includes bibliographical references (leaves 85-99).

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 168-181).

Across Scotland, there is a lack of research in care homes. This thesis explores this topic by examining links between inclusion, participation in general and participation in research and whether those who work and live in the care home environment experience social citizenship. Using a national survey and interviews with residents, staff, relatives and experts in care home research, this thesis investigated whether participation generally was linked to participation in research for residents, staff and visitors in a care home setting. The thesis further explored how social citizenship functions in a care home environment and whether there is a link between participation and citizenship. The findings suggest there is a lack of general participation which is connected with the leadership style and management within the care homes. There is misunderstanding about research and legislation amongst the care home staff, residents, visitors, as well as the junior research staff which inhibited staff and resident participation. Furthermore, citizenship is not experienced universally by residents or staff due to disempowerment, and exclusion occurs amongst residents due to age, frailty and dementia. By facilitating good leadership, communication and relationship-building such issues may be overcome. In addition, the analysis suggests a link is evident between inclusion, participation and citizenship. Where choice is provided and residents have their social position maintained, as well as have a degree of responsibility for shaping events, this leads to participation and inclusivity as described in Bartlett and O’Connor’s (2010) definition of social citizenship. Furthermore, if inclusion is adapted for cognition and frailty, then participation leads to the experience of social citizenship, encouraging a culture which can welcome research. The explicit emphasis on inclusion and participation in research has enabled this under-researched area of participation and experience of social citizenship in care homes to be more fully explored.

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Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / No Brasil, a populaÃÃo de idosos està em crescimento contÃnuo, causando um aumento da demanda por instituiÃÃes de longa permanÃncia para idosos. PorÃm, estudos no Nordeste brasileiro sobre a saÃde bucal em idosos institucionalizados sÃo praticamente inexistentes. Este estudo teve como objetivo analisar as condiÃÃes de saÃde bucal em idosos institucionalizados de 65 anos e mais em um asilo no MunicÃpio de Fortaleza / CE, Brasil. Foi realizado um estudo transversal com 160 indivÃduos (95,2% da populaÃÃo-alvo), consistindo de consulta aos prontuÃrios, aplicaÃÃo de um questionÃrio estruturado prÃ-testado e exame bucal. Na anÃlise estatÃstica, foram utilizados testes T, Kruskal-Wallis e regressÃo linear mÃltipla. A idade mÃdia foi de 76,6 anos. O Ãndice CPO-D (29,73) dos idosos asilados foi elevado. O componente dente perdido apresentou o maior valor (28,42); 109 (68,1%) idosos nÃo possuÃam nenhum dente hÃgido; 93 (58,1%) eram totalmente desdentados e 56 (35,0%) apresentavam dentes com raÃzes expostas. Dos 573 dentes presentes, 256 (44,6%) necessitavam de algum tipo de tratamento, sendo 194 (75,8%) para extraÃÃo dentÃria. Dos idosos, 112 (70%) nÃo faziam uso de prÃtese superior e 130 (81,3%) de prÃtese inferior. Quanto à necessidade de prÃtese, 135 (84,4%) necessitavam de algum tipo de prÃtese superior e 142 (88,7%) de prÃtese inferior. A maioria dos sextantes examinados (83,8%) apresentava cÃlculo dentÃrio. Sobre os cuidados e prÃticas em saÃde bucal, apenas 17 idosos (10,6%) nÃo faziam higiene oral. Poucos idosos tinham visitado o dentista nos Ãltimos trÃs meses. A extraÃÃo dentÃria predominou como o motivo da Ãltima visita ao dentista. Idade, instruÃÃo educacional e higiene oral apresentaram significÃncia (p<0,05) para o CPO-D mÃdio na regressÃo linear mÃltipla. Os dados mostram que a maioria dos idosos apresenta saÃde bucal precÃria. Assim, sÃo indispensÃveis intervenÃÃes focalizadas nessas populaÃÃes, como educaÃÃo em saÃde e tratamento precoce. / In Brazil, the elderly population has been growing continuously, leading to a higher demand for long-term institutions for the elderly. In spite of that, studies on the oral health of institutionalized elderly in northeast Brazil are virtually non-existent. The objective of the present study was to analyze the oral health conditions in institutionalized elderly of 65 year-olds or older in a nursing home in the city of Fortaleza / CE, Brazil. A cross-sectional study was conducted with 160 individuals (95.2% of the target population), consisting of the analysis of patient records, application of a questionnaire and oral examination. In statistic analysis, T-Student, Kruskal-Wallis and multiple linear regression tests were performed. Their mean age was 76.6 years. The DMFT index (29.73) was high. Lost teeth represented the highest proportion (28.42); 109 (68.1%) elderly did not have any healthy teeth; 93 (58.1%) were total edentates and 56 (35.0%) had teeth with exposed roots. Of 573 teeth present in total, 256 (44.6%) required some kind of treatment, and 194 (75.8%) of them dental extraction. Of the study population, 112 (70%) did not use any upper prosthesis, and 130 (81.3%) did not use any lower prosthesis. The need of an upper prosthesis was detected in 135 elderly (84.4%) and of a lower prosthesis in 142 (88.7%). The majority of sextants examined (83.8%) had dental calculus. About practices and care in oral health, only 17 individuals (10.6%) did not clean their mouth. Few elderly had visited the dentist at last three months. The dental extraction predominated as the reason at last time of going to dentist. Age, educational level and oral hygiene entered in the multiple linear regression. These data show that most of the elderly had poor oral health. Interventional measures focused on these populations, such as health education and preventive treatment, are, therefore, necessary.

Nursing home resident choice in daily life is recognized as vital to resident quality of life and quality of care. Advocacy and policy activities to promote resident choice abound, yet little research exists to guide nursing home staff in how to enable resident choice on a moment to moment basis. Our three studies developed conceptual and practical tools to elucidate the factors, challenges, and behaviors involved in enabling resident choice. We first crafted a conceptual model, the “REAlizing Resident CHoice (REACH)” model, as described in the first paper. The REACH model identifies the factors influencing staff efforts to enable resident choice and the broader contextual dimensions within which the resident-staff member relationship exists. The REACH model was developed through a literature review of 1,969 abstracts and expert opinion. The second study assessed 1) tensions nursing home staff members encounter when trying to enable resident choice and 2) resolutions employed in the face of these tensions. We conducted semi-structured, qualitative interviews with 26 staff participants in two Veterans Health Administration (VHA) Community Living Centers (i.e., nursing homes). Participants highlighted intra-personal, inter-personal, and organizational tensions that affected their resident choice enabling efforts. Resolutions to these tensions focused on preventive practices, education, reinforcement, deliberation, collaboration, and leadership. A formative assessment tool, the “Supporting Choice Observational Tool (SCOT),” was developed in the third study. The SCOT provides nursing home staff with detailed, non-graded feedback on how to offer and enable resident choice in-the-moment. We created the SCOT using the following methodologies, in order: ethnographic observation, tool piloting, expert panel consultation, and a representational algorithm. SCOT results can inform discussion amongst co-workers and supervisors on how to advance their resident choice enabling efforts. These three studies address an important research gap. They provide scientifically grounded concepts and tools to assist nursing home staff, researchers, and policy makers in advocating for and instituting resident choice. The REACH model can be used to frame future research, and future studies can be undertaken to validate the SCOT. Findings from the second study could improve quality improvement initiatives targeting tensions and resolutions in enabling resident choice. / 2018-02-17T00:00:00Z

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University of Macau / Faculty of Health Sciences