Background: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. Aim: The aim of this project was to gain an insight into residents’ experiences of mealtimes in order to inform the development of a mealtime intervention. By addressing the issues that impact on residents’ enjoyment of meals, interventions may target improvements in the health and wellbeing of residents more effectively. Methods: This thesis is comprised of three pieces of empirical work conducted using multiple methods. In a systematic review of stakeholder perceptions of mealtimes, five databases were searched from inception to November 2015, followed by thematic analysis of extracted data. In a second study, semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. These studies informed the development of a staff-focussed training programme (study three) using the process of Intervention Mapping (IM) as a guide. The feasibility of this intervention was assessed using qualitative surveys and analysed using multiple methods. Fourteen staff from two care homes participated in the feasibility study, which investigated the deliverability of the training programme and the acceptability of its content. Findings: The systematic review and resident interview study revealed that the dining experience was a focal point for residents’ broader experiences of residing in a care home. Whilst meal quality and enjoyment impacted on the dining experience, the provision of care was pivotal in determining mealtime culture and resident agency within the home. This had implications for self-efficacy and social relationships, particularly in the context of transitioning from independent living to a care home community. These findings informed the development of a mealtime intervention, which was found to be deliverable and acceptable to staff. Conclusion: Mealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. Evidence from the empirical work supports the development of interventions aimed at mealtime staff to improve resident self-efficacy. This thesis has established the necessary groundwork for a pilot trial and future definitive trial to assess resident (and staff) outcome measures including social (e.g., collective engagement) and psychological outcomes (e.g., wellbeing), as well as health outcomes (e.g., nutritional status).

Studies have shown that young people in residential care homes tend to be low achievers in school and are at high risk of entering adulthood with a low level of education. This group has also shown tendency to adverse psychosocial outcomes. The aim with this study is to reach an understanding of how teenagers and young adults view themselves and their future, what ambitions they have in life and how they see their opportunities to realize their goals. The study is based on a qualitative method and was conducted with semi structured personal interviews with five youngsters 15-21 years old in two different residential care homes. The theoretical viewpoints have been based on E.H Erikson’s theory about identity as well as the theory about resilience.The result of this study indicates that the persons we have interviewed have expressed difficulties in describing themselves. They also express a wish to finish their primary school with complete grades. All of them described what professions they would like to work with. It also came clear that they do not like to plan too far ahead, instead they take one day at a time.The young people that we interviewed expressed a positive view about their future, most of them knew what they want in life, but they find it difficult to describe the way to get there.

Background: Worldwide one in twelve people are living with diabetes and one in two people do not know they have diabetes. Currently large numbers of the older people live in residential care homes in the UK, and up to one in four older people living in residential care homes present with diabetes. Low vision is one of the complications associated with diabetes in older people. In those aged 75 and over, one in five, and in those aged over 90, one in two people are affected by low vision and they are at an increased risk of developing other eye diseases. Within 20 years of diagnosis nearly all people with Type 1 and almost two thirds of people with Type 2 diabetes (60%) have some degree of diabetic retinopathy. Aims and Objectives: This study aimed to investigate the issues and problems faced by older people living in residential care homes with low vision and diabetes; to evaluate health professionals’ knowledge and understanding of the impact of low vision associated with diabetes in older people living in residential care homes; and to develop an educational toolkit which aimed to educate health care assistants about low vision and diabetes. Methods: This study is an exploratory investigation of older people living in residential care homes with low vision and diabetes. Adopting an open-ended qualitative approach using focus groups, interviews and a health professional’s survey, 116 participants were involved. These included GPs, ophthalmologists, nurses, optometrists, health care assistants and older people with low vision and diabetes. The data was analysed thematically. The educational toolkit was developed in the second part of this study, and 20 healthcare assistants were trained using this toolkit. Their knowledge was tested before the training, immediately after the training and one month after the initial training. Following Kirkpatrick’s model, the skills and practical use of the educational toolkit was assessed using an open-ended qualitative approach. Results: The results found that many older people and the health care assistants had the perception that low vision was a normal ageing process and could not be rectified. The study found that there was evidence to suggest that eye health was not considered to be a priority; instead, it was considered to be a natural part of the ageing process. The results found that 82% of the HCAs had not had any training in the area, and more than half of the nurses and GPs did not have sufficient knowledge of low vision and diabetes. After training, however, their knowledge was increased. This suggested that low vision and diabetes toolkit training could be used to educate healthcare assistants on a regular basis. The study also found that knowledge does decline over time, and therefore regular training for HCAs is required in order to maintain eye health and diabetes in older people, as well as improving their quality of life. Conclusion: In the research findings it was found that 50% to 70% of low vision was preventable or treatable if detected in its early stages and could be avoided by simply wearing appropriate spectacles, or possible surgery. However, in order to identify these 50% to 70% with low vision, everyone concerned should be able to recognise the signs and symptoms of preventable low vision, particularly health care assistants, as according to this study, health care assistants spent large amount of time in the residential care homes compared to the other health professionals.

Bakgrund: Den psykiatriska vården har förändrats genom historien. En stor förändring skedde i samband med psykiatrireformen på 1990-talet. I samband med detta upplevde de närstående att de fick inta en mer vårdande roll och ett större ansvar för familjemedlemmen med psykisk ohälsa.   I tidigare studier framkommer att de närstående upplever börda i förhållande till sin familjemedlem och att det i sin tur har inverkan på den närståendes eget välbefinnande. Vidare påverkar detta den närståendes relation till familjemedlemmen med psykisk ohälsa.   Syfte: Syftet med denna studie var att beskriva närståendes upplevelser av hur relationen till en familjemedlem med psykisk ohälsa påverkas när familjemedlemmen flyttat till ett HVB-hem.   Metod: Studien genomfördes som en intervjustudie med kvalitativ induktiv ansats. I studien deltog tio respondenter och insamlat material bearbetades av författarna genom en kvalitativ latent innehållsanalys.   Resultat: I föreliggande studie framkommer att de närstående upplever att de befinner sig i en komplicerad situation. Rollen som närstående till en person med psykisk ohälsa kan upplevas som påfrestande och relationen blir på grund av olika anledningar ofta ansträngd. Det resultat som framträdde var att Relationen präglas av ömsesidig påverkan och att HVB-hemmet kan ge trygghet och underlätta relationen.    Slutsats: Att öka delaktigheten och att underlätta för de närstående gör att de kan minska sitt lidande och öka sitt eget välbefinnande. Vilket, ur ett helhetsperspektiv, kan skapa förutsättningar för en bättre relation och ökad livskvalité för samtliga individer i systemet. / Background: Psychiatric care has changed through history. A major change occurred in connection to the psychiatric reform in the 1990s. In relation to this, the relatives also felt that they were taking a more caring role and a greater responsibility for the family member with a mental illness.Previous studies have shown that close relatives to family members with a mental illness, experience a burden related to their family member. This burden is so significant that it affects the relatives own well-being and further influenced their relationship with the family member with mental illness. Purpose: The aim of this study was to describe relatives’ experiences of how the relationship to a family member with mental illness is affected when the family member moves to a residential care home. Method: The study was conducted as an interview study with a qualitative inductive approach. In the study ten respondents were interviewed and collected material were processed by the authors through a qualitative latent content analysis.Results: The present study revealed that the close relatives find that they are in a complicated situation. The role of being related to a person with mental illness can be experienced as stressful and the relationship, due to various reasons, becomes strained. The result that emerged was that the relationship is characterized by mutual influence and the residential care home can provide security and ease the relation.   Conclusion: To increase participation and ease the burden for the close relatives, can reduce their suffer and increase their own well-being. Which, from a holistic perspective, can create conditions for a better relationship and increase the quality of life for all individuals in the system.

The aim of this study is to explore and analyze the employee's experiences of using low arousal approach as a method in residential care homes. It is also done to better understand the employee's experiences, challenges and successes by using low arousal approach as a method with young people who show challenging behavior due to situations that makes them lose control over their behavior. The method used to answer the chosen questions is a qualitative method in the form of semi-structured interviews. This specific method was chosen because it allows for an in-depth exploration of our chosen topic. To answer the chosen questions, we have interviewed 6 employee's from one residential care home. These interviews provided a deeper understanding of their experiences with using the method and the advantages and disadvantages of applying it as a behavior management method. Their experiences with the method indicate that it is helpful when a child or young person with behavioral problems exhibits challenging behavior, as it helps to prevent the situation from escalating. Based on the interviews, we were able to conclude that there are more advantages than disadvantages. The method leads to strong relationships, greater understanding and positive behavioral change. The disadvantages include that over time, employee's may forget how to act in problem creating situations. The focus over time may shift more towards creating a calm working environment rather than helping the children or young people with behavioral problems who need assistance. In conclusion, with the help of the 6 semi structured interviews, the study was able to gain deeper insight into the employee's experiences, situations and the advantages and disadvantages of using the method while working with behavioral problems in residential care homes for children and young people.

Vår studie undersöker tolkens betydelse i kommunikationen mellan handledare på HVB och ensamkommande flyktingbarn. Vi fokuserade främst på möjligheter och brister som finns i tolkning idag, men även för att kunna förbättra handledarnas arbetssätt med barnen.  Vi har genomfört en kvalitativ studie där vi har intervjuat fyra tolkar och fyra handledare på HVB. För att analysera vårt resultat har vi använt oss av tre kommunikationsmodeller och Habermas teori om det kommunikativa handlandet. Modellerna har använts för att förklara specifika tolkningssituationer mellan barnen och handledare, och Habermas teori har vi använt för att förklara tolkningen utifrån samhället. I studien framkommer det att tolkningen ger goda möjligheter för att skapa en kommunikation mellan två individer. De största bristerna är att det saknas tolkar i vissa språk och att det blir fel i dialekter. Många av handledarna menar att tolkarnas kompetens är bristfällig och att tolkarna behöver vidareutbilda sig. Det framkommer även att många upplever att det är en fördel om tolken har kunskap om kultur och samhällen för att kunna överbrygga mellan barn och handledare. I tolkningen förekommer sällan känslomässiga samtal och att det är individuellt om barnet vill visa sina känslor vilket beror på vilket förtroende de har till tolk och handledare. Det finns mycket att förbättra inom tolkningen och det saknas riktlinjer kring hur man ska genomföra tolkning. / Our study investigates the interpreter´s significance in the communication between assistants at residential care homes and unaccompanied refugeechildren. We had our focus mainly on the possibilities and the deficiencies that are in interpreting today, but also to improve the assistants’ way of working with the children. We have implemented a qualitative study where we have interviewed four interpreters and four assistants at residential care homes. To analyze our results we have used three communication models and Habermas´ theory of communicative action. The models were used for explaining specific situations with interpreters between assistants and children, and we used Habermas´ theory to explain interpreting by society. The study reveals that interpreting gives good possibilities to create a communication between two individuals. The largest deficiencies are that there is a lack of interpreters in some languages and there occurs flaws in dialects. A lot of the assistants say that the competences of the interpreters are deficient and that the interpreters need more education. The study also reveals that many of the interviewed experiences that it is an advantage if the interpreter has knowledge about culture and communities to create a bridge between children and assistants. In interpreting, emotional conversations rarely presents and it is individual if the child wants to show its feelings and it depends on the trust they have to the interpreter and assistant. There are a lot of improvements needed and there is a lack of guidelines to how assistants should implement interpreting.

This doctoral thesis deals with the type of architecture that materializes when age-related problems become a long-term condition (LTC) and gradually restrain the individual’s ability to perform activities in daily life (ADL). Their life situation necessitates a support from relatives or municipal eldercare staff in order for them to continue to participate in everyday living. In addition, the architectural space requires a close adjustment to the personal panorama of cognitive or functional impairments. The habitat can be a flat appropriated many years previously or in a residential care home for dependent and frail seniors. Architecture for ageing with dependency demonstrates how space can be used either to affirm or oppress the older person’s attempts to maintain an independent life style. By use of design theory, case study methodology and a heterogeneous research strategy, this study uses a threefold approach—a retrospective, a contemporaneous, and a future-oriented approach—to explore frail older people’s interaction with the architectural space of residential care homes. This has resulted in seven papers that focus on aspects of these human interactions with the built environment. Based on twelve exemplary models, the research paper I concludes that national guidelines result in a homelike, a hotel-like or a hospital-like environment. Research paper II is a retrospective study that examines the use of architecture competitions as a socio-political instrument to define architectural guidelines. Research paper III focuses on dependent seniors’ spatial appropriation of the communally shared space of a ward in a residential care home. Research paper IV employs two environmental assessment methods from the architecture profession and gerontological research (TESS-NH) in order to evaluate the use of interior colouring when refurbishing two residential care homes while the residents remained in place. Research paper V displays a municipal organizer’s considerations to opt for an architecture competition as a means of renewing architecture for the ageing population. Research paper VI examines competition documentation of three municipal architecture competitions organized during the period of 2006 to 2009. Research paper VII, the final study, explores notions concerning the appropriate space for ageing found among a group of municipal representatives, and people from organizations defending older people’s right. It supplies a model for understanding the appropriate space for ageing. This study illustrates the absence of older people with frailties in the public discussion about appropriate architecture for ageing. During the 20th century, the multi-dimensional idea of an architectural space with a homelike appearance has been used to contrast the negatively charged opposite—the complete and austere institution. The overarching conclusion of this study is that architecture for dependent and frail seniors constitutes a particular type of built space that requires an extended dialogue involving dependent seniors, architects, building contractors and care planners in order to conceive appropriate architecture for the ageing society. / QC 20110921

The main purpose of this study is to research about how the staff at a residental care home strives to make the unaccompanied youths feel like they are a part of the society in Sweden. The purpose is also to explain how the staff at the care home legitimises their integrating actions. To accomplish the purpose, a qualitative approach was made; four staffs and three youths were interviewed at a care home in the southern part of Sweden. The theoretical approach were: social integration and social exclusion. The theoretical concepts in this study were: rules, norms, social norms and moral norms. The findings of this study was that the staff, mentors and the guardians of the youths were people that helped them understand the ”new” society by teaching them the mutual norms, values and attitudes in the society. The norms, rules and routines that were taught at the care home, were interpreted as social and moral norms that sets the framework of a ”correct behavior” in a given situation. To make the system of norms appear as legitimate to the youths, the staff explained why the norms are important to internalize as well as explaining what could happen if you would go against them. In this way, the youths corrected their behavior in relation to what the staff mediated and to what they thought was important themselves. To understand how the society works, including learning the norms, values and behaviours, were according to the staff a way for the youths to create a good start into the Swedish society.

The aim of this diploma thesis was to describe information about SARS-CoV-2 virus and coronavirus disease (COVID-19), to evaluate the course of the disease in the Home with a special regime in Břevnice, in which the epidemic took place at the beginning of the first wave of COVID-19 pandemic in spring 2020. Another goal was to perform an antibody analysis and evaluate the obtained data. I divided the diploma thesis into three main parts: theoretical, experimental and discussion. In the theoretical part, I worked with the literature and described information related not only to COVID-19, but also to other serious infections caused by human coronaviruses. In the experimental part, which I performed in the immunological laboratory of the Department of Joint Laboratories at Havlíčkův Brod Hospital, I dealt with the issue of the clinical course of the disease, the severity of the disease and possible consequences after the infection. I also dealt with methods for the determination of antibodies, the principles of which are described in Chapter 4.5. The diagnostic methods and procedures used are described in Chapter 5.3 Laboratory Assays. From the obtained data, I prepared graphs and tables and processed data on the clinical course of the infection in the Břevnice Home, both for the clients and the...

Syftet med denna studie är att undersöka hur HVB-personal på olika hem i Stockholm arbetar med ensamkommande flyktingbarn rörande barnens kulturer och traditioner samt ta reda på hur personalen arbetar för att integrera flyktingbarn in i vad de upplever vara ett svenskt samhälle. Studien har även till syfte att ta reda på ifall HVB- personalen upplever att det finns problematik kring att integrera barnen samtidigt som de måste ta hänsyn till ursprunglig kultur och tradition hos barnen. Uppsatsen grundar sig i en kvalitativ ansats av tio intervjuer med personal som arbetar på olika HVB-hem. Med hjälp av de teoretiska begreppen gräsrotsbyråkratier, systemintegration, social integration, kultur, kulturmöte och kulturkrockar men även tidigare forskning visar resultat och analys ett sammanhängande mönster. Resultaten visade att HVB-personalen i hög grad värderar hänsynstagande till de ensamkommande flyktingbarnens/ ungdomarnas kulturer och traditioner under integreringsprocessen. De främst återkommande punkterna som personalen menar är viktigast att ta hänsyn till rörande kultur och tradition är barnens/ ungdomarnas; värderingar, religioner, högtider och ursprungliga språk. HVB-personalen upplever att deras huvudsakliga mål som HVB-personal är att integrera barnen/ ungdomarna till det svenska samhället. Tillvägagångsätten för att integrera barnen beskrivs som ett vardagligt arbete som omfattar personalens engagemang i att vägleda, informera barnen/ ungdomarna om samhällets viktiga organ så som att gå i skolan eller att lära dem skillnaderna mellan rätt och fel enligt Sveriges normer och värderingar. Begreppet integrering handlar för våra respondenter sammanfattningsvis om att flyktingbarnen/ ungdomarna tar del av ett nytt samhälle och blir en del av det. Studien visade avslutningsvis att spänningar/ obalans kunde uppstå vid integreringen av barnen/ ungdomarna som resultat av kulturskillnader och kulturkrockar men även på grund av skilda tolkningar av arbetsuppgifter för personal. / The purpose of this study is to investigate how staff from residential care homes in Stockholm work with unaccompanied refugee children/ adolescents concerning the children's/ adolescents cultures and traditions. The study also aims to find out how the staff work to integrate refugee children/ adolescents into what they perceive to be a Swedish society. Lastly the study also aims to find out if the staff experienced problems concerning the integration of the children/ adolescents while they have to take their original culture and tradition into account. The essay is based on a qualitative approach of ten interviews with staff working in different residential homes in Stockholm. With the help of the theoretical concepts grassroots bureaucracies, systems integration, social integration, culture, culture meeting and cultural clashes but also previous research showing results and analysis of a coherent pattern. Results showed that staff and their perceived values take into account of the unaccompanied refugee children/ adolescents different cultures and traditions during the integration process. Values, religions, traditions and the original language were described as the most important parts to take into consideration when focusing on the children’s/ adolescent’s cultures and traditions. Approaches to integrate the children was described as a main objective and a casual work which includes staff involvement in guiding, informing the children/ adolescents of society's major institutions such as going to school or to teach them the difference between right and wrong according to Swedish standards and values. Further the concept of integration according to our respondents, means that the refugee children and adolescents take part of a new society and become a part of it. Finally, the study showed that stress or imbalance could arise during the integration of children/ adolescents as a result of perceived cultural differences and cultural conflicts but also because of different interpretations of the duties of staff.