Providing care for people with dementia is an increasing societal challenge. In Nursing Homes, Assisted Living Facilities and Housing alike, dementia-friendly concepts are needed. Whether it is possible to live well with dementia is determined by many factors, among which the architectural design of the living environment plays a major role. Dementia-friendly architectural concepts support the everyday activities, independence, and quality of life not only of people with dementia, but also their care givers. The following issues need to be addressed: Which living and care arrangements support best the needs of people with dementia? How can architectural and technological concepts support family care givers, professional care providers, and volunteers? Only a holistic approach to the provision of care for people with dementia will allow the generation of economically sustainable concepts. These are especially in demand in light of the demographic changes our society encounters and will become a key issue for the future development of shrinking regions. This book is a collection of the contributions to the symposium “Architecture for People With Dementia” which took place in Dresden, Germany, in May of 2014. It provides an overview on this important topic and includes new insights form research and care practice on the architectural design of various living and care arrangements of people with dementia.

The first chapter examines the impacts of health care provider exits on patient outcomes and subsequent reallocation. Using administrative data on the universe of nursing home patients, I estimate the mortality effects of 1,109 nursing home closures on incumbent residents with a matched difference-in-differences approach. I find that displaced residents face a short-run 15.7% relative increase in their mortality risk. Yet this increase is offset by long-run survival improvements, so the cumulative effect inclusive of the initial spike is a net decline in mortality risk. These gains are driven by patients reallocating to higher quality providers. I also find significant heterogeneity by local market conditions: the survival gains accrue only to patients in competitive nursing home markets, whereas residents in concentrated markets experience no survival improvements. I then develop and estimate a dynamic model of the nursing home industry with endogenous exit. Combining the model estimates with the mortality results, I examine the effects of counterfactual reimbursement policy experiments on nursing home closures and resident life expectancy. A universal 10% increase in the Medicaid rate decreases the frequency of closures, but causes some low-quality providers to remain open in competitive areas. In contrast, targeted subsidies for facilities in areas with limited alternatives improves overall life expectancy by averting the costliest nursing home closures. In the second chapter (co-authored with Szymon Sacher), we estimate a mortality-based Bayesian model of nursing home quality accounting for selection. We then conduct three exercises. First, we examine the correlates of quality, and find that public report cards have near-zero correlation. Second, we show that higher quality nursing homes fared better during the pandemic: a one standard deviation increase in quality corresponds to 2.5% fewer Covid-19 cases. Finally, we show that a 10% increase in the Medicaid reimbursement rate raises quality, leading to a 1.85 percentage point increase in 90-day survival. Such a reform would be cost-effective under conservative estimates of the quality-adjusted statistical value of life. The third chapter (co-authored with Michael Barnett and Adam Sacarny) examines why efforts to raise the productivity of the U.S. health care system have proceeded slowly. One potential explanation is the fragmentation of payment across insurers. Each insurer's efforts to improve care could influence how doctors practice medicine for other insurers, leading to unvalued externalities. We study these externalities by examining the unintended private insurance spillovers of a public insurer's intervention. In 2015, Medicare randomized warning letters to doctors to curtail overuse of antipsychotics. Even though the letters did not mention private insurance, they reduced prescribing to privately insured patients by 12%. The reduction to Medicare patients was 17%, and we cannot reject one-for-one spillovers. If private insurers conducted a similar intervention with their own limited information, they would stem half as much prescribing as a social planner able and willing to better target the intervention. Our findings establish that insurers can affect health care well outside their direct purview, raising the question of how to match their private objectives with their scope of influence.

Trata-se de uma pesquisa de cunho qualitativo que tem como objetivos desvelar as vivências de famílias de classe popular no cuidado a familiares idosos fragilizados, no domicílio, bem como obter subsídios para a sistematização do cuidado de enfermagem a essas famílias. O Referencial Teórico aborda temas relacionados à área temática do estudo: o cuidado de enfermagem domiciliar, a família de classe popular e a pessoa idosa fragilizada. Os sujeitos dessa investigação, intencionalmente escolhidos a partir de critérios previamente estabelecidos, são quatro famílias pertencentes à população adstrita a uma Unidade Sanitária do município de Porto Alegre. O Estudo de Caso do Tipo Etnográfico é a metodologia utilizada. Os instrumentos utilizados para a coleta de dados são a Observação Participante, a Entrevista, a Análise Documental e a Ficha Informativa. Do tratamento dos dados, através da análise de conteúdo, emergiram seis categorias: Características das famílias, Concepções das famílias, A (re)organização da família para o cuidado, A família no cotidiano do cuidado, Relação com as instituições sociais, O cuidado de enfermagem domiciliar. Foi possível perceber que as famílias são multigeracionais. Sobrevivem quase que exclusivamente das aposentadorias dos idosos e enfrentam constantemente o desemprego. Sua concepção de saúde está relacionada à capacidade de trabalho. Valorizam a família, na qual o idoso é reconhecido em sua experiência de vida. Ao necessitar de cuidado, este deve ser assumido, preferencialmente, pelos familiares. Uma pessoa envolve-se mais intensamente no cuidado, mas toda a família, auxiliada por uma rede apoio, constituída de amigos e vizinhos, interage. Nas atividades cotidianas, valem-se da criatividade para adaptar utensílios e o ambiente, bem como do saber popular, como recursos nos cuidados à saúde. As dificuldades destacadas estão relacionadas à condição socioeconômica precária, à moradia, ao vestuário e ao transporte. Percebem que o suporte social a famílias cuidadoras é restrito. Destacam que o acesso aos serviços de saúde é sofrível e ressaltam a urgência em solidificar o Sistema Único de Saúde, em busca da concretização dos seus princípios. Expressam a necessidade de implantação de programas de cuidado domiciliar, interdisciplinares, que assistam a família e o idoso de forma integral, continuada, participativa, contextualizada e humanizada. / This is a qualitative research, which aims to unveil the life experience of families from lower classes at caring for their frail elderly relatives at home, as well as to obtain subsides for creating a model of nursing care for such families. The theoretical model approaches issues related to the thematic area of caring: the family nursing home care, the lower classes families, and the frail elderly. The subjects of this investigation, intentionally chosen upon the criteria previously established, were four families from the Sanitation Unity of Porto Alegre. The design of this case study was an ethnographic type. Tools used for data collection were: participated observation, an interview, a documented analysis, and the informative report. From the analysis of data, through the content analysis, six categories were established: characteristics of the families, conceptions of the families, reorganisation of the family to the care, the family within the routine of the care, the relationship with social institutions, and the nursing home care. It was possible to perceive that families are multigeneration. They survive almost exclusively from the elderlies retirement and frequently they have to cope with unemployment. Their concept of health is related to their work skills. They value the family where the elderly is recognised for his or her life experience. When he or she needs to be cared of, it has to be performed preferably by the family. One is more involved in the care, but the whole family interacts, supported by a social net, composed of friends and neighbours. In the daily activities, they use creativity to adapt goods and the environment, as well as the popular knowledge as resources in the health care. The stressed difficulties are related to the poor social-economic condition, to dwelling, clothing, and transport. They perceive that the social support to caring families is restricted. They emphasise that access to health services is appalling and magnify the urgency in strengthening the "United Health System", aiming to establish their principles. They stress the need to introduce interdisciplinary home care programs, which could assist the family and the elderly in a holistic, permanent, participating, contextural, and humanised way. / Se trata de una investigación de tipo cualitativo que tiene como objetivos descubrir las vivencias de familias de clase popular en el cuidado a familiares ancianos fragilizados, en el domicilio, así como obtener subsidios para la sistematización del cuidado de enfermería a esas familias. El Referencial Teórico aborda temas relacionados al área temática del estudio: el cuidado de enfermería domiciliar, la familia de clase popular y la persona anciana fragilizada. Los sujetos de esa investigación, intencionalmente elegidos a partir de criterios previamente establecidos, son cuatro familias pertenecientes a la población perteneciente a una Unidad Sanitaria del municipio de Porto Alegre. El Estudio de Caso de Tipo Etnográfico es la metodología utilizada. Los instrumentos utilizados para la colecta de datos son la Observación Participante, la Entrevista, el Análisis Documental y la Ficha Informativa. Del tratamiento de los datos, a través del análisis de contenido, emergieron seis categorías: Características de las Familias, Concepciones de las Familias, La (re)Organización de la Familia para el Cuidado, La Familia en la Cotidianeidad del Cuidado, Las Relaciones con las Instituciones Sociales, El Cuidado de Enfermería Domiciliar. Fue posible percibir que las familias son multigeneracionales. Sobreviven casi exclusivamente de las jubilaciones de los ancianos y enfrentan constantemente el desempleo. Su concepción de salud está relacionada a la capacidad de trabajo. Valorizan la familia, en la cual el anciano es reconocido por su experiencia de vida. Al necesitar de cuidado, este debe ser asumido, preferencialmente, por los familiares. Una persona se envuelve mas intensamente en el cuidado, pero toda la familia, auxiliada por una red de apoyo, constituida de amigos y vecinos, interactúa. En las actividades cotidianas, se valen de la creatividad para adaptar los utensilios y el ambiente, tanto del saber popular, como en los recursos para el cuidado de la salud. Las dificultades destacadas están relacionadas a la condición socioeconómica precaria, a la vivienda, al vestuario y al transporte. Perciben que el soporte social a familias cuidadoras es restricto. Destacan que el acceso a los servicios de salud es sufrible y resaltan la urgencia en solidificar el Sistema Único de Saúde (Sistema Unico de Salud), en busca de la concretización de sus principios. Expresan la necesidad de implantación de programas de cuidado domiciliar, interdisciplinares, que asistan a la familia y al anciano de forma integral, continuada, participativa, contextualizada y humanizada.

Over the last decade, long-term care facilities have transitioned from institutional care models that focus on person-centered care, in which the resident is the center of the care. The purpose of this study is to explore the nurse and certified nursing assistant perception of the person-centered care services they deliver. Jean Watson's theory of human caring is the theoretical framework that guided this study. The theory focusing on the human caring experiences and person-centered care is being characterized as a caring feeling. The carative factors of Watson's theory, the fundamental concept of caring, has been associated with improved outcomes for the resident and the caregiver. Using a phenomenology research design, 3 focus groups of 15 nurses and 10 certified nursing assistants (CNA), working in a long-term care facility, were asked questions to describe their perception of person-centered care. The responses from the 25 participants were stored and organized using Nvivo. The thematic analysis revealed that the nurses and CNAs perceived person-centered care to include the caring and compassionate approach taken when care is being delivered. The participants also shared that person-centered care included involving the resident in decision making through communicating openly and developing relationships. The discussions revealed that 8 carative factors influenced their understanding, with the main factor being the creative problem-solving method for decision making. The �ndings from this study have the potential to impact positive social change at the organizational level, influencing the delivery of care within long-term care settings.

No description available.

No description available.

Shell Shock, described as the ‘emblematic psychiatric disorder’ of the First World War has long been synonymous with its soldiers. Its association with close proximity to exploding shells and thus the front lines, leading to the various symptoms of ‘shock’, has both facilitated and ensured its existence throughout the twentieth and twenty first centuries as a masculine affliction. Of the many shell shock studies that have been produced over the last few decades all have focused purely on the experience of the male combatant, predominantly because of this long held preoccupation with ‘front-line’ warfare and its consequences apparently being the preserve of men. Despite the prolonged interest and analysis of shell shock by medical and social historians along with a significant amount of work by feminist and, more recently, revisionist historians, detailing the involvement of women in the First World War, there is stHl no comprehensive study of the psychological problems encountered and suffered by the women who served alongside the British Expeditionary Forces (BEE). However, this study of the roles and duties of a specific group of women, namely nurses, voluntary aid detachments, and ambulance drivers, reveals they frequently endured a variety of traumatic experiences, involving injuries and fatalities, through the vicarious witnessing and dealing with horrific sights and sounds, all compounded by extremes of conditions and privations. Many, if not all, of these factors were given as antecedents for war neurosis in soldiers. Yet, while the nurse has been idolised for her role in the Great War, her experience of psychological ‘breakdown’ has not been examined. This thesis, through the analysis of professional medical literature, of medical case notes, personal testimonies, diaries and autobiographies, is a contribution to the areas of women’s history, medical history and, more specifically, to the history of psychological war trauma. Following a review of the literature in chapter one, chapter two is a re-examination of the proximity of nurses to the fighting zones and therefore of their exposure to danger. Chapter three analyses the nurses’ experience and subsequent symptoms of war trauma, including, importantly, how contemporary medical authorities understood the disorder, and then cared for and managed their female sufferers. These two chapters fundamentally argue that the notion of war-induced traumatic neurosis being the preserve of men is essentially pretence, and that this ‘focus’ on male sufferers means the history of the condition is incomplete. Chapter four essentially examines the issues of repatriation faced by these nurses, specifically examining the evolution of war disability pensions process of which they were excluded until 1920. It also looks at how the nurse, as female war veteran, coped with the consequences of her war experience. In conclusion, this thesis asserts that these nurses did indeed suffer psychologically for their involvement in this war and not because their symptoms and disorders ‘resembled’ those experienced by men, but were in fact, indistinguishable to the extent that some nurses were classed as ‘shellshocked’

When an energy simulation is performed for buildings it generates in lower energy consumption than what is later measured. This can often be a problem because of the building regulations which have requirements on the specific energy consumption. What distinguishes the newly built care and nursing accommodation Furugården, the building that the study deals with, is that it is differs from the normal case by having a lower measured energy consumption than what was originally planned. This study aims to find out which parts of the building's technical systems and residents' behavior that contributes to the low energy demand by means of the building energy simulation program BV2, a survey and monitored energy consumption. It can be concluded that the users' behavior has a great impact on the building's low energy consumption. Their behaviors were determined by surveys. It is mainly the low hot tap water usage that contributes to the low energy.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2002. / Typescript. Bibliography: leaves 216-228.

Psychosocial support is said to be an inherent component of nursing care and a major focus of palliative care. Literature exists which outlines perceptions of the psychosocial needs of patients and how psychosocial support should be provided. However, there is a lack of empirical evidence on how psychosocial support is operationalised in practice. This study provides a valuable and substantial new contribution to the evidence on the psychosocial needs expressed by patients in a hospice ward and how nurses immediately respond to these needs within their everyday practice. A study gathering data via observations with matched interviews of patients and nurses, organisational, documentary, and demographic variables, was conducted over an eight month period. Thirty-eight nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data was analysed using constant comparative qualitative techniques. Patients expressed a wide variety of psychosocial needs, often only signalling them whilst receiving care for other reasons. Considering these needs in relation to Maslow’s (1943) hierarchy of needs suggests that in-patients more commonly express prerequisites to physiological care and ‘lower level’ safety needs rather than the more thoroughly researched and espoused ‘higher’ level psychosocial needs. The nurses reacted to these psychosocial needs with a range of responses which indicated a diminishing level of immediate support: ‘dealing’, ‘deferring’, ‘diverting’ and ‘ducking’. The majority of the nurses were observed using each of these responses at some point during data collection. A variety of the responses were used for each type and context of psychosocial need. These responses were influenced by the ward’s workplace culture. This study demonstrates a requirement for more thorough consideration of the true psychosocial needs of patients, which appear to vary dependent on the context of care. Consideration should be v given to workplace culture and its influence over psychosocial support, with nurses being supported to expand their response repertoire so that patients’ psychosocial needs are acknowledged more. Increasing nurses’ knowledge of the reality of psychosocial support through education and research will encourage formalisation of the place of psychosocial support in the planning, documentation and provision of care. This study shows that ward nurses can offer psychosocial support as an inherent component of their everyday work. Findings derived from this research indicate that developing an understanding of how patients express psychosocial needs in practice, through a consideration of Maslow’s (1943) hierarchy of needs, may increase recognition and support of psychosocial needs and enable nurses to respond more comprehensively.