Clinical evidence-based practice guidelines providing recommendations for health care decision making have become vital components of long-term health care practice in the United States. Frequently changing guidelines have complicated nurse practitioners' (NPs) efforts to implement evidence-based practice into the daily care that they provide to patients. The purpose of this project was to develop an evidence-based practice guideline for doctoral-prepared NPs working in long-term care facilities. This project is important because practitioners use practice guidelines to provide patients with the most appropriate, evidence-based care. Kolcaba's comfort theory was used to guide this project. Kolcaba's theory holds that comfort exists in 3 forms: relief, ease, and transcendence. Comfort theory, with its emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will lead to a proactive, diverse, and multifaceted approach to providing patient care. A complete practice guideline was developed for doctoral-prepared NPs. For the review of the scholarly evidence, an electronic search that yielded 34 articles was completed. Twenty-six of these articles were excluded because the articles were more than 20 years old and/or focused on a specialty. Findings from the 8 articles were used to develop the practice guideline, which was reviewed by an advisory committee of 7 experts. The AGREE tool was used by the advisory committee to provide feedback on the quality of the practice guideline. Implementation of the practice guideline will take place in a facility in Indiana that currently uses 3 NPs. A doctoral-prepared NP will evaluate the practice guideline annually for patient trends including hospital readmission and infection rates.

Bakgrund: Globalt sett är depression det sjukdomstillstånd som står för störst sjukdomsbörda mätt i år förlorade till sjukdom. Incidensen av depression i världen har ökat med 49 % från 1990 till 2017 och forskning har visat ett samband mellan kön och ålder samt depression. Motiv: Det finns bristande kunskap om vad som kännetecknar personer med nedstämdhet. Det är oklart om de samband som finns gällande funktionsnedsättning och depression även har ett samband gällande nedstämdhet. En ökad kunskap hos distriktssköterskor om kännetecken för nedstämdhet hos äldre kan förväntas leda till att detta tillstånd identifieras både tidigare och bland fler personer. Syfte: Syftet med denna studie var att identifiera kännetecken på nedstämdhet hos äldre personer i särskilt boende. Metod: Data till denna studie har inhämtats från en longitudinell studie (Äldre vårdade på institution i Västerbotten) och består av data från instrumentet MultiDimensional Dementia Assessment Scale (MDDAS). Studien riktades mot personer boendes i särskilda boenden för äldre i Västerbotten i maj 2013. Totalt besvarades 2210 enkäter (svarsfrekvens 70,1 %). Chi2-analys användes för att identifiera variabler med statistiskt signifikanta samband med nedstämdhet. En stegvis logistisk regressionsanalys användes för att skapa en förklaringsmodell. Resultat: Resultatet visar att aggressivitet, verbalt störande eller uppmärksamhetssökande beteende, hallucinationer, smärta samt kvinnligt kön var förknippat med en ökad sannolikhet för förekomst av nedstämdhet. Det visar även att ålder var en skyddsfaktor i detta sammanhang. Modellen förklarade 6,7-12,6 % av variationen. Konklusion: Distriktssköterskor har en viktig roll när det gäller att identifieranedstämdhet hos äldre, vilket vårt resultat kan bidra till. / Background: Globally, depression is the medical condition with the highest burden of disease measured in years lost to illness compared to all diseases. The incidence of depression in the world has increased with 49 % from 1990 until 2017, and research shows a correlation between sex, age and depression. Motive: There is a lack of knowledge about what characterizes people with minor depression. It is not clear whether the existing association between disability and depression also are related to minor depression. Increased knowledge of characteristics of minor depression in the elderly among district nurses can be expected to lead to the condition being identified earlier and among more people. Aim: The aim of this study was to identify signs of minor depression in elderly persons living in elder care facilities. Methods: Data for this study was obtained from a longitudinal survey and consisted of data from the Multi-Dimensional Dementia Assessment Scale (MDDAS). It was aimed at persons living in elder care facilities in Västerbotten in May of 2013. In total, 2210 surveys were answered with a response rate of 70,1 %. Chi2-analysis were used to identify variables with a statistically significant relationship with minor depression. In addition, a step-wise logistic regression analysis was used to create a model of explanation. Result: The result shows that aggressiveness, verbally disruptive or attention-seeking behaviour, hallucinations, pain and female sex were associated with an increased chance probability of minor depression. It also shows that age was a protective factor in this context. The model explaineds 6,7-12,6 % of the occurence of minor depression. variance.  Conclusion: District nurses have an important role in identifying minor depression in older people, which our result can contribute to.

The main object of the research is to analyze the effect of the clinical intervention algorithms proposed for reducing antibiotic use for older adults in long-term care facilities (LTCFs) by managing urinary tract infections (UTIs). 20 paired nursing homes were enrolled in the 12-month study. Within each pair, one was randomized to use of the intervention algorithms and the other to use of regular management. Cluster-level paired t-tests (unweighted and weighted) and regression analyses (unweighted and weighted) were used in the analysis of the data. Paired t-tests show that the algorithms did not significantly reduce the antibiotic use, the number of urine cultures or the antibiotic use for urinary infections in most months. However, they did reduce the proportion of antibiotic use for urinary infections significantly in most months. Regression analysis indicates that the difference between the control group and intervention group has no significant increasing or decreasing trend with time (month). And the algorithms significantly reduced the antibiotic use for urinary infections, number of cultures and the proportions through the 12-month study. The analyses reached a similar conclusion using nonparametric methods and weighted analysis. / Thesis / Master of Science (MS)

The topic of this thesis is ``Feeding children and adolescents in children´s diagnostic institutions, children´s homes, children´s homes with school, educational institutions and the Center of Educational Care in the Hradec Králové region. Childhood and adolescence are specific periods in which each individual undergoes significant physical, mental and social development. For healthy development and health in adulthood it is important a properly chosen alimentation. It is necessary to be aware of the fact that lifestyle and the environment affect the health status of the population by up to 60 %, 40 % of which fall on the diet. Therefore, the research part of my thesis is focused on the survey of the quality of food served to children and adolescents who are almost entirely dependent on meals prepared in canteens of children´s diagnostic institutions and institutional care and preventive educational care facilities. The aim of this thesis was to find out whether the variety of dishes served in the selected facilities corresponds to current nutrition recommendations and if the consumer basket meets requirements of the Decree No 107/2005 Coll., as amended by Decree No. 107/2008 Coll. The research was conducted by the qualitative method. To collect data on the investigated facilities the technique of data file analysis was used. The research set was composed of children´s diagnostic institutions, children´s homes, children´s homes with school, educational institutions and the Center of Educational Care in the Hradec Králové region. At random six facilities were selected. They provided me with data such as menues, issue slips and consumer baskets in the months of March, April, October and November in 2008 The obtained data were summarized in tables and graphs which provide information on the composition of meals served, on the consumer baskets composition, on ways to cover the total consumption of fruits and vegetables, the ratio in which plant and animal fats are served, the amount of sausages, smoked products and haslet in the group of meat. The management of selected food facilities will be informed about the outcomes and possible shortcomings. In the case of any identified shortcomings, changes in the diet composition or food consumption may be recommended by the Regional Hygiene station in Hradec Králové.

Bakgrunn: Kontroll og overvåking av institusjonservervede infeksjoner (sykehusinfeksjoner) ble regulert i lov og forskrift i 1996. Helseinstitusjoner ble pålagt å ha infeksjonskontrollprogram. Hensikt: Å beskrive i hvilken utstrekning sykehjem i Akerhus fylke fulgte lovverket med å ha infeksjonskontrollprogram, inkludert infeksjonsforebyggende- og overvåkende tiltak. Metode: To tverrsnittsundersøkelser ble gjennomført i sykehjem i Akershus fylke i 2001 og 2005. En spørreundersøkelse ble utformet i 2001 for å kartlegge infeksjonskontrollprogram, inkludert lovverk, retningslinjer, ansattes helse og opplæring. I 2005 ble spørreundersøkelsen utvidet til å inkludere retningslinjer for meticillin resistente Staphylococcus aureus (MRSA), isolering, samarbeid med mikrobiolgoisk laboratorie og vaksinering. Spørreskjemaet ble sendt til institusjonssjef ved hvert sykehjem i fylket. I tillegg kontrollerte vi om institusjonene deltok i nasjonale prevalens registreringer og om de hadde erfaring med beboere med MRSA ved å benytte Nasjonale Folkehelseinstitutt sin database. Resultater: Antallet sykehjem som hadde etablert infeksjonskontrollprogram hadde steget fra 24 (48%) i 2001 til 45 (80%) i 2005 (Relativ risiko (RR)=1.6, 95% Konfidens interall (KI): 1.2-2.3). Det var en økning i kjennskap til fylkets lokale infeksjonskontrollprogram (RR=1.5, 95% KI: 1.1-2.1). Institusjonssjef vurderte det svært viktig å ha et infeksjonkontrollprogram (gjennomsnitt=6.2, variasjonsbredde 6.0-6.5 på en skala fra 1 til 7). Konklusjon: Det har vært økende oppmerksomhet på infeksjonskontroll og overvåking i sykehjem i Akershus fylke, Norge. Nasjonalt lovverk og gjentatte nasjonale prevalensregistreringer av institusjonservervede infeksjoner kan ha bidratt til dette / Background:In 1996, regulations regarding control and prevention of healthcare-associated infections in all healthcare institutions were implemented in Norway. It became mandatory for all healthcare facilities to have an infection control program. Objective: To describe to what extent long-term care facilities (LTCFs) in Akershus County have implemented infection control programs including guidelines and surveillance. Methods: A repeated, cross-sectional survey was performed among the LTCFs in Akershus County in 2001 and in 2005. A questionnaire was developed in 2001 investigating infection control programs including regulatory issues, guidelines, occupational health and training. In 2005, the questionnaire was expanded to include additional questions regarding policies and guidelines on methicillin-resistant Staphylococcus aureus (MRSA), isolation containment, collaboration with the microbiology laboratory and immunization policies. The questionnaire was sent to the head managing nurse of each LTCF in the county. Additionally, we searched for participation of LTCFs in the national prevalence surveys on healthcare-associated infections and for MRSA positive cases in the databases of Norwegian Institute of Public Health. Results: The number of LTCFs with an infection control program increased from 24 (48%) in 2001 to 45 (80%) in 2005 (Relative risk (RR) =1.6, 95% Confidence interval (CI): 1.2-2.3). There was an increasing knowledge about the county’s infection control program (RR=1.5, 95% CI: 1.1-2.1). The LTCF’s head managing nurses perceived having an infection control program as important (mean=6.2, range 6.0-6.5 on a scale of 1 to 7). Conclusion: There has been an increased attention towards infection control in LTCFs in Akershus County, Norway. National regulations and repeated national prevalence surveys on healthcare-associated infections may have contributed to this improvement. / <p>ISBN 978-91-85721-19-1</p>

An exploration of the interpersonal experiences of loneliness by older people in a residential care facility It is estimated that there were about 3, 8 million older people in South Africa in 2010 (Statistics South Africa, 2010). Many older people have to be cared for in residential care facilities due to their weakening health, the migration of children and grandchildren, or due to limited financial resources. This has led to the attempt in this research study to explore the interpersonal experiences of loneliness by older people living in a residential care facility. Loneliness is an unpleasant experience associated with inadequate interpersonal contact. It is widely accepted that loneliness is closely associated with ageing as a consequence of multiple losses – loss of abilities, loss of and changes in personal relationships, loss of relationships with familiar environments and changed contact with friends and relatives resulting in reduced relationships. Changes in the relationship with the environment are regarded as a particular loss by older people, especially if they have to rely on institutionalized care and loose contact with familiar social networks and the free association with other people. Lonely people are isolated people. For the purpose of this study, loneliness is regarded as a relational phenomenon, and the theory of complex responsive processes of relating will be used as the theoretical framework for this study. In an attempt to understand the interpersonal experiences associated with loneliness, a qualitative and exploratory research method was used. The research was conducted in a residential care facility in Johannesburg, South Africa. The group of older people, who was purposively selected for the study, consisted of 10 older persons: 7 female and 3 male and with ages ranging between 62 and 82 years of age. The data was collected by means of various qualitative techniques, including the Mmogo-methodTM and visual drawings. The collected data was analysed by using thematic analysis, visual analysis and key-words-in-context, and crystallization was used to increase the trustworthiness of the findings. Ethical approval for the research project was obtained from the North-West University. Two themes emerged from the findings, being: 1) Relationships are experienced in terms of the interactions in relationships as well as in terms of preferred interpersonal styles; and 2) The relationships experienced in the context of the residential care facility are described as being unsafe and lacking in care, while the environment is described as non-stimulating. Some of the findings are confirmed by existing literature. However, the unique contribution of the study is the finding that the environment in which the relationships are embedded is perceived to be dangerous, and that it is perceived to be a risk to become visible to each other in order to establish meaningful interpersonal relationships. Several suggestions regarding future interventions are made and some limitations of the study are mentioned. The contribution of the study is that loneliness are expressed and described in terms of interpersonal relationships embedded in the broader environment. Thus, the potential of older people to form meaningful interpersonal relationships are limited in the broader environment if the environment is experienced as unsafe and lacking in care. / Thesis (MSc (Research Psychology))--North-West University, Potchefstroom Campus, 2012

Der Umgang mit möglicher Selbstgefährdung demenzerkrankter Bewohner durch das selbständige Verlassen des Wohnbereichs wird in Altenpflegeeinrichtungen häufig und kontrovers diskutiert. In dieser Studie wurde untersucht, ob eine milieutherapeutische Intervention in Form eines Vorhangs vor der Ausgangstür die Bewohner am Verlassen des Wohnbereichs hindert. Das wesentliche Untersuchungsziel war es dabei zu erfassen, ob Veränderungen in Verhalten und Wohlbefinden der Bewohner zu verzeichnen sind.

An exploration of the interpersonal experiences of loneliness by older people in a residential care facility It is estimated that there were about 3, 8 million older people in South Africa in 2010 (Statistics South Africa, 2010). Many older people have to be cared for in residential care facilities due to their weakening health, the migration of children and grandchildren, or due to limited financial resources. This has led to the attempt in this research study to explore the interpersonal experiences of loneliness by older people living in a residential care facility. Loneliness is an unpleasant experience associated with inadequate interpersonal contact. It is widely accepted that loneliness is closely associated with ageing as a consequence of multiple losses – loss of abilities, loss of and changes in personal relationships, loss of relationships with familiar environments and changed contact with friends and relatives resulting in reduced relationships. Changes in the relationship with the environment are regarded as a particular loss by older people, especially if they have to rely on institutionalized care and loose contact with familiar social networks and the free association with other people. Lonely people are isolated people. For the purpose of this study, loneliness is regarded as a relational phenomenon, and the theory of complex responsive processes of relating will be used as the theoretical framework for this study. In an attempt to understand the interpersonal experiences associated with loneliness, a qualitative and exploratory research method was used. The research was conducted in a residential care facility in Johannesburg, South Africa. The group of older people, who was purposively selected for the study, consisted of 10 older persons: 7 female and 3 male and with ages ranging between 62 and 82 years of age. The data was collected by means of various qualitative techniques, including the Mmogo-methodTM and visual drawings. The collected data was analysed by using thematic analysis, visual analysis and key-words-in-context, and crystallization was used to increase the trustworthiness of the findings. Ethical approval for the research project was obtained from the North-West University. Two themes emerged from the findings, being: 1) Relationships are experienced in terms of the interactions in relationships as well as in terms of preferred interpersonal styles; and 2) The relationships experienced in the context of the residential care facility are described as being unsafe and lacking in care, while the environment is described as non-stimulating. Some of the findings are confirmed by existing literature. However, the unique contribution of the study is the finding that the environment in which the relationships are embedded is perceived to be dangerous, and that it is perceived to be a risk to become visible to each other in order to establish meaningful interpersonal relationships. Several suggestions regarding future interventions are made and some limitations of the study are mentioned. The contribution of the study is that loneliness are expressed and described in terms of interpersonal relationships embedded in the broader environment. Thus, the potential of older people to form meaningful interpersonal relationships are limited in the broader environment if the environment is experienced as unsafe and lacking in care. / Thesis (MSc (Research Psychology))--North-West University, Potchefstroom Campus, 2012

This thesis concentrates on the issues of both negative manifestation of adaptation syndrome and individual nursing care planning in elderly patients during their first days after the admission to the rest home.The theoretical part is engaged in the problems of process of adaptation and adaptation syndrome itself. The results of the research projectare presented in the practical part of the thesis.In the realization of this research there has been used such techniques and methods and as direct observation, analysis of the residents documentetion, the review of causation initiating into the issue of adaptation of a women client suffering the severe form of dementia.

The aim of this work is to give a comprehensive overview of the financial situation of the health-care facility and analyze the facility available in the longer time series using the methods of financial analysis. Find the weakest position in the financing of the facility and try to assign a structural analysis problem of cost centers as a tool for managerial decision-making.