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The purpose of this thesis has been to explore the discursive production of delirium in people over the age of 65 years. The philosophical approaches underpinning the study were derived from the field of critical gerontology, postmodernism and the utilisation of a Foucauldian understanding of discourse and power/knowledge. Data sources included published documents on delirium, interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, registered nurses and a doctor.Textual analysis revealed the presence of two contesting and contradictory discourses that impacted on being an older person who had delirium. These were identified as the discourse of delirium as a syndrome and a personal discourse of delirium. The discourse of delirium as a syndrome is underpinned by the biomedicalisation of the ageing process. This process utilises scientific methods as the foundation from which to understand, research and provide a health service to older people with delirium. Any personal perspectives on delirium are rendered unimportant and relegated to marginalised positions. Nursing through its vicarious relationship to medicine is interpellated into deploying the discourse of delirium as a syndrome and has largely ignored the personal dimensions associated with this phenomenon. Consequently, the older delirious 'body' is known and inscribed as unruly, problematic, physically unwell, cognitively impaired and at risk.Conversely, a personal discourse of delirium privileges the individual narratives of people who have been delirious and provides a different perspective of delirium. The deployment of a personal discourse of delirium offers another position that views this group of older people as bringing to the health care setting a rich tapestry of life experiences that are more than a cluster of signs and symptoms. It is these varied life experiences that need to be included as a legitimate source of knowledge about delirium. This thesis demonstrates how nursing needs to espouse a critical gerontological position when working with older people who have delirium. Critical gerontology provides nurses with the theoretical tools to challenge the status quo and uncover the multiple, varied, contradictory and complex representations of delirium in older people.

The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings. The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals. The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness. The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ. The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.

The aim of the research was to improve Taiwanese undergraduate nursing students' attitudes toward and knowledge about older people in order to encourage them to work with older people. People aged 65 and over currently make up 9.7% of the Taiwanese population (Department of Statistics 2006). With the increasing population of older people, health care professionals will have more experiences of caring for older people. However, an increasingly large body of literature suggests that most health care professionals have negative attitudes toward older people and little knowledge about older people. Studies from Western countries have indicated that attitudes toward and knowledge about older people can be improved through a variety of educational efforts. Two studies were conducted to examine these issues. Study 1 involved a cross sectional survey of 302 nursing students from four-year and two-year programs in a university in southern Taiwan. Overall, the results showed that nursing students held positive attitudes toward older people but had poor knowledge about older people. Moreover, the findings suggested that nursing students' intention to work with older people and gender were important factors influencing their attitudes toward older people. Age, nursing program, and living with older people were the variables which made independent contributions to knowledge about older people. Study 2 was a quasi-experimental design using pre-post tests with an intervention (experiental based learning) and control group (usual lecture based learning) (n = 60) to test the impact of a gerontological educational subject. Focus group data were also collected to examine students' reactions to the gerontological nursing subject and the experiential learning strategies used in an experiential-based learning group. The sample was students in the second semester of their second year from the same university used for Study 1. All 60 students were randomly assigned into either experiential-based learning or lecture-based learning groups for their gerontological nursing subject. The data were collected across three time points (pre-test, week 16 and week 20) using 2 validated instruments from Study 1. Qualitative data were also collected from the experimental group after students' clinical practice at week 20. In order to test for the effect of the intervention over time, repeated measures analysis of variance was used to determine the effectiveness of the experiential learning approach and clinical practice on each of the dependent variables of attitudes and knowledge. The results of Study 2 indicated that students' attitudes toward and knowledge about older people did not differ between the two groups In addition, there was no change in attitudes following the completion of the gerontological nursing subject. Students in both groups had improved their level of knowledge at the end of the gerontological subject. Therefore, the study hypotheses were not supported. Several factors such as lack of linkage between theoretical concepts and experience, the dominant 'exam culture', students' usual learning style and the structure of the program may explain the results. This was the first study which had introduced experiential learning into the selected university. It was necessary to conduct this initial study to understand the students' reaction to it. Therefore, based on the research findings from both the quantitative and qualitative results, the study indicates that additional studies are needed to continue exploring how experiential learning strategies may be used to improve students' attitudes toward and knowledge about older people.

Trata-se de um estudo quantitativo, com abordagem descritiva e comparativa, que objetivou verificar a influência da consulta de enfermagem gerontológica no nível de adesão terapêutica dos clientes com doenças crônicas não-transmissíveis, acompanhados num ambulatório especializado. Como objetivo específico, buscou-se comparar o nível de adesão terapêutica, perfil sociodemografico e clínico entre o grupo de clientes acompanhados na consulta de enfermagem e o grupo dos não acompanhados. Este foi motivado pela práxis da autora em consultas gerontológica, onde foram percebidos obstáculos enfrentados por muitos clientes com adesão inadequada ao tratamento, acarretando dificuldades no controle de suas doenças, fato este ratificado pela literatura. Os resultados evidenciaram similaridade entre os perfis sociodemográficos, com prevalência de sexo feminino, baixa escolaridade e renda. O perfil clínico revelou, em ambos os grupos, alto índice de hipertensão, diabetes e depressão, destacando-se esta última por ser desfavorável ao comprometimento com o autocuidado. Por fim, verificou-se que os níveis de adesão terapêutica ficaram majoritariamente dentro da faixa estabelecida como adesão ampla, sem diferença expressiva entre os grupos. É relevante citar que, entre os acompanhados pela consulta de enfermagem, observou-se, um maior conhecimento sobre a doença em tratamento e suas manifestações, maior acesso aos medicamentos e auto percepção de conhecimentos sobre efeitos colaterais. Constatando-se que, este último achado, exerce grande influência na adesão ao tratamento farmacológico. Este desfecho reflete a importância de uma assistência sistematizada, embasada em uma teoria de enfermagem, que neste contexto, foi a teoria do autocuidado de Orem, utilizada previamente nas consultas de enfermagem do ambulatório investigado. Os resultados corroboram o uso desta teoria, especialmente numa perspectiva educativa da assistência ambulatorial. Diante disso, é mister buscar novas abordagens de pesquisa, a fim continuar a investigação sobre as contribuições da enfermagem para uma melhor adesão terapêutica dos clientes idosos. Finalmente, a autora espera cooperar para o aprimoramento científico nesta matéria e para uma progressiva qualificação da assistência de enfermagem na prevenção e controle de agravos à saúde. / Using quantitative, descriptive and comparative approaches, this work aims at assessing the influence of the gerontological nursing consultation on treatment adherence of elderly clients with non-transmissible chronic illnesses in a specialized clinic. Urged by her experience, the author noticed difficulties faced by many elderly, leading to low levels of treatment adherence, and consequently to difficulty controlling their illnesses, a fact confirmed by the established literature. This study aims specifically, to compare both the level of adherence, of nursing consulted group with that of a non-consulted, and the sociodemographic and clinical profiles of the aforementioned groups. Results evidenced similarity between sociodemographic profiles, with the prevalence of female gender, low education and income. The clinical profiles showed a high degree of hipertension, diabetes and depression in both groups, the last one, with a considerable disadvantage to the commitment to self-care. The nursing consulted group client displayed a greater knowledge of the disease and its manifestations along the treatment, an increased access to medications, and knowledge about their side effects. Finally it was concluded that adherence levels it was good one, with no significant difference between groups. Such outcome reflects the importance of a systematized care, based on Orem's self-care theory, long deployed in gerontological nursing consultations in the aforementioned clinic. The results corroborate the use of Orem's theory, mostly in an educational perspective of the outpatient care. It is thus momentous to pursue new approaches in order to research nursing contributions to attain a higher degree of adherence of the elderly client. Lastly, the author hopes to contribute to the improvement of the knowledge in this field and to the onward qualification of nursing care in illness prevention and control.

Trata-se de um estudo quantitativo, com abordagem descritiva e comparativa, que objetivou verificar a influência da consulta de enfermagem gerontológica no nível de adesão terapêutica dos clientes com doenças crônicas não-transmissíveis, acompanhados num ambulatório especializado. Como objetivo específico, buscou-se comparar o nível de adesão terapêutica, perfil sociodemografico e clínico entre o grupo de clientes acompanhados na consulta de enfermagem e o grupo dos não acompanhados. Este foi motivado pela práxis da autora em consultas gerontológica, onde foram percebidos obstáculos enfrentados por muitos clientes com adesão inadequada ao tratamento, acarretando dificuldades no controle de suas doenças, fato este ratificado pela literatura. Os resultados evidenciaram similaridade entre os perfis sociodemográficos, com prevalência de sexo feminino, baixa escolaridade e renda. O perfil clínico revelou, em ambos os grupos, alto índice de hipertensão, diabetes e depressão, destacando-se esta última por ser desfavorável ao comprometimento com o autocuidado. Por fim, verificou-se que os níveis de adesão terapêutica ficaram majoritariamente dentro da faixa estabelecida como adesão ampla, sem diferença expressiva entre os grupos. É relevante citar que, entre os acompanhados pela consulta de enfermagem, observou-se, um maior conhecimento sobre a doença em tratamento e suas manifestações, maior acesso aos medicamentos e auto percepção de conhecimentos sobre efeitos colaterais. Constatando-se que, este último achado, exerce grande influência na adesão ao tratamento farmacológico. Este desfecho reflete a importância de uma assistência sistematizada, embasada em uma teoria de enfermagem, que neste contexto, foi a teoria do autocuidado de Orem, utilizada previamente nas consultas de enfermagem do ambulatório investigado. Os resultados corroboram o uso desta teoria, especialmente numa perspectiva educativa da assistência ambulatorial. Diante disso, é mister buscar novas abordagens de pesquisa, a fim continuar a investigação sobre as contribuições da enfermagem para uma melhor adesão terapêutica dos clientes idosos. Finalmente, a autora espera cooperar para o aprimoramento científico nesta matéria e para uma progressiva qualificação da assistência de enfermagem na prevenção e controle de agravos à saúde. / Using quantitative, descriptive and comparative approaches, this work aims at assessing the influence of the gerontological nursing consultation on treatment adherence of elderly clients with non-transmissible chronic illnesses in a specialized clinic. Urged by her experience, the author noticed difficulties faced by many elderly, leading to low levels of treatment adherence, and consequently to difficulty controlling their illnesses, a fact confirmed by the established literature. This study aims specifically, to compare both the level of adherence, of nursing consulted group with that of a non-consulted, and the sociodemographic and clinical profiles of the aforementioned groups. Results evidenced similarity between sociodemographic profiles, with the prevalence of female gender, low education and income. The clinical profiles showed a high degree of hipertension, diabetes and depression in both groups, the last one, with a considerable disadvantage to the commitment to self-care. The nursing consulted group client displayed a greater knowledge of the disease and its manifestations along the treatment, an increased access to medications, and knowledge about their side effects. Finally it was concluded that adherence levels it was good one, with no significant difference between groups. Such outcome reflects the importance of a systematized care, based on Orem's self-care theory, long deployed in gerontological nursing consultations in the aforementioned clinic. The results corroborate the use of Orem's theory, mostly in an educational perspective of the outpatient care. It is thus momentous to pursue new approaches in order to research nursing contributions to attain a higher degree of adherence of the elderly client. Lastly, the author hopes to contribute to the improvement of the knowledge in this field and to the onward qualification of nursing care in illness prevention and control.

Made available in DSpace on 2016-04-27T18:47:13Z (GMT). No. of bitstreams: 1 Rosalina Rosana do Vale.pdf: 151121 bytes, checksum: 915a03896ea16f7f6840386e8ed28d13 (MD5) Previous issue date: 2013-08-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aging process underway in Brazilian society coupled with increased life expectancy has the effect of the high number of elderly people over 60 years. Given this, it is relevant to new reflections and analyzes of health promotion and disease prevention in the elderly population aging situation. This paper is a literature review conducted in academic articles and books that deal with the theme of Gerontological Nursing. In this sense, I tried searching dissertations conducted by nurses in the Post- Graduate in Gerontology, thinking that contribute to the interfaces between the Nursing and Gerontology, reflecting on the contributions of Gerontological Nursing to think about the present and the challenges for nursing professionals regarding the expansion of the aging population and specific care for older people / O processo de envelhecimento em curso na sociedade brasileira, acoplado ao aumento da expectativa de vida, tem como efeito o elevado número de pessoas idosas acima dos 60 anos. Diante disto, tornam-se relevantes novas reflexões e análises acerca da promoção e prevenção da saúde do idoso na conjuntura do envelhecimento populacional. Este trabalho é um levantamento bibliográfico desenvolvido em artigos acadêmicos e livros que versam sobre o tema da Enfermagem Gerontológica. Procurei pesquisar dissertações produzidas por enfermeiros no Programa de Pós-Graduação em Gerontologia, que contribuem para pensar as interfaces entre a Enfermagem e a Gerontologia. Trabalhos que refletem sobre a contribuição da Enfermagem Gerontológica na análise do presente e os desafios para os profissionais de Enfermagem em relação à ampliação do envelhecimento da população e aos cuidados específicos destinados às pessoas idosas

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-11-27T16:44:17Z No. of bitstreams: 1 Analyane Conceiçao Silva dos Santos.pdf: 1957953 bytes, checksum: 375e557949aa5701d3b89e20e99b03a5 (MD5) / Made available in DSpace on 2015-11-27T16:44:17Z (GMT). No. of bitstreams: 1 Analyane Conceiçao Silva dos Santos.pdf: 1957953 bytes, checksum: 375e557949aa5701d3b89e20e99b03a5 (MD5) Previous issue date: 2011 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Trata-se de uma pesquisa qualitativa, descritiva- exploratória, do tipo estudo de caso único holístico, que teve como objeto de estudo o cuidado de enfermagem ao idoso hospitalizado com insuficiência cardíaca e os seguintes objetivos discutir o cuidado descrito pela equipe de enfermagem ao idoso hospitalizado com insuficiência cardíaca, identificar os elementos componentes desse cuidado, descrever os saberes gerontológicos da equipe de enfermagem que cuida desses idosos e analisar as possíveis dificuldades enfrentadas por essa equipe de enfermagem no cuidado ao idoso hospitalizado com insuficiência cardíaca. O cenário de pesquisa foi uma enfermaria clínica-cirúrgica de uma Organização Militar de Saúde, localizada no Rio de Janeiro. Fizeram parte do estudo 16 profissionais de enfermagem que atuam na referida enfermaria clínica-cirúrgica. A coleta de dados se deu através das entrevistas com os sujeitos, da observação sistemática do ambiente físico da enfermaria e da observação participante acerca do cuidado de enfermagem ao idoso hospitalizado. Os dados receberam tratamento qualitativo através de análise de conteúdo, utilizando como técnica, a análise temática. Os resultados apontaram como elementos do cuidado de enfermagem ao idoso hospitalizado com insuficiência cardíaca, àqueles relacionados à dimensão do afeto como o saber ouvir, o carinho, a atenção, e os relacionados à dimensão da prática como a monitorização dos parâmetros vitais e a minimização de esforços. As dificuldades enfrentadas pela equipe de enfermagem na realização do cuidado ao idoso hospitalizado com insuficiência cardíaca estão relacionadas à instituição, ao idoso, ao profissional e a equipe. Os saberes gerontológicos desta equipe têm origem no cotidiano profissional, como por exemplo, o reconhecimento da complexidade do cuidado a ser realizado ao idoso hospitalizado com insuficiência cardíaca. Conclui-se que a equipe de enfermagem desempenha um cuidado baseado em elementos afetivos e práticos, aplicando saberes que advém da prática profissional, havendo a necessidade da integração destes saberes com um saber de origem teórica, adquirido através de cursos de qualificação e/ou atualização com intuito de aumentar a qualidade do cuidado oferecido ao idoso hospitalizado com insuficiência cardíaca. Contribuições para a Enfermagem: espera-se que através desta pesquisa, a enfermagem aprimore seu olhar, suas técnicas e sua abordagem ao cliente idoso com insuficiência cardíaca contribuindo para a realização de um cuidado adequado e resolutivo. / It is a qualitative, descriptive-exploratory research, of the holistic unique case study which had as object of study the nursing care to institutionalized elders with heart insufficiency and the following objectives to discuss the care described by the nursing to the institutionalized elder with heart insufficiency, to identify the elements of these care, to describe the gerontology know-how of the nursing team that takes care of these elders and to analyze possible difficulties faced by this nursing team on caring the institutionalized elder with heart insufficiency. The research landscape is a clinical-surgical ward of a Health Military Organization, located in Rio de Janeiro. Sixteen professional nurses, who work in the mentioned clinical-surgical ward, were part of the study. Data collection was made through interviews with the individuals, by means of systematic observation of the physical environment of the ward and from the participant observation about the nursing care to the institutionalized elder. Data received qualitative treatment through content analysis, using as technique the thematic analysis. The results indicated as elements of the nursing care of the institutionalized with heart insufficiency those related to the dimension of the affection as to how to know to listen, the endearment, and the attention and still those related to the dimension of the practice of monitoring of vital parameters and the minimization of efforts. The difficulties faced by the nursing team in achieving the care to the institutionalized elder with heart insufficiency are related to the institution, to the elder, to the professional and to the team. The gerontology know-how of this team has origin from the professional quotidian, as for instance the recognition of the complexity of the care to be given to the institutionalized elder with heart insufficiency. It is concluded that the nursing team offers a care based in affective and practical elements, using the know-how acquired from the professional practice and there is the need of integration of all this knowledge to a knowledge of theoretical origin, acquired through qualification and/or refreshment courses with the aim of increasing the quality of the service offered to the institutionalized elder with heart insufficiency. Contributions to the Nursing: one expects that through this research nursing improves its focus, its techniques, and its approach to the elder with heart insufficiency, contributing to the implementation of an appropriate and resolutive care.