This paper will cover the following subject areas: a brief history of attitudes toward and treatment of the retarded, to give an historical perspective to current developments; a review of current research of attitudes toward the retarded; a statement of the research question and the research design; the results of this research; and a concluding discussion.

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Thesis advisor: Marilynn S. Johnson / This dissertation explores the labor and collective organization of domestic workers in metropolitan Boston to uncover the new labor activism of the last half century. In 2014, Massachusetts became the fourth state in the U.S. to pass a Domestic Workers’ Bill of Rights. The law, the nation’s most comprehensive at the time, signaled a remarkable triumph for household employees whose collective activism anchored in Boston over four years achieved basic labor protections for tens of thousands. While the tale of this recent success has been captured by journalists and a handful of scholars, my study uncovers a multi-generational history of domestic workers’ fight for dignity and economic justice. I locate the origins of the 2014 victory in the grassroots organizing of pioneering Black, Caribbean, and Latinx women decades earlier. Local domestic workers and their allies sustained three separate waves of collective action during a half century marked by growing economic inequality, a decline in trade unionism, and mounting xenophobia. As I demonstrate, they developed a savvy repertoire of strategies that transformed household employment from a seemingly private, hidden affair into a societal concern requiring government intervention. Ultimately, my dissertation explains the emergence of a powerful and unexpected form of labor organizing--the new labor activism--that is community-based, multi-issue oriented, and propelled by working-class women of color. In directing critical attention to the relatively obscure history of domestic worker organizing, my study joins scholarship that expands analysis beyond the realm of the white male industrial worker to reconsider what constituted work, who comprised organized labor, and how we characterize recent labor history. By examining this particular workers’ movement, I present new insights into the groundswell of labor mobilization that erupted in American cities during the later twentieth century. Historians have accurately cast the period as one of organized labor’s weakness, dormancy, and decline. Even so, by prioritizing community-based campaigns anchored by immigrant and non-white women employed as domestic workers, I demonstrate that they also made it a time of hope and agitation, of rebirth and revival rather than repose. With appreciation for complexity, I gauge their activism not merely in terms of wins and losses, but also in regard to workers’ evolving sense of empowerment alongside their ability to spark larger public policy conversations concerning labor standards, the care economy, and the role of government. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: History.

Bakgrund: Allt fler patienter med palliativt vårdbehov vårdas i hemmet. Detta kan skapa en komplex situation för den närstående då det kan upplevas betungande att vårda en svårt sjuk familjemedlem. Det är därmed värdefullt att vårdpersonal har kunskap om bemötandet av närståendes behov för att kunna ge anpassat stöd att hantera sin och den sjuke familjemedlemmens situation. Detta gör det betydelsefullt att undersöka närståendes upplevelser av vilka åtgärder och insatser denne är i behov av.  Syfte: Att beskriva närståendes behov av stöd när en familjemedlem vårdas med palliativ vård i hemmet. Metod: Studien genomfördes som en litteraturöversikt. En deduktiv analysprocess genomfördes där kodningen skedde utefter ett befintligt teoretiskt ramverk av Andershed och Ternestedt (1999) som sedan prövades gentemot aktuell forskning. Resultat: Att närstående kunde få möjlighet att förbereda sig genom information kring palliativ vård men också kring praktiska åtgärder och sjukdomsförlopp möjliggjorde en ökad trygghet hos närstående. Att få bekräftelse och bli sedd var något närstående ansåg som betydande. Vårdpersonalens tillgänglighet under dygnets alla timmar var av vikt men även att de tog tid för patient och närstående. Hjälp med praktiska göromål var av vikt då närståendes möjlighet att få tid för sig själv och avlastning visade sig vara en bärande punkt. Även samordning med andra professioner och vårdgivare ansågs värdefullt, liksom optimering av hemmiljön för att underlätta vården. Slutsats: Om de närstående får stöd anpassat efter deras behov underlättas deras situation och känsla av utsatthet kan minska. Generellt behöver närstående kunskap, trygghet och avlastning. Palliativ vård ställer krav på vårdpersonals förmåga att möta de närstående på en individanpassad nivå där denne befinner sig för att kunna möta de närstående med insatser efter deras behov.

Home health services are increasing for elderly individuals diagnosed with chronic diseases which are often treated by diet modification. This study was undertaken to evaluate the diabetic homebound client's understanding of and compliance to his/her prescribed diet. An interviewer assisted modified food frequency and food habit questionnaire was completed by 20 male and 28 female home care clients, ranging in age from 51 to 91 years. Living in a metropolitan area, these respondents met the Medicare definition of homebound and were diagnosed with diabetes mellitus. Computer driven dietary analysis was completed from questionnaire responses to estimate the food and nutrient intake of the home care clients. Calculated food intake was compared to physician diet orders taken from the home care medical record and to respondents' verbalization of their diet orders. This comparison was based on the composite diet and the components of energy, sodium, and cholesterol or fat. These findings were evaluated according to sex, age, length of time respondent had been diagnosed as diabetic, and a vulnerability index based on living situation using Chi square methods. / Master of Science

Introduction Patients with intestinal failure (IF) develop problems of malabsorption and malnutrition associated with short bowel syndrome (SBS). Home parenteral nutrition (HPN) became available to treat these patients since the 1970s. There is a paucity of qualitative research on patients’ experiences in the UK. The study aim was to generate theory that explains the experiences of adults living with HPN and complex medication regimens. Method The grounded theory methodology was used to explore the experiences and to generate theory about this health intervention. Twelve participants were interviewed. The interviews were recorded and transcribed verbatim. The joint process of data collection and analysis followed the principles of constant comparative approach. Results The core categories of stoma care and HPN treatment were supported by the subcategories of maintaining stoma output, access to toilets, maintaining HPN infusion routine, access to technical help to set up HPN infusion, and general health changes. Strategy used to manage living with loss was demonstrated by the subcategory of maintaining daily activities and social interactions. Discussion The theory of living with loss suggests that patients with a stoma receiving HPN experience the sense of loss at home and in social situations. Opportunities for professional practice development are detailed along with implications for future research. Conclusions The findings resonate with the Kubler-Ross Model of the five stages of grief (Kubler-Ross, 1970). The theory of living with loss was generated by the use of the grounded theory methodology. This study identified opportunities for changes and improvement in clinical practice.

Background: Because we are living longer today, the need for healthcare is increasing. Therefore, the need for care at home also increases, which can be a challenge for the nurse to provide. Teamwork means that those involved in the patients’ care use their competencies to complement each other. Nurses are responsible for care, the leadership role includes sharing knowledge, supervising, and giving colleagues feedback. Aim: The aim was to examine nurses’ experiences of teamwork in care at home. Method: This qualitative based literary study included ten articles, searched, and selected from the databases Cinahl and Pubmed. They were analysed using Friberg’s (2017) five steps model. Results: Lack of communication was an obstacle for cooperation, such as language difficulties, insufficient communication of information between colleagues and problems finding information related to different record systems. Hierarchy, mistrust of each other’s competence and uncertainty about who had the overall responsibility for the patient were other difficulties. Having a pleasant tone while talking, being humble and listening to each other was important. If the doctor was available was seen as positive as well as knowing each other in the team since before. Working alone was challenging and in complex situations nurses were happy to collaborate in pairs. It was desirable to have group reflections and supervision mentoring.  Conclusion: The conclusion was that communication and attitudes towards each other are essential for cooperation. Group reflections and tutoring guidance can increase cohesion and team strength. / Då vi lever allt längre och uppnår högre åldrar, ökar behovet av hälso- och sjukvård. Således ökar även behovet av vård i hemmet. Vård i hemmet gavs under år 2021 till 388 000 personer i Sverige. Teamarbete innebär att de inblandade i patientens vård använder sina kompetenser för att komplettera varandra. Sjuksköterskan är omvårdnadsansvarig, och i ledarrollen ingår att dela med sig av kunskap, samt handleda och ge återkoppling till kollegor. Vård i hemmet kan vara en utmaning för sjuksköterskan att ge. Syftet med denna litteraturstudie var därför att undersöka sjuksköterskors erfarenheter av teamarbete vid vård i hemmet. Metoden som användes var litteraturbaserad studie, där tio vetenskapliga artiklar av kvalitativ ansats analyserades och sammanställdes till ett nytt resultat. Resultatet visade att bristande kommunikation sågs som ett hinder för samarbete. Svårigheterna visade sig i form av språkförbistringar, otillräcklig förmedling av information kollegor sinsemellan, samt svårigheter att ta till sig information på grund av olika journalsystem. Det ansågs viktigt att ha en trevlig ton vid samtal, samt att vara ödmjuk och lyssna till varandra. Maktobalans mellan medlemmarna i teamet, och misstro till varandras kompetens, ledde till en försämrad kommunikation. Det kunde vara otydligt vem som hade det övergripande ansvaret för patienten, vilket också försvårade samarbetet. Att känna varandra sedan tidigare framkom som positivt för samarbetet. Att läkaren fanns tillgänglig när sjuksköterskan behövde råd, samt att alla i teamet var delaktiga kring patienten, ansågs också främjande. Sjuksköterskorna upplevde det som utmanande med ensamarbete, och samarbetade gärna i par när komplexa situationer uppstod. Att vara omvårdnadsansvarig och leda teamet krävde ett stort ansvar. Utveckling i form av gruppreflektioner och mentorskap med handledning var önskvärt. Slutsatser som drogs var att kommunikation är a och o för att samarbetet ska fungera. Även förhållningssätt mot varandra var viktigt, det vill säga att ha en trevlig ton i samtal, att se alla som lika värda och att inte se ner på någons kompetens främjar samarbetet. Genom gemensamma reflektioner och handledning kan samhörigheten ökas och teamet stärkas.

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Background. The consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home. Purpose. To compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic. Methods. A retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the over 280-item interRAI PC instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14th, 2019 to March 16th, 2020) and COVID cohort (March 17th, 2020 to May 18th, 2021). A propensity score analysis was used to match on 21 covariates, resulting in a sample size of 2479 unique interRAI PC assessments per cohort. Alternative propensity score methods were explored as part of a sensitivity analysis. Results. After matching the pre-COVID and COVID cohorts (using nearest neighbour matching), five of the 16 QIs had statistically-significant differences in the QI rates. The two alternative propensity score methods produced slightly different results with fewer statistically-significant differences between the cohorts. However, in examining the effect sizes, the results of all propensity score methods were found to be not clinically meaningful. High rates of the prevalence of shortness of breath with activity, no advance directives, and fatigue were observed in both cohorts and across all three propensity score methods. Discussion. This study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. Key limitations in interpreting the results include a limited understanding of the typical variation in QI rates over time and reliance on the comparison of a single proportion (the QI) in judging potential differences in quality. Importantly, a strength of this study was that these QIs focused on outcomes of care and were mainly symptom-focused as aspects of high-quality care valued by home care clients and families and in contrast to previous studies focusing on structure and processes of care. These QIs also indicated how frequently quality concerns may be occurring for those receiving palliative and end-of-life home care. Conclusion. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries and in creating benchmarks to project acceptable rates of different QIs. / Thesis / Master of Science in Nursing (MSN)