No / This paper reports on the evaluation of the Enriched Opportunities Programme in improving well-being, diversity of activity, health, and staff practice in for people with dementia. Participants were 127 residents with a diagnosis of dementia or enduring mental health problems in three specialist nursing homes in the UK. A repeated measures within-subjects design was employed, collecting quantitative and qualitative data at three points over a twelve-month period in each facility with follow-up 7 to 14 months later. Two-way ANOVAs revealed a statistically significant increase in levels of observed well-being and in diversity of activity following the intervention. There was a statistically significant increase in the number of positive staff interventions but no change in the number of negative staff interventions overall. There was a significant reduction in levels of depression. No significant changes in anxiety, health status, hospitalisations, or psychotropic medication usage were observed. The Enriched Opportunities Programme demonstrated a positive impact on the lives of people with dementia in nursing homes already offering a relatively good standard of care, in a short period of time. The refined programme requires further evaluation to establish its portability.

Through development of a conceptual model and an index measure based on actual performance, this dissertation focused on clarifying what is "very good" (and "very bad") in nursing home quality. The model expanded on the traditional narrow image of nursing home quality of care, and specified four major dimensions of this broader view of quality. The dimensions (staff intervention, nutrition/food service, physical environment, and community relations) were each reduced further to two subdimensions. Factors influencing quality were also delineated. The new model was then used to tie specific measurable indicators to the overall quality construct. Quality indicators derived from standardized assessments of Medicaid residents were employed in a study of 135 intermediate care facilities in Virginia. Process variables, such as use of physical restraints, catheters, and receipt of various therapies, were analysed for 12,327 residents. Outcome variables (weight loss, increased dependencies in activities of daily living, new pressure sores) were determined through longitudinal analysis for residents with an appropriate preceding assessment (n = 9,006). Assessments were aggregated in each home to calculate a mean (percentage incidence) for each of the 14 quality indicators. A scaling system was used to clearly identify industry"norms" for each variable. Quintiles based on relative incidence were employed to assign homes to five levels of performance. Scale scores were summed to obtain a facility index measure of relative quality. Reliability and validity were evaluated. Relationships of case-mix and selected structural variables (size, ownership, location, percent Medicaid, staff ratios) to the quality measure were analysed. Results suggested better performance by non-profit and smaller homes, but proprietary and non-prof it facilities were about evenly represented among the top tenth percentile of homes. Presence of a skilled care unit appeared to negatively influence quality. Possible interactions and explanations for this finding were considered. Most significantly, the study demonstrated that resident assessments can serve as excellent information sources about what goes on in nursing homes. However, additional variables must be incorporated to make a comprehensive quality measure, based on the model. Recommendations and policy implications were discussed. / Doctor of Philosophy

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs. The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care plans are communication plans with the addition of autobiographical information. Twenty residents and ten CNAs from two nursing homes participated in the study. Once CCPs were created, CNA participants in one facility received support each day. Following two weeks, CNAs participated in a semi-structured interview. Interviews were transcribed and analyzed using open, axial and selective coding. Findings revealed a core category, meeting resident’s needs through professional support and communication, which describes the progressive process these CNAs underwent to effectively communicate with residents in nursing homes using CCPs. Evolution of this process occurred as CNA participants became familiar with residents. An underlying component facilitating this familiarity was support during CCP implementation. Initially, these CNAs had negative views about nursing home care because they were unsure how to communicate with residents and received little support from higher levels of nursing authority. Over time and with application of CCPs, CNAs became familiar with residents and their communication behaviors. Application of specific communication strategies on CCPs required ongoing support from the investigator/speech-language pathologist which was evident by the comments between CNA participants from each facility. Participants from both facilities reported positive experiences during application of the autobiographical information on the CCPs. This personal information coupled with increased knowledge about resident’s specific communication abilities fostered the formation of a relationship between residents and CNAs. In summary, support during application of CCPs supplements CNAs’ abilities to meet residents’ needs.

No description available.

Hjärtsvikt är en av Sveriges största folksjukdomar och en vanlig orsak till sjukhusvistelse. Kvalificerad professionell vård i hemmet kan minska antalet inneliggande vårddygn för den hjärtsviktssjuke. Lyfts inte hjärtsviktssjuka personers behov av stödjande insatser fram finns risk för att professionella vårdare i hemmet inte uppmärksammar den sjukes behov av psykosocialt stöd. Syftet med litteraturstudien var att beskriva behovet av psykosocialt stöd för den hjärtsviktssjuke personen som vårdas i hemmet. Systematisk litteraturstudie valdes där 19 artiklar analyserades genom kvalitativ innehållsanalys. Det framkom två huvudkategorier; professionella stödet och det informella stödet. Resultatet beskriver behovet av stödjande insatser i form av psykosocialt stöd den hjärtsviktssjuke erfar i hemmet. Då den professionella vården gjorde en helhetsbedömning av den hjärtsviktssjuke uppmärksammades psykosociala behov hos den sjuke. Genom att stärka den inneboende förmågan med stödjande insatser kunde den sjuke hantera de psykiska symtom som hjärtsvikt medförde. För det professionella stödet var delaktighet av största vikt, delaktighet ökade känslan av att bemästra sjukdomssituationen och stärkte värdigheten hos den sjuke. Litterturstudien riktar sig främst till distriktsköterskor i kommunal hemsjukvård och är överförbar på personer med andra palliativa sjukdomar. Vidare forskning för att få en helhetsbild av den hjärtsviktssjukes vård i hemmet skulle vara att undersöka hur atienternas copingförmåga påverkar deras psykosociala välbefinnande. / Heart failure is one of the most common diseases and a major cause of hospitalization in Sweden. Professional health care provided at home might decrease the number of days of hospitalization for the heart failure patient. If not the heart failure patient´s need for support takes into consideration, there is a risk that professional caregivers in the home do not pay attention to the patient`s need of psychosocial support. The purpose of this study was to describe the heart failure patient's need for psychosocial support while being cared for in the home. A systematic literature review was chosen, 19 articles where selected and analyzed by qualitative content analysis. Two main categories revealed: professional support and informal support. Results of the study describe the supportive services in the form of psychosocial support on heart failure patient experience in the home. The professional care made a holistic assessment of the patient and they noticed psycho-social needs. By enhancing the inherent ability with supportive services, the patient could cope with the mental symptoms of heart failure. For the professional support the involvement of the supporting effort was of paramount importance. If the heart failure patient felt participating in the care, the patients feeling of mastering the disease situation and strengthening of the dignity increased. The literature study caters mainly to district nurses in municipal home care and is transferable to persons with other palliative diseases. Further research is needed to gain an overall picture of the heart failure patient's home care would be to examine how patients' coping, affect their psychosocial well-being.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Made available in DSpace on 2014-12-17T14:46:58Z (GMT). No. of bitstreams: 1 ElizabethVT_DISSERT.pdf: 1008448 bytes, checksum: 8817e98096ae87daa473b1282e9f94b7 (MD5) Previous issue date: 2013-02-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The implementation of the nursing process should be experienced by all nurses during their formative years. However, the lack of implementation of the nursing process for care planning during the educational process and the existing disorder in the formation process prompted the following research questions: What is the meaning of teaching the nursing process to the nursing professors? Do nursing professors use strategies and methods that promote critical thinking in their students? The objective of the study was to analyze the meaning that teaching of the nursing process has for the nursing faculty of the bachalaureate nursing course. Qualitative descriptive study conducted with a sample of 30 faculty members that taught nursing care courses in the nursing program of the Federal University of Rio Grande do Norte (UFRN) in Natal, RN. Two instruments were used, a questionaire and an interview guide. The questionnaire was designed to obtain sociodemographic, educational and work information, of faculty activities and of the teaching of nursing care. The guide was composed of five open questions regarding the understanding and perceptions of the nursing process, its utilization in teaching, and the nursing care teaching strategies. Interview data were submitted to content analysis techniques and interpreted according to the principles of Symbolic Interactionism. Six categories related to the analytical themes were identified: the nursing process as the guide for the care actions; clinical rationality; use of the care activities; teaching relevance; teaching barreirs; teaching strategies with focus on the abilities and competencies of the clinical rationale. Faculty perceptions regarding the teaching of the nursing process; nursing care approach in the nurses‟ formation. The study indicates that the participants understand the relevance of the nursing process a work instrument and that the use of this method during the nurses‟ formation enhances the abilities and competencies for critical thinking that is essencial for care. The strategies for teaching of abilities and competencies were identified, however the nursing faculty should use codes, direction and the influence so that the students can Interact and therefore stimulate the use of the nursing process / A aprendizagem do processo de enfermagem (PE) pelos enfermeiros deve come?ar na viv?ncia acad?mica, nos cursos de gradua??o de enfermagem e ao longo de sua forma??o profissional. Contudo, a reduzida utiliza??o do PE para planejamento da assist?ncia durante a gradua??o e o descompasso no processo de forma??o dos futuros enfermeiros levantam as seguintes quest?es para estudo: Qual o significado do ensino do PE para o docente enfermeiro? Ser? que os docentes enfermeiros implementam o ensino do PE com estrat?gias e m?todos que favorecem o desenvolvimento do pensamento cr?tico? Desenvolveu-se um estudo com o objetivo de analisar os significados e percep??es atribu?dos por docentes de gradua??o em enfermagem sobre o ensino do PE na forma??o do enfermeiro. Pesquisa qualitativa com delineamento descritivo realizado com uma amostra de 30 docentes de enfermagem que lecionam disciplinas espec?ficas de Enfermagem no Curso de Gradua??o em Enfermagem da Universidade Federal do Rio Grande do Norte (UFRN) em Natal, RN. Foram utilizados dois instrumentos, um question?rio e um roteiro de entrevista. O question?rio era destinado a obter informa??es de caracteriza??o sociodemogr?fica, educacional e de trabalho. A entrevista com cinco quest?es subjetivas acerca do entendimento e da percep??o dos docentes sobre o processo de enfermagem, sua utiliza??o no ensino e as estrat?gias utilizadas para lecionar a assist?ncia de enfermagem. Dados coletados por entrevistas, trabalhados pela t?cnica de An?lise de Conte?do. Os dados analisados deram origem a tr?s tem?ticas Significados docentes acerca do ensino do Processo de Enfermagem , Percep??es docentes acerca do ensino do Processo de Enfermagem e Abordagem do Processo de Enfermagem na forma??o do enfermeiro ? luz do Interacionismo Simb?lico e seis categorias relacionadas aos temas anal?ticos foram identificadas: Norteador das a??es de cuidado do enfermeiro; O racioc?nio cl?nico; Utiliza??o nas a??es de cuidado; Relev?ncia do ensino; Barreiras para o ensino; Estrat?gias de ensino com foco nas habilidades e compet?ncias do racioc?nio cl?nico. Desse modo, obteve-se que a maioria dos sujeitos compreende a relev?ncia do processo de enfermagem como um instrumento de trabalho do enfermeiro e que a abordagem desse m?todo durante a forma??o do enfermeiro proporciona o desenvolvimento de habilidades e compet?ncias para o pensamento cr?tico necess?rio ?s a??es de cuidado. Apesar disso, os relatos evidenciaram que o engajamento e a iniciativa para a concretude dessa pr?tica n?o ? t?o forte quanto a import?ncia que d?o ao m?todo, na teoria, por parte de alguns sujeitos. Identificaram-se as estrat?gias de ensino que estimulam as habilidades e compet?ncias para o desenvolvimento do racioc?nio cl?nico, contudo todo o corpo docente deve usar c?digos dotados de sentido, orienta??o e influ?ncia para que os discentes interajam e sejam suscitados a utilizar o processo de enfermagem

This study examined the effects of volunteer counselor training (empathy training versus information only) and age of volunteer (senior citizens versus adolescents) upon depression level of nursing home residents. Results showed that residents who received a volunteer counselor significantly improved (p < .01) in level of depression compared to the no volunteer control group. The empathy trained counselors were not significantly more effective than the information only group. The age of the. volunteer counselor was found not to be a significant variable.

As the United States' baby boom generation ages, the future of nursing home care becomes increasingly important. Through this study the researcher seeks to understand quality in nursing home care from the family's perspective. Surveys were collected at one North Texas nursing home, and data were analyzed to determine how gender and level of family involvement impact their concept of quality. Further, the information in this study is aimed at clarifying if interventions, specifically empowered CNA teams, have an impact on how family members view quality. Findings are identified and recommendations for future study are made.

Die Betreuung von Menschen mit Demenz wird immer mehr zu einer gesellschaftlichen Zukunftsaufgabe, mit der in Pflegeeinrichtungen, in ambulant betreuten Wohnformen, wie auch individuell im eigenen zu Hause umzugehen ist. Wie gut das Leben mit einer Demenz gelingen kann, wird auch maßgeblich durch die architektonische Gestaltung des Wohnumfelds bestimmt. Durch eine demenzsensible Architektur können eine Verbesserung der Alltagsaktivität, der Selbständigkeit, und insbesondere der Lebensqualität von Menschen mit Demenz und ihren Angehörigen erzielt werden. Eine ganz zentrale Rolle spielen dabei die Fragen: Wie können Wohn- und Lebensarrangements gestaltet werden, um den Menschen mit Demenz bestmöglich in seinen Bedürfnissen zu unterstützen? Und wie gelingt es durch architektonische und technische Lösungen pflegende Angehörige, ehrenamtlich Betreuende und professionell in der gesundheitlichen Versorgung Tätige in den notwendigen Erfordernissen der Versorgung und Betreuung von Menschen mit Demenz zu unterstützen? Nur durch eine ganzheitliche Betrachtung des Themas wird es unter den Bedingungen des demografischen Wandels auch zukünftig gelingen, wirtschaftliche Konzepte zu generieren, die eine entsprechende Versorgung der Menschen mit Demenz gewährleisten. Insbesondere in schrumpfenden Regionen und Märkten wird dies zu einer zentralen Zukunftsfrage werden. Der vorliegende Tagungsband vermittelt einen Überblick über das Thema „Architektur für Menschen mit Demenz“, indem neueste Erkenntnisse aus Wissenschaft und Praxis der architektonischen Gestaltung verschiedener Wohn- und Lebensarrangements für Menschen mit Demenz dargestellt werden.