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An evidence-based clinical practice guideline was developed to prevent and manage constipation in long-term care (LTC) residents, a vulnerable population not specifically addressed in previous guidelines. A literature review was completed, and evidence was evaluated and included in initial draft recommendations. The guideline was reviewed for content validity using a Delphi committee of clinical experts in gastroenterology, geriatrics, and pharmacy. The updated guideline was presented to an interdisciplinary team that reviewed its clinical applicability. Overall, interdisciplinary team members agreed or strongly agreed the guideline was clinically applicable (n=30). Finally, the guideline was evaluated by a group of doctorally-prepared practicing nurse practitioners using the Appraisal of Guidelines for Research and Evaluation II instrument. Appraiser scores were 85% or higher in every domain, indicating the guideline was perceived as high in quality. Development of this guideline signifies an initial step in the management and prevention of constipation in LTC residents.

Indiana University-Purdue University Indianapolis (IUPUI) / Access to healthcare services is important for improving health outcomes, preventing and managing illness, and achieving health equity. The geographic maldistribution of physicians has a negative impact on rural areas compared to urban, particularly as it relates to access to healthcare. Rural hospitals have been closing or converting to another form of healthcare service at an increasing rate, adding another element to the existing complexities in rural access to care. Although a hospital closure in any location may have a considerable impact on the community, the closure of a rural hospital may have disproportionately more substantial implications for the economy and employment, health outcomes, and access to care. The contributing factors preceding rural hospital closures have been studied, but less is known about the full impact of rural hospital closures on the community. There is some evidence of shortages in healthcare providers and services, and therefore communities may employ multiple strategies to mitigate the shortages and provide services, including utilizing telehealth/virtual services. This dissertation proposes to examine the effects of rural hospital closures on the community, healthcare services, access to care, and provide a qualitative assessment of telehealth as a strategy to bridge gaps in provider access. This dissertation includes three studies: 1) a systematic review of the literature to examine the impact of rural hospital closures on the community; 2) an empirical study that utilizes a generalized difference in difference design with county and year fixed effects to estimate the relationship between rural hospital closures and nursing homes; and 3) a qualitative study exploring the perceptions and experiences of the nurses that piloted a virtual care support project, providing insights into crucial elements important to the implementation of similar models and the role of telehealth in bridging healthcare workforce gaps.

Bakgrund: Djur har under väldigt många år varit en del av människans vardag från början i form av vakt och jaktdjur. Idag används djuren mer som sällskap och familjemedlemmar. Hundar och människor har genom århundradena tillsammans utvecklat ett samspel som gör att de kan kommunicera. Många äldre personer har idag husdjur som enda sällskap när barnen flyttat ut och make/maka gått bort. När personen måste flytta till ett vårdboende kan de bli tvungna att göra sig av med sitt djur för att många vårdboende idag inte tillåter djur där. Syftet med denna studie är att undersöka djurs betydelse för människor inom äldrevård och demensvård. Metoden är en litteraturstudie där 10 både kvalitativa och kvantitativa vetenskapliga artiklar är granskade och bearbetade. Resultaten visar att ha djur bland äldre har många fördelar, där ibland att djur väckte positiva känslor hos deltagarna och minnen från när de äldre var barn, minnen som aldrig tidigare talats om på vårdboendet. Även en del negativa aspekter framkom så som att den demenssjuka skulle falla eller snubbla på grund av djuret.Slutsats: Examensarbetet visade att många studier visade resultat som var förväntade att till exempel hundar och även andra djur förbättrar äldre personer och dementas livskvalitet så som ensamheten och sociala förhållande. Det var dock förvånande hur många positiva effekter som djur faktiskt ger en människa som tycker om djur. / Background: Animals have for many years been a part of human's life from the beginning as guard and hunting animals. Today the animals are more companion and family members. Dogs and humans have through the centuries in cooperation developed an interface that allows them to communicate. Many old people currently have pets for company when the children moved out and the spouse's passed away. When the person must move to a nursing home they can be forced to dispose their animals because many nursing homes do not allow animals. The purpose of this study is to investigate animal impact on people in elderly care and dementia care. The method of this study is a literature study in which 10 both qualitative and quantitative research articles are reviewed and processed. The results show that animal among the elderly has many advantages, where sometimes the animals aroused positive feelings among the participants and memories from when they were children, memories that have never before been mentioned in medical accommodation. Despite this, some negative aspects emerged as to the person with dementia would fall or stumble because of the animal. Conclusion: This study showed that dogs and other animals, improve the elderly and senile quality of life such as loneliness and social relationship witch in some extent was expected. However, it was surprising how many positive effects animals actually can give a person who is fond of animals.

Att åldras är en stor förändring både för de som bor kvar hemma och för dem som väljer att flytta till ett särskilt boende. Vilka upplevelserna är och vad det innebär har intresserat oss under vår utbildning och därför beslutade vi oss för att ta en djupare titt på detta fenomen.Syftet med denna studie var att undersöka upplevelsen äldre människor har av att flytta till ett särskilt boende och efter att ha bott där under en kort tid. Vi valde att använda en kvalitativ metod och genomförde sex intervjuer med personer som nyligen flyttat till ett särskilt boende. Resultatet visade att förändringen kunde delas in i fysiska, psykologiska och sociala upplevelser. I den fysiska upplevelsen var känslor förknippade med fysiskt beroende av omsorgspersonal samt den kroppsliga förändringen för de äldre. Den psykologiska upplevelsen visade både trygghet/otrygghet av att stanna hemma eller flytta, olika förluster, och att känna sig hemma. Och slutligen visade den sociala upplevelsen på en stor förändring i det personliga nätverket och också att anhöriga är viktiga under processen att flytta och tiden efteråt. / To age is a major change for both those who stay at home and for those who choose to move to a nursing home. What the experiences are and what it means has interested us during our education and therefore we decided to take a deeper look into this phenomenon.The aim of this study was to examine the experience older people have of moving to a nursing home and having lived there for a short time. We chose to use a qualitative approach and conducted six interviews with people who had recently moved to a nursing home. The result showed that the change could be divided into physical, psychological and social experiences. In the physical experience were feelings related to the physical dependence of the social care staff as well as the bodily change for the elderly. The psychological experience showed both security/insecurity of staying at home or moving, different losses, and to feel at home. And finally, the social experience showed a big change in the personal network and also that relatives are important during the process of moving and the time afterwards.

Demens är en folksjukdom som ökar och är vanligare idag än för 30 år sedan. Orsaken till detta är att människan lever längre och risken för att drabbas av demens ökar med stigande ålder. Personer med demens har begränsad förmåga att tolka samt förstå omgivningen de vistas i, därför är det viktigt att den fysiska inomhus miljön inte utgör ett hinder för personerna. Inomhusmiljön skall anpassas efter deras behov för att de skall känna trygghet och därmed påvisa positiv beteende. Syftet med denna litteraturstudie är var förkovra oss om hur inomhusmiljön påverkar personer med demens på vårdboende. Metoden som använts är en litteraturstudie där kvalitativa och kvantitativa vetenskapliga artiklar lästes samt granskades med hjälp av kriterier för vetenskap samt med hjälp av en kvalitetsgranskningsmall. De utvalda vetenskapliga artiklarna påträffades i databaserna PubMed och CINAHL. Resultatet visar att personer med någon demenssjukdom behöver en lugn och tolkningsbar miljö på vårdboende som är förenklad, ger möjlighet till aktivitet samt är speciellt skapad efter deras behov. De faktorer som är väsentliga är bland annat rätt ljusstyrka, ljusfärg samt sänkt ljudnivå som bidrar till positivt beteende samt mindre aggressiva vårdtagare. Även självständighet, välbefinnande samt delaktighet ökar av en trygg inomhusmiljö. / Dementia is a common disease that is increasing and is more common today than 30 years ago. The reason for this is that we are living longer today and the risk of dementia increases with age. People with dementia have limited ability to interpret and understand the environment they are surrounded by, for that reason it is important that the physical environment isn't a obstacle for the persons and that the environment is adapted to their needs so that they can feel secure, resulting to positive behavior. The aim of this study was to learn how the indoor environment affects people with dementia at nursing homes. The method which is used is a literature study in which qualitative and quantitative research articles were reviewed by using criteria for study science and a quality review model. PubMed and CINAHL were the databases where the articles were found. The results from the chosen articles shows that people with dementia requires a calm and intelligible environment at nursing homes that is simplified, provides opportunity for activity and are specially formed to their needs. The factors that are important include the right brightness, light color and reduced noise level that contribute to positive behavior and less aggressive residents. The possibility of more residents who are independent, having better well-being and participate more are those who are surrounded by a safe indoor environment.

For a long time, Lista-Gillberga has been a place where retired elders move to spend their last years in the fresh air in the countryside. Eskilstuna municipality's investment in expanding through new housing, population growth and a university means that the area could now have an increase ofyounger generations who want the proximity to the city of Eskilstuna but still want to feel the freedom of the countryside. This Community Center+ becomes one intergenerational institution, where both younger and older generations can meet and socialize. In addition to a part of the building that contains premises open to the public, the building contains a preschool with two departments, as well as a nursing home that includes 20 apartments. The premises that are open to the public are easily accessible to both the residents and the preschool children and here, for example, localassociations and other actors can activate the elderly and children in various activities. In addition to this, a common department is also provided for the nursing home and preschool. This contains a conservatory, open hangout area and studios specifically available for the residents and the children. An important driving force in this project lies in the fact that nursing homes should not just be a storage unit for the elderly during their final years of life. Research shows that contact between the elderly and children can contribute to strengthened mental health for the elderly and that symptoms of dementia can decrease. The elderly should experience the feeling of being needed and appreciated in society. They should be able to really live their lives to the fullest and not have to feel cut off from the outside world. Gillberga Generational can thus be seen as a hub for the residents of Lista-Gillberga where both older and younger people are welcomed and can socialize together. / Länge har Lista-Gillberga varit en plats dit pensionärer flyttar för att spendera sina sista år i frisk luft på landsbygden. Eskilstuna kommuns ’satsning på expandera genom nya bostäder, befolkningsökning och ett universitet innebär att området nu skulle kunna få en tillökning av yngre generationer som vill ha närheten till Eskilstuna stad men ändå känna friheten på landsbygden. Detta Folkets hus + blir en generationsöverskridande institution, där både yngre och äldre generationer kan mötas och umgås. Förutom en del av byggnaden som innehåller lokaler öppna för allmänheten innehåller byggnaden en förskola med två avdelningar, samt ett vård- och omsorgsboende som omfattar 20 lägenheter. De lokaler som är öppna för allmänheten är lättillgängliga för både de boende samt förskolebarnen och här skulle tillexempel lokala föreningar och andra aktörer kunna aktivera de äldre och barnen i olika aktiviteter. Utöver detta föreslås också en gemensam avdelning med vinterträdgård, allrum / myshörna och ateljéer specifikt tillgängliga för boendet och förskolan.  En viktig drivkraft i det här projektet ligger i att ett vård- och omsorgsboende inte bara ska bli en förvaring av äldre under deras sista år i livet. Forskning visar på att umgänge mellan äldre och barn kan leda till stärkt mental hälsa hos de äldre, att symptom på demens kan gå tillbaka samt ett allmänt gladare humör. De äldre ska få känna sig behövda och sysselsatta och på riktigt få leva livet fullt ut och inte behöva känna sig avskärmade från omvärlden. Gillberga Generational kan alltså ses som ett nav för invånarna i Lista- Gillberga där både äldre och yngre välkomnas och kan umgås ihop.

The impact of an education program on perception, knowledge, and infection rate was evaluated in this study. The educational intervention consisted of a video on infection control and a World Health Organization (WHO) pamphlet for hand hygiene. The study was conducted in one nursing home in the Southeastern United States. The survey sample consisted of 66 certified nurse assistants (CNAs). A pre- and post-intervention design was employed using the WHO’s Hand Hygiene Knowledge Questionnaire and the WHO Perception Survey. Friedman’s test and central tendencies showed no statistical relationship between the educational intervention and the overall knowledge scores of the sample. There also were no statistical differences in perception of hand hygiene in the CNA sample. Infection frequency was reduced with a percent change of -42%. While results of knowledge and perception surveys were not statistically significant, multiple conclusions were derived to suggest that educational opportunities may impact hand hygiene practice in CNAs and lead to a decrease in infection.

Nursing home residents often experience loneliness and social isolation. Research indicates that visitation via the telephone can decrease feelings of social isolation and loneliness. The purpose of this study was to introduce visual images to the telephone conversations of this population. It was hypothesized that the residents receiving this intervention would evidence decreased levels of loneliness and a greater sense of social support. This hypothesis was not supported by the data; however, emotional and social loneliness scores did show positive trends that may have been due to the intervention.

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. / Sodexo the Netherlands