Universidade Católica de Pernambuco / Introdução: Na fase da velhice, as alterações hormonais, culturais e psicossociais do idoso requerem cuidados adicionais por parte dos familiares, podendo aumentar a demanda por Instituições de Longa Permanência de Idosos, como uma alternativa de suporte para atender às necessidades de saúde e proporcionar atividades que garantam qualidade de vida aos idosos. A literatura aponta que essa mudança no contexto de vida tende a alijar o idoso do convívio familiar e social, prejudicando a sua qualidade de vida. Objetivo: Avaliar a qualidade de vida e a interação familiar em idosos institucionalizados. Método: Trata-se de um estudo de caráter quantitativo e qualitativo, de corte transversal e de prevalência, no qual envolveu uma estratégia de ação em que todos os participantes foram submetidos às mesmas atividades. A amostra foi constituída por 88 idosos residentes em instituições públicas (89,8%), de ambos os sexos (46 homens, 42 mulheres), cuja idade média foi de 73,95 (DP=6,52) variando entre 65 e 93 anos. Os participantes foram agrupados em três faixas etárias: idoso jovem (55,7%), idoso velho (35,2%) e idoso mais velho (9,1%). Foi realizada individualmente uma entrevista e aplicados dois questionários para avaliar a qualidade de vida; WHOQOL_BREF e WHOQOL_OLD. Resultados: Pela extração do alpha de Cronbach a consistência interna obtida do WHOQOL_BREF foi boa (&#945;=0,84) e a do WHOQOL_OLD foi satisfatória (&#945;=0,75), indicando uma adequação desses instrumentos para a avaliação da qualidade de vida nesta população. As médias foram comparadas através do teste t, verificando-se que os escores masculinos foram mais elevados que os femininos em ambos os questionários, sendo esta diferença significativa apenas no WHOQOL_OLD (t= 3,505, p<0,01). Essa significância foi identificada nas facetas atividades passadas, presentes e futuras (t (86)= 3,414, p<0,01) e participação social (t (86)= 2,841, p<0,01), sempre os homens apresentando escores mais elevados de qualidade de vida nas questões existenciais sobre sentido da vida, disposição física, aceitação da aparência, atividades ocupacionais, realizações pessoais, uso do tempo e nível de atividades pessoais e comunitárias. A análise temática de conteúdo foi realizada com 30 entrevistas, sendo escolhidas as respostas dos 15 idosos que apresentaram os escores mais elevados e os 15 menores escores no WHOQOL_OLD. Foram eleitos dois temas principais visão institucional e interação familiar. A visão institucional revelou quatro núcleos de sentido: cuidados, diversão e lazer, novas amizades e bem-estar. A interação familiar evidenciou três núcleos de sentido: manutenção do bom vínculo, conflito ativo e rompimento do vínculo. Discussão: o fator institucionalização não parece ter sido o determinante de uma percepção melhor ou pior sobre a qualidade de vida, pelo fato dos idosos, independentemente do escore obtido, ressaltarem com muita ênfase os aspectos e benefícios advindos da vida institucionalizada, mesmo nos casos em que o afastamento do contexto familiar era mais sentido. Considerações finais: A relação entre a qualidade de vida e interação familiar é o que parece influir mais fortemente nessa percepção, sinalizando a importância de se atentar para a manutenção de um vínculo familiar mais salutar, promovendo ações que minimizem os efeitos deletérios dos conflitos familiares sobre a saúde e qualidade de vida dos idosos. / Introduction: In the phase of the senility, the psychosocial, cultural, and hormonal alterations of the elder demand additional cares on the part of the relative, increasing the demand by Institutions of Long Permanence of Elders, as an alternative to support to attend the needs of health and provide activities that guarantee elders quality of life. The literature points out that changing the context of life tend to remove elders of the social and family closeness, injuring its quality of life. Objective: To evaluate quality of life and the family interaction with elders institutionalized elders. Method: This study deals with qualitative and quantitative character, a cross cut and predominance, in which involved a strategic action that all participants were submitted to the same activities. The sample was constituted by 88 resident elders in public institutions (89,80%), of both the sexes (46 men, 42 women), whose average age was of 73.95 years old (DP=6,52) varying between 65 and 93 years old. The participants were grouped in three age groups: young elder (55,70%), old elder (35,20%) and older elder (9,10%). It was carried out individually an interview and applied two questionnaires to evaluate the quality of life; WHOQOL_BREF and WHOQOL_OLD. Results: By extraction of the alpha of Cronbach the internal consistency obtained of the WHOQOL_BREF was good for WHOQOL_OLD was satisfactory indicating an adaptation of those instruments to evaluate life quality in this population. The average were compared through the test t, verifying that the male scores were higher than female score in both questionnaires, being this significant difference barely in the WHOQOL_OLD (t = 3.505, p<0,01). That significance was identified in the future, present, and past activities facets (t (86) = 3.414, p<0,01) and social participation (t (86) = 2.841, p<0,01), always men presented scores of life quality more elevated in the existential questions about life sense, physical arrangement, appearance acceptance, occupational activities, personal achievements, use of the time, community and personal activities levels. The thematic content analysis was carried out with 30 interviews, being chosen answers of 15 elders that presented higher scores and 15 lower scores in the WHOQOL_OLD. Were chosen two main subjects institutional vision and family interaction. The institutional vision revealed four nuclei of sense: cares, fun and leisure, new friendships and welfare. The family interaction showed up three nuclei of sense: maintenance of the good bond, active conflict and bond rupture. Discussion: The institutionalization factor does not mean to have determinant a better or worse perception about the quality of life, by the fact of the elders, independently of the score obtained, stand out with a lot emphasis on aspects and on resulting benefits of institutionalized life, even in cases that the family distance context was more sense. Final considerations: The relation between the quality of life and family interaction is what influence more strongly in that perception, signaling the importance to have of be a more salutary family bond, promoting actions to minimize the harmful effects of the family conflicts about the health and quality of life of the elders.

Made available in DSpace on 2017-06-01T18:08:43Z (GMT). No. of bitstreams: 1 bruno_gilberto_melo_silva.pdf: 805386 bytes, checksum: b5ad48cfceb1114060353477103c12a4 (MD5) Previous issue date: 2013-05-27 / Universidade Católica de Pernambuco / Introduction: In the phase of the senility, the psychosocial, cultural, and hormonal alterations of the elder demand additional cares on the part of the relative, increasing the demand by Institutions of Long Permanence of Elders, as an alternative to support to attend the needs of health and provide activities that guarantee elders quality of life. The literature points out that changing the context of life tend to remove elders of the social and family closeness, injuring its quality of life. Objective: To evaluate quality of life and the family interaction with elders institutionalized elders. Method: This study deals with qualitative and quantitative character, a cross cut and predominance, in which involved a strategic action that all participants were submitted to the same activities. The sample was constituted by 88 resident elders in public institutions (89,80%), of both the sexes (46 men, 42 women), whose average age was of 73.95 years old (DP=6,52) varying between 65 and 93 years old. The participants were grouped in three age groups: young elder (55,70%), old elder (35,20%) and older elder (9,10%). It was carried out individually an interview and applied two questionnaires to evaluate the quality of life; WHOQOL_BREF and WHOQOL_OLD. Results: By extraction of the alpha of Cronbach the internal consistency obtained of the WHOQOL_BREF was good for WHOQOL_OLD was satisfactory indicating an adaptation of those instruments to evaluate life quality in this population. The average were compared through the test t, verifying that the male scores were higher than female score in both questionnaires, being this significant difference barely in the WHOQOL_OLD (t = 3.505, p<0,01). That significance was identified in the future, present, and past activities facets (t (86) = 3.414, p<0,01) and social participation (t (86) = 2.841, p<0,01), always men presented scores of life quality more elevated in the existential questions about life sense, physical arrangement, appearance acceptance, occupational activities, personal achievements, use of the time, community and personal activities levels. The thematic content analysis was carried out with 30 interviews, being chosen answers of 15 elders that presented higher scores and 15 lower scores in the WHOQOL_OLD. Were chosen two main subjects institutional vision and family interaction. The institutional vision revealed four nuclei of sense: cares, fun and leisure, new friendships and welfare. The family interaction showed up three nuclei of sense: maintenance of the good bond, active conflict and bond rupture. Discussion: The institutionalization factor does not mean to have determinant a better or worse perception about the quality of life, by the fact of the elders, independently of the score obtained, stand out with a lot emphasis on aspects and on resulting benefits of institutionalized life, even in cases that the family distance context was more sense. Final considerations: The relation between the quality of life and family interaction is what influence more strongly in that perception, signaling the importance to have of be a more salutary family bond, promoting actions to minimize the harmful effects of the family conflicts about the health and quality of life of the elders. / Introdução: Na fase da velhice, as alterações hormonais, culturais e psicossociais do idoso requerem cuidados adicionais por parte dos familiares, podendo aumentar a demanda por Instituições de Longa Permanência de Idosos, como uma alternativa de suporte para atender às necessidades de saúde e proporcionar atividades que garantam qualidade de vida aos idosos. A literatura aponta que essa mudança no contexto de vida tende a alijar o idoso do convívio familiar e social, prejudicando a sua qualidade de vida. Objetivo: Avaliar a qualidade de vida e a interação familiar em idosos institucionalizados. Método: Trata-se de um estudo de caráter quantitativo e qualitativo, de corte transversal e de prevalência, no qual envolveu uma estratégia de ação em que todos os participantes foram submetidos às mesmas atividades. A amostra foi constituída por 88 idosos residentes em instituições públicas (89,8%), de ambos os sexos (46 homens, 42 mulheres), cuja idade média foi de 73,95 (DP=6,52) variando entre 65 e 93 anos. Os participantes foram agrupados em três faixas etárias: idoso jovem (55,7%), idoso velho (35,2%) e idoso mais velho (9,1%). Foi realizada individualmente uma entrevista e aplicados dois questionários para avaliar a qualidade de vida; WHOQOL_BREF e WHOQOL_OLD. Resultados: Pela extração do alpha de Cronbach a consistência interna obtida do WHOQOL_BREF foi boa (&#945;=0,84) e a do WHOQOL_OLD foi satisfatória (&#945;=0,75), indicando uma adequação desses instrumentos para a avaliação da qualidade de vida nesta população. As médias foram comparadas através do teste t, verificando-se que os escores masculinos foram mais elevados que os femininos em ambos os questionários, sendo esta diferença significativa apenas no WHOQOL_OLD (t= 3,505, p<0,01). Essa significância foi identificada nas facetas atividades passadas, presentes e futuras (t (86)= 3,414, p<0,01) e participação social (t (86)= 2,841, p<0,01), sempre os homens apresentando escores mais elevados de qualidade de vida nas questões existenciais sobre sentido da vida, disposição física, aceitação da aparência, atividades ocupacionais, realizações pessoais, uso do tempo e nível de atividades pessoais e comunitárias. A análise temática de conteúdo foi realizada com 30 entrevistas, sendo escolhidas as respostas dos 15 idosos que apresentaram os escores mais elevados e os 15 menores escores no WHOQOL_OLD. Foram eleitos dois temas principais visão institucional e interação familiar. A visão institucional revelou quatro núcleos de sentido: cuidados, diversão e lazer, novas amizades e bem-estar. A interação familiar evidenciou três núcleos de sentido: manutenção do bom vínculo, conflito ativo e rompimento do vínculo. Discussão: o fator institucionalização não parece ter sido o determinante de uma percepção melhor ou pior sobre a qualidade de vida, pelo fato dos idosos, independentemente do escore obtido, ressaltarem com muita ênfase os aspectos e benefícios advindos da vida institucionalizada, mesmo nos casos em que o afastamento do contexto familiar era mais sentido. Considerações finais: A relação entre a qualidade de vida e interação familiar é o que parece influir mais fortemente nessa percepção, sinalizando a importância de se atentar para a manutenção de um vínculo familiar mais salutar, promovendo ações que minimizem os efeitos deletérios dos conflitos familiares sobre a saúde e qualidade de vida dos idosos.

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.

The study was conducted among 100 assistant nurses working in six different residential home. The main purpose of the study was to increase awareness of the psychosocial work environment of assistant nurses in retirement home. In order to fulfill my purpose, I have chosen to use three questions: Have the period of employment in the workplace any impact on how the assistant nurses experience the psychosocial work environment? In the future it will become a lack of staff in elderly care. How do those working in elderly care today feel about the future? How important are the manager and colleagues for how assistant nurses are experiencing the psychosocial work environment? In order to answer the questions a quantitative method and a questionnaire has been used. The results were analyzed using SPSS and presented in the form of frequency tables, cross tabulations, chi square test and the sperman rho test. The results showed that the period of employment did not had an impact on the staffs´ experience of the psychosocial work environment. But what proved to be important was whether they felt their work as stressful. Where those who have worked between 3-10 years felt that the duties were more stressful than those with a shorter or longer period of employment.

Working as first line manager in elderly care means to meet business needs and at the same time relate to the political guidelines and decisions available. In order to perform their daily work and at the same time feel good working conditions requires that managers are given the right conditions. The purpose of this study is to increase the understanding of how the first line management in elderly care experience their work situation and the conditions they receive from the organization's management to perform their daily work. The aim is also to study what the first line managers believe are the most important prerequisites for achieving a sustainable work. The study is based on qualitative semi-structured interviews performed with seven first line managers in municipal elderly care. The collected material is analyzed from Granheim and Lundmans (2012) qualitative content analysis. The result shows that the economic conditions that managers have available in their operations is scarce and it is a challenge for managers to find enough time to their daily work, partly because all the administrative work is burdensome. Anyway, it shows that the managers who have learned to prioritize their time and have a long working experience, they can more easily manage their work situation. It appears that the most essential conditions that all managers feel that they receive from the organizations management is good management support and good educational opportunities. The result also shows that good management support is seen by all managers as one of the most important conditions to be able to create a sustainable work. The study do not differ in any significant way to the earlier research available in the field, and we can with our study further strengthen the organizations management needs to get a better insight in elderly operations and work to improve first line managers work situation and their prospects. / Att arbeta som första linjechef inom äldreomsorgen innebär att tillgodose verksamhetens behov och samtidigt förhålla sig till de poliska riktlinjer och beslut som finns. För att kunna utföra sitt dagliga arbete och samtidigt känna goda arbetsförhållanden krävs det att linjecheferna ges rätt förutsättningar. Syftet med denna studie är att öka förståelsen för hur första linjechefer inom äldreomsorgen upplever sin arbetssituation och de förutsättningar de får ifrån organisationens ledning för att kunna utföra sitt dagliga arbete. Syftet är även att studera vad första linjecheferna anser är de viktigaste förutsättningarna för att uppnå ett hållbart arbete. Studien är baserad på kvalitativa semistrukturerade intervjuer genomförda med sju första linjechefer inom den kommunala äldreomsorgen. Det insamlade materialet analyseras utifrån Graneheim och Lundman (2012) kvalitativa innehållsanalys. Resultatet visar att de ekonomiska förutsättningarna som linjecheferna har att tillgå i sin verksamhet är knappa och det är en utmaning för linjecheferna att få tiden att räcka till i det dagliga arbetet, vilket bland annat beror på att allt det administrativa arbetet är betungande. Däremot visar resultatet att de linjechefer som har lärt sig att prioritera sin tid och har en lång arbetslivserfarenhet upplever att de lättare kan hantera sin arbetssituation De mest centrala förutsättningarna som samtliga linjechefer upplever att de får ifrån organisationens ledning är ett gott chefsstöd och goda utbildningsmöjligheter. Resultatet visar också att ett gott chefsstöd ses av samtliga linjechefer som en av de viktigaste förutsättningarna till att kunna uppnå ett hållbart arbete. Resultatet skiljer sig inte från tidigare forskning som finns inom området. Studien stärker därmed att organisationens ledning behöver få en bättre inblick i äldreomsorgens verksamheter och arbeta för att förbättra första linjechefernas arbetssituation och deras förutsättningar.

The aim of this study is to increase the knowledge of the implementation process of the national core value at residential homes for the elderly, based on manager’s descriptions. The national core values were introduced in the Social Service Act (SFS 2001:453) 2011 with the aim to increase the quality in the elderly care. According to previous research, leadership has a major impact on the implementation of the national core values; therefore the study takes its outset from the managers perspective. The study is designed as a case study where qualitative interviews are used as a method. Through semi-structured interviews, managers at residential homes for elder have been interviewed. The collected material from the interviews has been analyzed based on theories of implementation and leadership. The result shows that the managers use different methods to implement the national core value in their operations and that different factors affect the implementation process. The factors that arise are mainly the manager, the staff’s attitude and resources. The result shows that managers are important in the implementation process, it is about the meaning that the managers gives the national core value and that the managers can be seen to take an active or a passive role in the implementation process. The managers are requesting education about the national core values, despite the government’s formulated guidance materials and education. The result shows that the managers don’t use these instruments, witch means that the managers are asking for something that already exists. In order for the operations to work in accordance with the national core values, the result shows that both managers and employees requires to provide the right conditions in terms of resources.

As the population of senior citizens increase, various housing options are required for an increasing competitive environment within elderly care. This study addresses the concept of profile housing for the elderly by outlining its definition and providing options for the different kinds of housing options available within the municipalities of Stockholm and Solna. The study reveals that these locations have different definitions of what constitutes a profile home. Based on this, should one assume there are further definitions to cover additional municipalities?      This study also touches upon how a group of senior citizens would perceive their living conditions if relocated into such housing. Members of the group have also expressed that they would like to go about their daily activities as they have prior to being relocated. They want health professionals to enable and encourage participation in various daily activities.

Arbetsterapeuter och fysioterapeuter arbetar utifrån ett rehabiliterande förhållningssätt. Detta kan bidra till känsla av utanförskap och konkurrens med kommunens övriga professioner och deras förhållningssätt. Forskning visar även att behov av socialt stöd finns för att kunna förklara vad rehabiliterande förhållningssätt är men att socialt stöd för att förankra detta inte alltid finns i organisationerna. Syftet var att beskriva arbetsterapeuters och fysioterapeuters erfarenheter av socialt stöd från kommunen gällande rehabiliteringsinsatser till patienter inom äldreomsorg. Induktiv innehållsanalys där åtta intervjuer med arbetsterapeuter och fysioterapeuter utgjorde data. Analysen genererade två generiska kategorier och fem subkategorier. Generiska kategorin att ha ett ledningssystem beskrivs genom subkategorierna: Närvarande/ansvarstagande chef, stöttande chef samt rutiner och stödfunktioner. Den generiska kategorin teamarbete beskrivs genom subkategorierna: behov av rehabiliteringsteam samt behov av tvärprofessionella team. Starkast stöd verkar fås av arbetsterapeut- och fysioterapeutkollegor om möjlighet till detta ges av organisation och dess företrädare.

The purpose of the study was to examine how first-line managers in municipal elderly care perceive their leadership role. This was put in relation to the level of discretion in work related tasks, employed by the first-line managers in order to increase knowledge about what requirements exist in leadership. The study used a qualitative method and in total, six interviews were conducted with first-line managers in municipal elderly care. We have used a hermeneutic approach and a qualitative thematic analysis. Theories applied are street-level bureaucracy and role theory. The results show that the first-line managers would have a more positive experience of their assignment if they are given clearer information about what their assignment means. Overall, the study shows that the first-line managers perceive their mission as positive and important, but that it includes many assignments, and high variance. The first-line managers in the study describe that they meet expectations, in their professional role from for example employees, management, political decisions and residents. The first-line managers have described that they have managerial discretion within their own branch, but one of the managers feel that she did not have enough managerial discretion. We believe that the margins of discretion do not have a negative impact on their ability to practice good leadership. / Syftet  med  studien  var  att  undersöka  hur  enhetschefer  verksamma  inom  kommunal äldreomsorg uppleversin roll irelation till uppdragets innehåll samt att undersöka deras handlingsutrymme,  för  att  öka  kunskapen  om  vilka  förutsättningar  som  finns  i ledarskapet. I studien användes en kvalitativ metod och sammanlagt genomfördes sex intervjuer  med  yrkesverksamma  enhetschefer  inom  kommunal  äldreomsorg.  Vi  har använts oss av en hermeneutisk ansats och en kvalitativ tematisk analys. Teorier som applicerats är gräsrotsbyråkrati samt rollteori. Den tidigare forskning som använts till studien innefattar rollen som enhetschef,den offentlig organisationen, enhetschefens handlingsutrymme samt enhetschefens förutsättningar i arbetet. Studiens resultat visar att  enhetscheferna  skulle  ha  en  mer  positiv  upplevelse  av  sitt  uppdrag  om  de  gavs tydligare information kring vad deras uppdrag faktiskt innebär. Överlag visar studien att enhetscheferna upplever sitt uppdrag som positivt och viktigt, men att det innefattar många uppdrag och är omväxlande.Enhetscheferna i studien beskriver att de möter förväntningar  från  många  håll  i  sin  yrkesroll,  från  exempelvis  medarbetare,  ledning, politiska   beslut   och   vårdtagare.   Enhetscheferna   har   beskrivit   att   de   har   stort handlingsutrymme i sin egen verksamhet, men en av enhetscheferna upplever att hon inte hade tillräckligt mycket utrymme. Generellt sett anser vi att handlingsutrymmet inte har en negativ påverkan gällande deras möjligheter i ledarskapet.

The aim of this study was to investigate unit managers views on staff continuity within municipal home care services to get a wider understanding regarding the organization’s work with staff continuity, which action dilemmas the unit managers encounter and how they handle these. The study was conducted by qualitative research through semi-structured interviews with six unit managers in one middle-sized municipality in Sweden. The results showed a diverseness in working methods regarding staff continuity between the home care services in the municipality. It was also concluded that the home care services are guided by goals and guidelines regarding staff continuity which the unit managers finds unclear and undeveloped. The conclusion highlights that the unit managers finds themselves in a position where the care users needs and requests of a staff continuity does not always match the conditions and regulations within the organization. Lastly the results showed that this position causes the unit managers to make priorities in the work for staff continuity. It can be concluded that the unit managers either finds themselves adjusting to the organizations conditions or regulations or they find solutions to meet the request and needs from the care users regarding staff continuity.