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Old Batswana persons' experience of loneliness : applying the Mmogo–methodTM / Carlien KahlKahl, Carlien January 2010 (has links)
Ageing in Africa and the world over is a phenomenon that affects individuals and societies. The expanding older population (people aged 60+) in South Africa led to this research, which represents an attempt to explore the experiences of loneliness of older persons in Africa and thereby gain some understanding of the subjective experiences of loneliness of a group of older African persons in their socio–cultural context.
Defining loneliness from the existing literature was challenging since it became evident that loneliness in the literature is defined and researched largely in terms of individual meanings attached to the concept, and the applicability of such individual meanings to an African context remains unconfirmed. Experiences of loneliness are not well known among older Setwana–speaking persons, and few studies have focused on collectivistic experiences as such. Loneliness is considered a complex, contextual experience that goes beyond the individual and also includes culture as an inseparable aspect of people’s lives. Conceptualising loneliness as a socially constructed phenomenon places this study within the paradigm of phenomenology exploring people’s experiences. The philosophy of ubuntu relates to being in the world among others thus creating the concept of a social self. In essence, to be a self, one has to belong to a community, and one is always contextualised as an existence among others in interaction.
A qualitative design was used together with a purposive convenience sampling method whereby the participants were selected on the basis of their availability during the research period. The participants’ ages ranged from 61 up to 73, and the sample included 16 female and two male participants. Two data sets were collected at different times from members of the Day Care Centre for the Aged in Ikageng, Potchefstroom, South Africa, as well as community residents who did not attend the centre.
Various qualitative techniques were used to collect the data including the Mmogo–methodTM, in–depth individual interviews and focus groups. Multiple methods were employed for analysing the data including phenomenological analysis, key–words–in–context and analysis strategies as stipulated by the Mmogo–methodTM. The rigour of the data was enhanced through the use of diverse qualitative data–gathering methods as well as an array of qualitative analysis methods in a process known as crystallisation. Ethical approval was granted by the Ethics Committee of the North–West University, Potchefstroom Campus, under a larger project, “An exploration of enabling contexts (05K14)”.
The researchers constructed two main themes from the findings: descriptions of loneliness and coping with loneliness. Loneliness related to the self and to others, and coping with loneliness involved actively engaging with the environment, being with others and using coping strategies. Some of the findings are linked to the existing literature, and some are unique relating to being with others and including social embeddedness as a multi–layered phenomenon connected to experiences of loneliness - it is here where the literature falls short in clarifying the findings within our context. Suggestions are made for future research, and some of the limitations of the study are pointed out.
To conclude: Loneliness is a multi–dimensional phenomenon that older Batswana people experience on many levels of engagement with and disengagement from the self and others. / Thesis (M.Sc. (Research Psychology))--North-West University, Potchefstroom Campus, 2011.
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Old Batswana persons' experience of loneliness : applying the Mmogo–methodTM / Carlien KahlKahl, Carlien January 2010 (has links)
Ageing in Africa and the world over is a phenomenon that affects individuals and societies. The expanding older population (people aged 60+) in South Africa led to this research, which represents an attempt to explore the experiences of loneliness of older persons in Africa and thereby gain some understanding of the subjective experiences of loneliness of a group of older African persons in their socio–cultural context.
Defining loneliness from the existing literature was challenging since it became evident that loneliness in the literature is defined and researched largely in terms of individual meanings attached to the concept, and the applicability of such individual meanings to an African context remains unconfirmed. Experiences of loneliness are not well known among older Setwana–speaking persons, and few studies have focused on collectivistic experiences as such. Loneliness is considered a complex, contextual experience that goes beyond the individual and also includes culture as an inseparable aspect of people’s lives. Conceptualising loneliness as a socially constructed phenomenon places this study within the paradigm of phenomenology exploring people’s experiences. The philosophy of ubuntu relates to being in the world among others thus creating the concept of a social self. In essence, to be a self, one has to belong to a community, and one is always contextualised as an existence among others in interaction.
A qualitative design was used together with a purposive convenience sampling method whereby the participants were selected on the basis of their availability during the research period. The participants’ ages ranged from 61 up to 73, and the sample included 16 female and two male participants. Two data sets were collected at different times from members of the Day Care Centre for the Aged in Ikageng, Potchefstroom, South Africa, as well as community residents who did not attend the centre.
Various qualitative techniques were used to collect the data including the Mmogo–methodTM, in–depth individual interviews and focus groups. Multiple methods were employed for analysing the data including phenomenological analysis, key–words–in–context and analysis strategies as stipulated by the Mmogo–methodTM. The rigour of the data was enhanced through the use of diverse qualitative data–gathering methods as well as an array of qualitative analysis methods in a process known as crystallisation. Ethical approval was granted by the Ethics Committee of the North–West University, Potchefstroom Campus, under a larger project, “An exploration of enabling contexts (05K14)”.
The researchers constructed two main themes from the findings: descriptions of loneliness and coping with loneliness. Loneliness related to the self and to others, and coping with loneliness involved actively engaging with the environment, being with others and using coping strategies. Some of the findings are linked to the existing literature, and some are unique relating to being with others and including social embeddedness as a multi–layered phenomenon connected to experiences of loneliness - it is here where the literature falls short in clarifying the findings within our context. Suggestions are made for future research, and some of the limitations of the study are pointed out.
To conclude: Loneliness is a multi–dimensional phenomenon that older Batswana people experience on many levels of engagement with and disengagement from the self and others. / Thesis (M.Sc. (Research Psychology))--North-West University, Potchefstroom Campus, 2011.
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'Unregarded age' : texts and contexts for elderly characters in English Renaissance drama, c.1480-1625Sheldon, Dania S. K. January 2000 (has links)
This study seeks to provide historical and literary contexts for elderly characters from English play-texts c.1580 to 1625. Its primary aim, from a literary perspective, is to draw attention to the ways that a better understanding of elderly characterisation can enrich the appreciation of much-studied play-texts, and to indicate some interesting features of more obscure ones. Its secondary aim is to suggest the value, for social historians of old age in early modern England, of play-texts as social evidence. I have examined most of the published extant play-texts of the period, and have found approximately 150 of these to be relevant (the most important of these are listed in the Appendix). Because of the problems of handling all aspects of such a large amount of material, I have chosen to consider the plays chiefly as texts to be read, with little reference to their performative aspects. However, I analyse the dramas as literary as well as social documents. Specific plays provide illustrations for observations and support for various hypotheses about dramatic representations of the elderly. In some instances, I address plays which have received little critical attention. The thesis falls into two parts. In the first three chapters, I discuss the socio-historical, cultural and non-dramatic literary contexts for representations of elderly men and women in play-texts. In chapters four through seven, I examine elderly characters in specific role or relationship categories: as sovereigns and magistrates, in sexual and marital relationships, and as parents. In the final chapter, I offer a detailed analysis of The Old Law by Thomas Middleton and William Rowley.
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ÅLDRANDE, HÄLSA, MINORITET : äldre finlandssvenskar i Finland och Sverige / AGEING, HEALTH, MINORITY : Older Finland-Swedes in Finland and SwedenKulla, Gunilla January 2009 (has links)
Bakgrund: Minoritetsgrupper, inklusive invandrargrupper, tenderar att skatta sin hälsa sämre i jämförelse med majoriteten. Syfte: Det övergripande syftet med föreliggande avhandling var att beskriva, analysera, jämföra och fördjupa förståelsen för äldre finlandssvenskars hälsa i form av upplevd och självskattad hälsa återspeglad ur ett livsloppsperspektiv. Upplevd hälsa studerades kvalitativt bland äldre finlandssvenskar i Finland och bland äldre finlandssvenskar i Sverige och som återflyttare till Finland (delstudierna I, IV). Självskattad hälsa studerades kvantitativt bland äldre finlandssvenskar i Finland (delstudie II), samt bland äldre finlandssvenskar i Sverige jämfört med äldre finskspråkiga i Sverige (delstudie III). Migration (III, IV) och åldrandet (I, II, IV) återspeglade sig i äldres hälsa. Metod: Urvalen erhölls från Befolkningsregistet i Finland samt Statistiska Centralbyrån i Sverige. Studiegrupperna bestod av totalt n=982 personer. Data insamlades genom strukturerad muntlig och inbandad intervju, halvstrukturerad inbandad intervju, strukturerat intervjuformulär samt postad enkät. Data analyserades genom hermeneutisk ansats med kärnberättelser, tematisk kvalitativ innehållsanalys, kumulativ multipel regressionsanalys samt Chi2-test. Resultat: Äldres upplevda hälsa tog sig uttryck genom personligheten, fysisk hälsa, sociala relationer och samhället. Över hälften skattade sin hälsa som god. Hälsa skattades som bättre ju mindre mediciner man behövde, ingen värk/smärta, bättre funktionsförmåga, bättre livslust och bättre ekonomi. Äldre finlandssvenskar i Sverige skattade sin hälsa som bättre jämfört med finskspråkiga i Sverige. Migration hade medfört svårigheter i samband med flyttningen till Sverige och arbetslivet i Sverige. Återflyttningen kunde försvåras av ohälsa och åldrandet. Åldrandet medförde en anpassning till att sätta egen hälsa och nuläge i perspektiv. Resultaten visade att äldre kan bidra med kunskaper om friskfaktorer. Konklusion: Ur ett folkhälsovetenskapligt hälsofrämjande perspektiv är det av relevans att lyfta fram minoritetsgrupper ur ett resursperspektiv. Det är centralt att beakta att det kan förekomma skillnader i hälsa mellan minoriteter, inom minoriteter och inom etniska minoriteter. Sociala och kulturella skillnader kan inverka på hur äldre skattar sin hälsa. Äldre i minoritet kan vara mera sårbara på grund av ohälsa, migration och kön / Background: Minority groups, including immigrants, generally tend to report lower self-rated health than the majority. Aims: The overall object of the dissertation was to describe, analyze and compare the self-rated health of older Finland-Swedes, and deepen the understanding of their experience of health in a life-course perspective. The experience of health was qualitatively studied among older Finland-Swedes in Finland, Finland-Swedes in Sweden and after re-migration in Finland (parts I, IV). Self-rated health was quantitatively studied among older Finland-Swedes in Finland (part II), and among older Finland-Swedes in Sweden compared to older Finnish-speakers in Sweden (part III). Migration (parts III, IV) and ageing (parts I, II, IV) were reflected in the health of older persons. Methods: The sample was obtained from the Population Register Centre of Finland and Statistics Sweden. The target groups consisted of 982 persons. The data was collected in structured oral and taped interviews, semi-structured taped interviews, structured interview forms, and postal enquiries. The data were analyzed through a hermeneutic approach with core narratives, thematic qualitative content analysis, cumulative multiple regression analysis, and chi-square test. Results: The experiential health of older persons manifested itself in personality, physical health, social relations, and society. More than a half of the respondents rated their health as good. Better health was reported with less medicine, no pain/suffering, better functional capacity, more zest for life, and better financial position. Older Finland-Swedes in Sweden reported better health than the Finnish-speaking respondents in Sweden. Migration had caused difficulties in connection with the move to Sweden and with working life in Sweden. Ill-health and ageing could cause problems with remigration. Ageing involved an adjustment in setting own health and the present in perspective. The results showed that older persons could contribute knowledge about health factors. Conclusions: From the perspective of public health science and health promotion, it is relevant to present minority groups from the vantage point of resources. It is essential to realize that there can be health differences between minorities, within minorities, and among ethnic minorities. Social and cultural variations can affect the way older persons evaluate their health. Older persons in minorities can be more vulnerable owing to ill-health, migration and gender.
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Learning with, from and about each other : interprofessional education on a training ward in municipal care for older personsLidskog, Marie January 2008 (has links)
The overall aim of this thesis was to describe and evaluate interprofessional education on an interprofessional training ward in municipal care for older persons. Interprofessional education has for some years now been proposed as a means to meet the call for effective collaboration, co-ordination and quality in health and social care. On the interprofessional training ward considered in this thesis, stu-dents from nursing, occupational therapy and social work programmes worked together for three weeks to learn with, from and about each other. In the first study (I) students’ perceptions and attitudes concerning the training on the ward were studied. An attitude questionnaire and a retrospective goal-fulfilment questionnaire were distributed to all students. Non-parametric statistics were used for the quantitative analysis, and qualitative content analysis for the qualitative parts. The results showed that the students had positive attitudes to-wards the training ward and in most respects the learning goals set up for the course were considered to have been met. In Studies II and III the focus was on students’ knowledge and understanding of their own and the others’ professions. Sixteen students were interviewed before and after. In the analysis of the interviews a phenomenographic approach was used. The findings showed a variation from simplistic conceptions of the profes-sions in terms of tasks to more complex conceptions in terms of the profession’s knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were espe-cially accentuated. The comparison between before and after indicated that there were changes in the students’ views. In some areas, however, there remained dis-crepancies between students’ understanding of their own profession and the oth-ers’ understanding of this profession. To promote mutual agreement on each other’s role this needs to be given careful consideration. In the fourth study (IV) the focus was on the students’ participation in the community of practice on the ward, and the findings reveal an ambivalent picture of this participation (and thus of their learning). The students collaborated in the care of the patients. However, they sometimes experienced a gap between expec-tations and reality with regard to both the profession-specific and the interprofes-sional training on the ward: what they had to do was sometimes felt to be be-neath their qualifications and irrelevant to the programme of education they were pursuing. This applied to all three groups, but especially student social workers. Interprofessional training wards can promote interprofessional learning, but it is crucial that setting should be right: it needs to be realistic for all the students involved, offering relevant profession-specific and interprofessional tasks and situations where the students can develop skills in collaborative, patient-centred care.
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Självbestämmande och inflytande i vardagen : Äldre personers uppfattningar om självbestämmande och inflytande relaterat till rambeslut i hemtjänsten / Autonomy and influence in everyday life. : Older people's perceptions of autonomy and influence related to Framework Decision in Home Help ServicesÅgren, Helena January 2016 (has links)
Syftet var att undersöka äldre personers uppfattningar om självbestämmande och inflytande relaterat till rambeslut i hemtjänsten. Att respektera individens rätt till självbestämmande och inflytande är grundläggande värden och förhållningssätt i svensk äldreomsorg. Rambeslut i hemtjänsten är ett salutogent arbetssätt som syftar till att i högre utsträckning stärka individens möjlighet till självbestämmande och att utöva inflytande över insatsernas utformning avseende hur och när de ska utföras. Uppsatsen tar sin utgångspunkt i den salutogena teorin. Studien genomfördes med kvalitativ metod. Åtta äldre personer deltog i semistrukturerade intervjuer. Intervjuerna bandades och transkriberades ordagrant och analyserades med kvalitativ innehållsanalys. Deltagarna ingick i ett pilotprojekt där rambeslut skulle utvecklas för att därefter införas för alla hemtjänstkunder i den aktuella kommunen. Analysen resulterade i tre kategorier som beskriver äldres uppfattningar om självbestämmande och inflytande relaterat till rambeslut i hemtjänsten. Kategorierna inkluderade 1) de äldres vaga uppfattningar om innebörden av begreppen, 2) vad de äldre tycker är viktigt att ha inflytande över och 3) att de äldre uppfattar sig ha inflytande i stunden men inte i planeringen. De äldre uttryckte bland annat att det är viktigt att ha inflytande över när man ska få sin hemtjänst, hur städningen utförs och att det finns flexibilitet utifrån dagsform. En slutsats som kan dras utifrån detta är att det som de äldre tycker är viktigt att ha självbestämmande och inflytande över stämmer väl överens med intentionerna för införandet av rambeslut. En annan slutsats är att de äldre uppfattar att de har självbestämmande och inflytande i stunden, i den faktiska vardagen, men inte i själva planeringen av insatserna. En tredje slutsats är att samtliga tre salutogena faktorer, begriplighet, hanterbarhet och meningsfullhet, är essentiella för att rambeslutets intentioner om ökat självbestämmande och inflytande ska uppnås. / The objective was to examine older people’s perceptions of autonomy and influence related to Framework Decision in Home Help Services. Respect of individual's rights of autonomy and influence are fundamental values and attitudes in Swedish elderly care. Framework Decision in the Home Help Services has the main goal of strengthening the individual’s right to decide for himself and have influence over how the Home Help Service should be carried out and when it should be performed. The study was conducted using qualitative method. Eight older persons participated in semi-structured interviews. The interviews were taped and transcribed verbatim, and the data was analyzed using qualitative content analysis. The participants were part of a pilot study aimed at developing Framework Decisionsin Home Help Services that subsequently would be implemented for all home care clients in the municipality. The analysis resulted in three categories that describe the older persons’ perceptions of autonomy and influence related to the Framework Decision in Home Help Services. The categories included 1) the older persons have vague notions about the meaning of the terms, 2) what the older persons think is important to have influence over, and 3) that the older persons perceive themselves to have influence in the moment but not in the planning. The participants expressed, among other things, that it is important to have control over when to get help service, how the cleaning is carried out and that there is flexibility on daily basis. One conclusion that can be drawn from this is that the things the older persons think is important to have self-determination and influence over is in line with the intentions of the introduction of the Framework Decision. Another conclusion is that the older persons feel that they have autonomy and influence in the moment, in the actual everyday life, but not in the planning of activities. A third conclusion is that all three salutogenic factors, comprehensibility, manageability and meaningfulness, are essential in order to achieve the Framework Decision’s intentions of greater autonomy and influence.
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Credibility of a Person-Centered Design Decision-making Prototype: Spaces for Older Persons with Vision LossGowda, Vidya 29 June 2016 (has links)
Decline in both visual acuity and visual performance is a fact of life for older people and their increasing share of the population requires that buildings be designed with their visual needs in mind. As their field of vision decreases, people find it harder to identify an objects location, distance, and orientation. Elderly people with vision impairments usually find it harder to perform daily activities such as navigation through indoor spaces. Functional vision can be improved by modifying the design of spaces, for example, with better lighting. However, architects typically do not know how to take the needs of the visually impaired into account in their design process, or simply do not think of doing so. The researcher designed and feasibility-tested a prototype person-centered tool to help architects judge how appropriate a designed space will be for visually impaired people. The study was conducted as a qualitative mixed-methodology research analysis. The researcher used knowledge from literature interpretation to rationalize the development of a person-centered prototype. The researcher immersed design PhD students and vision science experts to inform the prototyping process. Along with an expert group of design and vision science professionals, the researcher beta-tested the prototype during a mock design-process scenario. The researcher also selected a small group of industry experts to participate in open-ended interviews on post-use demonstrations to qualitatively triangulate the findings on the prototypes usability. The study summarizes the feasibility including the challenges of using the prototype for professional purposes and suggests improvement. / Ph. D.
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The experience and views of indigent older persons in Atteridgeville on the Indigency policy / programme of local governmentLatakgomo, Christabela Nthabiseng 02 1900 (has links)
The Indigency Policy / Programme was introduced by the Tshwane Municipality in 2000 to alleviate poverty by assisting the poor with subsidized limited basic municipal services. The goal of this study was to explore the experiences and views of indigent older persons in Atteridgeville of the Indigency Policy / Programme of the Tshwane Municipality.
Limited literature was available on the topic and hence the researcher undertook a qualitative study that was exploratory and descriptive in nature to explore this unknown area.
The key recommendations were: There is a need for active involvement and availability of municipal social workers; continuous monitoring, education and evaluation by the municipality for the communities. It was recommended that the Municipality conduct a full scale research on indigents` experience and perceptions/ views of their Indigency Policy / Programme in Tshwane. / Social Work / M. A. (Mental Health)
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Tendances et déterminants de l’utilisation de l’aide à domicile subventionnée par le gouvernement par les personnes âgées au Canada, 1996-1997 à 2009-2010Binette Charbonneau, Anne 03 1900 (has links)
Il est connu que le vieillissement de la population canadienne va augmenter la demande d’aide à domicile et qu’un soutien insuffisant du secteur public accroît l’implication des réseaux informels et privés. En s’appuyant sur les données de l’Enquête nationale sur la santé de la population (ENSP) et de l’Enquête sur la santé dans les collectivités canadiennes (ESCC), cette recherche analyse les tendances et déterminants de l’utilisation de l’aide à domicile subventionnée par le gouvernement au Canada et en Ontario entre 1996-1997 et 2009-2010.
Il en ressort que la proportion de bénéficiaires âgés de 65 ans et plus est en diminution, passant de 9,9% à 9,2% au Canada (1996-1997 à 2005) et de 10,2% à 8,8% puis 9,6% en Ontario (1996-1997, 2005, 2009-2010). Les compressions sont particulièrement ressenties dans les services de maintien à domicile, dont l’aide pour les travaux ménagers (de 51% à 34% en Ontario). Les personnes âgées, les femmes, les gens vivant seuls ou qui ont besoin d’assistance pour accomplir certaines activités de la vie quotidienne (AVQ) ou activités instrumentales de la vie quotidienne (AIVQ) reçoivent de moins en moins d’aide publique à domicile.
En conclusion, le présent système de santé, qui semble se concentrer sur les soins de santé plutôt que sur les services de maintien, ne répond pas aux besoins des personnes âgées. Par ailleurs, le cas ontarien évoque l’impact que peuvent avoir les décisions politiques sur l’utilisation de l’aide à domicile. Les résultats suggèrent qu’entre 1996-1997 et 2005, ce sont surtout les personnes âgées de 18 à 64 ans et ceux nécessitant des soins qui bénéficièrent des programmes publics. Durant la période suivante (2005 à 2009-2010), il semble y avoir un intérêt plus marqué pour les 65 ans et plus dont la proportion d’utilisateurs s’accroît plus rapidement. / It is known that the aging of the Canadian population will increase the demand for home care and that insufficient support from the public sector increases the implication of the informal and private networks. Using cross-sectional data from the National Population Health Survey (NPHS) and the Canadian Community Health Survey (CCHS), this research analyzes the trends and predictors of subsidized home care in Canada and Ontario between 1996/97 and 2009/10.
It shows that the proportion of care receivers aged 65 and older is decreasing, going down from 9.9% to 9.2% in Canada (1996/97 to 2005) and from 10.2% to 8.8% then 9.6% in Ontario (1996/97, 2005, 2009/10). Government cuts are particularly felt in terms of home support services, like support for housework (from 51% to 34% in Ontario). Older persons, women, people living alone or those who need assistance to perform some activities of daily living (ADLs) or instrumental activities of daily living (IADLs) are receiving less and less subsidized home care.
In conclusion, the actual health system, that appear to focus on health care instead of home support services, do not meet the needs of older persons. Furthermore, the Ontario case evokes the effect that policies can have on home care utilization. Results suggest that between 1996/97 and 2005, it is mostly persons aged from 18 to 64 years old or needing health care that benefited from the public program. During the next period (2005 to 2009/10), there seems to be a greater interest for the 65 and older, whose proportion of users increases more rapidly.
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Mise à l’essai et évaluation qualitative d’une intervention inspirée de la pédagogie narrative destinée aux infirmières soignant des personnes âgées en état confusionnel aiguBélanger, Louise 07 1900 (has links)
Les personnes âgées occupent une proportion importante des lits dans les centres hospitaliers de soins de courte durée québécois et leur présence est en augmentation. Parmi ces personnes, plusieurs présentent un état confusionnel aigu (ÉCA), voire un délirium, au cours de leur hospitalisation. Les soins infirmiers qu’elles requièrent sont complexes et les études portant sur la formation continue des infirmières tiennent peu compte de cette réalité. Les approches utilisées dans les études sont surtout centrées sur l’acquisition de connaissances et d’habiletés techniques et négligent les aspects créatifs, relationnels, critiques, réflexifs et éthiques essentiels à une prestation de soins infirmiers de qualité. On y retrouve également peu d’informations sur la conception de l’intervention éducative et sur son évaluation. C’est dans cette perspective que le but de l’étude était de mettre à l’essai et d’évaluer qualitativement le processus et les résultats d’une intervention éducative auprès d’infirmières soignant des personnes âgées hospitalisées en ÉCA. Plus particulièrement, ce sont les conditions facilitant et contraignant l’intervention, les aspects les plus utiles pour la pratique, les différents savoirs exprimés et les résultats de soins perçus par les participantes qui étaient recherchés. C’est en s’inspirant de la pédagogie narrative de Diekelmann (2001) et des savoirs infirmiers de Chinn et Kramer (2008) que l’intervention a été conçue et évaluée. La description d’expériences de soins vécues par les infirmières et la création d’un environnement d’apprentissage favorisant l’interprétation, en groupe, de ces expériences à l’aide d’informations théoriques et empiriques caractérisent la pédagogie narrative à la base de cette intervention.
Pour atteindre le but, une étude de cas a été retenue. La stratégie d’échantillonnage par choix raisonné a permis de sélectionner des participantes travaillant sur les trois quarts de travail, ayant différents niveaux de formation et une expérience comme infirmière variant de huit mois à 36 ans, dont l’âge variait de 23 à 64 ans. L’échantillon, composé de 15 infirmières soignant fréquemment des personnes en ÉCA et travaillant sur des unités de soins chirurgicaux cardiologiques et orthopédiques, était réparti dans trois groupes égaux de cinq participantes. L’intervention éducative comprenait quatre journées de formation offertes à intervalle de trois semaines pour une durée totale de 12 semaines. Au cours de chacune de ces journées, les participantes devaient effectuer un travail écrit réflexif concernant une situation de soins vécue avec une personne en ÉCA et, par la suite, partager, interpréter et s'interroger sur ces situations en faisant des liens avec des informations théoriques et empiriques sur l’ÉCA dans le cadre d’un atelier de groupe. Une triangulation de méthodes de collecte de données, incluant des notes de terrain de l’investigatrice, les travaux réflexifs des participantes, des questionnaires complétés par les participantes après chaque journée de formation et une entrevue individuelle avec chaque participante réalisée par une intervieweuse externe à la fin de l’intervention, a permis de décrire la mise à l’essai de l’intervention et d’évaluer qualitativement son processus et ses résultats. Une analyse de contenu des données qualitatives intra et inter participante a été effectuée.
La mise à l’essai de l’intervention a mis en évidence l’importance de tenir compte des besoins variés des participantes et d’ajuster l’intervention éducative d’un groupe à l’autre, notamment eu égard aux contenus théoriques et empiriques sur l’ECA. L’évaluation du processus souligne que l’intervention a été facilitée par les attitudes et la diversité des expériences des participantes, ainsi que par l’utilisation de situations de soins réelles permettant d’intégrer la théorie dans la pratique. L’accès à de nouveaux outils d’évaluation des personnes en ÉCA a été perçu particulièrement utile par les participantes. Quant à l’évaluation des résultats, elle a permis de rendre visibles de nombreux savoirs empiriques, éthiques et esthétiques et certains savoirs personnels et émancipatoires exprimés par les participantes. Les participantes ont, entre autres, réalisé des évaluations plus approfondies des personnes en ÉCA, ont réduit ou évité les mesures de contrôle physiques des personnes atteintes et ont impliqué davantage les familles dans les soins. L’évaluation a aussi permis de décrire certains résultats perçus par les participantes sur le bien-être physique et psychologique des personnes soignées et sur les familles. Les personnes en ECA étaient, entre autres, rassurées, plus calmes et soulagées et les familles moins inquiètes et davantage impliquées dans les soins.
Les résultats de l’étude mettent en évidence l’applicabilité d’une intervention éducative narrative basée sur un cadre de référence en sciences infirmières et son utilité pour la formation continue dans les milieux de soins. L’étude ouvre la porte à des possibilités de transfert de l’intervention à d’autres populations d’infirmières soignant des clientèles ayant des besoins complexes, notamment en gériatrie, en oncologie ou en soins palliatifs. Des études visant à évaluer l’intervention auprès d’un échantillon plus important et à explorer ses effets sur les personnes soignées et leurs familles sont proposées. / Older persons occupy a growing proportion of the beds in Quebec short-stay hospitals. Many of these persons present acute confusional state (ACS), or delirium, in the course of their hospitalization. The nursing care that they require is complex but studies show that continuing nursing education takes scant account of this reality. The approaches used in these studies have focused above all on the acquisition of knowledge and technical skills and have neglected the creative, relational, critical, reflexive and ethical aspects essential to delivering quality nursing care. In addition, these studies contain little information relative to the design of pedagogical interventions and their evaluation. Against this background, a study was undertaken aimed at field-testing and qualitatively evaluating the process and results of a pedagogical intervention for nurses who care for hospitalized older persons with ACS. The focus was more specifically on identifying the facilitating and constraining conditions to learning, the aspects most useful to practice, the different types of knowledge expressed, and the care outcomes perceived by participants. Inspiration for the design and evaluation of the intervention was drawn from the narrative pedagogy approach developed by Diekelmann (2001) and the various patterns of knowing knowledge defined by Chinn and Kramer (2008). The narrative pedagogy at the root of this intervention consists essentially of describing the lived care experiences of nurses and creating a learning environment conducive to group interpretation of these experiences based on theoretical and empirical data.
To achieve the objectives, a case study design was used. Purposive sampling allowed selecting participants working all three work shifts, possessing different levels of training, boasting nursing experience ranging from eight months to 36 years, varying in age from 23 to 64 years. The sample, composed of 15 nurses who worked on cardiac and orthopedic surgery units and who often cared for persons with ACS, was divided into three equal groups of five. The pedagogical intervention comprised four days of training offered at an interval of three weeks for a total duration of 12 weeks. On each of these days, participants had to complete a written reflexive exercise regarding a lived care situation involving a person with ACS and then, in the context of a group discussion, share, interpret and question these situations by drawing connections with available theoretical and empirical data on ACS. A triangulation of data collection methods, including the investigator’s field notes, the participants’ written reflexive exercises, questionnaires completed by the participants after each day of training, and individual interview with each participant carried out by an outside interviewer at the end of the intervention, allowed describing the field-testing of the intervention and qualitatively evaluating its process and results. The qualitative intra and inter-participant data was then subjected to content analysis.
Field-testing of the intervention highlighted the importance of taking account of the varied needs of the participants and to adjust the pedagogical intervention from one group to the next, particularly with respect to the theoretical and empirical content on ACS. Process evaluation underscored that the intervention was facilitated by the attitudes and the diversity of experiences of the participants, as well as by the use of real care situations, which allowed integrating theory in practice. Access to new tools for assessing persons with ACS was perceived to be particularly useful by the participants. As for the results evaluation, it allowed revealing various types of knowledge, including of the empirical, ethical and esthetic sort, but also some personal and emancipatory knowledge expressed by the participants. Moreover, the participants performed more in-depth assessments of persons with ACS, reduced or avoided the use of physical control measures on these persons, and involved families more in care. The evaluation also allowed documenting some of the effects perceived by the participants on the physical and psychological well-being of care recipients and their families. Persons with ACS were reassured, calmer and soothed, among other things, while families were less worried and more involved in care.
The study’s results evidence the applicability of a narrative pedagogy intervention based on a nursing frame of reference and its utility in continuing education in the field of care. The study opens up the possibility of transferring the intervention to other populations of nurses who tend to clienteles with complex needs, particularly in geriatric, oncological and palliative care. It is proposed that future studies evaluate the intervention on a larger sample and explore its effects on the persons cared for and their families.
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