This research project was a systematic evaluation of the effects of a personalized system of prosthetic aids to memory established in the home environment for individuals with mild to moderate dementia. The system of aids developed were in the form of a free-standing "Memory Center" unit. Caregivers were responsible for actively training their relatives to use the aids to compensate for deficits in orientation and memory for information necessary for daily functioning. The investigation was conducted in two phases, using a modified multiple baseline across subjects design. The two clients in Phase I met research criteria for Alzheimer type dementia and received a clinical dementia rating of moderate progression. Of the three clients in Phase II, two satisfied research criteria for Alzheimer type dementia, while one met research criteria for vascular dementia. All three were determined to have mild dementia. The effects of the intervention on the clients and the caregivers were examined over a four week intervention period and at a one month follow-up. The primary question addressed was whether clients could be trained to effectively use the prosthetic aids to orient themselves and compensate for deficits in memory function. This was assessed via daily assessments of verbal orientation. Weekly ratings of the behavioral functioning of clients were provided by the caregivers. And finally, caregivers rated their own stress and mood levels on a weekly basis throughout the study. Although the rates of learning varied, all of the clients increased their levels of verbal orientation following the introduction of the prosthetic aids and training. Evidence for generalized effects on the behavioral functioning of the clients was found. Overall, the clients were rated as expressing fewer negative emotions and as evidencing more oriented behaviors and less confused and disturbed behaviors during the intervention and at follow-up. Overall, the caregivers reported a consistent pattern of decline in their levels of stress and dysphoric mood. A common area of improvement was a reduction in negative emotions felt and expressed toward their relatives. Factors related to the success of the intervention and potential causal elements of change were discussed. Finally, recommendations for clinical practice and future research were provided. / Ph. D.

HIV/AIDS is a pandemic infecting and affecting millions of people worldwide. South Africa is also severely affected by this disease. Because hospitals cannot cope with patients admitted daily especially with the influx caused by HIV/AIDS patients, the government has introduced home-based care of people living with HIV/AIDS. Amongst those who practice home-based care are the volunteers. This study is aimed at exploring and describing the experiences of volunteers involved in home-based care of people living with HIV/AIDS in the Lusikisiki Magisterial district in the former Transkei area of the Province of the Eastern Cape. The researcher used a qualitative methodology with the aim of finding out what it is like to be a volunteer involved in home-based care in a rural area. The data was collected by means of semi-structured one-to-one interviews or guided interviews. A total sample of thirteen research participants was acquired through purposive as well as snowball sampling. The interviews were guided by a number of broad question themes. Data was analyzed using Tesch’s framework of data analysis as described in Creswell (1994). The researcher used Guba’s model as outlined in Krefting (1991) to ensure trustworthiness of the research findings. A literature control was undertaken to find out what other researchers and authors say about the issues raised by the study. There were five themes that came out of the data analysis process and these themes are: o The experiences of volunteers with home-based care. o Factors facilitating the work of volunteers. o Problems encountered by volunteers. o Possible solutions to problems encountered. o Views of volunteers regarding home-based care. These broad themes were further reduced into sub-themes and categories. Based on the discussion of themes, sub-themes, and categories, some research findings were presented. The discussion of the themes, sub-themes and categories was supported by verbatim quotations from the participants. On the basis of research findings, conclusions and recommendations were made.

published_or_final_version / Social Work / Master / Master of Social Work

The problem of this study was to better understand spouse caregivers' leisure involvement, experience, and barriers and their relationships with perceived burden. Thirty-six wife and 19 husband caregivers of persons with Alzheimer's disease and related disorders volunteered to participate in this study, either by mailed questionnaire or interview. Respondents were primarily female, white, with an average age of 72 years. The conclusions of the study were: (a) caregivers significantly reduce both their leisure involvement; (b) self-reported health, perceived social supports, income level, use of paid help, and leisure activity patterns are major factors associated with caregivers' leisure; and (c) leisure barriers are a significant contributor to caregivers' perceived burden. Recommendations were presented for caregivers, practitioners, and future study.

A sample of 22 persons who care for relatives exhibiting initial symptoms of senile dementia were administered paper-and- pencil questionnaires to determine their level of subjective burden and psychological symptomatology. Each participant's attributional style was measured on an internal-external dimension, and their causal attributions regarding their relative's symptomatic behaviors were assessed. Results indicated that attributional style did not predict specific attributions about illness-related behaviors, but the tendency to not blame an afflicted relative for their behavior was predictive of subjective burden and symptoms of depression and anxiety. Subjective burden was found to predict feelings of hostility in caregivers.

<p>Dagens och framtidens avancerade vård flyttas alltmer ut i patientens hem. Utskrivning från den slutna vården sker i allt snabbare takt, större krav ställs på hemsjukvården. Överlämning och rapportering av patienten mellan olika funktioner och personal skall ske så att patientens omvårdnadsbehov tillgodoses på ett tillfredsställande sätt. Studiens syfte var att beskriva överlämnande och rapportering i patientens hem från distriktssköterska till ambulanspersonal. Postenkät, med slutna frågor av Likert typ och med möjlighet att motivera svaren, har använts i studien. Databearbetningen har gjorts med statistical package for social sciencies (SPSS). Enkäten avslutades med fem öppna frågor, vars svar analyserats enligt kvalitativ innehållsanalys. Studien beskriver hur uppfattningarna mellan distriktssköterskor och ambulanspersonal inte alltid är samstämmiga. Om ambulanspersonal frågar efter eller om distriktssköterskor lämnar viss information vid överlämning av patient. Professionernas insikt i varandras yrken är begränsad och en vilja uttrycktes om att öka denna kunskap. Detta kunde vara ett steg i riktning mot att förbättra kommunikationen i överlämnandet och därmed säkra att viktig information följer patienten genom hela vårdkedjan. Ökad kunskap om hur kommunikationen sker mellan yrkesgrupper vid överlämnandet av patienten till annan vårdgivare i vårdkedjan är nödvändig. Framtida forskning utgående från denna studies syfte och population där kvalitativa djupintervjuer är metod skulle kunna ge en djupare insikt i de svar informanten i denna studie givit.</p> / <p>The advanced care of today, and the future, relocates more and more to the home of the patient. Discharge from the institutional care occurs more rapidly, greater demands are made on home nursing, and the link between these two nursing methods is the ambulance care. The hand over of a patient and the reports of the patient between different functions and personnel shall occur in a way that provides for the patient`s nursing needs in a satisfactory way. The purpose of the study was to describe patient hand over´s and reports in the patient´s home, from district nurse to ambulance personnel. In the stydy a questionnaire sent out by mail, containing of closed questions, formulated according to the Likert model and with a possibility to motivate the answers, has been used. The processing of the data has been made with a statistical package for social sciences (SPSS). The questionnaire was completed with five open questions, whose answers have been analyzed according to qualitative analysis of content. The study describes how perceptions between district nurses and ambulance personnel not always are in accordance. If ambulance personnel ask for or district nurses provides certain information when delivering a patient. The professions` knowledge of each others work is limited and a wish to increase this knowledge has been expressed. It could be a step towards improving the communication when handing over a patient and by those means secure that important information follows the patient throughout the entire treatment process. Increased knowledge about communication between different occupational groups at the hand over of the patient to a colleague in the nursing staff is necessary. Future research based on this study´s purpose and population where qualitative in-depth interviews are method could give a deeper insight into the answers this study has resulted in.</p>

Dagens och framtidens avancerade vård flyttas alltmer ut i patientens hem. Utskrivning från den slutna vården sker i allt snabbare takt, större krav ställs på hemsjukvården. Överlämning och rapportering av patienten mellan olika funktioner och personal skall ske så att patientens omvårdnadsbehov tillgodoses på ett tillfredsställande sätt. Studiens syfte var att beskriva överlämnande och rapportering i patientens hem från distriktssköterska till ambulanspersonal. Postenkät, med slutna frågor av Likert typ och med möjlighet att motivera svaren, har använts i studien. Databearbetningen har gjorts med statistical package for social sciencies (SPSS). Enkäten avslutades med fem öppna frågor, vars svar analyserats enligt kvalitativ innehållsanalys. Studien beskriver hur uppfattningarna mellan distriktssköterskor och ambulanspersonal inte alltid är samstämmiga. Om ambulanspersonal frågar efter eller om distriktssköterskor lämnar viss information vid överlämning av patient. Professionernas insikt i varandras yrken är begränsad och en vilja uttrycktes om att öka denna kunskap. Detta kunde vara ett steg i riktning mot att förbättra kommunikationen i överlämnandet och därmed säkra att viktig information följer patienten genom hela vårdkedjan. Ökad kunskap om hur kommunikationen sker mellan yrkesgrupper vid överlämnandet av patienten till annan vårdgivare i vårdkedjan är nödvändig. Framtida forskning utgående från denna studies syfte och population där kvalitativa djupintervjuer är metod skulle kunna ge en djupare insikt i de svar informanten i denna studie givit. / The advanced care of today, and the future, relocates more and more to the home of the patient. Discharge from the institutional care occurs more rapidly, greater demands are made on home nursing, and the link between these two nursing methods is the ambulance care. The hand over of a patient and the reports of the patient between different functions and personnel shall occur in a way that provides for the patient`s nursing needs in a satisfactory way. The purpose of the study was to describe patient hand over´s and reports in the patient´s home, from district nurse to ambulance personnel. In the stydy a questionnaire sent out by mail, containing of closed questions, formulated according to the Likert model and with a possibility to motivate the answers, has been used. The processing of the data has been made with a statistical package for social sciences (SPSS). The questionnaire was completed with five open questions, whose answers have been analyzed according to qualitative analysis of content. The study describes how perceptions between district nurses and ambulance personnel not always are in accordance. If ambulance personnel ask for or district nurses provides certain information when delivering a patient. The professions` knowledge of each others work is limited and a wish to increase this knowledge has been expressed. It could be a step towards improving the communication when handing over a patient and by those means secure that important information follows the patient throughout the entire treatment process. Increased knowledge about communication between different occupational groups at the hand over of the patient to a colleague in the nursing staff is necessary. Future research based on this study´s purpose and population where qualitative in-depth interviews are method could give a deeper insight into the answers this study has resulted in.

The purpose of this study was to examine the relationship between life stressors, resources, and psychological symptomatology of 20 family caregivers of Alzheimer's patients. Stressors were categorized as stressors specific to the caregiving role and general life stressors. Resources were also categorized as resources specific to the caregiving role and general life resources. Multiple regression determined which stressors, resources, and demographic variables predicted psychological symptomatology. Specific stressors that were significant predictors included: caregiving events, caregiving event chronicity, and mean burden scores. Significant general stressors included: size of caregivers' household, non-caregiving events and non-caregiving event chronicity. Significant resources included: other caregivers, the duties other caregivers provided, and caregiver's educational level. No Other Demographic Variables were found to be significant predictors.

The purpose of this study was to examine the effect of an intervention program for Alzheimer's patients on coping efficacy of their family caregivers. Using a pre-post repeated measures design, 16 family caregivers were interviewed before and after a medical, nursing, and social service intervention. Self-report measures, adjusted for caregiver satisfaction and caregiver mastery, were used to determine if there was a change in: resources, burden, and coping efficacy with caregiver specific and general life events. Results showed a marginal effect [F = 2.6, df(4,10), p<.10] for the omnibus MANCOVA. Most of this change was due to an increase in resources. Covariates of caregiver satisfaction and mastery were correlated with average burden. Results suggest that interventions such as this will be helpful for family caregivers of Alzheimer's patients.

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.