Thesis (Ph. D.)--Open University.

published_or_final_version / Public Health / Master / Master of Public Health

China has 9 million elderly individuals with dementia, which places it first in the world. Although family care remains the major source of support for people with dementia, residential care has become an indispensable choice in recent years. The biggest concern is the quality of life of the elderly with cognitive impairment or dementia (QOL-ECI) in residential care facilities (RCFs). Previous studies have explored many individual-level factors associated with QOL-ECI; however, less discussion has been conducted on how to improve it from an organizational-level perspective. China serves as a good research setting for this issue. The present study aims to establish an organizational-level framework to investigate QOL-ECI in RCFs. The Person-centered Care (PCC) Approach serves as an organizational strategy, and the High Commitment Work System (HCWS) is used as a human resource management practice. The study exposes the QOL-ECI status of RCFs in Xi’an China; and examines the relationship between PCC/HCWS and QOL-ECI respectively and jointly. A quantitative research method, survey in particular has been designed to achieve the research objectives, and has been conducted in two phases. Phase one of the study aims to validate a Chinese Version of the Person-centered care Assessment Tool (P-CATC), which is designed to measure the extent to which formal caregivers rate their facility as being person-centered. The resulting 24-item P-CAT-C is validated among a sample of full-time employees (n=330) in all 34 RCFs in urban Xi’an, a city in China. Phase two is a survey conducted among the same 34 RCFs. Full-time employees (n=330) evaluated the HCWS level for each RCF; residents with cognitive impairment (n=307) and their respective personal care workers (n=207) were invited to evaluate QOL-ECI. Hierarchical Linear Modeling (HLM) has been adopted to test the hypothesis. In phase one study, Confirmatory Factor Analysis (CFA) shows that a three-factor 15-item solution of the P-CAT-C provided adequate fit indices to the data (χ2 = 145.69, df = 81, p< 0.001, CFI = 0.93, TLI=0.91; RMSEA = 0.05). The internal consistency coefficient (Cronbach’s α=0.68) is satisfactory. The inter scale correlation shows good construct validity. The result of Phase two study shows that the total mean patient-rated QOL-ECI score is 36.06 (SD=8.16) and the caregiver-rated score is 34.09 (SD=6.88). Using caregiver-rated QOL-ECI as the dependent variable, the HLM regression analysis shows that PCC and HCWS are statistically significant with QOL-ECI respectively, and that the HCWS has a positive moderate effect on the relationship between PCC and QOL-ECI. Using patient-rated QOL-ECI as the dependent variable, the hypotheses are partially supported. This study is among the first to report the QOL-ECI status of RCFs in China. It initially demonstrates that PCC and HCWS are positively associated with QOL-ECI both respectively and jointly. It also primarily establishes an organizational-level framework to examine QOL-ECI. This will generate valuable implications and insight into research, practice and policy-making. Finally, this study further develops the PCC theory from an organizational perspective, and contributes to both management and social work literature by first adopting the HCWS for service organizations for the elderly. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

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Syftet med studien som presenteras i denna uppsats var att undersöka vad som anses viktigt i SiS-institutioners behandlingsarbete med personer mellan 13-20 år, som har ett kriminellt förflutet, och som skall socialiseras in i samhället. Vi som skrivit den har genomfört en kvalitativ studie som bygger på intervjuer med fem yrkesverksamma behandlingsassistenter på två SiS-institutioner. Av dessa fem intervjuer var två stycken direktintervjuer som genomfördes i en lokal på institutionen, och tre av intervjuerna genomfördes via telefon. Det som har varit genomgående för studien har varit att vi har haft ett hermeneutiskt synsätt där tolkningar av behandlingspersonalens åsikter har varit centrala. För att bearbeta vårt empiriska material har vi använt oss av innehållsanalys vilket gav oss möjlighet att utläsa de likheter och skillnader som fanns i personalens utsagor. Resultatet av vår studie är att relation, utbildning och förbättrad psykosocial funktionsförmåga anses vara de viktigaste faktorerna i deras behandlingsarbete. / The aim of this study was to investigate what is regarded important in SiS institutions treatment work, with persons between 13-20 years which has a criminal past and is going to be socialized in the community. We who have written this essay have conducted a qualitative study which builds on interviews with five attendants employed at two SiS- institutions. Two interviews where performed in person and three on telephone. The study has been based on a hermeneutic approach in the interpretation of our transcribed interviews. To process our empirical material we have applied content analysis, which gave us opportunity to search for and find similarities and differences that were in the informants statements. The result that emerged from our study was relation, education and psychosocial functioning, this was regarded as the most important factors in their treatment work.

This study investigates some of the variations in factors underlying the identification of children as mental defectives and the decision to commit them to an institution. The fieldwork was carried out at the State Training School for Mental Defectives in St. Louis, Missouri. The data consist of material abstracted from case records of eighty-seven recent admissions to the institution and of interviews with parents of twenty of these children. [...]

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In the context of integration of the Lithuanian social service sector into the international social security system of the European Union where relations of market economy are getting more and more stronger, it is important to substantiate the trends and priorities for efficient development of the mentioned services. In order to ensure rendering of one of the types of the mentioned services – institutional care services – for elderly population not only by the objective structure and scope, but also to ensure sufficient funding thereof, it is necessary to identify the priorities and principles of efficient rendering of the mentioned services. Researches carried out in the European Union show that most of the goals of effectiveness of institutional care services (further – “the ICS”) for the elderly are short-term, driven to technical efficiency, where efforts are taken to render maximal quantity of services (of the definite quality) for the minimal ICS costs. However, the increasing need for these services in a result of new changes in the structure and values of the society is not adequate to public resources and does not ensure satisfaction of the ICS need either. As we can see from EU and Lithuanian experience, the old model of rendering of the mentioned services, which is based on the unified conception of the customers, is not a long-term model, as it does not meet the objectives of economic and social efficiency. Researches covered by this thesis demonstrate that... [to full text]

The study problem was that sane individuals found institutionalizing a family member stressful, and family members required assistance in coping. The purposes of the study were to examine threat appraisal, degree of threat, and coping responses in a sample of family members of newly institutionalized elderly. The study was a descriptive correlational investigation which utilized Lazarus' theory of stress and coping as the theoretical framework.There were 21 questionnaires received from a convenience sample obtained through four nursing hens in the vicinity of a small city in Indiana. Five major categories of threat were identified. A high degree of threat was associated with each category. Both problem-focused coping and emotion-focused coping were utilized.Pearson product-mcinent correlation was used to determine that no significant relationship existed between coping responses utilized and degree of threat. ANOVA was used to reveal that there were no significant differences between coping responses utilized and demographic variables. Each scale was determined to be reliable by usage of Cronbach's alpha. / School of Nursing

This thesis explores the communication of a group of older people with dementia living in a residential care home and specifically, seeks to understand how living with dementia in a care home influences communication. The study draws broadly on a symbolic interactionist perspective and uses an ethnographic, inclusive, video methodology. In so doing, the study grounds the research in the experiences of the older residents with dementia and explores communication as it is interwoven with social life. The empirical data, on which this thesis is based, were gathered over the course of six months in one residential care home in Central Scotland. Analysis of these data, in conjunction with the theoretical literature informing the study, led to the development of a framework and a set of concepts to understand the communication of the older people with dementia living in residential care. This framework was used to examine the ways in which the older residents' experiences of institutionalisation, ageing, and dementia, generally, and of life in the care setting, specifically, influenced their communication. The findings revealed that the older residents made diverse meanings of their experiences in the home, and mat many of the meanings that they made were threatening to their self-identity, self-determinacy and social relationships. The residents engaged in a range of strategies to respond to the impact of these meanings and to negotiate their life in the care home. The research presented in this thesis has many implications for understanding the experiences of older people with dementia in residential care. In particular, the research highlights the need for a new social understanding of dementia, that examines the experience of dementia in relation to broad structural and cultural processes and that seeks to promote the social inclusion and citizenship of older people with dementia.