Telecare has been an approach to care that, internationally, has experienced a generally rapid development during the last ten years. There are many examples of successful pilot projects where ICT applications have been used in the care of elderly: for improved remote consultation with health professionals, to improve the communication and support of the elderly person’s social network, and as intelligent sensors intended to improve the safety of the elderly person. Despite these successes, implementation has been slow. This research project was set up to provide additional knowledge on some of the important questions regarding quality and implementation aspects of the use of ICT application on the care of frail elderly persons. The overall aim of the research project is to illuminate reasoning and experiences of using applications of telecare for frail elderly persons. The research project comprised five studies that were conducted using qualitative research methods. Four of them were carried out within the framework of three telecare projects. Different qualitative research approaches such as content analysis, phenomenological hermeneutics and conversational and discourse analysis were used, in accordance with the research questions of each study. The experiences revealed in the findings of the studies indicate that it is possible to have communication of good quality via videoconferencing with frail elderly persons, even those that have mild or mid-level dementia, provided the conditions are right. Technical limitations of the videoconferencing media in transferring communication cues and the limitations on what the camera can expose place special demands on those communicating with the frail elderly and on the general setting. On the other hand, these limitations on the context of interaction in some situations also seem to be an advantage for demented elderly persons and contribute to increased attention. One example of meaningful remote communication with frail elderly persons was family members’ videophone conversations with their demented relatives when they were placed in nursing homes or homes for respite services. This communication gave new possibilities of being involved in caring for, and of maintaining a relationship with, their demented relative. An introduction of teleconsultations in the care of frail elderly persons will, according to the experiences recorded, affect the professional role and the practical spheres of involved health professionals. The perceptions and experiences of participating health personnel indicate that in order for ICT applications to become valuable assets in the care of frail elderly persons they have to be part of a care alternative that is viewed by all concerned as the best alternative, as a whole, for all affected parties. Further research is needed in order to confirm or refute the findings of this thesis and in order to further broaden our understanding of the use of ICT applications in the care of frail elderly persons. This could facilitate a development of ICT applications suitable for the care of frail elderly persons and their introduction into regular care activities, to the benefit of both the frail elderly persons and their carers.

Objective: determine whether accreditation through Accreditation Canada is associated with more favorable resident safety in Ontario LTC homes and which facility characteristics are predictive of accreditation. Methods: logistic regression was used to determine predictors of accreditation. To examine the association between accreditation and safety, safety was operationalized as five MDS-RAI quality indicators: prevalence of falls, restraints, catheters, pressure ulcers, and infections. Separate multivariable models were developed for each indicator. Results: the odds of accreditation were approximately six times smaller for municipal (p < 0.001) and non-profit facilities (p < 0.001) relative to for-profits; three times greater for chains relative to non-chains (p < 0.001); and twice as large for urban relative to rural facilities (p = 0.04). Of the five quality indicators examined, only one (falls) was associated with accreditation. After adjusting for confounders, accredited homes were estimated to have 8% lower fall rates than non-accredited homes (p = 0.01).

No description available.

No description available.

Syftet med denna uppsats var att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelse av mötet med kunderna utifrån aspekterna kvalitet, tid och makt. Vi har genomfört en kvalitativ intervjustudie med sex personer som arbetar inom hemtjänstverksamheten. Studiens resultat har analyserats och tolkats utifrån teorierna socialkonstruktionism och roll­teori samt begreppet relationell makt. Resultaten visar att tiden är central i mötet mellan hem­tjänstpersonal och kunder då den inverkar på när och hur länge insatserna ska utföras. Lyhörd­het och att utgå från kundens behov och önskemål definieras som god omsorgskvalitet medan maktförhållandet växlar mellan hemtjänstpersonal och kund utifrån varje unikt om­sorgs­möte. För att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelser av mötet med kunderna behöver aspekterna kvalitet, tid och makt belysas och analyseras i en och samma kontext. Resultaten visar att de tre aspekterna samverkar i mötet och analysen med­verkar till att nå en djupare förståelse för hemtjänstpersonalens upplevelser. / The purpose of this study was to gain a deeper understanding and knowledge of home based care giver´s experiences of the encounter with clients from three perspectives: quality, time and power. We conducted a qualitative interview study with six people working in home based care. Our results have been analyzed and interpreted by the theories social construc­tionism and role theory and the concept of relational power. The results of the study demon­strate that time is central for the encounter between home care giver´s and clients affecting both when and how long the care should be performed. Responsiveness and putting the client´s needs in focus are defined as good quality of care, while the power relationship between home care givers and clients changes between each unique encounter. To get a deeper understanding and knowledge of home care givers experiences of the encounter with clients the three aspects: quality, time and power, needs to be highlighted and studied in the same context. The results demonstrate that the three aspects interact in the encounter and analyzing these together creates a deeper understanding of home care giver´s experience of the encounter.

Syfte: Att testa den patientenkät som används i utvärdering av en leversjuksköterskemottagning på patienter med dekompenserad levercirros för att undersöka upplevelsen av att besvara frågorna samt frågornas relevans till patientens situation. Metod: Pilotstudiens metod var mixad. Resultat: Spridningen av deltagarnas upplevelse av oro/obehag av enkäten var stor (VAS 6-100 millimeter). Vid få sjukdomssymtom väcktes oro om framtida sjukdomsutveckling men vid längre tids sjukdom kändes samtliga symtom igen, tankar om tidigare beteende uppstod vid alkoholsorsakad sjukdom. En mindre spridning (VAS 66-92 millimeter) sågs gällande hur viktiga/väsentliga frågorna upplevdes. Frågor om bemötande ansågs viktiga och påverkade upplevelsen av rätten till vård. Kompletterande frågor om individuellt anpassad information samt upplevelsen av delaktighet vid information efterfrågades. Deltagarna visade hög uppskattning (VAS 73-95 millimeter) till att sjukdomen/situation uppmärksammades genom enkäten. Besöken till sjuksköterskan skiljde sig från läkarbesök. Sjuksköterskan fokuserade på egenvård och mer tid fanns för information. För en informant innebar försöksverksamheten ökade antal sjukhusbesök, samordning innebar för- och nackdelar. Vid symtom på fatigue och nedsatt koncentrationsförmåga upplevdes enkäten lång, tvådelad enkät efterfrågades. Vid lindrig sjukdom upplevdes enkäten inte ansträngande. Språket var enkelt att förstå och innehållet upplevdes relevant. De öppna frågeställningarna tillförde inte något för de tre informanterna. / Purpose: To test the patient questionnaire used in the evaluation of an intervention with nurse-led clinic for patients with decompensated liver cirrhosis to examine the experience of answering the questions as well as their relevance to the patient's situation. Method: The pilot study was conducted with a mixed method. Results: The variation of the participants' experience of anxiety/discomfort of the questionnaire was large (VAS 6-100 millimeters). Individuals with few disease symptoms had concerns about future development of the disease, in the case of long disease experience all the symptoms was familiar. Following alcohol induced disease thoughts of past behavior occurred. A smaller variation (VAS 66-92 millimeters) was seen regarding the experience of how important/essential the questions felt. Questions about treatment were considered important and affected the perception of care. Questions about individualized information was requested as well as the experience of participation in the exchange of information. The participants showed a high appreciation (VAS 73-95 millimeters) that the disease/situation was highlighted by the survey. The visits to the nurse differed from appointments to physicians. The nurse focused on self-care and more time was available for information. For one informant the intervention increased the total number of hospital visits, coordination meant advantages and disadvantages. Symptoms of fatigue and impaired concentration made the questionnaire experienced as too long, a two-parted questionnaire was requested, the size was not strain in mild disease. The language was easy to understand and the content perceived relevant. The open issues brought nothing for the three informants.

Darbo tikslas - įvertinti Kauno Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninės darbo organizavimo ypatumus ir jo gerinimo galimybes. Tyrimo metodika. Kauno Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninės 2005-2007 metų veiklos statistinių rodiklių analizė, anketinė pacientų (n = 102) ir personalo (n = 82) apklausa, bei jų vertinimų palyginimas. Duomenų analizė atlikta naudojant statistinę programą SPSS for Windows 12,0. Rezultatai. Palaikomojo gydymo ir slaugos ligoninių poreikis auga: 2007 metais Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninėje gydyta 18 proc. pacientų daugiau nei 2005 metais. Ligoninėje slaugomų ligonių daugumą sudaro asmenys sergantys širdies ir smegenų kraujotakos sutrikimais (70 proc.), po traumų (11 proc.) ir sergantys onkologiniais susirgimais (8 proc.). Lovos funkcionavimo rodiklis ir vidutinė ligonio gulėjimo ligoninėje trukmė aukšti (364,9 ir 74,9 dienos), lyginant su kitomis Lietuvos slaugos ligoninėmis (atitinkamai 345,2 ir 51,7), galimai dėl nemažo skaičiaus savivaldybės finansuojamų ligonių, laukiančių eilėje į globos įstaigas (2007 m. 1,2 proc. gydytų ligonių pateko į globos namus, 2008 m.sausio 1 d. - 34 laukiantys eilėje). Patekti į ligoninę galima greitai – 70 proc. pacientų pateko iš karto arba laukė eilėje iki 7 d. Didelė problema ligoninėje yra slaugos personalo kaita: per tris metus įsidarbino 82, o atleista 57 slaugytojų padėjėjos, priimta 11 ir atleista 8 bendrosios praktikos slaugytojos. Tiriant... [toliau žr. visą tekstą] / Aim of the study – to evaluate the management and potential for improvement at Kaunas Red Cross long-term care hospital. Material and methods. The study included analysis of statistical performance indicators at hospital setting during 2005–2007, the questionnaires for patients (n = 102) and staff (n = 82). Data analysis was conducted using statistical package „SPSS for Windows 12.0“. Results. The demand of long-term care institutions is increasing: in 2007 the number of patients was increased by more then 18% compare to 2005. The majority of patients had cardiovascular disorders (70%), post-traumatic conditions (11%), or cancer (8%). The bed occupancy and average length of stay were relatively high (364.9 and 74.9 days, respectively), compared to other hospital care settings in Lithuania (345.2 and 51.7, respectively), probably due to high number of patients waiting for municipality-financed nursing homes (in 2007 only 1.2% of patients got to nursing home, while on 1st January 2008 the waiting list contained 34 persons). On the other hand, the acceptance to long-term care is quite fast – 70% of patients were hospitalized immediately or were on the waiting list up to 7 days. However, a significant issue is the changing of staff: during 3 years, 82 nurse assistants were employed and 57 dismissed, while general practice nurses 11 and 8, respectively. Analysis of quality of care revealed, that lowest scores were for hospital signalization system (average scores 3.0 by staff and... [to full text]

Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients’ health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers’ skills and clients’ satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities.

<p>The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of &ldquo / acceptable&rdquo / waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests.</p>

No description available.