Currently, 6 million Americans have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). As the segment of Americans aged 65 and older continues to increase, the number of older adults with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) also grows. Additionally, the use of health care services, such as hospitalizations, is increasing among PLWD. Indeed, hospitalizations are more prevalent among PLWD compared to older adults without dementia. Some of these hospitalizations are ambulatory care sensitive condition hospitalizations that can be prevented if individuals have better access to high-quality primary care. However, delivering high-quality primary care is becoming increasingly challenging given the projected PLWD population increase and the shortage of primary care providers. On the other hand, the number of primary care nurse practitioners who can deliver high-quality and cost-effective care to older adults has grown in recent years and will continue to increase with demand. Nonetheless, little is known about how to strengthen essential practice features (i.e., structural capabilities) needed to deliver high-quality care in practices where nurse practitioners provide care to PLWD. Enhancing primary care delivery by strengthening structural capabilities in primary care, such as electronic health records, care coordination, community integration, and reminder systems, can be an effective way to reduce hospitalizations among PLWD. The overall objective of this dissertation is to assess the effects of primary care structural capabilities in practices employing nurse practitioners on both ambulatory care sensitive conditions and all-cause hospitalizations among PLWD. This dissertation entails five chapters. Chapter 1 describes the significance of structural capabilities and related outcomes among PLWD. Chapter 2 includes a systematic review of existing dementia care models in various ambulatory care settings and summarizes the impact of dementia care models on hospitalizations among community-residing PLWD in the United States. Chapter 3 describes the availability of the selected structural capabilities in primary care practices where nurse practitioners provide care to PLWD. The structural capabilities of practices that provide care to a high volume of PLWD are also compared to those caring for a low volume of PLWD in this chapter. Chapter 4 assesses the impact of structural capabilities in primary care practices employing nurse practitioners on hospitalizations among PLWD. Finally, Chapter 5 summarizes the findings from Chapters 2 to 4 and includes information on the strengths, limitations, and implications of the research and findings of the dissertation.

Dialysis patients are operated to have AV Fistula which is a joint junction of an artery and vein in the arm, operated to increase the blood flow through the dialyzer machine. AV- fistula is a type of vascular access which is a path into the body to connect/disconnect devices, but in this case, it is mainly Dialyzer. To reduce the failure rate during maturation period of AV Fistula, doctors recommend squeezing ball exercise as a necessary precaution for AV Fistula failure. Doing Squeezable interaction for about 3-4 times a day is recommended based on patient’s health condition. Hence, the proposed architecture adopts this squeezable exercise by embedding with sensor and measuring the angle at which the sensor is bent. The framework also proposes a new care coordination system having the hardware layer which has key components such as raspberry Pi, sensor which help in recording the pressure values when user presses the ball and software layer which solely focuses on data sync among the applications used by the user. It has been recorded that 53 % of patients having AV-Fistula fail because of negligence and lack of care. The maturation period is so critical and important which made us to build a gamification platform to monitor the exercise and track the activity through android application to keep users motivated and disciplined. In further chapters of the study will focus on different clinical like procedure around AV-Fistula and technical information such as different technologies used and implemented in the proposed system along with sensor circuit. This project goal is to present a way of monitoring patients and to keep track of the compliance whether the patient is active doing exercise daily. This way we are trying to present a care monitoring system for patients to help prevent AV Fistula failure. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.

published_or_final_version / Nursing Studies / Master / Master of Nursing

This study explores the perceptions of care and support for those with HIV/AIDS by community members within the KwaNgcolosi community who are currently not involved in such care and support, and have no current perceived obligation to do so. The Social Capital framework was used to understand the current community perceptions and dynamics related to current care and support for those who are ill with HIV/AIDS. This was followed with suggestions for how this could be improved, current obstacles to this, and possible personal contributions towards improving the current situation. Data was collected by means of six semi-structured, in-depth focus groups, which were conducted in IsiZulu with the assistance of a translator. These were then transcribed and thematically analysed. Overlapping quantitative data specifically for the themes of social cohesion and trust exists in the form of two social assessment surveys, and so frequency counts were done with applicable survey questions, and compared with data collected from focus group interviews. Focus group discussions revealed a marked difference between perceived ideals of how care and support should be, and what is currently happening within the community. Mistrust and stigma surrounding HIV/AIDS appear to still be prevalent within the community, which hampers community social networks and involvement, and acts as a barrier for those who wish to provide care and support for those who are ill. Triangulation with Social Assessment surveys, revealed a discrepancy between social cohesion as related to HIV/AIDS, and general social cohesion within the KwaNgcolosi community. This social cohesion is not currently leading to collective action, which points to a deficit both in information sharing regarding how to do so, as well as a deficit in Social Bridging. Family members and individuals who are ill may, for various reasons, also prevent community members who wish to become involved, from providing care and support to those who are ill. Reciprocity also affects the social credibility of community initiatives, which are not taken seriously if nothing can be expected in return. Additionally, expectations of economic reciprocity regarding contributions to household expenses negatively affects providing care for family members, who are blamed once they become ill, if they did not contribute to the household while still working. Social norms regarding gendered social and economic expectations also hinder and restrict desires to assist in care and support for those who are ill with HIV/AIDS. The obstacles highlighted by the themes of trust, reciprocity and social norms have resulted in potential barriers to mobilization of social networks, and resources that may be available through these networks. There is a need to provide education to community members according to their perceived contributions, in providing care and support for those with HIV/AIDS, and in keeping with current gendered norms which point towards women undertaking much of the physical aspects of care and support, with men engaging in social and emotional support. However, care should be taken that current destructive gender stereotypes, in which women are expected to undertake primary caregiving roles, are not encouraged and perpetuated. Additionally, education surrounding perceived contributions to HIV/AIDS care and support will increase perceived personal abilities and competence, and act as an enabling factor towards more individuals becoming involved in care and support. Gateways to identified sources for information, such as the Home Based Caregivers and the KwaNgcolosi Clinic should also be tapped, and a flow of information encouraged. However, the current situation is a complex combination of stigma, discrimination and blame towards those who are ill, as well as mistrust from the ill person and their family members, who isolate themselves and block any attempts of care and support from community members. This has resulted in many possibilities and untapped resources within the community. Future initiatives must therefore, from a programme perspective, shift from a focus on current obstacles, to encouraging and developing community members. potential contributions towards care and support for those with HIV/AIDS. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Stroke is a medical event that has serious consequences for the survivor, his family, and society. Stroke is the third leading cause of death in the United States, and two-thirds of stroke survivors are permanently disabled with one-half of these survivors considered severely impaired. The economic burden from stroke is estimated to be $30 billion annually in health care costs and lost productivity.This study described the needs of 35 caregivers of stroke survivors within 24 hours of discharge to home from an acute care "safety net" teaching hospital in Indiana and how well those needs were met. Two subscales, (a) the Need for Information and (b) Patient Care Needs, of the Home Caregiver Need Survey were used. The theoretical framework for this study was the Neuman Systems Model.The stroke survivors were over 50 years old (77.1 %), half were African-American and half were Caucasian, and about a quarter were minimally impaired (25.8%) and less than a quarter were very impaired (22.9%) cognitively and/or physically upon discharge to home. Their caregivers were their children (48.6%) or spouses (28.6%), half of whom worked full-time outside the home. Most (85.7%) caregivers were female, in good health, and with no experience (81.8%) in caring for patients at home. / School of Nursing

This thesis explores the communication of a group of older people with dementia living in a residential care home and specifically, seeks to understand how living with dementia in a care home influences communication. The study draws broadly on a symbolic interactionist perspective and uses an ethnographic, inclusive, video methodology. In so doing, the study grounds the research in the experiences of the older residents with dementia and explores communication as it is interwoven with social life. The empirical data, on which this thesis is based, were gathered over the course of six months in one residential care home in Central Scotland. Analysis of these data, in conjunction with the theoretical literature informing the study, led to the development of a framework and a set of concepts to understand the communication of the older people with dementia living in residential care. This framework was used to examine the ways in which the older residents' experiences of institutionalisation, ageing, and dementia, generally, and of life in the care setting, specifically, influenced their communication. The findings revealed that the older residents made diverse meanings of their experiences in the home, and mat many of the meanings that they made were threatening to their self-identity, self-determinacy and social relationships. The residents engaged in a range of strategies to respond to the impact of these meanings and to negotiate their life in the care home. The research presented in this thesis has many implications for understanding the experiences of older people with dementia in residential care. In particular, the research highlights the need for a new social understanding of dementia, that examines the experience of dementia in relation to broad structural and cultural processes and that seeks to promote the social inclusion and citizenship of older people with dementia.

Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.

The human immunodeficiency virus/acquired immune-deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. “AIDS, (Acquired Immune Deficiency Syndrome), has devastated the social and economic fabric of African societies, made orphans of a whole generation of children and become the epicentre of the HIV/AIDS pandemic” (Fassin, 2007: 76). Like the virus itself, the AIDS crisis mutates rapidly. Children who are AIDS orphans living in South Africa, as in other African countries, suffer from recurrent psychological trauma. It starts with the illness and death of their parents and is followed by cycles of poverty, malnutrition, stigma, exploitation, sickness and often sexual abuse. The figures concerning those affected, which are staggering, offer various predictions regarding the number of orphans left in the wake of the pandemic. Between 1990 and 2003, the number of orphaned children rose from fewer than 1 million to more than 12 million in sub-Saharan Africa (UNICEF, 2005: 68). South Africa is severely affected by the AIDS pandemic, with the largest number of HIV infections in the world, a total of 5.7 million (RSA, 2010: 10), affecting approximately 3.2 million women and 280 000 children aged from 0 to14 years. There is a significant variation in HIV prevalence per province, with the Eastern Cape (EC) reportedly having an average prevalence rate of 28 percent. Hence South Africa is likely to be the country with highest percentage of children orphaned by AIDS within its population. Orphanhood is a major consequence of the AIDS pandemic in South Africa with an estimated 2.2 million AIDS-orphaned children, 11,188 per 100,000 by 2015. Most children who are AIDS orphans living in township communities live predominantly uncared for and unsupported. Therefore the purpose of this research study was to develop strategies to provide care and support to children who are AIDS orphans living in township communities. To achieve the purpose of this research study, a qualitative, exploratory, descriptive and contextual design was used by the researcher to gain insight from health and social care practitioners who render care and support to children who are AIDS orphans living in these communities. The data from in-depth interviews with the health and social care practitoners was used by the researcher to develop strategies to provide care and support to children who are AIDS orphans living in township communities. The study comprised the following four phases: Phase One: During this phase, the researcher will present an overview of the current legislative framework policies at an international, national and provincial level, regarding the the rights of children living in South Africa. Phase Two: During this phase data from two research populations were collected and analysed. As the research process of this study dealt with two groups of participants, namely in group one health care practitioners and group two comprised social workers and psychologists, who work in the township communities to provide care and support to children who are AIDS orphans living in these communities. The researcher discussed each group separately in the discussion of phase two of the study. Phase Three: Comprised the themes identified in the data gathered from the transcribed in-depth interviews, the field notes as well as the reflective journals were cross-validated to ensure trustworthiness of the data which was then organised into a conceptual framework. The conceptual framework was used to clarify the relationships of the concepts and the themes identified during the research process and also used to link the gathered data to previously established models and theories (Schneider, 2004: 133). Phase Four: The last phase of the research design, focused on the development of the “Steps of progression strategies” to provide holistic care and support to children who are AIDS orphans living in township communities. This was done making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008: 237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, simple, applicable and significant to nursing practice have been developed for use by the Department of Health and Department of Social Development as well as primary health and social care practitioners to provide holistic care and support to children who are AIDS orphans living in township communities in South Africa.

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