No description available.

No description available.

The impact of a short-term training program upon learned helplessness among nursing home staff and residents was studied. Learned helplessness among staff was defined in terms of depression, self-monitoring, short-term memory, absenteeism, and turnover. Among residents, urinary incontinence was the selected measure of helplessness.

Bakgrund: Användandet av djur inom vård- och omsorgsverksamheter har visat sig ha en positiv inverkan på bland annat patienters blodtryck, hjärtfrekvens och depression, och hundar har visat sig vara mer effektiva vid omvårdnadsbehandling jämfört med andra djur eftersom hundarna har det mest utvecklade kommunikationssystemet av våra sällskapsdjur. Följaktligen finns ett kunskapsbehov om patienters erfarenheter och upplevelser av hundbaserad omvårdnad. Syfte: Syftet med studien var att beskriva patienters upplevelser och erfarenheter av hundbaserad omvårdnad inom vård- och omsorgsverksamheter. Metod: En litteraturöversikt som baserades på sex vetenskapliga kvalitativa artiklar genomfördes. Artikelgranskning skedde utifrån Högskolan Kristianstads granskningsmall och analysarbetet följde Fribergs rekommendationer. Resultat: Det framkom tre huvudkategorier, Hundens betydelse i omvårdnaden, Hundens betydelse för välmåendet och Hundens betydelse för ett meningsfullt dagligt liv. Patienterna kände bland annat glädje, trygghet, meningsfullhet, ökad livskvalité och bekräftelse. Den hundbaserade omvårdnaden ökade också den sociala samvaron och bidrog dessutom till ökad självsäkerhet hos patienterna. Slutsats: Samtliga patienter oavsett ålder, kön, verksamhetsområde och diagnos erfor hundbaserad omvårdnad som positiv. Liknande resultat framkom även vid alternativa behandlingsmetoder, således behövs mer forskning om hundbaserad omvårdnad då det med säkerhet inte går att fastställa vad det är som bidrar till patienternas upplevelser och erfarenheter.

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.

The purpose of this randomized control trial (RCT) was to investigate the effects of a story-sharing intervention on older adults transitioning to long-term care (LTC). The specific aims were (1) to determine the effects of story sharing on the health transition outcomes of depression and well-being of adults transitioning to LTC; and (2) to determine if the sociodemographic characteristics (age, gender, ethnicity, marital status, level of education (LOE), months living at LTC facility, choice to move, and health problem(s) that may have resulted in the move) predict depression and/or well-being. Story sharing was defined as the respectful space where one tells and listens to stories of others (Heliker, 2009) while being guided by another (the investigator). Meleis’ middlerange theory of transitions (MMRTT) (Meleis et al., 2000) was used as a guide to understand the transitioning process. A convenience sampling design was used to recruit 100 participants from 11 LTC facilities in Broward County, located in Southeast Florida. The sample included adults, age 65 years and older, who were transitioning to a LTC facility within the past two years. Participants were randomly assigned to the control group (n = 52), who received standard care, or to the intervention group (n = 41), who received story-sharing and standard care. The results indicated there was no significant greater improvement to suggest an Intervention and Time effect for depression and/or well-being. Overall, predictive ability of the sociodemographic variables for depression and well-being were not statistically significant. However, LOE (junior college) did account for a significant portion of unique variance for increased depression, and time, marital status, ethnicity, LOE, and choice to move did account for a significant proportion of unique variance for well-being. Months living in LTC (more months) and marital status (all but divorced) were significant for improved well-being while ethnicity (Hispanic), LOE (high school and junior college), and choice to move (no choice) were significant for reduced well-being. Similar studies using a larger sample size, including non-English speaking participants; lengthier storysharing sessions; and measuring for pain, health, and bereavement may offer additional insights to healthy transition outcomes for this population. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

No description available.

Univ., Diss.--Osnabrück, 2005.

Across Scotland, there is a lack of research in care homes. This thesis explores this topic by examining links between inclusion, participation in general and participation in research and whether those who work and live in the care home environment experience social citizenship. Using a national survey and interviews with residents, staff, relatives and experts in care home research, this thesis investigated whether participation generally was linked to participation in research for residents, staff and visitors in a care home setting. The thesis further explored how social citizenship functions in a care home environment and whether there is a link between participation and citizenship. The findings suggest there is a lack of general participation which is connected with the leadership style and management within the care homes. There is misunderstanding about research and legislation amongst the care home staff, residents, visitors, as well as the junior research staff which inhibited staff and resident participation. Furthermore, citizenship is not experienced universally by residents or staff due to disempowerment, and exclusion occurs amongst residents due to age, frailty and dementia. By facilitating good leadership, communication and relationship-building such issues may be overcome. In addition, the analysis suggests a link is evident between inclusion, participation and citizenship. Where choice is provided and residents have their social position maintained, as well as have a degree of responsibility for shaping events, this leads to participation and inclusivity as described in Bartlett and O’Connor’s (2010) definition of social citizenship. Furthermore, if inclusion is adapted for cognition and frailty, then participation leads to the experience of social citizenship, encouraging a culture which can welcome research. The explicit emphasis on inclusion and participation in research has enabled this under-researched area of participation and experience of social citizenship in care homes to be more fully explored.

This research provides a feminist perspective on the lowest paid sector of the United States long-term care industry, Certified Nursing Assistants. This research adds to current feminist scholarship on the modern professional caregiving industry by focusing on the perspective of the workers. As the population of older adults requiring care is expected to increase over the coming decades, the demand for paid caregivers will increase as well. Historically, care work was an expected duty done freely by the women of the family, but today much of the vital intimate caring labor is relegated to paid caregivers. I examine how alternative social, political and economic frameworks can transform United States society’s attitude towards the increasingly relevant issue of caring labor. I argue that incorporating a feminist perspective will be helpful in developing a sustainable model for caring labor that acknowledges the dignity of both patients and their caregivers. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection