The presence of human pharmaceuticals in the aquatic environment is now becoming a well-established fact. The identified problems associated with their presence include the fact that these compounds are biologically active, some of them are toxic in nature, and a number of compounds have potential to foster and maintain drug resistant microorganisms. They are discharged into the aquatic environment from a variety of sources, but mainly by the excretion of incompletely metabolized pharmaceuticals by individuals into the wastewater. This situation makes finding a source-control strategy difficult. However, healthcare facility (hospitals and long-term-care homes) effluents are suspected to have relatively higher concentrations of these compounds, as such facilities use pharmaceuticals in large amounts for diagnostic, cure and research purposes. It is expected that controlling discharges from these facilities may provide a cost-effective solution to reduce the pharmaceutical loads entering the aquatic environment.

Die sich im Verlaufe einer Demenz manifestierenden Orientierungsstörungen schränken die Selbständigkeit der Erkrankten ein und sind oftmals einer der Gründe für die Übersiedlung in eine Pflegeeinrichtung. Aufgrund ihrer krankheitsspezifischen kognitiven Einschränkungen ist es den Betroffenen dort erschwert, sich ihr neues Wohnumfeld zu erschließen. Demzufolge sind Demenzerkrankte zur Aufrechterhaltung von Mobilität und Selbständigkeit in einem ganz besonders hohen Maße von baulichen Strukturen abhängig, die ihnen räumliche, zeitliche und situative Orientierung bieten. Bisher liegen jedoch nur sehr wenige empirisch fundierte Forschungsarbeiten zu deren geeigneter Gestaltung vor. In dieser Dissertation wurde untersucht, welche baulichen Merkmale von Altenpflegeeinrichtungen das räumliche Orientierungsvermögen demenzerkrankter Bewohner beeinflussen. Dazu wurden die baulichen Strukturen von 30 Einrichtungen analysiert und umfangreiche Daten zur Orientierung der dort lebenden Bewohner erhoben. Es wurden fünf Wege innerhalb der Wohnbereiche identifiziert, die Bestandteil der Aktivitäten des täglichen Lebens sind und in allen Einrichtungen vorgefunden wurden. Durch Einschätzung der Pflegekräfte wurde bewertet, ob, bzw. wie gut, die Bewohner diese Wege zurücklegen können. Der Einfluss der unterschiedlichen baulichen Merkmale auf die resultierenden Orientierungswerte wurde mittels statistischer Signifikanztests überprüft. Die Ergebnisse zeigen, dass mit fortschreitender Demenz das Orientierungsvermögen sinkt. Gleichzeitig steigt die Abhängigkeit von der Ausprägung der baulichen Strukturen jedoch an. Signifikante Einflussfaktoren bestehen u. a. in der Bewohnerzahl, der Erschließungstypologie und der Ausformung der Gemeinschaftsflächen. Kleinere Einrichtungen begünstigen zwar die Orientierung, aber auch Wohnbereiche mit 25-30 Bewohnern können gute Werte erzielen, wenn sie eine geradlinige Horizontalerschließung über Flure, die keine Richtungswechsel beinhalten, aufweisen. Gleichartige Elemente, wie z.B. mehrere Wohn- und Essbereiche oder Cluster kleinerer Wohngruppen, schränken die Orientierung hingegen ein. Diese und weitere Erkenntnisse wurden in Gestaltungsempfehlungen überführt, die in der Versorgungspraxis bei der Planung sowie Umstrukturierung von Pflegeeinrichtungen angewendet werden können. Weiterhin wurden auf Grundlage im Krankheitsverlauf eingesetzter Orientierungsformen und –strategien Modelle des Orientierungsprozesses Demenzerkrankter entwickelt.

No description available.

Thesis (doctoral)--Umeå University, 2005. / Includes bibliographical references.

Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 123-128).

Since a substantial increase in lawsuits, settlements, jury trial awards, and insurance premiums involving nursing facilities began in the mid 1990s, addressing litigation has been a growing concern for the industry, consumers and their families, insurance carriers, and state and national elected officials. Curbing lawsuit growth has mirrored medical malpractice containment efforts, focusing on the addition of laws to inhibit litigation. The state of Florida initiated such tort reforms along with mandatory increased nursing facility staffing in 2001. Through secondary data analyses, this study examined the initial effects of Florida's tort reform measures. Lawsuits filed (N = 546) against any Hillsborough County nursing facility (N = 33) from 1999 through 2003 were reviewed. One-way analyses of variance and two-way contingency tables were used to identify variations in the elements, extent, and outcome of lawsuits between pre and post tort reform periods. Based on nursing facility admission dates, post tort reform lawsuits exhibited multiple significant changes. Lawsuits filed per month dropped to 14% of pre reform monthly filings. On average, lawsuits were associated with shorter residencies, were filed earlier, and settled six months sooner. They were less apt to include combined wrongful death and negligence survival damage claims, charges intentionally addressed by reform measures in order to eliminate double damage claims. Other lawsuit charges increased, e.g., lethal negligence and breach of fiduciary duty. Mediation was less likely and arbitration attempts more likely to be documented in lawsuits. Mean somatic allegations did not change significantly. Staff-related allegations decreased 21.5% to 8.51 per lawsuit, with 12 out of 22 staff-related allegations decreasing significantly. On average, settlement proposals, total settlements, and attorney fees decreased to 40% and net plaintiff awards to 25% of pre reform amounts. Overall, it appears that 2001 tort reform impacted post reform litigation substantially. However, further research examining a larger post reform lawsuit sample and longer post reform period is required to verify that research findings are stable and reflect sustained changes. Other factors, e.g., decreased nursing facility professional liability insurance coverage, may have affected the numbers and characteristics of lawsuits filed and require further investigation as well.

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This thesis is concerned with the quality of care for the elderly in nursing homes, responding to a critical social and demographic imperative. The aim of this study is to provide a service quality construct for nursing homes to increase client focus and satisfaction. The research is underpinned by the service quality literature. It utilises the SERVQUAL construct to explore the nature of service quality in nursing homes through semi-structured interviews with nursing home residents and resident's families. A service quality scale was constructed comprising six dimensions and 27 scale items capturing service delivery in nursing homes. This scale was purified through a survey of residents and family members (n=263). Through exploratory factor analysis, six importance and four experience factors were identified. Regression analysis was used to identify relationships between the factors, service quality and satisfaction. The results indicate that importance does not predict perceived quality, though experience of responsiveness and hospitality and courtesy and personal approach are indicators of service quality. Furthermore, quality emerges as a predictor of satisfaction. From these outcomes, a service quality construct was developed which comprises of service marketing and service quality dimensions. This thesis contributes to the construction of the concept of service quality in nursing homes, its dimensionality and thus the precursors of satisfaction. These have considerable implications for the management of nursing home services.homes, its dimensionality and thus the precursors of satisfaction. These have considerable implications for the management of nursing home services.

No description available.

Antalet äldre i världen ökar och den äldre befolkningen blir allt friskare. Trots detta är det sällsynt att äldre klarar sig själva till livets slut. Då det inte är möjligt att tillgodose de äldres behov i hemmet har samhället ansvar att erbjuda plats på särskilt boende. Beroende av andra innebär inte att de äldres livskvalitet behöver reduceras och det har påvisats att ökad ålder och låg livskvalitet inte är sammankopplade med varandra. Syftet med studien var att beskriva vad livskvalitet är för äldre på särskilt boende. Litteraturstudien grundar sig på elva vetenskapliga artiklar som analyserades utifrån en induktiv ansats. I resultatet framkom fyra områden som var betydelsefulla för livskvaliteten för de äldre: relationer, identitet, aktiviteter samt miljö och organisation. De äldre önskar goda relationer med personalen där de blir sedda som unika individer. De vill även delta i meningsfulla aktiviteter på sina egna villkor samt omges av en hemlik miljö. Sjuksköterskan kan stärka de äldres livskvalitet genom att ta hänsyn till dessa områden. Mer utbildning i ämnet för allmänsjuksköterskan samt kvalitativ forskning om äldres livskvalitet behövs för att öka sjuksköterskans kunskap och förståelse om vad livskvalitet är för äldre på särskilt boende. / The number of elderly people in the world is increasing and the elderly population is getting healthier. Despite this, it is uncommon for elderly people to be able to manage on their own until the end of life. When it isn't possible to cater for the needs of the elderly at home, the society has a responsibility to offer them room at a nursing home. Dependency on others doesn't mean the quality of life for the elderly has to be reduced and it's been found that there is no connection between rising age and low quality of life. The aim of this study was to describe what quality of life is for elderly people living in nursing homes. This literature study is based on eleven scientific articles that were analysed using an inductive approach. Four areas that were important for quality of life for the elderly emerged from the results: relations, identity, activities and environment and organisation. The elderly wanted close relationships with the staff and wanted to be seen as unique individuals. They wanted to participate in meaningful activities on their own terms and live in a homelike environment. The nurse can strengthen quality of life for the elderly be taking these areas into account. More education in the matter for general nurses and more qualitative research on the subject of quality of life for the elderly is needed to increase the nurses knowledge and understanding of quality of life for elderly people in nursing homes.