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1
Moran, Shane. „China's aged care crisis : problems, resources, solutions“. Thesis, View thesis, 2000. http://handle.uws.edu.au:8081/1959.7/23015.
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China is currently facing what I expect to be its most significant challenge to date - a crisis in the care of its rapidly ageing population. The causes of this crisis are complex and multi-faceted and its implications far-reaching from the social, economic and political perspectives. This thesis examines the causes and consequences of the impending aged care crisis in China, with a particular focus on the urban elderly. In addition to extensive interviews with government officials, a sample of 2,000 retires and their children were surveyed in Shanghai as part of my research. My findings from the Research Survey and Questionnaire, together with my observations from site visits to numerous aged care crisis and the associated problems. Of primary concern is the fact that the Chinese government does not have in place an appropriate aged care structure nor a strategy to implement systems to cope with the impending crisis. I conclude that it is imperative the Chinese government recognises both the immediacy and scale of the crisis and acts accordingly. Failure to do so may result in both significant social unrest and severe economic consequences. Recommendations are offered for consideration by the Chinese government in an effort to manage the impending aged care crisis in China.
2
Moran, Shane. „China's aged care crisis : problems, resources, solutions /“. View thesis, 2000. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030829.165655/index.html.
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Thesis (Ph.D.)--University of Western Sydney, Hawkesbury, 2000."A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, Faculty of Health, University of Western Sydney."
3
Preece, Michael. „Knowledge management : a residential aged care perspective“. Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/561.
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This research explores perceptions of knowledge management processes held by managers and employees in a service industry. To date, empirical research on knowledge management in the service industry is sparse. This research seeks to examine absorptive capacity its four absorptive capacity capabilities of acquisition, assimilation, transformation and exploitation and their impact on effective knowledge management. All of these capabilities are strategies that enable external knowledge to be recognised, imported and integrated into, and further developed within the organisation effectively.The research tests the relationships between absorptive capacity and effective knowledge management through analysis of quantitative data (n=549) drawn from managers and employees in 35 Residential Aged Care organisations in Western Australia. Responses were analysed using Partial Least Square-based Structural Equation Modelling. Additional analysis was conducted to assess if the job role (of manager or employee) and three industry context variables of profit motive, size of business and length of time the organisation has been in business, impacted on the hypothesised relationships.Structural model analysis examined the relationships between variables as hypothesised in the research framework. Analysis found that absorptive capacity and the four capabilities correlated significantly with effective knowledge management, with absorptive capacity explaining 56% of the total variability for effective xiv knowledge management. Findings from this research also show that absorptive capacity and the four capabilities provide a useful framework for examining knowledge management in the service industry. Additionally, there were no significant differences in the perceptions held between managers and employees, nor between respondents in for-profit and not-for-profit organisations. Furthermore, the size of the organisation and length of time the organisation has been in business did not impact on absorptive capacity, the four capabilities and effective knowledge management.The research considers implications for business in light of these findings. The role of managers in providing leadership across the knowledge management process was confirmed, as well as the importance of guiding routines and knowledge sharing throughout the organisation. Further, the results indicate that within the participating organisations there are discernable differences in the way that some organisations manage their knowledge, compared to others. To achieve effective knowledge management, managers need to provide a supportive workplace culture, facilitate strong employee relationships, encourage employees to seek out new knowledge, continually engage in two-way communication with employees and provide up to date policies and procedures that guide employees in doing their work. The implementation of knowledge management strategies have also been shown in this research to enhance the delivery and quality of residential aged care.
4
Shohel, Mohammad. „Antibiotic Stewardship in Residential Aged Care Facilities“. Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/86378.
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Aged care residents are at increased risk of infections due to their frailty and comorbidities. This study aimed to identify and reduce the risk of antibiotic-related misadventure in this population. Particular medicines were associated with use of antibiotics, suggesting compromised immunity via numerous mechanisms. Potential interactions between antibiotics and residents’ other medicines were also identified, and may increase morbidity in this vulnerable group. Expanded scope of antimicrobial stewardship in aged care facilities is recommended.
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Daskein, Robyn. „Nursing Documentation and Quality of Care in Residential Aged Care in Queensland“. Thesis, Griffith University, 2008. http://hdl.handle.net/10072/367277.
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Little is known about the relationship between registered nurses’ (RNs’) knowledge of nursing documentation, their attitudes towards this documentation, and how they perceive the importance of the forms used in the documentation process within residential aged care. The current study has several aims. This investigation sought to gain a measure of RNs’ knowledge of, and attitudes towards documentation, and assess their perception of the importance of forms used to document care.
There were two phases of study. Study 1 utilised a cross-sectional, retrospective design with a large sample of RNs (n = 360) who completed Edelstein’s (1990) modified questionnaire to identify factors that influence nurses’ documentation in residential aged care in Queensland. A factor analysis was undertaken to extract influencing factors.
The second study developed and tested a conceptual model of nursing practice and quality of care to determine relationships between the factors under investigation. This phase used a smaller sample of RNs (n = 46). Participating RNs were asked to provide personal characteristics (e.g. age, gender, first nursing qualification and studies in aged care) and to complete Edelstein’s (1990) modified questionnaire. A chart audit was conducted on residents’ records where the resident required interventions for challenging behaviour. Relatives of residents whose charts were audited also completed a survey to measure their perceived satisfaction with care of their family member. Finally, a model of the relationships between documentation and outcome measures was developed on the basis of prior literature and previous empirical studies. This model was labelled “The Nursing Practice and Quality of Care Model”. This model was then tested with a smaller sample of RNs, seeking to find out if it appropriately represented the relationships that exist between RN documentation and outcomes.
Edelstein’s (1990) modified questionnaire was demonstrated to have acceptable reliability and validity. Results of Study 1 revealed that RNs working in aged care in Queensland have high levels of knowledge about documentation, and consider the forms they use to document care to be very important, but have mixed attitudes towards documentation. Several issues influenced the results for the knowledge and attitude scales. These included knowledge factors such as care-reporting guidelines, nurse time issues, legal issues and quality of reporting. Attitudes were influenced by charting, practice and policy issues. These findings provide important information on what variables affect RNs’ documentation.
The RN participants in Study 2 were comparable to the national and state figures for RN aged care demographics (Hsu, Moyle, Creedy, & Venturato, 2005; Richardson & Martin, 2004). Overall, the findings of Edelstein’s (1990) modified questionnaire in Study 2 were consistent with Study 1, although different relationships were found between the knowledge and attitude factors. The chart audit revealed that although RNs did complete most items on the forms, no form was fully complete, and suggests that RNs are not generally fully compliant with nursing documentation requirements in residential aged care. Relatives of aged care residents were generally happy with the level of care for their family member, but felt that individual issues such as leisure and activity programs, meals, and dining services could be improved.
Analysis of “The Nursing Practice and Quality of Care Model” involved structural equation modeling (SEM) to determine the relationship between experiences, knowledge and attitudes toward nursing documentation, compliance with writing nursing documentation and relatives’ satisfaction. Testing revealed that the model was generally a good fit; however, only some variables predicted to be included in the model were significant. Of greatest interest was the strong predictive relationship between care reporting guidelines and caring behaviour, which suggested that the more RNs knew about documentation, the better they were able to care for residents with challenging behaviour. Positive attitudes to policy issues by RNs, and high completion of charting review items also predicted better outcomes for residents. RNs who had studies in aged care showed a relationship with quality issues suggested that the more education RNs completed the more they knew about quality issues. However, there were some significant negative predictive relationships between variables such as quality issues and caring behaviour that were not anticipated. Overall results suggest that some RN documentation factors did significantly predict residents’ quality of care. This is an important step forward in finding ways to improve the care of residents in aged care facilities.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
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DeBeyer, Carrie Jeanette. „Diabetes care : the status of diabetes care in Queensland residential aged facilities“. Thesis, Curtin University, 2010. http://hdl.handle.net/20.500.11937/2627.
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Diabetes care of the elderly in residential aged care facilities has often been unstructured and non-standardised, with disparities in both the practice and knowledge of health care workers caring for this vulnerable group. Poorly controlled diabetes can contribute to a range of adverse events, including impaired wound health and cardiovascular events. The purpose of this study was to establish if current Australian diabetes management guidelines for the elderly are being met in residential aged care facilities in Queensland and identify areas for clinical practice improvement.A cross-sectional, descriptive design was employed to measure demographic data, perceived and actual diabetes-related knowledge, availability of diabetes management and care guidelines, and facilitators and barriers to meeting diabetes related care. A sample of 109 health care workers from residential aged care facilities completed a postal survey.Diabetes guidelines shown to be available in residential aged care facilities were aimed at care planning, with guidelines for both screening and monitoring of diabetes and diabetes care specific skills more available in private aged care and high care classified facilities. Limited monitoring of outcomes of diabetes care were evident. Overall, participants perceived their diabetes knowledge as “good”, however deficits were found in the level of actual knowledge on diabetes complications and medication management. Ratings for perceived and actual diabetes knowledge was higher with older aged health care workers by those employed in their current position the longest.Furthermore, a positive relationship was shown between perceived and actual diabetes knowledge with years of experience in aged care, employment status (RNs/ENs, AINs and other health care workers) and education status (grade 12 schooling, Technology and Further Education and university award). Diabetes – related knowledge was shown to be the most significant facilitator as well as barrier to diabetes care provision. Factors affecting perceived level of confidence in providing diabetes self-management education included experience in aged care, employment position and level of education.The contribution of this research to the area of study was to provide important data on the availability of diabetes guidelines and protocols and diabetes knowledge base. Data has also been provided for the availability of diabetes guidelines and protocols in different facility types and with different classifications of care as well as data for the perceived level of confidence in providing diabetes care in residential aged care facilities. Study findings indicate a need for an increased focus on diabetes care in residential aged care to improve health outcomes.
7
Geoghegan, John. „What do RNs working in hospital aged care units identify as the positive and negative aspects of aged care nursing?“ Thesis, View thesis, 2006. http://handle.uws.edu.au:8081/1959.7/19352.
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This study reports the positive and negative aspects identified by registered nurses
(RNs) working with older people in public hospital aged care units and was conducted in 4 public hospitals in Sydney, Australia. Qualitative data using questionnaires and telephone interviews was collected from 26 female and 4 male RNs of which 46% (n 14) had worked in an aged care unit for 10 years or more. The participants identified positive perceptions within three major themes: a genuine liking of older people; the stories older people tell and the complexity of the older patient’s illnesses. Positive responses were a focus as it was identified that this was a gap in the literature which required addressing at the time. These findings are significant and have implications for nursing practice for several reasons: Data was collected exclusively from RNs and focused on their positive perceptions about aged care nursing in public hospitals. Participants reported a genuine liking for older people. Patients’ telling their stories was reported by 60% (n 18) of participants as being interesting in their work and meaningful to the patient and should be considered more as a therapeutic process during hospitalisation to assist support and enhance patient outcomes and therapy. The participants reported that aged care nursing is complex, rewarding and requires mature nurses, with current nursing knowledge and skilled in the art of caring for older people. These findings can be used to improve recruitment and retention of RNs within aged care nursing.
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Geoghegan, John. „What do RNs working in hospital aged care units identify as the positive and negative aspects of aged care nursing?“ View thesis, 2006. http://handle.uws.edu.au:8081/1959.7/19352.
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Thesis (M.Sc.(Hons) Health) -- University of Western Sydney, 2006.A thesis submitted for examination for the degree of Master of Health Science (Hons) to the University of Western Sydney, College of Health and Science, School of Nursing. Includes bibliography.
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Horner, Barbara Joan. „The impact and influence of change on a residential aged care community: an action research study“. Thesis, Curtin University, 2005. http://hdl.handle.net/20.500.11937/1924.
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This study was an investigation of the complexities and challenges of change in a community-based aged care facility in Western Australia, to reveal the impact and influence of change on the community. It explored the impact of change on both the residents and the senior management team, as leaders of the organisation, and explored how change influenced the redevelopment process and future of the organisation. There is considerable literature on organisational change including the impact of change on the structure, function, process, workforce and leaders of the organisation. There is, however, little literature on organisational change within aged care communities, particularly with an emphasis on the complexities and challenges associated with change within an organisation that is both a business and a home for its residents. The study took the form of a participative action research study, occurring predominantly over two years (2002-2003) with some continuation into a third year (2004). The study had three phases and included two action research cycles and a critical reference group (CRG), comprising the senior management team (SMT) and researcher. It adopted a broadly qualitative methodology, using data from participatory observation and semi-structured interview; however, it did include quantitative and qualitative data from two 'quality of service' surveys for independent living residents and a staff satisfaction survey. The finding of this study are presented as a narrative account of the experiences of the participants. The study reveals that change associated with the redevelopment impacted on residents' wellbeing, described by them as quality of life.The redevelopment process and associated change also emphasised the importance of communication and explanation with residents to understand elements of quality of life and to monitor and manage the impact of change. The findings of the study highlight the challenge faced by community-based aged care communities classified by government, the industry and the wider community as primarily not-for-profit, to balance financial accountability and social conscience. The perception of benevolence influenced the attitudes of residents and staff and made business accountability more difficult to explain and realise. The study reveals that change also impacted on the structure and function of the organisation as it built its capacity for change. It reshaped the relationship between the Board and senior management team (SMT), which was reported as an improvement in communication, work relations and leadership effectiveness. The development of the leadership team, being the senior management team, was influenced by change and the change process enabled this team to become a competent, confident, cohesive senior team, with a preferred leadership style. A further finding was the realisation of the value and appropriateness of the action research process. It provided tools and processes that were used to plan, act, analyse and reflect on the many aspects of organisational change and enabled the organisation, principally the SMT, to reflect on the impact and influence of change. The research process supported their development as leaders as well as the development of the team. The process of planning, collecting data, analysing data, reflection and action provided a structure and process that they continued to use in their management practices, as new situations continued to arise with the redevelopment process.
10
Kaine, Sarah Jane. „Managing labour in the residential aged care sector“. Thesis, The University of Sydney, 2010. http://hdl.handle.net/2123/6300.
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Aged care is a critical public policy issue in Australia. The growing significance of the sector raises important and pressing questions about many aspects of care itself, the size of the labour force and employment relations. Answering these questions is vital, with demand for labour in the sector already outstripping supply and with demand certain to grow substantially. The implications of this labour shortfall for the sector have already been the subject of a number of key government reports. Although these reports have begun to construct a more detailed picture of the issues facing aged care workers and employers, significant gaps remain, most notably any explicit examination of approaches to the management of labour or the importance of labour law in determining these approaches. Despite the obvious importance and critical social and economic significance of the ageing population, we do not sufficiently understand many of the critical labour market features, workplace characteristics or management strategies which are evident in the aged care sector. This study seeks to build knowledge of employment and labour management in this growing and crucial sector at a decisive moment in history. It deepens our understanding of these issues and processes through a study of three residential aged care providers in New South Wales during the period from 2005 to 2009. The thesis specifically examines employer strategy in relation to the management of labour in the three cases. Further, it investigates the impact of the regulatory environment on these approaches. In doing so, the case studies reveal the intricate web of internal and external, direct and indirect, formal and informal regulation which shapes the management of labour within the sector. The complexity of the regulatory web in aged care demands the use of an explanatory framework which recognises that labour-management approaches are influenced by constraints not traditionally associated with the direct, legal regulation of employment relations. Consequently, regulation theory is applied here as an organising framework and as an interpretive prism for the research. This allows for an explicit acknowledgment of the importance of non-legal, informal and indirect regulation ‘at work’ in this sector. The study finds that in the period under review labour law was not the primary determinant of labour-management approaches in aged care. The case studies presented here show that it was, in fact, a second order consideration for aged care providers struggling with what they saw as insufficient funding, onerous ‘paperwork’ and staff recruitment and retention difficulties – in short a range of other regulatory influences. This study also shows that, despite the constraints imposed by these other regulatory modes, employers remained free to exercise their prerogative within the workplace; this, in turn, is revealed as a form of internal regulation in aged care.
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Kaine, Sarah Jane. „Managing labour in the residential aged care sector“. University of Sydney, 2010. http://hdl.handle.net/2123/6300.
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Doctor of Philosophy (PhD)Aged care is a critical public policy issue in Australia. The growing significance of the sector raises important and pressing questions about many aspects of care itself, the size of the labour force and employment relations. Answering these questions is vital, with demand for labour in the sector already outstripping supply and with demand certain to grow substantially. The implications of this labour shortfall for the sector have already been the subject of a number of key government reports. Although these reports have begun to construct a more detailed picture of the issues facing aged care workers and employers, significant gaps remain, most notably any explicit examination of approaches to the management of labour or the importance of labour law in determining these approaches. Despite the obvious importance and critical social and economic significance of the ageing population, we do not sufficiently understand many of the critical labour market features, workplace characteristics or management strategies which are evident in the aged care sector. This study seeks to build knowledge of employment and labour management in this growing and crucial sector at a decisive moment in history. It deepens our understanding of these issues and processes through a study of three residential aged care providers in New South Wales during the period from 2005 to 2009. The thesis specifically examines employer strategy in relation to the management of labour in the three cases. Further, it investigates the impact of the regulatory environment on these approaches. In doing so, the case studies reveal the intricate web of internal and external, direct and indirect, formal and informal regulation which shapes the management of labour within the sector. The complexity of the regulatory web in aged care demands the use of an explanatory framework which recognises that labour-management approaches are influenced by constraints not traditionally associated with the direct, legal regulation of employment relations. Consequently, regulation theory is applied here as an organising framework and as an interpretive prism for the research. This allows for an explicit acknowledgment of the importance of non-legal, informal and indirect regulation ‘at work’ in this sector. The study finds that in the period under review labour law was not the primary determinant of labour-management approaches in aged care. The case studies presented here show that it was, in fact, a second order consideration for aged care providers struggling with what they saw as insufficient funding, onerous ‘paperwork’ and staff recruitment and retention difficulties – in short a range of other regulatory influences. This study also shows that, despite the constraints imposed by these other regulatory modes, employers remained free to exercise their prerogative within the workplace; this, in turn, is revealed as a form of internal regulation in aged care.
12
Martin, Christine. „The lived experience of the aged care nurse“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1996. https://ro.ecu.edu.au/theses/959.
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The purpose of this phenomenological study was to describe and interpret the common, shared meanings of the experience of aged care nursing from the perspective of the registered nurse working in a nursing home. There are insufficient registered nurses being attracted into aged care, with resulting difficulties in maintaining regular staffing levels in nursing homes. Previous studies conducted in Australia have predominantly used quantitative research methods to investigate various influences QD the recruitment and retention of aged care nurses. These studies do not take into account the practitioners' perceptions of their experience of aged care nursing. A purposive sample of 15 registered nurses was interviewed and the resulting data were analysed using phenomenology to identify thematic structures of the experience of aged care nursing. The NUD.IST qualitative data analysis software package was used as an analysis tool. Significant statements were coded, patterns and relations between categories were identified and the categories were clustered into conceptual, hierarchical themes. Four major themes emerged as being central to the experience of aged care nursing-Gratification, Rapport, Non-productivity and Conflict. While constraints and obstacles to productivity and personal and political conflict may be seen as the negative aspects of aged care, these experiences were relieved by uplifting events described within the framework of resident care and rapport, and collegial support. The nature of aged care nursing is both complex and ambiguous but nurses have readily identified the interwoven threads of the experience. Findings from this study will increase the depth of understanding of aged care nursing and hence contribute to the development of a nursing home environment which enriches the experience of both nurse and resident.
13
Tuckett, Anthony Gerrard. „Truth-telling in aged care : a qualitative study“. Thesis, Queensland University of Technology, 2003. https://eprints.qut.edu.au/15862/1/Anthony_Tuckett_Thesis.pdf.
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This thesis argues that truth-telling in high level (nursing home) aged care is a undamentally important aspect of care that ought to reside equally alongside instrumental care. The health of the resident in a nursing home, as with individuals in other care contexts, is directly linked to care provision that allows the resident to be self determining about their care and thus allows them to make reasonable choices and decisions. This qualitative study explores the meaning of truth-telling in the care providerresident dyad in high level (nursing home) aged care. Grounded within the epistemology of social constructionism and the theoretical stance of symbolic interactionism, this study relied on oral and written text from care providers (personal care assistants and registered nurses) and residents. Thematic analysis of data relied on practices within grounded theory to determine their understanding and the conditions and consequences of their understanding about truth-telling in the nursing home. Through an understanding of the relationship-role-residency trinity, truth-telling in high level (nursing home) care comes to be understood. It has been determined that the link between truth-telling and the nature of the care provider-resident (and residents' families) relationship is that both personal carers and nurses in this study premise their understanding of truth disclosure on knowing a resident's (and resident's family's) capacity for coping with the truth and therefore catering for the resident's or family's best interests. The breadth and depth of this knowing and how the relationship is perceived and described determine what care providers will or will not tell. That is, the perceptions both personal carers and nurses have about the relationship - how they describe themselves as 'family like', 'friend' and 'stranger', has implications for the way disclosure operates and is described. Additionally, how care providers perceive and understand their role determines what care providers will or will not tell. That is, the perceptions both carers and nurses have about their own and each other's role - how they describe themselves for example as 'hands-on' carer and 'happy good nurse' has implications for the way disclosure operates and is described. Furthermore, care providers' meaning and understanding of truth-telling in aged care is not possible in the absence of an appreciation of how the care providers give meaning to and come to understand the care circumstance - residency, the aged care facility, the nursing home. That is, the perceptions both personal carers and nurses have about the aged care facility - how they describe residency as 'Home away from Home' (and what this means), as a place of little time and a plethora of situations have implications for the operation of truth-telling as a whole. Recommendations from the study include the implementation of a telling audit to better serve the truth-telling preferences of residents and the reorientation of care practices to emphasise affective care (talk rather than tasks). Furthermore, it is recommended that changes occur to the care provider roles, that care providers define themselves as facilitators rather than protectors, and education be ongoing to improve communication with and care of residents with dementia and those dying. Finally, the language of residency as 'home' needs to capture an alternate philosophy and attendant practices for improved open communication.
14
Tuckett, Anthony Gerrard. „Truth-telling in aged care: a qualitative study“. Queensland University of Technology, 2003. http://eprints.qut.edu.au/15862/.
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This thesis argues that truth-telling in high level (nursing home) aged care is a undamentally important aspect of care that ought to reside equally alongside instrumental care. The health of the resident in a nursing home, as with individuals in other care contexts, is directly linked to care provision that allows the resident to be self determining about their care and thus allows them to make reasonable choices and decisions. This qualitative study explores the meaning of truth-telling in the care providerresident dyad in high level (nursing home) aged care. Grounded within the epistemology of social constructionism and the theoretical stance of symbolic interactionism, this study relied on oral and written text from care providers (personal care assistants and registered nurses) and residents. Thematic analysis of data relied on practices within grounded theory to determine their understanding and the conditions and consequences of their understanding about truth-telling in the nursing home. Through an understanding of the relationship-role-residency trinity, truth-telling in high level (nursing home) care comes to be understood. It has been determined that the link between truth-telling and the nature of the care provider-resident (and residents' families) relationship is that both personal carers and nurses in this study premise their understanding of truth disclosure on knowing a resident's (and resident's family's) capacity for coping with the truth and therefore catering for the resident's or family's best interests. The breadth and depth of this knowing and how the relationship is perceived and described determine what care providers will or will not tell. That is, the perceptions both personal carers and nurses have about the relationship - how they describe themselves as 'family like', 'friend' and 'stranger', has implications for the way disclosure operates and is described. Additionally, how care providers perceive and understand their role determines what care providers will or will not tell. That is, the perceptions both carers and nurses have about their own and each other's role - how they describe themselves for example as 'hands-on' carer and 'happy good nurse' has implications for the way disclosure operates and is described. Furthermore, care providers' meaning and understanding of truth-telling in aged care is not possible in the absence of an appreciation of how the care providers give meaning to and come to understand the care circumstance - residency, the aged care facility, the nursing home. That is, the perceptions both personal carers and nurses have about the aged care facility - how they describe residency as 'Home away from Home' (and what this means), as a place of little time and a plethora of situations have implications for the operation of truth-telling as a whole. Recommendations from the study include the implementation of a telling audit to better serve the truth-telling preferences of residents and the reorientation of care practices to emphasise affective care (talk rather than tasks). Furthermore, it is recommended that changes occur to the care provider roles, that care providers define themselves as facilitators rather than protectors, and education be ongoing to improve communication with and care of residents with dementia and those dying. Finally, the language of residency as 'home' needs to capture an alternate philosophy and attendant practices for improved open communication.
15
Bitner, Grace Anne. „The 'home'/'homelessness' continuum in residential aged care“. Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/128714/2/Grace_Bitner_Thesis.pdf.
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This project drew on the experiences of residents and staff in two different residential aged care facilities in South East Queensland, in order to better understand the factors that affect residents' ability to feel 'at home'. The resulting theoretical model reveals how the factors interconnect over time to contribute in a unique way to the meaning of home for individual residents. Ultimately, the model invites, and supports, a more sensitised and integrated approach to the design and management of Residential Aged Care Facilities.
16
McCormack, Cynthia Ann. „LONELINESS IN THE INSTITUTIONALIZED AGED“. Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275240.
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17
Courtney, Karen Lynne. „Privacy and senior adoption of assistive technology in residential care“. Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4399.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2006.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2006" Includes bibliographical references.
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Piercy, Kathleen Walsh. „Family ties and care for aged parents at home“. Diss., This resource online, 1996. http://scholar.lib.vt.edu/theses/available/etd-06062008-154400/.
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19
Nusem, Erez. „A design-led approach to innovation in aged care“. Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/96318/23/Erez_Nusem_Thesis.pdf.
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This research explores the journey of a non-profit organisation seeking to respond to prominent change drivers in aged care through the strategic integration of design. A longitudinal action research project investigated the business models of aged care providers, the viability and capacity of existing aged care business models, and the ways aged care organisations could utilise design to drive innovation and address emerging challenges in practice. The thesis identified a new aged care business model typology, a framework and methods for integrating design in practice, offering new knowledge and approaches for leveraging design to realise social and economic outcomes.
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Pappne, Demecs Ilona. „Woven narratives: Creative participatory art in residential aged care“. Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/133260/2/Ilona_Pappne%2520Demecs_Thesis%5B1%5D.pdf.
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This thesis presents a participatory art project which involved relocating my tapestry weaving studio into an aged care home for six months and working with residents to co-design and co-create a woven tapestry. The project's concept, materials and processes were designed as an interpretation of two theoretical models: the motivation to meaning and transcendence in ageing focusing on subjective experiences. This thesis contributed to the arts and health literature by presenting craft as a practice and method that connects materials, ideas and people through engagement and facilitates wellbeing. It also highlighted the complexity and the advantages of the research context.
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Shapera, Leah Elizabeth. „Meeting the nursing care needs of the elderly in the community : clients' perspectives on adult day care“. Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28797.
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A trend toward non-institutionalization of the elderly, in conjunction with the increasing size of the elderly population has resulted in the development of a variety of community programs and services to help meet their complex and diverse health care needs in the community setting. Although there is substantial documentation pertaining to the needs of the elderly in the community and the available services (Lifton, 1989; Padula, 1983; Starrett, 1986; Wallace, 1987), this documentation has been generated primarily by health care professionals and agencies, rather than from the perspectives of the elderly themselves.
Adult Day Care [ADC] programs were established in the late 1960s as one means of attempting to meet the needs of the frail elderly in the community (Padula, 1983). On the surface, these programs appear to be effective in meeting the needs of clients through the provision of nursing services and a wide variety of therapeutic programs and social activities.
This exploratory descriptive study was based on the premise that there exists a need to gain insight into the clients' perspectives regarding the ways in which ADC services are instrumental in meeting their perceived needs.
Data were collected and analyzed to identify the self-perceived needs of ADC clients and their perceptions of how the
ADC nursing services were instrumental in assisting them to meet these needs. Two interviews were conducted with each of the 11 ADC participants comprising the sample, using a semi-structured interview guide developed by the researcher.
The two needs most commonly identified by participants included the need to cope with a range of concurrent and/or successive losses, and the need to establish new support systems.
Participants identified the most significant components of the nursing role as those of the provision of emotional support through counselling, and the provision of health monitoring services. Participants viewed the overall ADC program as important in assisting them to meet their needs by providing access to social outings, individualized care, emotional support, and the opportunity to enhance their self-esteem, confidence, and feelings of belongingness.Applied Science, Faculty of
Nursing, School of
Graduate
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De, Bellis Anita Marie, und anita debellis@flinders edu au. „Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility“. Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.
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This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care.
Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care.
Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'.
The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision.
The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice.
There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation.
If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.
23
Price, Marilyn. „Assessing spirituality and spiritual care needs of elderly people living in aged care facilities“. Thesis, Price, Marilyn (2016) Assessing spirituality and spiritual care needs of elderly people living in aged care facilities. Masters by Coursework thesis, Murdoch University, 2016. https://researchrepository.murdoch.edu.au/id/eprint/35201/.
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Australians are now able to live longer due to scientific and medical technology advances and improved economic conditions, but, ironically, such benefits do not necessarily guarantee that, as we age, we will all be able to support and maintain ourselves financially, physically, mentally or socially. Residential aged care facilities provide safe accommodation and a range of care services for elderly people for whom remaining in their own homes is not viable. Although some of these facilities provide religious and pastoral care in addition to personal, medical and therapy services, research has indicated that the ‘spiritual care’ dimension of holistic aged care services in Australia is either absent, or given low priority. Spiritual care overarches religious and pastoral care, and is therefore as essential a dimension of holistic care as are its medical, psychological, psychosocial, familial and emotional dimensions.
This research project was undertaken with residents of aged care facilities in Perth, Western Australia, as an assessment of the participants’ understanding and presence of spirituality, and to determine whether their spiritual and religious needs are being met. The results showed that the participants are generally representative of their generation in their affiliations with Christian denominations, worship practices and traditions, with their perceptions of the concepts of ‘spirituality’ and ‘religion’ either being confused, or couched in terms of their religious backgrounds and experiences. The majority of participants was found to possess a stoical desire to withstand encroaching debility and loss of independence, while remaining optimistic, keeping occupied, and endeavouring to identify the meaning and purpose within their lives. Most participants expressed contentment with, and acceptance of, the current living arrangements, level of care, and religious and spiritual support provided within their aged care facilities.
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Bhandari, Kunwar Sushma. „End-of-life care in residential aged care: The perceptions of bereaved family members“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2590.
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Background
In recent years, life expectancy has increased causing a higher global percentage of older people living with multiple chronic health problems including dementia. This increase in the aged population with complicated health issues has required governments and health care systems internationally to provide suitable accommodation and health care support such as residential aged care facilities. In residential aged care facilities comprehensive and holistic health care and assessment should ensure good quality of life and a supported death. The Australian Royal Commission into Aged Care Quality and Safety (2021) recognised a need for improvement in the residential aged care sector highlighting end of life care as a core business in aged care. Little research has been completed to explore the family perspective of end of life care provided in the residential aged care setting.
Methods
This study used an inductive interpretive research method to explore participants’ experiences of their relatives’ end of life care within two residential aged care facilities in Western Australia. Two facilities assisted with the recruitment of participants (n=5) and provided letters of support, and one participant (n=1) was recruited via an advertisement and did not disclose the facility. Fifty one potential participants from two residential aged care facilities were invited to participate in the study, with (n=5) family members agreeing. Qualitative data collection was undertaken using semi-structured face to face individual interviews with six participants utilising predesigned interview questions. The interviews were conducted in the aged care facilities’ meeting rooms (n=5), and Edith Cowan University’s meeting room (n =1) with each interview lasted for approximately 60 to 90 minutes. The eight Principles for Palliative and End of Life Care in Residential Aged Care from Palliative Care Australia were applied as the conceptual framework for the study.
Results
Through the analysis of data collected from participants, two themes and subthemes were identified about their experiences during the end of life care period of their family member. Family reflecting on care described their experiences of personal care, emotional and spiritual care, symptom management, grief and bereavement, and concerns about care. Providing a supportive environment was related to the palliative care plan, involving families in care, care delivery, staff communication with family, and the physical environment. Families generally observed and expressed satisfaction to the emotional and spiritual care, and to some degree to personal care and pain management. Additionally, most of the families stated that the physical environment of the facility was appropriate, however, key aspects of care highlighted for improvement included bereavement support, and the need for improved communication with families, and in providing timely information. Participants further observed that care staff were attentive, however, two participants mentioned that their expectations of professional behaviour was not met by all staff as they experienced poor communication from a few staff and one participant perceived a personality clash with care staff member.
Conclusion
This thesis explored the end of life care in Australian residential aged care facilities from the perspective of bereaved family members using a qualitative interpretative methodology. Findings from this study suggest that bereaved families perceived personal, emotional and spiritual care of the residents as satisfactory. Similarly, medication and pain symptoms management were observed to have met most of the families’ expectation. Additionally, emotional, psychological and religious supports was offered to the residents and their family, and they were involved in care discussions and decisions. Issues in communication and post death support and a lack of awareness to the cultural sensitivity were the key aspects identified for improvement.
25
Chawewan, Sriburapapirom Veena Sirisook. „Self care practice of the elderly in Bangkok /“. Abstract, 2000. http://mulinet3.li.mahidol.ac.th/thesis/2543/43E-Chawewan-S.pdf.
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Horner, Barbara Joan. „The impact and influence of change on a residential aged care community: an action research study“. Curtin University of Technology, Centre for Research into Aged Care Services, 2005. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=16051.
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This study was an investigation of the complexities and challenges of change in a community-based aged care facility in Western Australia, to reveal the impact and influence of change on the community. It explored the impact of change on both the residents and the senior management team, as leaders of the organisation, and explored how change influenced the redevelopment process and future of the organisation. There is considerable literature on organisational change including the impact of change on the structure, function, process, workforce and leaders of the organisation. There is, however, little literature on organisational change within aged care communities, particularly with an emphasis on the complexities and challenges associated with change within an organisation that is both a business and a home for its residents. The study took the form of a participative action research study, occurring predominantly over two years (2002-2003) with some continuation into a third year (2004). The study had three phases and included two action research cycles and a critical reference group (CRG), comprising the senior management team (SMT) and researcher. It adopted a broadly qualitative methodology, using data from participatory observation and semi-structured interview; however, it did include quantitative and qualitative data from two 'quality of service' surveys for independent living residents and a staff satisfaction survey. The finding of this study are presented as a narrative account of the experiences of the participants. The study reveals that change associated with the redevelopment impacted on residents' wellbeing, described by them as quality of life.The redevelopment process and associated change also emphasised the importance of communication and explanation with residents to understand elements of quality of life and to monitor and manage the impact of change. The findings of the study highlight the challenge faced by community-based aged care communities classified by government, the industry and the wider community as primarily not-for-profit, to balance financial accountability and social conscience. The perception of benevolence influenced the attitudes of residents and staff and made business accountability more difficult to explain and realise. The study reveals that change also impacted on the structure and function of the organisation as it built its capacity for change. It reshaped the relationship between the Board and senior management team (SMT), which was reported as an improvement in communication, work relations and leadership effectiveness. The development of the leadership team, being the senior management team, was influenced by change and the change process enabled this team to become a competent, confident, cohesive senior team, with a preferred leadership style. A further finding was the realisation of the value and appropriateness of the action research process. It provided tools and processes that were used to plan, act, analyse and reflect on the many aspects of organisational change and enabled the organisation, principally the SMT, to reflect on the impact and influence of change. The research process supported their development as leaders as well as the development of the team. The process of planning, collecting data, analysing data, reflection and action provided a structure and process that they continued to use in their management practices, as new situations continued to arise with the redevelopment process.
27
Ohura, Tomoko. „Studies of setting care goals and understanding subjective needs in aged care facilities: care providers' and residents' view“. Kyoto University, 2017. http://hdl.handle.net/2433/218011.
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Stone, Timothy T. „Cultures of consumption within residential care homes : understanding elderly bricoleurs' cultural maps of meaning“. Thesis, University of Stirling, 2006. http://hdl.handle.net/1893/107.
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Set within the context that the world’s population is ageing at an unprecedented rate, it is argued that care of the elderly, and their everyday lived experiences are poised to become prominent concerns. In the shadow of this, the ageing population poses a myriad of challenges not only for the elderly but also for policy makers who put in place systems for the provision of services within residential care homes. By virtue, given that communities of elderly consumers voices are often muted within many academic analyses of social policy and service provision this study illuminates and distils communities of elderly consumers understandings of residential care homes. Given the absence of suitable literature within the fields of marketing and interpretive consumer research, this study turns to the sociological and anthropological literature of Hall and Jefferson (1976) and Levi-Strauss (1966). In doing so, communities of elderly consumers within residential care homes can be theorised as a cultural community of ‘bricoleurs’ within a ‘cultural map of meaning’. Furthermore, viewed through this lens, such bricoleurs can be seen to understand their meaningful everyday lived experiences within, and through, the use of ‘bricolage’. Emanating from eight existential-phenomenological interviews, a rich picture emerges wherein bricoleurs understandings of residential care homes can be seen to be embedded not only within, but also through, such things as the body, leisure trips, noise disturbances, death, large items of furniture, small hand-sized objects, mobility aids, quality of care and social interaction. Moreover, in the light of the resultant interpretations common themes can be seen to emerge within communities of bricoleurs social and material understandings of residential care homes, namely the notion of cultures of dependency, trauma and comfort. This research contributes to marketing knowledge in that it argues that communities of ‘elderly bricoleurs’ within residential care homes can be seen to be held together by unique understandings of cultures of dependency, trauma and comfort. Furthermore, it is also argued that elderly bricoleurs address themselves to a relatively limited amount of bricolage that enables them to keep alive actual, desired, imagined and fictional community ties. Furthermore, the reality and efficacy of cultural communities of elderly bricoleurs seems to depend on their ability to address ‘whatever is to hand’ (Levi-Strauss, 1966) in order to construct and understand their cultural maps of meaning within residential care homes.
29
Grenade, Linda Elise. „Accreditation of residential aged care facilities: experiences of service providers“. Thesis, Curtin University, 2003. http://hdl.handle.net/20.500.11937/1306.
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The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study.Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.
30
Frean, Isobel. „Modelling communication requirements in aged care using HL7 V3 methods“. Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20070221.131236/index.html.
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31
Crilly, Julia. „Program Evaluation of the Aged Care Early Intervention Management Strategy“. Thesis, Griffith University, 2007. http://hdl.handle.net/10072/367530.
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In 2001, there were an estimated 2.4 million Australians aged 65 and over, or 12.5% of the total population of 19.4 million. Over the next 50 years is it expected that one quarter of the total population will be aged 65 or over (Australian Institute of Health and Welfare [AIHW], 2002). In recent years, the priority attached to ageing issues has increased substantially in Australia and in most first world countries at both a national and international level. Concerns over the implications of population ageing have prompted responses to ensure the sustainability of economic, health and social support systems that are directly influenced by the changing age structure of the population.
Older Australians are the largest consumers of health care. As a result of the general ageing process, older adults are at risk of developing iatrogenic complications associated with hospital admission. Services that have been implemented overseas and in Australia that aim to provide care for patients in their own environment include hospital in the home (HIH) and, more recently hospital in the nursing home (HINH). The ability to be able to deliver acute care within the Aged Care Facility (ACF) has not previously been evaluated extensively within Australia. Further, it is not known whether the HINH model utilised in a Queensland demonstration contained sufficient components to benefit patient care. Therefore, an evaluation of the structure, processes and outcomes of this model was conducted in order to inform all stakeholders involved and allow for further refinement.
Thus, the aims of this research study were to:
1. Determine which factors predict poor outcomes for all older people who present to the ED and are admitted to hospital;
2. Determine whether HINH enrolment was a predictor for better outcomes for ACF residents;
3. Evaluate the structures involved in the HINH program; and
4. Evaluate the processes involved in the HINH program.
In addressing these aims three phases of research were undertaken. The first was a precursor to the evaluation. It involved conducting a cohort study that described the clinical characteristics and outcomes of all acutely unwell older adults who presented to an Emergency Department (ED) in south-east Queensland. The second and third phases evaluated the HINH program that was implemented in order to improve the care pathway for ACF residents who presented to hospital. A structure, process and outcomes approach was used to do this. The second phase focussed on evaluating outcomes. A case control study was used to compare outcomes of ACF residents enrolled into the HINH program (cases) with ACF residents who were not enrolled into the program (controls). The third phase of this research evaluated the structures and processes of the HINH program using semi-structured interviews with doctors, nurses and HINH patients.
This research has provided the first comprehensive evaluation of a HINH program within Australia utilising a structure, process and outcomes approach. Results from Phase 1 highlighted that negative outcomes occurred for ACF residents as well as the health care organisation when ACF residents presented to the ED and were admitted to hospital. Results from Phase 2 identified that enrolment into the HINH program had a significant positive impact on patient and health care organisation outcomes. Furthermore, by providing hospital care in the ACF, the HINH program, was a cheaper alternative to the standard in-hospital treatment, allowed for more in-hospital bed days to be available and reduced the risk of hospital related complications such as death for patients. Findings from Phase 3 showed that for this HINH program to operate, effective referral and communication strategies were integral. Given the current political climate that is concerned over the implications of population ageing, this evaluation is timely. The HINH program is one innovative model of health care delivery that benefits the economic, health and social support systems for ACF residents and the health care organisation.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Faculty of Health
Full Text
32
Grenade, Linda Elise. „Accreditation of residential aged care facilities : experiences of service providers /“. Curtin University of Technology, School of Public Health, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15068.
Der volle Inhalt der QuelleAnnotation:
The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study.Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.
33
McNamara, Laurence James. „Just health care for aged Australians : a Roman Catholic perspective /“. Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm1682.pdf.
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34
Nurgalieva, Leysan. „Technology Mediated Information Sharing Within the Triad of Aged Care“. Doctoral thesis, Università degli studi di Trento, 2019. https://hdl.handle.net/11572/368749.
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More than other age group, older adults suffer from multiple chronic conditions, receive care from multiple healthcare providers and settings, and transition across this continuum of care as they age. During the last decade, we have observed the transformation of aged care worldwide both on organisational and legal levels due to an increasing older population from one side and the use of technology in their care from another. In addition, the involvement of family members as informal caregivers introduces the concept of a triad of aged care: a collaboration of senior patients, their relatives and professional caregivers; and poses additional challenges such as appropriate and efficient communication from the points of views of all care stakeholders. Hence, sharing of health and wellbeing information (HWBI) in the care triad becomes particularly important, and e-Health services have shown the potential to support this, for example, by becoming a channel that could mediate sharing, while taking into account the values and concerns of all groups of users.
In this thesis, we explore existing strategies of HWBI sharing in various aged care scenarios and identify the challenges and opportunities of designing information systems that could support them. In particular, by conducting a systematic literature review and a series of user studies with all three groups of care stakeholders, we study if and how technology-based mediation of informational exchange can improve institutionalized care for older adults. We primarily focus on different dimensions of aged care scenarios, based on the involvement of triad stakeholders, the level of acceptance of technology, and the degree of control seniors have over sharing their HWBI. To gather design recommendations for such information systems, we investigate HWBI-related work practices of professional caregivers; information needs of family members, and information disclosure preferences and associated concerns of seniors, including their reasons to share or not to share. We raise a critical discussion on values addressed by e-Health interventions and illustrate the views of care stakeholders, revealing that these views can be conflicting, given their needs and priorities. For instance, tensions emerge between values that prioritize placing the responsibility on a physician for their patients versus a value system that prioritizes patient autonomy.
By discussing information and interaction design of technology-based mediation of HWBI sharing and based on the research findings of this thesis, we provide a set of design principles and requirements targeting the following areas and roles:
- e-Health and HCI researchers, providing a foundation for their future research,
- designers, who could benefit from a complete image of the abilities and needs of potential users in this sensitive and complex care context,
- healthcare and legislation policies, that could adhere to a system of values that place a premium on patient empowerment, and
- educational programs, that need to provide seniors and triad actors with the knowledge of how to share personal health information digitally.
Finally, following a user-centred design approach, we implement these design recommendations and evaluate them with caregivers to validate our findings.
35
Nurgalieva, Leysan. „Technology Mediated Information Sharing Within the Triad of Aged Care“. Doctoral thesis, University of Trento, 2019. http://eprints-phd.biblio.unitn.it/3724/1/Nurgalieva_Thesis_v3_(3).pdf.
Der volle Inhalt der QuelleAnnotation:
More than other age group, older adults suffer from multiple chronic conditions, receive care from multiple healthcare providers and settings, and transition across this continuum of care as they age. During the last decade, we have observed the transformation of aged care worldwide both on organisational and legal levels due to an increasing older population from one side and the use of technology in their care from another. In addition, the involvement of family members as informal caregivers introduces the concept of a triad of aged care: a collaboration of senior patients, their relatives and professional caregivers; and poses additional challenges such as appropriate and efficient communication from the points of views of all care stakeholders. Hence, sharing of health and wellbeing information (HWBI) in the care triad becomes particularly important, and e-Health services have shown the potential to support this, for example, by becoming a channel that could mediate sharing, while taking into account the values and concerns of all groups of users.
In this thesis, we explore existing strategies of HWBI sharing in various aged care scenarios and identify the challenges and opportunities of designing information systems that could support them. In particular, by conducting a systematic literature review and a series of user studies with all three groups of care stakeholders, we study if and how technology-based mediation of informational exchange can improve institutionalized care for older adults. We primarily focus on different dimensions of aged care scenarios, based on the involvement of triad stakeholders, the level of acceptance of technology, and the degree of control seniors have over sharing their HWBI. To gather design recommendations for such information systems, we investigate HWBI-related work practices of professional caregivers; information needs of family members, and information disclosure preferences and associated concerns of seniors, including their reasons to share or not to share. We raise a critical discussion on values addressed by e-Health interventions and illustrate the views of care stakeholders, revealing that these views can be conflicting, given their needs and priorities. For instance, tensions emerge between values that prioritize placing the responsibility on a physician for their patients versus a value system that prioritizes patient autonomy.
By discussing information and interaction design of technology-based mediation of HWBI sharing and based on the research findings of this thesis, we provide a set of design principles and requirements targeting the following areas and roles:
- e-Health and HCI researchers, providing a foundation for their future research,
- designers, who could benefit from a complete image of the abilities and needs of potential users in this sensitive and complex care context,
- healthcare and legislation policies, that could adhere to a system of values that place a premium on patient empowerment, and
- educational programs, that need to provide seniors and triad actors with the knowledge of how to share personal health information digitally.
Finally, following a user-centred design approach, we implement these design recommendations and evaluate them with caregivers to validate our findings.
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Palo-Bengtsson, Liisa. „Social dancing as a caregiver intervention in the care of persons with dementia /“. Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4573-x/.
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Alizadeh-Khoei, Mahtab. „Assessing factors in utilisation of health services and community aged care services by the Iranian elderly living in the Sydney metropolitan area acculturation aged care /“. Connect to full text, 2008. http://hdl.handle.net/2123/3986.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed Jan. 19, 2009) Includes tables and questionnaires in English and Farsi. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliography. Also available in print form.
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Sinasac, Patricia A. „Residential aged care health workers' knowledge, attitudes and confidence in providing care to a person with a stoma : a needs analysis for education“. Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/104436/1/Patricia_Sinasac_Thesis.pdf.
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This study of residential aged care health workers’ knowledge, attitudes and confidence in providing care to an older person with a stoma was conducted to identify characteristics of the learners and educational needs to effectively provide stoma care. The findings will be valuable to inform development of an educational program aimed at aged care health workers’ to give appropriate and confident stoma care to residents.
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Walker, Helen M. „The experience of care assistants who care for residents in the final stage of life in residential aged care facilities“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/278.
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This thesis presents the results of a study that explores the experience of care assistants who care for residents in the final stages of life in residential aged care facilities in metropolitan Perth. Care assistants, with little formal training and no regulation, play a pivotal role in the direct care of dying residents in these facilities. Yet little was known about the palliative care role and the impact that caring for residents in the final stage of life has on this health care group. The literature relating to end of life care in residential aged care facilities revealed limited research in this area. In particular, there is a lack of studies that relate specifically to the care assistants' role and their experiences of end of life care. Research to date has focused on the context of palliative care in residential aged care facilities, the workplace environment, how to provide a dignified death, relationships and the central role of the care assistant. This study used a qualitative narrative inquiry research design.
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Johnson, Lula Juanita. „The effects of home based primary care with chronically ill older adults on visits to the emergency department, hospitalization, and bed days of care“. free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1422981.
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Rzepka, Susan G. „Geriatric trauma care: A population-based study“. Case Western Reserve University School of Graduate Studies / OhioLINK, 1996. http://rave.ohiolink.edu/etdc/view?acc_num=case1057600839.
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Glasson, Janet, University of Western Sydney, College of Social and Health Sciences und of Nursing Family and Community Health School. „Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process“. THESIS_CSHS_NFC_Glasson_J.xml, 2004. http://handle.uws.edu.au:8081/1959.7/481.
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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge.Master of Health Science (Hons)
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Flesner, Marcia K. „Person centered care : a model for nursing homes /“. free to MU Campus, others may purchase, 2003. http://wwwlib.umi.com/cr/mo/fullcit?p3091924.
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Moscatel, Sarah J. „End-of-life transition experiences of ICU nurses : mindful realization /“. Connect to full text via ProQuest. IP filtered, 2005.
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Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2005.Typescript. Includes bibliographical references (leaves 139-146). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;
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Simms, Mary. „The aged 'in limbo' : accounts of 'community care' in the 1980s“. Thesis, Queen Mary, University of London, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295723.
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LoMonaco, Marina Lucia. „Investigation of registered nurses' clinical decision-making processes in aged care“. Thesis, Australian Catholic University, 2014. https://acuresearchbank.acu.edu.au/download/82226bdbfa1530c6d8ab4af6a353544c82d3bc780769c21c2f7a712a069d908e/2826137/201404_Marina_LoMonaco__PhD_FINAL_28Feb2015pdf.pdf.
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An ageing global population places increasing humanitarian and financial loads on government, health and welfare agencies; necessitating change and innovation to meet and manage clinical and physically complex needs and demands. Australian residential aged care has been influenced by these international and jurisdictional socio-political forces. This thesis aims to inform healthcare professionals and others about Australian aged care registered nurse (RN) decision-making processes, as well as convey understanding of the responsibilities and contextual influences upon RNs working in this sector and scope of practice according to their professional responsibilities...
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McKenzie-Green, Barbara. „Living life in residential aged care: A process of continuous adjustment“. Thesis, Australian Catholic University, 2010. https://acuresearchbank.acu.edu.au/download/320774175c89792c3179b6b3583c698b49a8502b130a6659b78c752f33a2bc23/2084272/Barbara_McKenzie_Green_2010_Living_life_in_residential__aged_care.pdf.
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The aim of this study was to examine whether, and how, residents living in residential aged care homes become involved in their care, and what areas of their care and life they work to influence or negotiate.
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Springer, ML. „User centred design and aged care : a case study investigation into aged care nurses’ information systems user needs within five Tasmanian aged care facilities“. Thesis, 2010. https://eprints.utas.edu.au/10809/5/02whole.pdf.
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This thesis investigates aged care nurses‟ information systems user needs in their delivery of care to patients within five Tasmanian aged care facilities. The thesis generates insights aimed at improving the design, adoption and use of human-centred information systems in residential aged care.
The ageing demographic of the Australian population is changing the nature of demand for health care services. This has led to a situation in many health service areas of demand outstripping supply at a time when the workforce is also shrinking in relative size (Hogan, P, Moxham & Dwyer 2007). In aged care, these problems are compounded by the sector itself having an ageing workforce and major challenges in recruitment and retention of staff (Hogan, P, Moxham & Dwyer 2007).
E-health initiatives have been promoted by the Australian government and the aged care sector as one set of responses to the challenges being faced. Business cases focused on increased information access, cost efficiencies and improved auditing of service delivery have driven the design and implementation of most IT systems in aged care, with relatively few focused on the delivery of care at the bedside (Chau, Cummings & Turner 2004; Yu & Yu 2004). While some business benefits have been gained, it is evident that the deployment of these systems raises numerous socio-technical and clinical challenges for nursing staff that require more detailed investigation (Kushniruk & Borycki 2008).
The limited involvement of aged care nurses in the design of these information systems is partly a product of conventional information systems methodologies that presume users have some experience or knowledge of the potential for IT systems – experience that many aged care nurses lack (Eley et al. 2008). Indeed, even where nurses have participated, often their lack of exposure to technology and perceived technophobia (Toofany, 2006, Timmons, 2003, Simpson, 2004) have inhibited the clear articulation of the importance of such nursing activities as reflective practice to providing quality care.
In this context, this research deploys a case study methodology informed by Grounded Theory to investigate aged care nurses‟ user needs through an exploration of their work practices and nursing techniques proven to enhance the quality of care. One such technique is reflective practice (Ashby, 2006a).
Deploying a subjective ontology (Orlikowski & Baroudi 1991) and an interpretivist epistemology (Hirschheim 1992), the research strategy was completed in three phases. Phase one involved the use of detailed semi-structured interviews, a focus group with aged care nurses and limited participant observation, to determine their technological sophistication and the existing role of reflective practice for nurses within the field. The collected data was used to generate core categories in Phase two, describing interactions between themes in the analysed data. Phase three identified the user needs from the core categories as the central findings of the research and developed a model to demonstrate how the user needs interacted to focus upon the human requirements of aged care. Scenarios were developed based upon this model to communicate the model‟s application.
The nurses‟ technique of reflective practice offered a way of opening discussion with the nurses to discover their user needs. Reflective practice was a useful tool in this role due to the legal requirement for its practice (ANMC, 1992), and its positive role in providing quality care (Ashby, 2006a). Aged care facilities were carefully selected that were on the cusp of introducing e-health solutions to their facilities.
This thesis reveals that for the nurses in the aged care environments studied, the presumption of technophobia is problematic. The nurses were limited in their experience and knowledge of information systems, yet their flexibility and acceptance of any technology that could improve nursing outcomes ensured that with the appropriate assistance, aged care nurses could fully and meaningfully participate in the systems development process. The documentation burden has rightly been a major focus for IT in aged care (Courtney-Pratt 2005; Little & Carland 1991; Yu 2005a; Yu & Yu 2004), but while it is a worthy focal point, engaging with empowered nurses aware of the possibilities of technology, aware of their own specialised human-centric care techniques, far more holistic, relevant and beneficial systems can be developed. This thesis represents a starting point for the development of such systems for the aged care sector.
This thesis contributes to the Information Systems body of knowledge on three levels. At the substantive level this research has used an exploration of the reflective practices undertaken by aged care nurses in order for the researcher to reveal the nurses‟ user needs. At the methodological level, this research has demonstrated the potential for using a range of techniques to gain a qualitative understanding of a field where the level of technological sophistication of the users is very low. At the theoretical level the research developed a model for encouraging patient centric design of systems in aged care, without ignoring the sector‟s business requirements.
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(9777431), Lovasoa Andriamora. „Identifying strategies to alleviate aged-care worker burnout: A study from two aged-care facilities in Sydney“. Thesis, 2014. https://figshare.com/articles/thesis/Identifying_strategies_to_alleviate_aged-care_worker_burnout_A_study_from_two_aged-care_facilities_in_Sydney/13387226.
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This thesis identifies strategies that will help alleviate the burnout experienced among aged-care workers in Sydney. Specifically, the study investigates the factors contributing to burnout in the human services sector with particular application to two aged-care facilities.Burnout among carers has been a major concern for many years in health care fields. Previous studies of the issue have generally focused on examining
the causes of burnout and the associated consequences. However, there seems a lack of studies which suggest interventions for the alleviation of burnout. The literature in this field has identified ten factors pre-disposing carers to burnout in the aged-care industry. In this study the factors are categorised into three major groups: fixed, moderate and non-fixed factors. To gather data to achieve the research goals, a qualitative interview approach was employed. Data was elicited from twenty-five survey participants grouped as follows:
ten assistant nurses, eight nurses, three facility managers and four relatives of those in care. Participants were selected from the Canterbury Domain Principal Aged Care facility and the Frank Vickery Lodge of the Wesley Mission at Sylvania. A version of the Copenhagen Burnout Inventory was adapted and used as a verification tool for interviews completed by those participating in the study. Major factors identified as influencing burnout among aged-care workers included:
problems with facility staffing, the lack of ethics (or otherwise described as a breach of duty of care), and the unrealistic expectations of relatives. Recommendations arising from the study findings include: a review of training for aged-care workers, promotion of the professionalism of the aged-care profession, regulation with regard to the staff-resident ratio, and synergistic collaboration between relatives and staff. There are significant challenges to the development and maintenance of a healthy aged-care workforce in Australia. Although the data in this study is generated by
small cohorts from only two sites, the strategies identified might be applied to those sites and have wider application potential for the well-being of aged-care workers in other aged-care facilities.
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Moran, Shane, University of Western Sydney und Faculty of Health. „China's aged care crisis : problems, resources, solutions“. 2000. http://handle.uws.edu.au:8081/1959.7/23015.
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China is currently facing what I expect to be its most significant challenge to date - a crisis in the care of its rapidly ageing population. The causes of this crisis are complex and multi-faceted and its implications far-reaching from the social, economic and political perspectives. This thesis examines the causes and consequences of the impending aged care crisis in China, with a particular focus on the urban elderly. In addition to extensive interviews with government officials, a sample of 2,000 retires and their children were surveyed in Shanghai as part of my research. My findings from the Research Survey and Questionnaire, together with my observations from site visits to numerous aged care crisis and the associated problems. Of primary concern is the fact that the Chinese government does not have in place an appropriate aged care structure nor a strategy to implement systems to cope with the impending crisis. I conclude that it is imperative the Chinese government recognises both the immediacy and scale of the crisis and acts accordingly. Failure to do so may result in both significant social unrest and severe economic consequences. Recommendations are offered for consideration by the Chinese government in an effort to manage the impending aged care crisis in China.Doctor of Philosophy (PhD)