Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 48-50).

This ethnographic nursing home study explores the meaning which residents make of being old and in care. Its primary focus is on the role of social and communicative interactions in maintaining residents’ sense of self. Throughout the thesis I argue that the self is socially constructed, narratively communicated and is continuous throughout the life span. This narrative, relational self is diminished in old age by bereavement and the loss of social networks, and threatened by the loneliness and isolation of the institutional environment. Nonetheless, despite the stripping of relational layers entailed in the loss of the people with whom the younger self was constructed, there is a continuing core of self which, while bending, does not break. I argue that the nursing home can be a site of recovery for this vulnerable, diminished self, offering support and the opportunity to take on new roles and form new relationships, and through these relationships, new layers of self. / Staff are key players in the healing process, and staff-resident relationships important new sources of meaning for the relational self. The ageing, marginalised self is strengthened through empathetic communication which recognises the individual person and the importance of that individual’s life, acknowledges residents’ adult status, and enhances self-esteem by enhancing personal control. For residents, telling their stories and remembering their past lives provides a means of making sense of where and who they are in the present, and of envisaging a future. Consequently, it is vital that residents have opportunities to speak and be heard, and to be recognised and spoken to. These opportunities are sometimes adequately provided by families, friends, church and other visitors and volunteers, but frequently they are not. Staff then become the main source of resident support. / The capacity of individual staff to meet residents’ communication needs is dependent on many factors including the legislative framework and funding of the aged care system, the philosophy of the individual provider organisation (translated into work routines, staffing practices, and the training, mentoring and support available to staff) and the individual personalities and communication skills of staff themselves. Continuity of staffing is a vital factor, with “Know your resident” identified by staff in this study as the most important element in understanding and recognising the needs of residents withcognitive and communicative impairment, and in building relationships which support residents and enhance their autonomy.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2008. / Title from first page of PDF document. Includes bibliographical references (p.66-68).

Mémoire (M.P.M.O.)--Université du Québec en Abitibi-Témiscamingue, 1989. / Ce mémoire à été réalisé à l'Université du Québec en Abitibi-Témiscamingue dans le cadre du programme de la Maîtrise en gestion des petites et moyennes organisation, extensionne de l'Université du Québec à Chicoutimi. CaQCU Document électronique également accessible en format PDF. CaQCU

Medellivslängden i Sverige stiger och utmaningarna inom äldreomsorgen ökar. Studiens syfte var att undersöka biståndshandläggares syn på välfärdsteknik och dess implementering inom äldreomsorgen i Dalarna. Genom tematisk analys av semistrukturerade intervjuer av sju biståndshandläggare framkom att biståndshandläggare ser positivt på välfärdsteknik inför framtiden men att den behöver vara pålitlig och individanpassad till brukarna. Biståndshandläggare beskrev att välfärdsteknik kan bidra till förbättrad livskvalitet och en ökad känsla av trygghet. För att underlätta implementering av välfärdsteknik behövs stödjande organisationsstrukturer och resurser som möjliggör att personal får information och utbildning. Bland annat ekonomiska begränsningar, tidsbrist och låg prioritet ansågs hindra implementering av välfärdsteknik. / Life expectancy in Sweden is increasing and the challenges in the care of older people are rising. This study aimed to examine social workers’ view of welfare technology and its implementation in the care of older people in Dalarna. Following thematic analysis of semistructured interviews of seven social workers, it was found that they view welfare technology positively for the future, but that it needs to be reliable and individually adapted to the users.Social workers described that welfare technology can contribute to an improved quality of lifevand an increased sense of security. To facilitate the implementation of welfare technology,supporting organizational structures and sufficient resources that enable staff to receive information and training are required. Among other things, economic limitations, lack of time,and low priority were considered barriers to the implementation of welfare technology.

Studiens syfte är att undersöka hur omsorgspersonal inom äldreomsorgen upplever äldres behov av samtalsstöd. Metoden som har använts är kvalitativ i form av individuella semistrukturerade intervjuer med sex informanter som arbetar som omsorgspersonal inom den kommunala äldreomsorgen. De teoretiska utgångspunkter som har tillämpats är socialkonstruktionism samt Erik Homburger Eriksons teori om människans livsstadier. Resultatet av studien visar att det enligt omsorgspersonalen finns ett samtalsbehov hos brukare inom äldreomsorgen som inte alltid kan tillgodoses idag på grund av omsorgspersonalens tidsbrist samt avsaknad av kompetens i att möta djupa frågor. Kuratorer inom äldreomsorgen skulle kunna bidra med samtalsstöd för äldre samt vara ett stöd för anhöriga och personal. Resultatet antyder till att behovet av kuratorer inom äldreomsorgen kommer att öka. Framtidens äldre förmodas ställa mer krav än de gör idag på att få samtalsstöd eftersom denna insats blir högre och mer accepterad i samhället. / This study aims to examine how professionals in care for older people experience older people´s needs of counselling in grievous life questions. A qualitative method has been chosen in the form of individual semi-structured interviews with six care workers in municipal care for older people. The theoretical bases which have been applied are social constructionism and Erik Homburger Erikson's theory: Stages of Psychosocial Development. The result of the study shows that older people in care for older people sometimes are in need of counselling. These needs are not always fulfilled today because of the care workers lack of time and expertise in facing grievous life questions. Counsellors in care for older people are presumed to increase because older people in the future will make more demands and also will find it more natural in life crisis to talk to a counsellor.

Care transition, the process of moving from community care to residential care, is one of the biggest changes that older people can experience in their later life. Evidence from the literature suggests that older people's experiences of care transition tend to be negative and traumatic, with most of them being little involved in the process of care transition. How older people exercise choice during the period of care transition is important for understanding their experiences of care transition for the following two reasons: first, choice has been referred to in the literature as the key to less stressful care transition experiences, which can subsequently lead to a better quality of life in residential homes; second, the introduction of choice in public services has been the key plank of British social policy in recent decades and there has been a movement towards extending choice in residential care. This research aims to study older people's care transition experiences and their exercise of choice during the process of care transition, to explore the meaning and the perceived effects of choice and to identify the role of choice in promoting a positive care transition. This thesis presents findings from 48 in-depth interviews with older people who became new residents in one of the ten participating residential homes in London and had their care paid for by the local authority. This research identified four groups of older people who showed marked differences in terms of their needs, their exercise of choice during the care transition process and their adaptation to residential care: Active Planners, Conformists, the Unsettled and Shelter-Seekers. The findings from this research suggest that the older people's care transition experiences varied and that they stretch beyond the prevailing evidence emphasising the stressfulness of the care transition. The cases of Active Planners and Shelter-Seekers show the potential for positive roles for care homes in the case of users with genuine needs for residential care. An overwhelming majority of the older people who were interviewed were great proponents of choice and many of them actively exercised choice in the course of their care transition. This challenges the claim of the passivity of older people which has been argued in the literature. However, the cases of some Conformists who did not want to exercise choice also highlight that having no choice can be a choice for some older people. On the whole, older people’s exercise of choice played an important role in facilitating a positive transition, despite it not being a precondition for such a transition. However, there were administrative issues limiting the level and the extent of choice that were available to the older people and the Unsettled experienced an undesired move into a care home, having their choices denied or rejected. This thesis also questions the working of choice and competition in residential care, as the older people did not seem to enjoy the expected benefits of choice relating to service improvements which have been argued for in the literature.

<p>The overall aim of the present thesis was to gain further knowledge about the nursing theoretical basis of care of older people, to translate the theory of gerotranscendence into practical guidelines<b>,</b> and to implement the theory and guidelines in practical settings. </p><p>Study I comprised a literature search and a review with qualitative analysis of nursing theories. The conclusion drawn was that nursing theories do not provide guidance on how to care for older people or on how to support them in the developmental process of ageing. Thus, there is a need to develop a nursing care model that, more than contemporary theories, takes human ageing into consideration. </p><p>Study II was a qualitative interview study involving staff working in care of older people. The interviews were qualitatively analysed. The conclusion was that staff members need an interpretative framework that allows them to understand the signs they sometimes observe in older people. Such a framework would enable staff to develop a broader approach to their care for older people. Parts of this framework can be found in the theory of gerotranscendence. </p><p>In Study III, guidelines for practical care of older people<b> </b>were derived from the theory of gerotranscendence. Focus group interviews were used and other sources supporting the guidelines were given. A qualitative analysis of the interviews was carried out, and the theory of gerotranscendence was used as the theoretical framework. The guidelines could be used to promote a development toward gerotranscendence and could also be of value for people who have already attained a state of gerotranscendence. The guidelines focus on the individual, activities and the organisation.</p><p>In Study IV, the theory of gerotranscendence and practical guidelines were introduced in a nursing home. Data were collected via qualitative interviews with staff and residents, and observations were made. Qualitative analysis and triangulation were performed. As theoretical frameworks, both the theory of gerotranscendence and innovation theory were used. The result showed that the most used guidelines were those focusing on the individual; these concern what each staff member could do in his/her relation to the resident and care. The findings showed further that those staff members who interpreted signs in line with the theory of gerotranscendence also used the guidelines. The staff who were early to adopt and promote the guidelines were those individuals who described a feeling of harmony with essential parts of the gerotranscendence theory. </p><p>The most important finding of this thesis was that it was possible to translate a theory such that it could generate practical guidelines that could be used by the staff. There are probably many theories that could be translated in order to be implemented in practical care, e.g. to build a bridge between theory and practice, thereby helping staff. Innovation theory could be of general interest in all contexts in which work towards change is being conducted.</p> / <p>Det övergripande syftet med denna avhandling var att få kunskap om den omvårdnads teoretiska basen för vård av äldre, och att översätta teorin om gerotransendens till praktiska guidelines, och att införa teorin om gerotranscendens och guidelines i praktiken</p><p>Studie I, var en litteratursökning med en kvalitativ analys av omvårdnadsteorier. Den visade att dessa teorier inte ger någon vägledning om hur omvårdnad av äldre ska ske eller hur man kan stödja äldre i deras utvecklingsprocess. Därför finns det ett behov att utveckla en omvårdnadsmodell som mer än nuvarande teorier beaktar människans åldrande.</p><p>Studie II, var en kvalitativ intervjustudie med personal i äldrevård. Intervjuerna analyserades kvalitativt. Studien påvisade att personal behöver mer kunskaper om åldrandeprocessen så att de kan förstå tecken och beteenden de ibland observerar hos de äldre. Detta skulle göra det möjligt för personal att utveckla ett vidare perspektiv för hur de kan stödja äldre personer. </p><p>I studie III, utarbetades guidelines från teorin om gerotranscendens. Fokus grupps intervjuer användes. Intervjuerna analyserades kvalitativt och teorin om gerotranscendens användes som teoretisk grund. Dessutom ges i studien hänvisning till andra källor som stödjer guidelines. Guidelines kan användas för att stödja en utveckling mot gerotranscendens och kan också vara av värde för personer som redan uppnått gerotranscendens. Guidelines innehåller åtgärder som vårdare kan göra enskild, ger förslag till aktiviteter och organisatoriska åtgärder. </p><p>I studie IV, introducerades teorin om gerotranscendens och de utarbetade guidelines på ett äldreboende. Kvalitativa intervjuer gjordes med personal och boende och observationer genomfördes. Detta analyserades kvalitativt och triangulering användes, både teorin om gerotranscendens och innovations teori användes som teoretisk grund. Resultatet visade att de mest använda guidelines var de som enskilda vårdare kunde utföra självständigt. Vidare att den personal som förklarade tecken de såg hos äldre i linje med teorin om gerotranscendens, använde också guidelines. Den personal som tidigt tog till sig och stödde användandet av guidelines var de som själva beskrev att de kände igen sig själva i delar av teorin,</p><p>Det viktigaste resultatet in denna avhandling är att det var möjligt att översätta en teori till praktiskt användbara guidelines. Förmodligen finns det fler teorier som skulle kunna översättas och implementeras i praktisk verksamhet, vilket skulle vara att bygga en bro mellan teori och praktik, och hjälpa personal att kunna omsätta teorier praktiskt. Innovationsteori kan vara av generellt intresse i alla sammanhang när förändringsarbete bedrivs. </p>

The overall aim of the present thesis was to gain further knowledge about the nursing theoretical basis of care of older people, to translate the theory of gerotranscendence into practical guidelines, and to implement the theory and guidelines in practical settings. Study I comprised a literature search and a review with qualitative analysis of nursing theories. The conclusion drawn was that nursing theories do not provide guidance on how to care for older people or on how to support them in the developmental process of ageing. Thus, there is a need to develop a nursing care model that, more than contemporary theories, takes human ageing into consideration. Study II was a qualitative interview study involving staff working in care of older people. The interviews were qualitatively analysed. The conclusion was that staff members need an interpretative framework that allows them to understand the signs they sometimes observe in older people. Such a framework would enable staff to develop a broader approach to their care for older people. Parts of this framework can be found in the theory of gerotranscendence. In Study III, guidelines for practical care of older people were derived from the theory of gerotranscendence. Focus group interviews were used and other sources supporting the guidelines were given. A qualitative analysis of the interviews was carried out, and the theory of gerotranscendence was used as the theoretical framework. The guidelines could be used to promote a development toward gerotranscendence and could also be of value for people who have already attained a state of gerotranscendence. The guidelines focus on the individual, activities and the organisation. In Study IV, the theory of gerotranscendence and practical guidelines were introduced in a nursing home. Data were collected via qualitative interviews with staff and residents, and observations were made. Qualitative analysis and triangulation were performed. As theoretical frameworks, both the theory of gerotranscendence and innovation theory were used. The result showed that the most used guidelines were those focusing on the individual; these concern what each staff member could do in his/her relation to the resident and care. The findings showed further that those staff members who interpreted signs in line with the theory of gerotranscendence also used the guidelines. The staff who were early to adopt and promote the guidelines were those individuals who described a feeling of harmony with essential parts of the gerotranscendence theory. The most important finding of this thesis was that it was possible to translate a theory such that it could generate practical guidelines that could be used by the staff. There are probably many theories that could be translated in order to be implemented in practical care, e.g. to build a bridge between theory and practice, thereby helping staff. Innovation theory could be of general interest in all contexts in which work towards change is being conducted. / Det övergripande syftet med denna avhandling var att få kunskap om den omvårdnads teoretiska basen för vård av äldre, och att översätta teorin om gerotransendens till praktiska guidelines, och att införa teorin om gerotranscendens och guidelines i praktiken Studie I, var en litteratursökning med en kvalitativ analys av omvårdnadsteorier. Den visade att dessa teorier inte ger någon vägledning om hur omvårdnad av äldre ska ske eller hur man kan stödja äldre i deras utvecklingsprocess. Därför finns det ett behov att utveckla en omvårdnadsmodell som mer än nuvarande teorier beaktar människans åldrande. Studie II, var en kvalitativ intervjustudie med personal i äldrevård. Intervjuerna analyserades kvalitativt. Studien påvisade att personal behöver mer kunskaper om åldrandeprocessen så att de kan förstå tecken och beteenden de ibland observerar hos de äldre. Detta skulle göra det möjligt för personal att utveckla ett vidare perspektiv för hur de kan stödja äldre personer. I studie III, utarbetades guidelines från teorin om gerotranscendens. Fokus grupps intervjuer användes. Intervjuerna analyserades kvalitativt och teorin om gerotranscendens användes som teoretisk grund. Dessutom ges i studien hänvisning till andra källor som stödjer guidelines. Guidelines kan användas för att stödja en utveckling mot gerotranscendens och kan också vara av värde för personer som redan uppnått gerotranscendens. Guidelines innehåller åtgärder som vårdare kan göra enskild, ger förslag till aktiviteter och organisatoriska åtgärder. I studie IV, introducerades teorin om gerotranscendens och de utarbetade guidelines på ett äldreboende. Kvalitativa intervjuer gjordes med personal och boende och observationer genomfördes. Detta analyserades kvalitativt och triangulering användes, både teorin om gerotranscendens och innovations teori användes som teoretisk grund. Resultatet visade att de mest använda guidelines var de som enskilda vårdare kunde utföra självständigt. Vidare att den personal som förklarade tecken de såg hos äldre i linje med teorin om gerotranscendens, använde också guidelines. Den personal som tidigt tog till sig och stödde användandet av guidelines var de som själva beskrev att de kände igen sig själva i delar av teorin, Det viktigaste resultatet in denna avhandling är att det var möjligt att översätta en teori till praktiskt användbara guidelines. Förmodligen finns det fler teorier som skulle kunna översättas och implementeras i praktisk verksamhet, vilket skulle vara att bygga en bro mellan teori och praktik, och hjälpa personal att kunna omsätta teorier praktiskt. Innovationsteori kan vara av generellt intresse i alla sammanhang när förändringsarbete bedrivs.

Syfte: Huvudsyftet med denna undersökning var att kartlägga den psykosociala arbetsmiljön samt identifiera stressfaktorer bland undersköteskor och vårdbiträden i olika kommunala hemtjänstverksamheter. Metoder: Till denna undersökning användes en metodkombination utav kvantitativa samt kvalitativa undersökningar. En enkätsundersökning skickades till 149 medarbetare i berörd kommun och 91 medarbetare besvarade frågorna. Därefter analyserades svaren med hjälp av programmet SPSS. Slutligen genomfördes nio intervjuer med ändamålet att förstå samt försöka identifiera orsaken till stressfaktorer som visade sig i enkätsundersökningen. Resultat: En hög svarsfrekvens av stressrelaterad ohälsa bland hemtjänstpersonal påvisas utifrån mina undersökningar. Analysen har visat att den psykosociala arbetsmiljön på de olika hemtjänstverksamheterna består av höga krav och låga kontrollmöjligheter. Dock var det sociala stödet högt eftersom flertalet upplevde en god sammanhållning inom arbetsgrupperna. Resultatet i den kvantitativa undersökningen visade att det fanns stressfaktorer i dessa verksamheter. Det som var intressant och stack ut var att det allmänna hälsotillståndet upplevdes som mycket bra/ ganska bra av 70.8% av deltagarna, dessutom bedömde 80.3% arbetsförmågan kring psykiska krav som mycket god/ ganska god. 82.4% bedömde arbetsförmågan när det gäller fysiska krav som mycket god/ ganska god. Trots dessa positiva procentenheter svarade flertalet att arbetet krävde att man arbetar fort samt hårt. Dessutom svarade 83.5% att man ibland, ganska ofta, nästan jämt kände sig uppvarvad, 67,1% svarade att man ibland, ganska ofta, nästan jämnt känner sig pressade på gränsen av vad man klarar av. Ytterligare var det 71.8% som upplevde stress ibland, ganska ofta, nästan jämnt. Det vill säga att resultatet påvisade stressfaktorer dock inga bakomliggande orsaker. För att definiera bakomliggande orsaker genomfördes nio intervjuer i studie 2 med ändamålet att förstå medarbetarnas arbetssituation. Resultatet av studie 2 påvisade att orsakerna till att stress uppstod var förändrade arbetsuppgifter där administrativa uppgifter hade ökat radikalt, därtill poängterades det av alla intervjupersoner att man fått flera kundbesök med kort restid emellan vilket ledde till frustration, oro, stress samt dåligt samvete. På så sätt påverkades medarbetarnas meningsfullhet med arbetet. Därtill påvisade undersökningen att medarbetarnas arbetsplatser var så kallade ”spända arbeten” eftersom kraven var höga och beslutsutrymmen väldigt små.