Bibliography: p. 493-562. / iv, 562 p. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Provides a philosophical and theological analysis of health care for aged persons, exploring the ways in which Roman Catholic moral theory might contribute to the development of just health care for aged Australians. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1998?

The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents' care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents' health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents' pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident's distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents' needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings.

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

The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research methodology for this study comprised the following steps: Firstly, the demographics of the world and South Africa were researched. The concept of frail (long-term) care in the United States of America and New Zealand was investigated to determine what is available. The subsidisation concept of the South African Government towards caring for the elderly was also investigated. Secondly, a questionnaire was sent to the residents of five retirement complexes in George to determine their interest in such a plan. The records of the frail care unit that these residents utilise were analysed to determine the number of residents needing frail care. A comparative study of the cost of frail care in the Southern Cape was undertaken. Thirdly, two options to partly subsidise the cost of frail care were examined, where the first option covers the running cost, and the second option, subsidising one third of the frail care cost, builds up a sustainable fund after the first five year period. The funds of the second option can then be utilised in the subsequent years to increase the subsidisation portion of frail care cost. The final step of this study entailed the formulation of recommendations to implement the frail care nursing levy as soon as possible, with special attention given to the following: a) It must be compulsory for new residents to join the fund. b) A yearly capital amount of R100 000 or more is needed to sustain the fund. c) A contract must be drafted to set out all the rules and regulations to the residents. d) An attitude change amongst some residents is required. Individuals must realise that the success of this plan depends upon themselves and with the necessary support could make a significant contribution towards their own peace of mind if and when frail care is needed.

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.

M.A. (Social Work) / Relevant literature clearly indicates a steady increase in not only the number of aged persons but also the demented population. Consequently it has become imperative that the nursing staff responsible for the day - and night care of demented patients in a residential setting, acquire appropriate knowledge of dementation as such, and clarity on their roles in an endeavour to decelerate the dementation process. They, furthermore, need to be aware of the special needs of demented aged persons --needs which call for particular professional skills. In this study the emphasis is on the development and evaluation of a group work programme for nurses in two homes for demented aged persons. The programme is based upon knowledge on dementation, and its contents are directed at a repertoire of skills which, when effectively practised, will serve as a support system to nurses. Researcher made use of an indirect measuring method: an experimental - and control group were established at two homes where direct observation was done in respect of the behaviour of the residents and the nature of nursing. A questionnaire was completed by the experimental - and control group, prior to and following on the provision of a group work programme. The target universe consisted of fifteen nurses at two homes for demented aged persons. Nine and six members of the nursing staff were respectively connected to the experimental - and control groups. The experimental group attended nine sessions which incorporated the mediating - goal model designed by Papell and Rothman (in du Preez 1979:73)...

Examing the antecedents and outcomes of elder care based work-family conflict, - presenting family interference with work and work interference with family as major components.

The care of the elderly is a growing problem. Existing services are inadequate for the needs of an aging population. In order to suggest new services to deal with the care of the elderly, this report examined four areas: the demographic characteristics of our aging society, the nature of services in general, services provided to the elderly population, and the application of role theory to the caregiver/care recipient dyad. Role theory identified conflicts felt by both the caregiver and care recipient. These conflicts were explored in three sets of focus group interviews: women 65 years old and older, women familiar with the experience of primary caregiver, and women between the ages of 23 and 42 (the age range representative of the Baby Boom cohort). Information from these interviews was used to understand both current and future perceptions of the elderly and of the role of caregivers in this society and what services they perceive are necessary for the elderly to function independently in this society. / Master of Science

Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: This study is a pastoral care strategy for the affirmation of the dignity of the poor Black older persons. In this study there is a discussion of how the poor Black older persons suffered the defacement of their dignity under Apartheid and how to a large extent their dignity is still being defaced under the new democratic dispensation in South Africa. These poor Black older persons are victims of various forms of older person abuse. They experience the prejudice of ageism intensely as it is exacerbated by racism; and with no appropriate medical and health strategies in place to provide quality health care; and with inappropriate housing, social services, and residential care services, their dignity is denied. Due to past discriminatory laws and policies these vulnerable older persons suffer the consequences of low levels of formal education within an environment of engineered poverty and racial discrimination which made it impossible for them to enter into quality employment which would enable them to provide adequately for old age. The deprivation thus experienced made it difficult for them to flourish economically and otherwise. At present they are still marginalised and they experience intense forms of loneliness. These poor Black older persons continue to suffer humiliation and indignity in spite of legislation and policies purporting to ensure their well-being. Within a society embracing a neo-liberalist philosophy they are considered unimportant as they do not contribute productively to the economic well-being of the community and are therefore relegated to the lowest ranks of society. With the effacement of their dignity through socially constructed systems their human development is seriously hampered, resulting in a disintegration of human wholeness. The inequality that the poor Black older persons suffer is an indictment against humanity as these older persons have the right to feel at home on the planet. Due to the fact that they are not recognised as having been created in the image and likeness of God, their uniqueness and distinctness as human beings are denied, their identities distorted, and they are not considered worthy citizens. In order to affirm the dignity of the poor Black older persons a practical theological methodology as proposed by Osmer (2008) and consisting of four tasks, has been employed. The notion of a moral economy for the affirmation of the dignity of these poor Black older persons has been utilised. With the moral economy orientation linked with a Liberation Theology methodology the dignity of the poor Black older persons is affirmed as a personal attribute based on the older persons being a category of people being carried into old age by God, enjoying privileged positions of honour and respect, and being eschatological signs and symbols of God’s goodwill towards restored communities in Christ. Within a moral economy the values of reciprocity, responsibility, and interdependence are used to affirm the dignity of these older persons intergenerationally and contextually. / AFRIKAANSE OPSOMMING: Hierdie studie is ʼn pastorale sorg strategie vir die bevestiging van die menswaardigheid van die arm Swart ouer persone. In hierdie studie word daar aangedui hoe die arm Swart ouer persone se menswaardigheid onder Apartheid en in ‘n groot mate in die nuwe demokratiese dispensasie geskend is. Die arm Swart ouer persone het die slagoffers geword van verskeie vorms van misbruik. Die diskriminasie teen ouderdom word intensief deur hulle ervaar soos dit vererger word deur rassisme; en met geen behoorlike mediese en gesondheidstrategieë in plek om in die behoefte van hierdie kwesbare ouer persone te voorsien nie; en met gebrekkige behuising, sosiale dienste en onvoldoende plekke van sorg vir ouer mense, is die menswaardigheid van hierdie ouer mense erg misken. Weens historiese diskriminerende wette en regeringbeleid ly hierdie kwesbare ouer persone die gevolge van lae vlakke van formele opvoeding binne ‘n omgewing waar armoede kunsmatig geskep is en waar rassediskriminasie geheers het. Hierdie omstandighede het dit vir hulle onmoontlik gemaak om kwaliteit werk te kry wat hulle in staat sou stel om toepaslik vir die ouderdom voor te berei. Die ontberinge wat gevolglik gely word, maak hulle ekonomiese en andersydse ontwikkeling onmoontlik. Hulle is gemarginaliseerd en ly aan intense eensaamheid. Hierdie arm Swart ouer persone gaan voort om vernedering en onmenswaardighede te ly ongeag van wetgewing en beleidstukke bedoel vir hul welsyn. Binne die gemeenskap wat ‘n neoliberalisties filosofie aanvaar, word hierdie ouer mense misken omdat hulle nie produktief tot die ekonomiese welvaart van die gemeenskap bydra nie, en daarom word hulle beskou as sonder enige sosiale kapitaal wat hulle dan sosio-ekonomies op die laagste vlak van die gemeenskap sonder enige erkenning van hulle menswaarde en menswaardigheid plaas. Met die skending van hul menswaardigheid deur sosiaal gekonstrueerde sisteme word hul menslike opbloei ernstig gestrem wat lei tot die disintegrasie van menslike heelheid binne die demokratiese bestel van die Republiek van Suid- Afrika. Die ongelykheid wat die arm Swart ouer mense ly is ‘n klag teen die mensdom omdat hierdie ouer mense ontuis voel op die planeet. Hierdie groep is na die beeld van God geskape, maar hulle uniekheid en besondersheid word miskien. Om die menswaardigheid van hierdie arm Swart ouer mense na te gaan, is ’n praktiese teologiese metodologie gebruik soos voorgestel deur Osmer (2008) en word die vier teologiese take soos deur hierdie metodologie voorgestel, gevolg. Betreffende die vierde taak van hierdie metodologie is die konsep van ’n morele ekonomie gebruik vir die bevestiging van die menswaardigheid van die arm Swart ouer persone. Met die skakel van hierdie morele ekonomiese oriёntering met die Bevrydingsteologiese metodologie is die menswaardigheid van die arm Swart ouer persone bevestig as ’n persoonlike eienskap gebaseer of die feit dat hulle ’n kategorie van mense is wat deur God in die ouderdom gedra word, wat dan bevoorregte posisies van eer en respek geniet as eskatologiese tekens en simbole van God se toegeneëntheid teenoor herstelde gemeenskappe in Christus. Binne ’n morele ekonomie word die waardes van wedersydsheid, verantwoordelikheid, en interafhanklikheid gebruik om die menswaardigheid van hierdie ouer mense intergenerasioneel en kontekstueel te bevestig.