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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Thesis (M.S.)--Boston University

Complications due to stroke account for a significant proportion of admissions to medical wards in Thailand. Unlike western countries where community rehabilitation programs have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community and family care givers are the primary source of ongoing care and support. This research was a comparative study with concurrent controls, using a two-group pre-test and post test design. The aims of this study were to develop and implement a nurse led supportive educative learning program for care givers of stroke survivors, and to evaluate outcomes for patients and their carers. The study demonstrated that providing education and support to the family caregiver of stroke survivors does benefit both the survivors and caregiver by empower carers to make decisions about the care they provide which has a follow on effect of reducing care stress and burden. It is recommended that programs to provide carers with skills and knowledge to assume an active and therapeutic role in the management of family members who suffer a stroke be established and appropriately supported. Furthermore, implementing this research in other regions of Thailand is recommended. / Doctor of Philosophy (PhD)

Face às modificações na assistência institucional ao paciente psiquiátrico, através de tratamento sem a internação em hospital, nova postura é exigida dos profissionais de saúde que prestam assistência a essa clientela, como é o caso do enfermeiro. Assim, o objetivo deste trabalho é enfatizar a importância da sistematização da assistência de enfermagem, também na área da saúde mental, como um recurso a mais para aprofundar o conhecimento das condições de saúde física e emocional do paciente em busca de reabilitação psicossocial. Para tanto, foi utilizado um instrumento para abordagem qualitativa de sete sujeitos, contendo histórico de enfermagem baseado nos nove padrões de reações humanas da NANDA – North American Nursing Diagnosis Association, que contemplam os âmbitos psicossocial, fisiológico, econômico e cultural do ser humano, adaptado para o serviço de reabilitação psicossocial. Todos os sujeitos são pacientes de centro de saúde mental, provenientes de unidades básicas de saúde do município de Araras – SP e ex-internos da clínica psiquiátrica Antonio Luiz Sayão, da mesma cidade, por motivo de alta hospitalar. O histórico de enfermagem favorece a prestação de cuidado individualizado e qualificado e vem sendo utilizado há três anos no Centro Universitário Hermínio Ometto – Uniararas, na disciplina de semiologia e semiotécnica. Quatro categorias foram enfocadas na análise dos dados – histórico de enfermagem (com as condições relevantes sobre o estado de saúde dos sujeitos), diagnósticos de enfermagem prioritários para a reabilitação psicossocial, síntese das intervenções de enfermagem propostas e, a avaliação do obtido com as intervenções operadas. Foi possível constatar que o processo proposto promove atuação mais eficaz do enfermeiro e vislumbra uma práxis mais consciente nessa área da assistência à saúde, ao possibilitar-lhe melhor conhecimento daquele a quem direciona seu cuidado e, consequentemente, mais subsídios para auxiliá-lo na almejada trajetória rumo à retomada do exercício de sua cidadania. Quanto ao aprimoramento de sua prática profissional recomenda-se que o enfermeiro busque na educação continuada suprir as falhas na sua ação. / In face of the institutional changes concerning the assistance to psychiatric patients, new stance is demanded on the part of health professionals for the rehabilitation of this clientele. Thus the purpose of this work is to emphasize the importance of a nursing systhemic framework specially addressed to the area of psychiatric nursing. Through the application of an instrument to evaluate the patient mental and physical status – based on the NANDA nine standard human reactions, including psychological, social, physical, economical and cultural domains, adapted for patient rehabilitation, seven subjects were interviewed on the basis of qualitative approach. All of them were patients from a mental health center in Araras, São Paulo, Brazil, and had been in-patients in a psychiatric clinic in the same city. The instrument provides means to raise patients’ background aiming a qualified and individualized care and has been used since 1999 at the Centro Universitário Hermínio Ometto – UNIARARAS – in the discipline of semiology. Four categoies were focused for data analysis: patients’ background, nursing diagnosis (aiming the most important interventions proposed for patients’ rehabilitation, synthesis of the actions proposed and evalution of the success or failure of such actions. It was observed that the instrument can improve nurses’ help to psychiatric patients and that continued education is the best tool to supply nurses’ lack of knowledge concerning areas other than nursing itself.

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

Face às modificações na assistência institucional ao paciente psiquiátrico, através de tratamento sem a internação em hospital, nova postura é exigida dos profissionais de saúde que prestam assistência a essa clientela, como é o caso do enfermeiro. Assim, o objetivo deste trabalho é enfatizar a importância da sistematização da assistência de enfermagem, também na área da saúde mental, como um recurso a mais para aprofundar o conhecimento das condições de saúde física e emocional do paciente em busca de reabilitação psicossocial. Para tanto, foi utilizado um instrumento para abordagem qualitativa de sete sujeitos, contendo histórico de enfermagem baseado nos nove padrões de reações humanas da NANDA – North American Nursing Diagnosis Association, que contemplam os âmbitos psicossocial, fisiológico, econômico e cultural do ser humano, adaptado para o serviço de reabilitação psicossocial. Todos os sujeitos são pacientes de centro de saúde mental, provenientes de unidades básicas de saúde do município de Araras – SP e ex-internos da clínica psiquiátrica Antonio Luiz Sayão, da mesma cidade, por motivo de alta hospitalar. O histórico de enfermagem favorece a prestação de cuidado individualizado e qualificado e vem sendo utilizado há três anos no Centro Universitário Hermínio Ometto – Uniararas, na disciplina de semiologia e semiotécnica. Quatro categorias foram enfocadas na análise dos dados – histórico de enfermagem (com as condições relevantes sobre o estado de saúde dos sujeitos), diagnósticos de enfermagem prioritários para a reabilitação psicossocial, síntese das intervenções de enfermagem propostas e, a avaliação do obtido com as intervenções operadas. Foi possível constatar que o processo proposto promove atuação mais eficaz do enfermeiro e vislumbra uma práxis mais consciente nessa área da assistência à saúde, ao possibilitar-lhe melhor conhecimento daquele a quem direciona seu cuidado e, consequentemente, mais subsídios para auxiliá-lo na almejada trajetória rumo à retomada do exercício de sua cidadania. Quanto ao aprimoramento de sua prática profissional recomenda-se que o enfermeiro busque na educação continuada suprir as falhas na sua ação. / In face of the institutional changes concerning the assistance to psychiatric patients, new stance is demanded on the part of health professionals for the rehabilitation of this clientele. Thus the purpose of this work is to emphasize the importance of a nursing systhemic framework specially addressed to the area of psychiatric nursing. Through the application of an instrument to evaluate the patient mental and physical status – based on the NANDA nine standard human reactions, including psychological, social, physical, economical and cultural domains, adapted for patient rehabilitation, seven subjects were interviewed on the basis of qualitative approach. All of them were patients from a mental health center in Araras, São Paulo, Brazil, and had been in-patients in a psychiatric clinic in the same city. The instrument provides means to raise patients’ background aiming a qualified and individualized care and has been used since 1999 at the Centro Universitário Hermínio Ometto – UNIARARAS – in the discipline of semiology. Four categoies were focused for data analysis: patients’ background, nursing diagnosis (aiming the most important interventions proposed for patients’ rehabilitation, synthesis of the actions proposed and evalution of the success or failure of such actions. It was observed that the instrument can improve nurses’ help to psychiatric patients and that continued education is the best tool to supply nurses’ lack of knowledge concerning areas other than nursing itself.

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