M.Cur. / The purpose of the research study is to describe guidelines to counteract unethical behaviour in homes for the aged by auxiliary nurses and care workers. The objectives are to explore and describe the factors related to the unethical behaviour in homes for the aged by auxiliary nurses and care workers by: Exploring and describing the perceptions of the auxiliary nurses and care workers relating to unethical behaviour of auxiliary nurses and care workers in homes for the aged; and Exploring and describing the perceptions of the registered nurses relating to unethical behaviour of auxiliary nurses and care workers in homes for the aged. The point of departure for the research was an uncovering of abuse in homes for the aged by M-Net's Carte Blanche team and the observations of the researcher over a long period of time

D.Cur. / Limited funds for the delivering of health and social services necessitate the cost-effective utilization of all categories of nursing personnel in old age homes. Professional nurses are being retrenched and supervision over weekends and after hours is being scaled down due to a lack of guidelines for the cost-effective utilization of nursing personnel in old age homes. A combined quantitative-qualitative approach had been applied in this empirical study to explore and describe the utilization of nursing personnel in old age homes. The goal of the study was to compile guidelines for the cost-effective utilization of nursing personnel in old age homes. Data collection and data analysis were conducted during three phases. A survey of the population of old age homes in South Africa was first conducted to determine the composition of the residents and nursing personnel in these old age homes and to explore the cost implications of the personnel composition. The contents of job descriptions of professional nurses working in old age homes were analysed on a computer by the researcher using NUDtIST software during the second phase of the study. The third phase consisted of conducting and analysing focus groups with professional nurses regarding. their expectations of their own duties, tasks and responsibilities and those of nursing auxiliaries and lay caregivers in old age homes. The three phases were conducted simultaneously and the results of the three phases were triangulated and subjected to a limited literature control. The results were verified during visits to nursing homes in the USA, Canada and the UK. A conceptual framework and guidelines for the cost-effective utilization of nursing personnel in old age homes were developed from the findings of this study. Respondents from the first phase of the study and experts verified the guidelines for being applicable, important, clear and accessible. The findings indicated that most of the residents of the old age homes are very old and are in need of 24 hours nursing/care due to their level of frailty. The nursing personnel budget forms a significant portion of the operating budget of the old age homes and managers are of the opinion that professional nurses are expensive but an essential component of the nursing personnel. The duties, tasks and responsibilities of professional nurses were identified as well as those which are shared with nursing auxiliaries and lay caregivers in old age homes. The conceptual framework which was established from the results of the study indicates that the goal, costeffective utilization of nursing personnel, is reached when quality care has been delivered within the constraints of the budget limitations. The process has been described as the compiling of guidelines for all categories of nursing personnel regarding clinical nursing, nursing management and nursing education as well as the handling of non nursing tasks while considering the personnel standards and job descriptions. The role players are the manager, all categories of nursing personnel, lay caregivers, family and volunteers which perform within the restrictions of the personnel composition and the appropriate code of conduct regulations. The context for the utilization of nursing personnel is the old age home where nursing/care giving is delivered on a continuum and the dynamics which influence the cost-effective utilization of nursing personnel include applicable legislation and policies of government departments and non government organizations.

published_or_final_version / Community Medicine / Master / Master of Public Health

No Brasil, a porcentagem de pessoas idosas e sua expectativa de vida aumentam gradualmente. O envelhecimento é considerado um fenômeno natural, social, cultural e econômico. Ademais, a redução da taxa de fecundidade, diminuição de integrantes das famílias, as mudanças nos padrões de nupcialidade e a crescente inserção da mulher no mercado de trabalho reduzem a disponibilidade de cuidadores familiares; tudo isso torna o idoso mais suscetível ao stress. Assim, pensar em questões referentes ao envelhecimento e ao dia a dia dos idosos passa a ser uma necessidade dentro da realidade brasileira. Entre os serviços especializados voltados para a população idosa em nosso país, estão as ILPIs (Instituição de Longa Permanência para Idosos), responsáveis por auxiliar os idosos em suas tarefas diárias e/ou dificuldades relacionadas ao envelhecimento físico, psicológico, cognitivo e social. O aumento paradoxal do nível de stress na vida cotidiana e da longevidade dos seres humanos convida a refletir sobre as estratégias desenvolvidas para minimizar o efeito deletério do agente stressor. Assim, este estudo pretende compreender e descrever o stress, a partir da perspectiva ainda pouco estudada, de idosos em situação de dependência física e/ou financeira, com autonomia cognitiva-funcional, residentes em ILPIs. Investigaremos a relação entre a história pessoal e o nível de stress nessa população, buscando compreender e descrever o impacto de eventos estressores em sua qualidade de vida. Foram entrevistados apenas idosos em condição de autonomia cognitivo-funcional, com idade igual ou superior a 70 anos, que residem em ILPI, na cidade de Santos SP. Para tanto, foram aplicados um Quesionário de Informações Gerais, O Mini Exame do Estado Mental, o Life Events Units (LEU/VAS) e algumas Questões Complementares. Entre os eventos de vida com nível de stress mais relevantes, estão Morte do Cônjuge, Acidente ou Doença, Casamentos, Aposentadoria, Gravidez, Nascimento de Crianças na Família, Morte de Alguém na Família, Mudança na Condição Financeira, Férias e Cirurgia. Foi possível observar que, os eventos citados atingiram nível de stress altíssimo no período em que foram vividos e nível alto ainda nos dias de hoje. Apesar dos altos níveis de stress encontrados, o grupo em que houve diminuição do nível de stress corresponde a 100% da amostra / The percentage of senior citizens and their life expectancy have been increasing gradually in Brazil. Aging is considered to be a natural, social, cultural and economic phenomenon. Therefore, questions concerning this phenomenon and the daily life of the elderly people have become a necessity in the Brazilian society. The ILPIs (long stay old age homes) are the institutions responsible for assisting the senior citizens in need of special care such as carrying out daily chores and/or difficulties related to physical, psychological, cognitive and social aging. Furthermore, factors like the decrease of the fertility rate, the decrease of members in families, changes in marriage patterns and the increase of the participation of women at the work market , have affected the availability of relatives to become care takers. Therefore, the elderly have become more susceptible to stress as before. The absurd rise of stress levels in our daily lives and the increase of our longevity, invite us to reflect upon the strategies which should be developed in order to minimize the harmful effect of the stress then.That being the case, this study intends to cast light on the comprehension and description of stress in the elderly people who find themselves in an economical and/or physical dependency but are still cognitively and functionally fit and living in the ILPIs, mentioned above. We will investigate the relationship between their life history and the stress level while living in the old age homes. Only cognitively and functionally fit elderly people have taken part in our research, at the age of 70 and older. The following tests and questionnaires have been applied: Firstly, a general questions questionnaire, then The mental health status examination, The Life Events Units(LEU/VAS) and other complementary questions. Relevant events which are linked to the rise of the stress levels are: the death of a spouse, accident or illness, marriage, retirement, pregnancy, the birth of children in the family, death in the family, financial difficulties, holidays, and surgery. It is important to mention that the stress levels have reached their highest during the occurrence of these life events mentioned before, and they still have an impact on the stress levels presently. Despite of the high levels of stress, we could observe that the people in the group which had a stress reduction corresponds to 100% of the samples taken

Before the main study commenced, empirical work was conducted to establish and validate the Chinese version of the Satisfaction with the Nursing Home Instrument (SNHI-C), which was an instrument used to measure resident satisfaction in the main study. Testing was conducted on a cluster sample of 330 residents from 16 elderly residential care homes in Hong Kong. Findings demonstrated that the SNHI-C had good content validity with an index of .93. It also demonstrated high construct validity by having significant correlation with depression (r = -.42, p < .001), the physical component of health-related quality of life (r = .16, p < .05), the mental component of health-related quality of life (r = .41, p < .001), and global quality of care (r = .49, p < .001). The SNHI-C also demonstrated satisfactory internal consistency and good stability by having a Cronbach's alpha of .79 and intra-class correlation coefficient of .94, respectively. / Current study adds new knowledge to the psychosocial health benefits of Tai Chi for the residents living in elderly residential care homes. Findings were discussed in relation to previous research findings and in the context of elderly residential care setting. The present study has the strength of evaluating the health benefit of Tai Chi using a more stringent research design, in comparing with the previous studies. Limitations of this study included the use of convenience sampling, without random assigning participants into groups, and inadequacy in quantifying Tai Chi learning. The implications of the findings support incorporating Tai Chi training in routine elderly residential care. Based on the study experience, recommendations for a successful implementation of a Tai Chi program were provided. Future research is advised to further explore the most beneficial mode of a Tai Chi program particularly for the elderly residential care home residents. Evaluation of its effect over a longer period of time and using various approaches are also suggested for obtaining a more comprehensive picture of the health benefit of Tai Chi. Finally, it is also worthwhile to investigate the experience of practicing Tai Chi through a qualitative approach to complement present findings. / Like many areas in the world, Hong Kong is facing an aging population. To accommodate the increasing elderly population, particularly those who are frail and have limited family support, elderly residential care homes are growing in size and number. Despite of the escalating demand, it has been documented repeatedly that the nature of residential living can predispose the residents to a number of psychosocial challenges. Study findings highlight consistently that residents are prone to experience lowered self-esteem, poor social support, and poor health-related quality of life. Providing psychosocial support to the residents is an important dimension in elderly residential care. It is because older residents, despite of their deteriorating physical functions that cannot be cured, can still have the potential to live with optimum psychosocial well-being. Even though a number of interventions have been considered in the past to address the residents' psychosocial needs, evaluation on the effectiveness of these interventions is inconclusive. There is still a paucity of evidence suggesting a promising intervention that can promote psychosocial health for the residents. Given the general consensus that exercise is beneficial for the psychosocial health, and considering that the characteristics of Tai Chi are particularly suitable for the elderly population, Tai Chi is considered as a possible means to promote psychosocial health for the residents. This study aimed to examine the psychosocial effects of a Tai Chi program on the residents of the elderly residential care homes. / The main study adopted a non-equivalent pretest-posttest control group design to examine the psychosocial effect of Tai Chi on residents of elderly residential care homes. Residents were recruited from six elderly residential care homes in Hong Kong by convenience sampling. The experimental group (n = 66) joined a 26-week Tai Chi program three times per week with each session lasted for one hour. The control group (n = 73) continued their daily activities as usual. Outcome variables encompassing state self-esteem, the physical component of health-related quality of life, the mental component of health-related quality of life, social support network, and social support satisfaction were assessed at baseline, the 13th and 26th week of the intervention period. Doubly multivariate analysis of covariance was performed to examine the effect of the Tai Chi program. / With the confounding effect of resident satisfaction controlled, findings demonstrated that participants in the experimental group experienced greater improvement in the psychological composite outcome of state self-esteem, the physical component of health-related quality of life, and the mental component of health-related quality of life (p < .05). No significant changes were detected in any of the three individual psychological outcome variables. Non-significant result was also found regarding the social effect of Tai Chi program on the participants. / Lee Yin King. / "May 2006." / Advisers: Diana Lee; Jean Woo. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1558. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 249-269). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

This thesis is an examination of the definition and implementation of ‘good practice’ in residential care for senior citizens. The central contention is that ‘good practice’ is a term that has been variously defined. Different groups define it in different ways, and their definitions have changed over time. This reflexive qualitative study explores ‘good practice’ in local authority, voluntary and private residential care homes in Scotland from the perspective of policy, practice and the experience of senior citizens who live in them. The study is based on analysis of policy documents, historical studies, and reanalysed interview and survey data from two earlier studies conducted by the author and colleagues. The thesis shows that the notion of ‘good practice’ that emerges in policy and practice documents is a confused and often conflicting set of ideas. Historically, the earliest were driven by concerns over cost. In more modern times, statements about ‘good practice’ have had a more benevolent intent but are frequently flawed by paternalistic and ageist assumptions. It is shown that staff in residential homes typically adopt a different set of attitudes: their preoccupation is with safety and the avoidance of risk. Although benevolent in intention, these interpretations of ‘good practice’ are also at variance with what residents themselves actually want. Two particular models or styles of care are examined in detail. One of these is the use of ‘keyworkers’, often implemented in ways that fail to realise its potential. The other is the ‘hotel’ model of care. The potential of this model as an alternative to the statutory model is explored. The thesis concludes that it is a model that can realise the goal of enabling residents to exercise independence, choice and privacy while meeting their needs in residential care.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1997. / Includes bibliographical references.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1997. / Includes bibliographical references.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.