<p>This was a descriptive qualitative study. Eight people living with HIV, four of which had disclosed their status, were individually interviewed. Two focus group discussions (each comprising 6 participants) were also conducted with health workers. The study was based at an urban TB hospital which is currently providing a range of HIV-related services including HIV Voluntary Counselling and Testing, case management and treatment.</p>

Mast cells are long-lived effector cells of importance for both acute and chronic inflammations. Mast cells can be activated in many different ways, leading to the release of inflammatory mediators. In contrast to most other inflammatory cells, activated mast cells have the capacity to recover, regranulate and thereby be activated again. In this thesis I have investigated the mechanisms involved in regulating activation-induced mast cell survival. We have found that cross-linking of FcεRI-bound IgE with an antigen (IgER-CL) induces a survival program in mast cells. Upon IgER-CL, mouse and human mast cells upregulate the pro-survival Bcl-2 family gene A1/Bfl-1. A1-/- mast cells degranulate upon FcεRI activation but they cannot recover most likely due to the lack of A1. Sensitized and provoked A1-/- mice exhibit lower amounts of mast cells compared to littermate controls. In contrast to mast cells, no Bfl-1 expression or survival promotion can be detected in basophils after IgER-CL. Another mast cell secretagogue, an adenosine receptor agonist, neither promoted upregulation of A1 nor survival. Although it is well established that mast cell survival is dependent on stem cell factor (SCF), it has not been described how this process is regulated. We have found that SCF promotes survival through Akt-mediated inhibition of the forkhead transcription factor FOXO3a and its transcriptional target Bim, a BH3-only pro-apoptotic protein. SCF-treatment prevents upregulation of Bim protein expression and leads to an upregulation of Bim phosphorylation through PI3-kinase and MEK-dependent pathways. Overexpression of FOXO3a causes an upregulation of Bim and induces mast cell apoptosis, even in the presence of SCF. Taken together, the work in this thesis demonstrates that A1/Bfl-1 and Bim play key roles in mast cell survival. These findings might be of importance in understanding the mechanisms of mast cell longevity and hence for possible new therapeutics used for mast cell-associated inflammations.

With the aging of our population and the higher risk of chronic illness and disability with age, more and more family members may be faced with the experience of having a relative transition into a long-term care (LTC) home. This reality necessitates greater understanding of family care partner needs to ensure wellness throughout their caring career. Using participatory action research, notions of wellness were explored for family partners in care with relatives residing in LTC homes. Using two LTC homes from a privately owned company called Specialty Care, ten family members were interviewed, followed by one focus group at each of the two LTC homes. Three major themes were revealed, each with several sub themes: (1) understanding wellness amidst challenges to keep a sense of wellness in life; (2) self-appraisal: becoming aware of personal beliefs and perceptions that influence wellness; and (3) assessing LTC homes and their influence on the experience of wellness. We not only revealed more about wellness and how it is experienced in the caring context, we also discovered leisure’s role in maintaining wellness and how embedded leisure’s influence is on the various aspects of wellness that family partners in care experience. Relationship-centred care is a framework we used to guide this study. It highlights the importance of family member needs, along with the needs of the residents and staff. With our enhanced understanding of family care partner needs, recommendations were made to the Specialty Care communities so they can work together to ensure optimal wellness is maintained for all parties, including family partners in care.

<p>This was a descriptive qualitative study. Eight people living with HIV, four of which had disclosed their status, were individually interviewed. Two focus group discussions (each comprising 6 participants) were also conducted with health workers. The study was based at an urban TB hospital which is currently providing a range of HIV-related services including HIV Voluntary Counselling and Testing, case management and treatment.</p>

Scientific literary analysis educed, that scientific literary lacks material for relations among children and parents having risk factors, for peculiarities of interaction and for possibilities of social work in order to improve noted relations. That’s why the topic of my master’s work is about social possibilities in order to improve relations among children and parents having risk factors. Aim of the research is to find out the possibilities of social work in order to improve relations among children and parents having risk factors.

With the aging of our population and the higher risk of chronic illness and disability with age, more and more family members may be faced with the experience of having a relative transition into a long-term care (LTC) home. This reality necessitates greater understanding of family care partner needs to ensure wellness throughout their caring career. Using participatory action research, notions of wellness were explored for family partners in care with relatives residing in LTC homes. Using two LTC homes from a privately owned company called Specialty Care, ten family members were interviewed, followed by one focus group at each of the two LTC homes. Three major themes were revealed, each with several sub themes: (1) understanding wellness amidst challenges to keep a sense of wellness in life; (2) self-appraisal: becoming aware of personal beliefs and perceptions that influence wellness; and (3) assessing LTC homes and their influence on the experience of wellness. We not only revealed more about wellness and how it is experienced in the caring context, we also discovered leisure’s role in maintaining wellness and how embedded leisure’s influence is on the various aspects of wellness that family partners in care experience. Relationship-centred care is a framework we used to guide this study. It highlights the importance of family member needs, along with the needs of the residents and staff. With our enhanced understanding of family care partner needs, recommendations were made to the Specialty Care communities so they can work together to ensure optimal wellness is maintained for all parties, including family partners in care.

Introduction: The purpose of this study was to improve family members' transfer from Intensive Care. A structured pre-transfer educational method of patient transfer was introduced and evaluated. Background of the study: Many studies have documented the needs of family members whilst in intensive care units (ICU) but few have evaluated interventions to support meeting these needs. No studies have documented 'uncertainty in illness' levels of family members around transfer from ICU or the relationship between uncertainty and anxiety. Method: The study used a quasi-experimental pre-test, post-test non-equivalent control group design based on the General System Theory (von Bertalanffy, 1972). There were four phases to the study with the intervention grounded in Knowles' Adult Learning Theory (1980). Family members of patients in an ICU were purposively allocated to a control(n = 80) and intervention group (n = 82). A pre-test, post-test strategy was used with data from the control group collected first and once completed, the intervention was introduced into the ICU. The intervention group data were then collected using the same data collection tools. The intervention group experienced a transfer method designed to improve communication with the bedside nurse in ICU whereas the control group received existing ad hoc transfer methods. Participants were surveyed before and after transfer using Spielberger et al.'s state anxiety inventory and Mishel's 'uncertainty in illness' scale. Demographic data were collected for both patients and family members together with family members' satisfaction with the transfer process they experienced. At the completion of the study, intensive care nurses (n = 40) were surveyed to assess their perception of the efficacy of the intervention. Results: Three factors were found to significantly affect levels of 'uncertainty in illness' and these included state anxiety scores (F = 50.9, p < .000), the relationship of the family member to the patient (F = 2.9, p = .022), and the unexpected nature of the admission (F = 23.09, p < .000). These factors accounted for 33% of the variance of 'uncertainty in illness' scores. State anxiety levels were significantly affected by the degree of family social support (F = 10.0, p = .002) and uncertainty as previously mentioned. State anxiety reduced significantly following transfer for both groups and 'uncertainty in illness' reduced significantly for the intervention group (t = 2.21, p = .03).When controlled for pre-transfer levels, however, there was no significant reduction in the intervention group when compared with the control group.' Uncertainty in illness' for the intervention group reduced, however, whereas scores for the control group did not. The intervention group experienced significantly higher levels of satisfaction with transfer (Z = -2.43, p = .015) and felt significantly better prepared for transfer(Z = -3.26, p = .001) than did the control group. The vast majority of ICU nurses(90.6%) thought the intervention provided a useful framework for discussing the patient's condition with family members and 94% thought it should be introduced for all transfers from ICU. Conclusions: Uncertainty is significantly related to state anxiety in this sample. Previous research suggests that individual's coping ability is affected by both anxiety and' uncertainty in illness' which limit their adaptation to the new ward situation. This results in relationship disturbances and psychological distress (Mishel, 1981)at a time when patients rely on family support. The intervention reduced uncertainty and improved family members' satisfaction with the transfer process by improved communication between family members and ICU nurses. The intervention was fully endorsed and supported by ICU nurses who recommended its introduction for all future transfers.

Introduction: The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU). Background to the study: Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment. Design of the study: This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research. Setting: This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital. Phase One: Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two. Phase Two: Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU. Phase Three: Phase Three of the study addressed research question three: &quotHow can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of &quotestablishing the context" and attitudes, confidence, empathy and culture under the theme of &quotbuilding a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2). Phase Four: Finally, Phase Four of the study has addressed research question four: &quotIs action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey. Conclusions: Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four.

Sammanfattning Bakgrund: Inom akutsjukvård behandlas och vårdas kritiskt sjuka eller skadade patienter till följd av trauma eller sjukdom. Sannolikt kommer de i sällskap av närstående som kan vara oroliga och rädda. Om patienten dessutom plötsligt avlider kan situation bli traumatisk för närstående och resultera i bestående men. Omhändertagande av närstående i dessa situationer är därför av stor vikt och ligger inom sjuksköterskans kompetensområde. Genom att belysa sjuksköterskans erfarenheter av dessa möten syftar vi till att få en djupare förståelse och öka kunskapen inom omhändertagandet av närstående i samband med plötsliga dödsfall. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att möta närstående i samband med dödsfall inom akutsjukvård, med särskilt fokus på plötslig död.  Metod: Elva vetenskapliga artiklar har analyserats i enlighet med Fribergs (2017) metod och sammanställts i en litteraturöversikt. De använda databaserna var CINAHL Complete, Medline with Full Text samt PubMed. Både kvalitativa och kvantitativa artiklar inkluderades i resultatet.  Resultat: Denna litteraturöversikt resulterade i fyra huvudteman: sjuksköterskans upplevelser och uppfattning av dödsfall. Arbetsrelaterade faktorer med underteman utbildning, erfarenhet och miljöns påverkan. Närvaro av närstående med underteman vid återupplivningsförsök och hos döende patienter Sjuksköterskans roll i mötet med närstående med underteman sjuksköterskans kommunikativa roll och sjuksköterskans praktiska roll. Diskussion: I metoddiskussionen diskuterades styrkor och svagheter med litteraturöversikten. Styrkorna låg i författarnas gemensamma arbete att hitta relevanta vetenskapliga artiklar samt att vidare minska risken för språkliga feltolkningar då artiklarna var skrivna på engelska. I resultatdiskussionen diskuterade författarna den emotionella påverkan sjuksköterskor kan uppleva samt sjuksköterskans roll i samband med plötsliga   dödsfall. Vidare diskuterades hur närstående kunde påverkas av bristen på avskildhet inom akutsjukvården och hur det kunde relateras till Roys adaptionsmodell. Resultatet diskuterades även mot bakgrunden samt annan forskning.   Nyckelord: Sjuksköterskans erfarenheter, närstående, akutsjukvård, plötslig död. / Abstract  Background: In emergency medical care critically sick or injured patients are being cared and treated for following trauma or disease. They are likely accompanied by their family members who can be frightened and scared. If the patient also suddenly dies the situation can be traumatic for the family members and result in lasting marks. The care of family members in these situations is there for important and this lies within the nurses’ area of   competence. By illustrating nurses’ experiences of these encounters we aim to receive a deeper understanding and knowledge in caring for family members in conjunction with sudden death.      Aim: The aim was to illustrate nurses’ experiences of encountering with family members in conjunction with death in emergency medical care, with a particular focus on sudden death. Method: Eleven scientific articles were analyzed in accordance with Fribergs (2017) method and complied in a literature review. The databases CINAHL Complete, Medline with Full Text and PubMed were used. Both quantitative and qualitative articles were included in the   result.   Results: This literature review resulted in four main themes: Nurses experiences and perception of death. Work related factors with subthemes education, experience and environmental impact. Presence of family members with subthemes during resuscitation attempts and with dying patients. Nurses role while encountering with family members with subthemes nurses communicative role and nurses practical role. Discussion: In the method discussion the authors discussed strengths and weaknesses with the literature review. The strengths were a joint effort to find relevant scientific articles and to further reduce the likelihood of linguistic misinterpretations when the articles were written in English. In the outcome discussion, the authors discussed the emotional impact nurses may experience as well as the nurse's role in the event of sudden deaths. Furthermore, it was discussed how family members could be affected by the lack of privacy in emergency medical care and how it could be related to Roys adaptation model. The result was also discussed against the background and other research. Keywords: Nurses experiences, family members, emergency medical care, sudden death.

Made available in DSpace on 2016-12-23T13:46:55Z (GMT). No. of bitstreams: 1 Convivencia familiar com o idoso acometido pela Doenca de Alzheimer.pdf: 1043450 bytes, checksum: 33c7137dec1f2fd0daf9753525f94d36 (MD5) Previous issue date: 2006-12-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Trata-se de um estudo de caso de dois casos , que visa compreender a convivência familiar com o idoso acometido pela Doença de Alzheimer (DA), por meio da investigação de suas características, de como o diagnóstico foi percebido e assimilado pela família, da observação das informações sobre a doença, dos suportes recebidos e da maneira que lidam com esta convivência. Foram entrevistados 11 familiares de dois idosos: 05 do caso 01 (José), acometido pela DA há seis anos e usuário de serviços públicos de saúde; 06 do caso 02 (Maria), há doze anos com DA e usuária de serviços particulares de saúde. Foi utilizado um roteiro de entrevista contendo perguntas norteadoras sobre o paciente, a família, os cuidados prestados e a convivência com o doente. Os depoimentos foram analisados através do método Análise de Conteúdo e da técnica Análise Temática. Os temas encontrados foram: relações familiares, assistência à saúde, cuidados prestados, mudanças, enfrentamento e necessidade de suporte. Constatou-se que os familiares estão sujeitos a sobrecargas de ordem física, psíquica e emocional; os cuidados prestados são exercidos, principalmente, por mulheres e estão relacionados às necessidades fisiológicas; as principais mudanças ocorridas na família foram observadas na rotina, nos papéis e na perda dos sonhos, por parte dos familiares; o diagnóstico foi assimilado considerando o grau de instrução do familiar e as informações prévias sobre a doença; estas foram fornecidas pelos profissionais de saúde dos serviços que utilizam; os suportes recebidos correspondem à ajuda mútua entre os membros da família e o auxílio nos cuidados é feito por cuidadoras informais contratadas, que não são profissionais de saúde, não pertencem à família, mas possuem vínculo afetivo; o enfrentamento de situações difíceis da convivência se dá por meio da crença e fé em Deus; as necessidades de suporte são: fornecimento de informação sobre a doença para a família e para a população; criação de espaços para discussão sobre o assunto; e, identificação precoce da doença por parte de pessoas leigas, para que possam buscar ajuda profissional. Concluiu-se que os familiares devem ser tratados como clientes pelos serviços de saúde, pois também estão submetidos ao adoecimento decorrente do estresse gerado pela convivência familiar com o idoso acometido pela Doença de Alzheimer. / It consists of a case study of two cases that aims to comprehend the way that families live and cope with elderly sufferers of Alzheimer s disease (AD) through the investigation of the family characteristics, the way the diagnostic was perceived and understood by them, their level of information about the disease, received support and the way they cope with the situation. Eleven family members of 2 elderly were interviewed: 05 from case 1 (José) who suffers from AD for 6 years and uses the public health service; 06 from case 2 (Maria) who suffers from AD for 12 years and uses the private health service. The interview schedule comprised of orientating questions about the patient, the family, the care given and the daily life with the ill. The interviewees speeches were analysed through the Content Analysis Method and the Thematic Analysis technique. The themes found were: family relations, health assistance, care given, changes, coping and support need. It was observed that family members are submitted to physical, psychological and emotional strains; the care of the sick is mainly given by women and is related to the sick physiological needs; the main observed changes in the family life occurred in their routine, in their roles and sleep patterns. Given the levels of schooling and knowledge about the disease, family members were capable of understanding the diagnostics and such information about the disease was given by health professionals. The received support consists of: mutual help in between family members and the aid of informal contracted carers who are not health professionals and do not belong to the family but have an emotional bond. Coping with the difficult situation of living with the ill is overcome by faith in God. The main support needs are: information supply to the family members and general public; creation of discussion channels for the subject; early identification of disease by laypeople so they can reach professional help. It was concluded that family members must be treated by the health services as clients since they also become ill due to the strains of living and coping with the elderly sufferers of Alzheimer s disease.