Thesis (Ph. D.)--Duquesne University, 2003. / "UMI Number: 3125394." Abstract. Includes bibliographical references (p. 200-206) and index.

Thesis (Ph. D.)--Duquesne University, 2003. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 200-206) and index.

The health care requirements of older people admitted to acute hospitals and their need for nursing care have been identified in current literature as problematic. Hospital organisations which are medically oriented and more focused on implementing programs directed by economics, efficiency and effectiveness may be unsupportive of nursing practices based on a professional value system. There is a need, therefore, to examine how health care structures that tend to promote cost containment and a technical imperative, impact on the professional capability of nurses to provide the standard of care required by acutely ill older hospitalised patients. The collected data, analysed thematically, indicates that the nurses were knowledgeable and potentially competent in providing the standard of technical and functional care required by older adults in hospital. However, although nurses articulated that they wanted to provide the quality of care needed by acutely ill older patients, they nevertheless admitted they were optionalising this care because of constraints in the health care system.While the nurses’ constructions revealed they believed technical tasks took up most of their time during shifts, it is evident during the observations that this was not the case. Through the use of Giddens’s (1984) Structuration Theory, a very different picture began to unfold about the incongruence about was said, and what was actually done. The significance of this study is that the incongruence found between the nurses’ knowledge and their actions has been revealed. / Doctor of Philosophy (PhD)

Made available in DSpace on 2014-07-29T15:04:40Z (GMT). No. of bitstreams: 1 dissertacao Walquiria Lene dos Santos.pdf: 1276690 bytes, checksum: f310b23a18d27f16d793e56e0aa64328 (MD5) Previous issue date: 2008-04-30 / The planning of the discharge should begin in the entrance patient in atmosphere hospitalar. This study aims: to identify and analyse the profile of the nursing diagnosis of NANDA (2006), to analyse the following characteristics of the participants: gender, age, education, income and religion, to describe the related factors, risk factors and defining characteristics for diagnoses identified discharge in hospital of elderly, treated in a hospital school of the Region Western-Central. Used a structured form for collect data and the process of clinical reasoning (analysis and synthesis of data) according Risner (1995) for identify the nursing diagnosis. Most elderly people belonged to male sex (72%), age group of 60 to 69 years (52%), married (64%), the profess catholicism (80%), had less than four years schooling (88%) and monthly income of up to one minimum wage (52%), greater than a minimum wage (40%) and without income (8%). The spheres most frequently were: health promotion (100%), protection and security (100%), perception and cognition (96%), self (88%), relationship of paper (88%), coping / tolerance to stress (88%) and activity and rest (84%). The spheres of sexuality (24%) and principles of life (4%) had lower frequency. The diagnosis that received frequency greater than 50% were: damaged teeth (96%), arrangement improved self (80%), arrangement increased confront (80%) arrangement improved processes relatives (76%), infection risk (68%), arrangement increased the control of the therapeutic regimen (64%), sensory perception (visual, olfactory, auditory and tactile) altered (60%), inadequate knowledge about the disease (60%) and arrangement for improved nutrition (52%). The defining characteristics with more frequency were: health care resources are insufficient to impact or prevalence of disease (100%), account the problem (100%), demonstration of disease (100%), locomotion at random (100%), reported experience of forgotten (100%), inability to recall factual information (100%), lack of energy (100%), inability to maintain the level of habitual physical activity (100%), impaired ability to obtain or reinstate articles of apparel (100%), appropriate choices of daily activities to achieve the objectives of a programme of treatment or prevention (90,9%), tiredness (85,7%), acceptance of qualities and limitations (85%) and visual distortions (83.3%). The related factors encountered with more frequency were: sensory perception altered (100%), lack of interest in learning (100%), lack of exposure (100%), lack of familiarity with the use of information (100%), weakness and tiredness (100%), harmful agents (physical) (100%), emotional state especially frustration (100%), state of illness and weakened physical condition (85,7%) and destruction of layers of the skin (80%). The risk factors encountered were: effects of medications (diuretics) (100%), abnormalities of the anal sphincter (100%), invasive procedures (100%), age more than 65 years (100%), respiratory and circulatory problems (83,3%), decreased energy and fatigue (80%) and falls historical (66,6%). The knowledge of nursing diagnosis, by systematization of care realized discharge in hospital of elderly, it should involve the whole family and caregivers, guaranteeing thus, continuity of humanized care, the return of elderly in home / O planejamento da alta deve iniciar na entrada do paciente no ambiente hospitalar. Este estudo tem como objetivos: analisar e identificar o perfil de diagnósticos de enfermagem da NANDA (2006), analisar as seguintes características dos participantes: sexo, idade, escolaridade, renda e religião, descrever os fatores relacionados, os fatores de risco e as características definidoras, para os diagnósticos identificados na alta hospitalar, de idosos hospitalizados, atendidos em um hospital escola da Região Centro-Oeste. Utilizou-se um formulário estruturado para a coleta de dados e o processo de raciocínio clínico (análise e síntese dos dados) de acordo com Risner (1995) para identificar os diagnósticos de enfermagem. A maioria dos idosos pertencia ao sexo masculino (72%), faixa etária de 60 a 69 anos (52%), casados (64%), professava o catolicismo (80%), possuíam escolaridade, menor que quatro anos (88%) e renda mensal de até um salário mínimo (52%), maior que um salário mínimo (40%) e sem rendimentos (8%). Os domínios com maior freqüência foram: promoção de saúde (100%), segurança e proteção (100%), percepção e cognição (96%), autopercepção (88%), relacionamento de papéis (88%), enfrentamento/tolerância ao estresse (88%) e atividade e repouso (84%). Os domínios de sexualidade (24%) e princípios de vida (4%) apresentaram menor freqüência. Os diagnósticos que obtiveram freqüência maior que (50%) foram: dentição prejudicada (96%), disposição para autoconceito melhorado (80%), disposição para enfrentamento aumentado (80%) disposição para processos familiares melhorados (76%), risco de infecção (68%), disposição para o controle aumentado do regime terapêutico (64%), percepção sensorial (visual, olfativa, auditiva e tátil) perturbada (60%), conhecimento deficiente sobre a doença (60%) e disposição para nutrição melhorada (52%). As características definidoras com maior freqüência foram: recursos da assistência à saúde são insuficientes para incidências ou prevalências das doenças (100%), verbalização do problema (100%), demonstração das doenças (100%), locomoção ao acaso (100%), experiência relatada de esquecimento (100%), incapacidade de recordar informações factuais (100%), falta de energia (100%), incapacidade de manter o nível habitual de atividade física (100%), capacidade prejudicada para obter ou repor artigos de vestuário (100%), escolhas apropriadas de atividades diárias para atingir os objetivos de um programa de tratamento ou prevenção (90,9%), cansaço (85,7), aceitação de qualidades e limitações (85%), distorções visuais (83,3%). Os fatores relacionados encontrados com maior freqüência foram: percepção sensorial alterada (100%), falta de interesse em aprender (100%), falta de exposição (100%), falta de familiaridade com o recurso de informação (100%), fraqueza e cansaço (100%), agentes lesivos (físicos) (100%), estado emocional especialmente frustração (100%), estado de doença e condição física debilitada (85,7%) e destruição das camadas da pele (80%). Os fatores de risco encontrados foram: efeitos de medicação (diuréticos) (100%), anormalidades do esfíncter anal (100%), procedimentos invasivos (100%), idade acima de 65 anos (100%), problemas circulatórios e respiratórios (83,3%), energia diminuída e fadiga (80%) e históricos de quedas (66,6%). O conhecimento dos diagnósticos de enfermagem, por meio da sistematização da assistência realizada durante a alta hospitalar, deve envolver toda a família e cuidadores, garantindo, assim, a continuidade do cuidado humanizado, no retorno do idoso ao domicilio

Die Festlegung einer Quote für den Anteil an Plätzen in Einzel- und Doppelzimmern in stationären Altenpflegeeinrichtungen wird im Zuge des Übergangs der Heimgesetzgebung auf die Bundesländer derzeit intensiv diskutiert. In den letzten Jahren ist der Anteil an Plätzen in Einzelzimmern in allen Bundesländern bereits ohne die Festlegung einer Zielgröße kontinuierlich angestiegen. In welchem Maß die Festschreibung eines erhöhten Einzelplatzanteils auch höhere bauliche Investitionskosten und ansteigende Betriebskosten verursacht, wird in den bisher vorliegenden Studien kontrovers diskutiert. In den hier vorgenommenen Untersuchungen im Auftrag des Bayerischen Staatsministeriums für Arbeit und Sozialordnung, Familie und Frauen wird untersucht, welche flächen- und baukostenseitigen Kompensationspotenziale in den Raumprogrammen aktuell realisierter Bauvorhaben bestehen, die bei zukünftigen Neubauvorhaben zu einer Erhöhung des Einzelplatzanteils auf 85% herangezogen werden können. Dazu werden Modellrechnungen durchgeführt und anhand derer retrospektiv untersucht, ob geänderte Konzeptionen sowohl im betrieblichen Konzept als auch in der konkreten Raumprogrammierung sich flächen- und damit auch Kosten reduzierend hätten auswirken können und damit zukünftig eine Erhöhung des Einzelplatzanteils kompensiert werden könnte. Die Maßnahmen werden hinsichtlich ihrer Auswirkungen auf die Pflege und Versorgung diskutiert. Die Ergebnisse der Modellrechnungen zeigen, dass in den aktuellen baulichen Standards der Neubauten der letzten Jahre durchaus Variablen bestehen, die den unbestrittenen Zuwachs an Fläche und baulichen Investitionskosten bei der Realisierung eines erhöhten Einzelzimmeranteils von ca. 85% bei zukünftigen Neubauten kompensieren können. Entsprechende Ansatzmöglichkeiten werden im Bereich der Größe und Anzahl von Bädern in den Bewohnerzimmern sowie von Pflegebädern, in der Form der Speisenversorgung sowie der Größe von zentralen Funktionen, wie z.B. Cafeteria, Mehrzweck- und Therapiebereiche, gesehen. / As legislation on nursing home care in Germany is no longer a federal law, the former regulations are revised and newly legislated by the German federal states. In this context it is being intensely discussed if the percentage of single and shared bedrooms in nursing homes should be legally stipulated. Within the last years the percentage of single rooms increased continuously even without a compulsory quote. To what extent a higher share of single rooms causes higher costs in investment and operating is being controversially discussed in the existing studies. The following study was commissioned by the Bavarian State Ministry of Labour and Social Welfare, Family Affairs, Women and Health. Focus of this study was to identify elements within the room allocation plans of the homes which could be redesignated in futures programmes in order to achieve a percentage of 85% single rooms within the Nursing homes- without causing higher costs in investment. Model calculations showed that modifications of the conceptual designs can compensate the investment cost in new developments. Influencing factors are the size and number of resident’s bathrooms and therapeutic baths, the catering concept and the surface area of common rooms such as the cafeteria and multipurpose rooms.