Dissertationen zum Thema „Care“

This thesis presents a retrospective critique of the social and political construction of 'informal care' within community care policy from the period of the late 1970s to the mid 1990s. The thesis considers the question of the degree of 'choice' available to informal carers to say 'no' to caring, or aspects of caring, within the reforms' positioning of informal care as the first line of support for adult dependants. The critique focuses on subjectivity, difference, agency and choice. A theoretical and methodological synthesis is developed between feminist post-structuralism, feminist critiques of mainstream social policy, and feminist theory and research, within which a qualitative in-depth interview study with informal carers is situated. The critique is then expanded through the development of a 'Q' Methodology study with a larger cohort of informal carers. The research identified gendered generational differences between the carers, and a 'burden' of care imposed as an outcome of consecutive governments' attempts to residualise welfare. The older carers' levels of agency and choice were severely curtailed. However, the younger female carers were more able to resist the drive of the community care reforms, their counter discourses being based on a new emergent notion of 'rights'. The direction of community care policy was found to be out of step with how the carers within this study perceived their responsibilities and 'obligations'. The thesis argues that whilst post-modernism may have constrained the capacity of governments and reconstituted our understanding of 'care', it has not done so to the extent that we are no longer prepared to make demands for 'care' from and by the state.

Includes bibliographical references
Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.

Over the past 20 years, there has been a steady increase in permanent care placements in Australia, however, relatively little research has been conducted on how to best support this growing population. Little is known about what variables contribute to the development and preservation of positive carer-child relationships. The current study examined the relationship of carer and child variables in permanent care carerchild relationships. In particular, the role that carer empathy, carer parenting style, child emotional and behavioural problems, child temperament, and child resilience played in the prediction of carer-child relationships was investigated. Using quantitative and qualitative approaches, the current study gathered data from a total of 46 permanent carers in Victoria. Participants were permanent carers who had at least one child aged between 3-12 years. Carers were recruited from metropolitan and rural permanent care agencies. Participants completed a questionnaire booklet on their empathy, parenting styles, their relationship with their child, and on child variables including emotional and behavioural difficulties, temperament, and resilience. Thirteen carers also participated in the qualitative part of the study, consisting of an interview that aimed to further target the study's key variables. It was hypothesised that both carer and child variables would correlate with and predict carer-child relationships and that carer variables would emerge as the strongest predictors. The findings from the quantitative analyses indicated that carer variables were less important in predicting carer-child relationships and only authoritarian parenting was related to less positive carer-child relationships. Child variables, particularly the emotional and behavioural difficulties children manifested, had greater significance in the prediction of carer-child relationships.;Qualitative data were consistent with quantitative findings, showing that it was the child's troubling behaviours which were the most taxing on the development of positive carer-child relationships. Where carers perceived improvements in their children's behaviours or could recognise positive aspects in their children and their relationships with them, this seemed to support carer-child relationships. From a policy-driven perspective, it is in the best interests of permanent care agencies to connect children and their carers with services and strategies which help promote child adjustment and well-being, whilst simultaneously educating carers on how to most effectively manage the emotional and behavioural challenges evidenced by their children.

Magister Artium (Social Work) - MA(SW)
Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

I sjuksköterskeprofessionen är omsorg en viktig del. Det används av sjuksköterskor varje dag och är en integral del i det bilaterala förhållandet mellan sjuksköterska och patient. Syftet med denna litteraturgranskning är att undersöka omsorg i omvårdnad samt se om omsorg kan orsaka utbrändhet. Författarna har granskat 11 vetenskapliga studier, gjorda till och med tio år tillbaka runt om i världen. Genom analysering av resultaten identifierades fem huvudteman: patientens syn på god omsorg, patientens syn på dålig omsorg, sjuksköterskans syn på god omsorg, sjuksköterskans syn på dålig omsorg, samt processen och konsekvenserna av utbrändhet.
In the nursing profession, caring is the most essential part. It is used by nurses’ everyday and is an integral part in the responsive nurse-patient relationship. The main aim of this study was to investigate caring in nursing. Furthermore, because of Maslach (1998) statement that close contact within the nurse-patient relationship contributes to burnout in nurses, the authors wanted to investigate studies exploring the cause of burnout in nurses.Additionally, the cause of burnout in nurses is explored. The authors reviewed 11 scientific studies, performed in the past ten years around the world. The results showed that five main themes could be identified. These were: patient’s view of good care, patient’s view of bad care, nurse’s view of good care, nurse’s view of bad care, and the process and consequences of burnout.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.
Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).

Der Begriff Care wird im deutschsprachigen Raum zumeist mit Sorge, Fürsorge, fürsorglicher Praxis oder Sorgearbeit übersetzt. Als gemeinsamer Bezugspunkt theoretischer Konzeptionen kann gelten, dass Care eine spezifische Logik der Relationalität aufweist. Care fungiert in wissenschaftlichen, philosophischen und politischen Kontexten als sensibilisierendes Konzept zur Kategorisierung von Sorge sowie als Analyseinstrument, das auf die Kritik der geschlechtshierarchischen Arbeitsteilung und der kapitalistischen Produktionsverhältnisse gerichtet ist. Empirische Forschungsvorhaben zu Care weisen in ihren Fragestellungen häufig einen expliziten Bezug zur Geschlechterforschung auf.

The study attempts to answer the question: How do employees experience the organizational value care? The organization Nortec introduced care as one of its organizational values. The application of care in business may counteract and combat possible undesirable side effects of increased organizational efficiency. Some reported side effects experienced by employees are colder and more demanding working environment (Maslach & Leiter, 1997). Therefore I was intrigued to study how care was experienced by employees within an organization that had already put care on the agenda and applied it as an organizational value. Care is an ambitious value and may not be straight forward to implement into the workday’s interactions. A total of four employees, two subordinates and two leaders, were interviewed with regard to how they experienced care at work. The qualitative semi-structured interviews were audio recorded, transcribed and analyzed. The analysis returned a total of four categories that were labeled as: Perception of care, Experience of care, Trust and Attentiveness. All four categories contributed into the understanding of the experience of care for each of the informants. The perception would determine the informant’s expectation of care, according to which the informants rated their experience. Finally the last two categories, trust and attentiveness were considered basic constituents for applied care to be recognized. In the theory section I proposed a model of care composed of various dimensions representing my pictorial understanding of care. However, the empirical findings returned with a revised model where the main constituents of care were trust and attentiveness. All informants revealed these dimensions as significant in the care experience. Also, the findings indicated a difference in experienced care between the subordinates and the leaders. Both subordinates expressed low level care in terms of trust and attentiveness from leader, whereas the leaders did not convey a similar discontent. The study reveals essential information about how care is experienced for the participants and consequently how care is recognized inside the specified relations. The study provides important information towards possible future studies to identify whether the same trends are identifiable through a quantitative study in the organization. Finally all information from this study and future studies would add significant value into the management’s strategic leadership development to increase understanding and employee contentment and to root the care value within the company’s DNA.

This DNP project focused on the spiritual aspects of care that are often neglected in the outpatient setting. Most patients value their spiritual health and believe that it is just as important as their mental and physical health. The purpose of this project was to improve the overall spiritual care provided to patients, their families, and/or caregivers in times when they were experiencing spiritual distress. This quality improvement (QI) project was designed to determine whether embedding a chaplain in an outpatient clinic instead of providing a pamphlet about chaplain services increases patient satisfaction. Secondary analysis of the data in this project show that of 306 patients who completed the 4-item screener, 70 patients were identified as having spiritual distress. There were 34 people who benefited from having an embedded chaplain. Spiritual distress was measured using a 10-item survey prior to and after seeing the chaplain; a 3.7 point decrease was seen across 6 patients. It was not a statistically significant improvement, largely due to the small sample (p=.08). Non-parametric chi square fisher exact results showed that satisfaction scores were higher in 5 patients seen by the chaplain (p=. 048) versus 4 not seen by the chaplain. Qualitative results were obtained from 5 chaplain participants were all positive. Though a very small sample, this QI project emphasizes that spiritual care needs are an integral part of holistic care provided through nursing practice. Nursing is tasked to be concerned with each person's human experience, which includes spirituality. This QI projects' contribution to positive social change is that it enhanced the health outcomes and quality of life of those participants involved.

Concussions are brain injuries--also called mild traumatic brain injuries--that affect the function of the brain temporarily or permanently. The purpose of this doctoral project was to develop an education module for staff at an urgent care center to address the lack of knowledge and low level of comfort regarding the care for patients with a head trauma. This project introduced and educated the clinical staff on an evidence-based protocol for the treatment and management of a patient with a concussion. The Rosswurm and Larrabee model for evidence-based change was used as a foundation for refining the practice question, gathering evidence, and translation of the protocol into the clinical setting. The Dreyfus model of the 5 stages of skill acquisition was used to measure the learners' level of achievement. A pretest and posttest were conducted to determine whether there was a gain in knowledge and confidence as a result of the project. There were 6 participants: 3 nonclinical staff and 3 nurses. Overall, there was a statistically significant improvement in confidence based on the Wilcoxon sign ranks test (z = -2.201; p = .028); however, a statistically significant increase in knowledge was not apparent, even though the scores did improve. All staff members were able to apply the practice guideline and make sound judgments using case studies. This project resulted in the translation of evidenced-based care into the urgent care setting, enhanced the confidence of the nursing staff, and has the potential to bring about positive social change by improving the quality of care that will be provided to patients with head injuries.

This study explores the negotiation of care between a young carer and a parent facing mental illness and addiction. The paradigm derived from the current research focuses mainly on issues faced by young carers, seeing them as a population at risk. With an overrepresentation of research exploring children's caring work, the highly complex relationships between disabled and/or ill parents and their children who care for them tend to be overlooked. Using action theory this study explores a case study of a young carer and parent to answer the question: how is care negotiated between the two? The results demonstrated the fluidity in the relationship in terms of how care was negotiated and that is was more reciprocal than that which is often presented in the literature. This reciprocity challenges the stigma and stereotypes often associated with young caring and parents with disability and/or illness and can help inform both future research and practice.

Thailand faces increasing mental health problems, however mental health services are limited. In particular, mental health services provided in communities across the country are not clearly structured. Research in regard to community mental health care is rare. The purpose of this study was to explore mental health care management in two primary care units (PCUs) in Thailand in order to understand the ways they operate within Thai communities. The specific objectives were to identify mental health care practices and roles of health providers, models of care and influences on mental health care practices in the two PCUs as case studies. An ethnographic approach using participant observation, semi-structured interview, quantitative questionnaire and document analysis was used in gathering data. The participants were seven nurses and three public health workers practising in the PCUs. Findings enhanced understanding in the context of two PCUs located in communities of the Northern and Central Thailand. Both were local health centres providing a wide range of health services based on the principles of primary health care (PHC). The PCUs were operated without mental health specialists, however nurses were the main resource in providing mental health care in terms of primary and secondary prevention. Primary prevention was provided through counselling sessions, drug prevention activities and seniors clubs. In addition, the health providers conducted activities of mental health promotion towards particular risk groups after assessing risks. They also gave support to mental health and normal cases that had possible mental health problems. Secondary prevention was provided in home visits, primarily in giving injections. The health providers played four main roles as educator, consultant, agent and manager in primary and secondary prevention. There was no single model of mental health care practice provided in the PCUs. Information derived from the present study showed a variety of models underpinning care practices. The nursing process was clearly adopted, as well as integrated care, community participation, collaboration and consultation, and using standard guidelines. Personal knowledge and interest in mental health were mentioned as an important factor in practising mental health care. Environmental factors such as adhering to policy, being family-oriented, being mindful of economic factors, using Buddhist Principles to guide interactions, guarding against occupational risks, maintaining a teamwork approach and the lack of specialists appeared to be factors influencing mental health care. This study contributes to the body of knowledge of community mental health care management in Thailand. The findings suggest implications for practices, education, and policy making to improve quality of care.

This study compared the efficacy of using online dementia training modules on both direct and non-direct care providers in long-term care settings and how this impacted their delivery of Person Centered Care (PCC), as well as their knowledge of caring for residents with a diagnosis of Alzheimer Disease (AD), dementia. Traditional educational opportunities for staff working specifically with demented residents inside Memory Care Units (MCU) were investigated, along with an alternative approach of training all staff (to include direct and non-direct care providers). The option of utilizing online dementia training modules for all staff was then evaluated by using an observational Person Centered Care tool, to see if education had made an impact on interactions between staff and the demented residents that they care for. This study utilized a single-group, repeated measures design to test a 10-week, standardized and computerized set of 10 interactive training modules in a 60-bed MCU . Fifty-one observations were made between MCU residents and staff and included in this study, employing a single-group pre-post-posttest design. The findings suggest that online dementia training modules may be beneficial for both knowledge and delivery of PCC to staff in MCUs who care for residents with a diagnosis of AD.

Residential care provides for approximately 500 children and young people in Victoria each year, yet the dynamics of providing care within this system have received little scholarly attention, at least in part because it forms a much smaller part of the system than home-based care – in 2014 there were 5,900 children and young people in foster care and kinship care in Victoria. It has long been recognised that, despite being highly traumatised and vulnerable, young people placed in the care of the state are often exposed to further distress, instability and torment because of the nature of the out-of-home care system, and the available literature confirms that this is certainly true in residential care. Central to the care these young people receive, and their experience of being ‘in care’, are the agents through which the care is delivered: residential care workers. This thesis fills a gap in knowledge by examining the perspectives and practice of residential care workers, asking how they understand their ability to support good outcomes for children and young people within the restrictions of residential care settings which are far from perfect. This thesis presents the findings of a qualitative study of interviews with twelve residential care workers that was guided by the principles of grounded theory. Led by the themes which emerged from these interviews, this project examines the pillars of good practice as residential care workers themselves understand them – both those which they can directly articulate, and those which are part of their tacit knowledge. The findings point to three key areas. Using the framework of ‘care’ as provided by Tronto, the three areas that emerged were (i) caring about, (ii) taking care of and (iii) care giving. At the heart of these areas are the concepts of being rooted in genuine relationships, trauma informed practice and connection to the community. These findings point to guiding principles that residential care workers see as helping them to be effective in not only doing their job, but also in providing authentic and personal care to the young people.

The purpose of this study was to explore and describe the experiences of disabled women, attending the state-provided reproduction health services, regarding the quality of care rendered by health professionals in the Eastern Cape. The study was conducted on disabled women at Flagstaff and Lusikisiki self-help group project sites.

Background: Advance care planning (ACP) is a method used for patients to express in advance their preferences, beliefs and values for life-sustaining treatments at the end-of-life. With growing ethnocultural diversity in Canada, health care providers are managing an increasing number of diverse beliefs/values that are commonly associated with preferences for mechanical ventilation (MV) at the end-of-life. The aim of this project is to explore methods used by health care providers to set care plans for MV with ethnocultural populations. Methods: Qualitative analysis of semi-structured interviews with open-ended questions and two clinical vignette components was conducted with eight (8) health care providers who engage in ACP. Participants were recruited using a snowball-sampling approach from five acute-care hospitals within the Ottawa region. Results: Three major themes emerged from collected dataset: 1) Goals of care across illness trajectories, 2) Respecting beliefs, values, and wishes for care, and 3) Cross-cultural support in ACP. Using a value-based approach in ACP was described as an effective method for managing and interpreting diverse beliefs/values that impact decisions for MV. However, organizational, systemic, and personnel barriers that exist continue to hinder the provision of cross-cultural ACP across health settings. Contexte: La planification préalable des soins (PPS) est une méthode utilisée par les patients et les familles pour exprimer à l'avance leurs préférences liées aux traitements de prolongation de vie. En raison de la diversité ethnoculturelle croissante au Canada, les professionnels de la santé sont confrontés à des croyances et valeurs différentes, souvent associées à une préférence pour l’initiation et le maintien de la ventilation mécanique (VM) en fin de vie. L'objectif de ce projet consiste à explorer les stratégies utilisées par les professionnels de la santé lors des discussions associées à la VM auprès d'une clientèle multiculturelle. Méthodes: Huit (8) participants (médecins et infirmières) impliqués dans la PPS ont accepté de participer à une entrevue semi-structurée avec des questions ouvertes et deux scénarios cliniques. Les participants ont été recrutés à l'aide de la méthode d’échantillonnage par réseau (« boule de neige ») de cinq hôpitaux de la région d'Ottawa. Résultats: Trois grands thèmes ont émergé des entrevues: 1) les objectifs de soins à travers les trajectoires de la maladie, 2) le respect des croyances, valeurs et souhaits pour les soins, et 3) le soutien dans la PPS en contexte interculturel. Lors de la PPS, utiliser une approche basée sur les valeurs a été décrite comme une méthode efficace pour interpréter et prendre en compte les diverses croyances et valeurs qui ont une influence sur les décisions liées à la VM. Cependant, les barrières systémiques, organisationnelles et personnelles continuent d'entraver les services associés à la PPS en contexte interculturel dans les établissements de santé.

End of life conversations are challenging in all health care settings, and health care providers’ (HCPs) fears about holding end of life conversations are a barrier to quality patient centred care. This study explored HCPs’ experiences using a conversation “companion card” to structure end of life discussions and sought to understand HCPs’ experiences with goals of care (GOC) conversations. A theoretical perspective of relational ethics and a research methodology of Interpretive Description (ID) guided this research study. The methodology produced a qualitative description of experiences from a sample of HCPs. Over a two month period, the researcher gathered data during four semi-structured focus groups with twenty one participants at one urban acute care setting in Western Canada. In addition to focus groups the researcher relied on other processes to enhance her reflexivity, including journaling and memos; all of which are essential to ID inquiry. The findings of this study centre around four themes relating to participants’ experiences discussing GOC and the usefulness of the companion card in discussions. These themes are titled, the big struggle; responsibility; building relationships and the utility of the GOC companion card. Recommendations from this study addressed the need for research into the ethics of discussing GOC with patients and families with life limiting illnesses; organisational prioritisation ensuring therapeutic GOC discussions take place; incorporation of GOC discussions in educational programs across all health care sectors; and policy reform to ensure community care services can support ongoing GOC conversations.

Includes bibliographical references (leaves 86-91).
This study occurred in the context of three problems that have arisen within the South African HIV/AIDS crisis: the prevalent HIV and tubertulosis (TB) co-epidemic, the concern that antiretroviral (ARV) provision might compromise the existing TB control programme, and that the Western Cape's current limited vertical model of ARV roll-out will soon reach capacity. This study evaluated whether and how TB control changed following ARV introduction in a Cape Town primary care TB clinic and explored the process of integration of the TB and ARV services in the clinic.

In this study I articulate what it means to care for the self and care for others, and the association between the two. Juxtaposing self-understanding through the method of currere and studying the historical character of hakbeolism, I articulate how self-understanding in conjunction with historical study, together allegorically, can be a transformative possibility that may contribute to subjective reconstruction which can be a way of self-care. After discussing how Korean schooling exercises coercive care, disconfirmation, and the “whip of love” for the students’ own good, I ponder how having one’s own standards can be a way of making one’s life a work of art without entirely conforming to externally imposed standards. My special emphasis is on the internalization of external standards in students and on teachers’ and parents’ culpability in practicing and reproducing them. Focusing on Nel Noddings’ ethic of care and analyzing The King’s Speech, I discuss how care-for-others can contribute to self-understanding, indeed to building an authentic self-self relationship. What might an education with self-care and care-for-others look like? I imagine that it may be one that allows and encourages students to come up with their own standards, perhaps with the help of or in relationship with others. However, there are structural and relational challenges in exercising self-care and care-for-others and keeping a balance between them. I suggest breaking the unnecessary linkage between our ethic and the constraining structures, teaching and learning, and our preference and reality, and that by doing so it is possible to build linkages between our knowledge and ethics, which requires our courage, and ethicality to make professional judgment. Arguing that self-care and care-for-others are intrinsically intertwined, I suggest that we may be able to keep a balance between them using discernment, surrendering to reality, and that in the discernment we may be able to make better decisions for the well-being of the self, others, and the society.
Education, Faculty of
Curriculum and Pedagogy (EDCP), Department of
Graduate

Patients with dementia in acute care often experience poor outcomes, as nurses and other staff in hospitals are not equipped to provide good dementia care. Person-centred care has been recognized as the best practice for dementia care, but its application in hospital environments remains unclear. This action research involved patients with dementia, a team of staff members, and public advisors to co-create changes in a medical unit. The objectives of the project were to: (a) develop person-centred care in a medical unit, (b) explore ways to support the involvement of patients with dementia in research, (c) examine the processes of staff engagement for bringing together staff from different disciplines to co-inquire, and (d) evaluate the impact of research on the process of change and identify the lessons learnt to inform practice, education, policy, and research. Various methods were used such as: interviewing patients with dementia, focus group sessions with a team of inter-disciplinary staff, and participant observations. In this thesis, I argue for a new positive and collaborative approach that views change as a continuous process. In the past, the problem-focused model that sees change as fixing people has largely failed with regards to advancing practice developments in dementia care. An important outcome of this research is the heuristic guide ‘Team Engagement Action Making’ (TEAM), which can be used to support teams to engage staff in co-creating positive change. The results of this study indicate that appreciative inquiry is a useful strategy for engaging people on a team to learn together and to co-create a better future of care. The findings also suggest that more attention should be paid to the dynamic inter-connection of research and practice, rather than just one or the other. The results demonstrate that action research can affect the process of change by generating positive energy, attitude change, and momentum for action activities in the unit and beyond. Future research should further explore strategies that would maximize the potential of bringing patients, families, researchers, and practitioners to work together for positive change. Supplementary material : http://circle.library.ubc.ca/handle/2429/63499
Applied Science, Faculty of
Nursing, School of
Graduate

I realized the importance of kinship connection and family preservation the first time I met one of my birth family members at age twelve. As an adopted child, I often felt I was living in a borrowed state of being. In someone else's family, borrowing someone else's name and culture. Meeting my birth family and recognizing my connection to the Metis community gave me a sense of belonging for the first time in my life.

This dissertation builds on the current anthropological studies of care relations in practice. It draws inspiration from science and technology studies (STS) and postfeminist technoscience. A qualitative ethnographic approach grounds the empirical data collection and analysis. This entails ethnographic fieldwork with senior home care in the United States and Sweden during 2007–2008 and 2011–2012. Analytical attention centers on how movements situate various tensions of senior home care in practice. Four interrelated published works comprise the main thematic chapters. Each article exemplifies how human and nonhuman relations move and mediate care. They develop several heuristic terms that advance ideas about how older people, aging bodies, technologies, spaces, and times that tinker each other through movements of care in practice. The comprehensive summary frames these articles with an overview of the primary thematic orientations and methodological concerns. A discussion of the main contributions and implications of the dissertation concludes the work.

Background: Neonates who require specialized care and life-saving therapies in neonatal intensive care units (NICUs) and neonatal special care units (NSCUs) can be exposed to separation from their parents and families. Consequently, establishing a parental-neonate bond can be difficult. However, addressing this problem of separation through involving parents and families in neonatal care to improve parent-professional collaboration can result in positive outcomes for neonates and their families. Family-centred care (FCC) has developed over decades and is broadly recommended as an ideal model of care in daily clinical practice in NICUs. However, FCC implementation is challenging at individual, organizational, cultural, and healthcare system levels. In particular, developing countries are challenged by the lack of material resources, infrastructure, and staff shortages. In Thailand, the practical incorporation of FCC into daily clinical practice in neonatal care units is difficult, and it has not been sustainably achieved. Furthermore, there has been minimal research reporting on the development, implementation, and evaluation of FCC in the neonatal critical care context within Thailand. Aim and Objectives: The aim of this PhD study has been to develop, implement and evaluate innovation to facilitate FCC by improving respect, collaboration, and support in a Thai NICU. It had three objectives, each representing a distinct phase in the study: (1) to identify perceptions, current practices and FCC strategies; (2) to develop and implement an innovation to facilitate FCC by improving respect, collaboration, and support in a Thai NICU; and (3) to evaluate the FCC innovation developed in Phase 2. Methods and Results Design: The multistage, mixed-methods study design applied the Participatory Intervention Model (PIM) to guide the innovation’s development, implementation, and evaluation to facilitate FCC by improving respect, collaboration, and support in a Thai NICU. Setting and context: This study was conducted in a tertiary care hospital in southern Thailand (February 2020-January 2021). Ethics approval was obtained from the Research Ethics Committee of Hatyai Hospital and Griffith University. Phase 1: Identification of perceptions, current practices, and FCC strategies Phase 1 was planned to include data collection over 3 months. Due to the COVID-19 pandemic, it was reduced to 2 months during the very early stages of the pandemic (February to March 2020). This phase consisted of two parts, including surveys and interviews with parents and the interdisciplinary professionals. Participants: Participants consisted of two groups: parents of neonates (all gestational ages with no life-threatening or life-limiting diagnosis) who had an expected NICU stay of at least 72 hours and visited the study NICU at least once, and interdisciplinary professionals with a permanent position for at least 1 year in the study unit. Part A: Survey of parents and interdisciplinary professionals Surveys of parents and interdisciplinary professionals were conducted using the validated Perceptions of Family Centred Care – Parent (PFCC-P) and Perceptions of Family Centred Care – Staff (PFCC-S) instruments which were translated into Thai. Sample size: Sample size was based on availability of parents and interdisciplinary professionals over the planned 3-month Phase 1 period. Recruiting parent participants in Phase 1 was prior/during the very early stages of the COVID-19 pandemic and needed to be stopped prior to pre-determined sample size of 100 parents due to visitor restriction (n = 85). Eighty-five parents and 20 interdisciplinary professionals completed the surveys. Data analysis: Demographic characteristics of parents, interdisciplinary professionals, and neonates are reported using descriptive statistics. The subscale scores for parents and interdisciplinary professionals were not normally distributed, so medians were calculated for each of the three sub-scales (respect, collaboration, and support). Parents’ and interdisciplinary professionals’ perceptions of FCC (PFCC-P & PFCC-S) were compared using the Mann-Whitney U test to examine differences in medians in the preimplementation phase because they were unpaired groups. Part B: Semi-structured interviews with parents and interdisciplinary professionals Face-to-face, semi-structured, individual interviews were planned to gain information from extended family members and parents and interdisciplinary professionals; however, given the visitation restrictions, only parents and interdisciplinary professionals were recruited to participate (during the first half of February 2020). Sample size: The sample size was determined when data saturation was identified. Eight interdisciplinary professionals and nine parents participated in face-to-face interviews. Data analysis: Thematic analysis was used to analyse the transcribed Thai language interviews. Results: The survey results across the median of three subscales demonstrated that parents and interdisciplinary professionals’ perceptions on the FCC strategies in current practice were 2-3/4 (Interquartile range [IQR] 1.7-3.8) and 3-4/4 (2.85-3.55), respectively. Considering the median subscale scores, the interdisciplinary professionals had significantly higher subscale scores for respect (median 3.00 (95% CI, 2.91-3.24) vs 2.50 (2.37-2.81)), collaboration (median 3.22 (3.10-3.37) vs 2.33 (1.9-2.62)), and support (median 3.20 (3.03-3.39) vs 2.60 (2.03-2.61)) (all p ≤ 0.001). The interview findings highlighted that the interdisciplinary professionals in this study accepted that the three critical elements of FCC (respect, collaboration, and support) were necessary to be implemented into clinical practice. However, they believed that in reality it was not easy in the Thai NICUs context. This finding identified that the challenge to promote parent-healthcare professional partnerships was associated with the structure and processes of the healthcare delivery system. In addition, the individuality of families' readiness and healthcare providers' perceptions of parents’ involvement as obstacles to providing care were found to be challenges to current practices of FCC. Phase 2: Development and implementation of innovation to facilitate FCC This phase was achieved by two different methods: strategy development working group and implementation of the FCC innovation. Strategy development working group: The development of FCC innovations by the strategy development working group (June to August 2020) was based on Phase 1 findings and the reported integrative literature review. In addition, the FCC innovations were considered within the policies and practices of the NICU in the context of COVID- 19 in Thailand. The development working group members were key and high-level stakeholders in the NICU. Educational activities for the healthcare professional team to incorporate the FCC innovations into their clinical practice in NICU were provided. Implementation of the FCC innovation: The FCC innovations were then implemented over 2 months (September to October 2020), during a period of restrictions on parents and staff arising from COVID-19. Results: The working group identified the gaps in the three key elements (respect, collaboration, and support) to providing FCC in a Thai NICU through the analysis of Phase 1’s results in consort with the findings from the integrative review. A preliminary protocol for the FCC innovations and implementation plan were developed consistent with the challenges associated with COVID-19 in Thailand. FCC practice innovations associated with improving communication were established, including changes and updates to the material within the parent booklet with specific material related to COVID- 19, neonatal updates at bedside or conducted via telephone calls, interdisciplinary family meeting for complex care situations, structured communication checklists, and documentation templates. In addition, although visiting restrictions were limiting, parents were provided with more flexibility as to when they could visit based on individual circumstances. The majority of the healthcare providers in this setting (80%) attended the educational activities to incorporate the FCC innovations into their clinical practice in the NICU. The FCC innovations were incorporated into daily NICU practice by nurses in cooperation with other healthcare providers and ancillary support staff during the pandemic. Phase 3: Evaluation of the FCC innovation Phase 3 (post-implementation) was conducted over 3 months (November 2020-January 2021), and it focused on evaluating the FCC innovations. This phase repeated the collection of data from the validated PFCC-P and PFCC-S surveys of parents and interdisciplinary professionals' perceptions, as per Phase 1, to assess respect, collaboration, and support changes after implementing the FCC innovations in the Thai NICU during the pandemic. Sample size: One hundred parents and 20 interdisciplinary professionals completed the surveys. Data analysis: As per Phase 1 for demographic characteristics. The Mann-Whitney U test was used to analyse parents' perceptions of the items of the PFCC-P pre- and postimplementation given they were two independent groups. Wilcoxon signed-rank test was used to compare the perceptions of the interdisciplinary professionals pre- and postimplementation using the PFCC-S given they were matched samples. Results: The participants consisted of 83 pairs of parents (i.e., mother and/or father of neonate participated) (35 pre; 48 post), which represented 102 neonates (50 pre; 52 post). There were 185 parents; 85 pre-implementation and 100 post-implementation. For the NICU health care team, 20 participated. The median scores of parents' perceptions post-implementation significantly improved for respect (2.50 to 3.50; 95%CI, 3.02-3.53), collaboration (2.33 to 3.33; 2.90- 3.40), support (2.60 to 3.60; 2.84-3.62), and the overall score (2.50 to 3.43) (p < 0.001, 95%CI 2.93-3.51). There was an absolute difference of at least 0.3 in the pre- and postimplementation scores for three subscales and overall score, where 0.3 corresponds to 10% of the rating scale. Comparatively, interdisciplinary professionals' perception of FCC did not significantly change pre- and post-implementation for respect ([median] 3.00 to 2.92; 95%CI, 2.87-3.16), collaboration (3.22 to 3.33; 3.16-3.47), support (3.20 to 3.20; 2.96-3.28) and overall (3.15 to 3.20; 95%CI, 3.10-3.25). Conclusions:Results from this study indicate that incorporating FCC innovations in the NICU appeared to be successful, despite the challenges of COVID-19. The key finding was that the innovations incorporated in the NICU were primarily based on communication strategies, a simple means to support, collaborate with, and respect parents that required low investment within the complex situation arising from COVID-19. These innovations were essential to engage collaborative working between parents and healthcare providers to promote parents as partners in a neonatal critical care team. To successfully implement FCC innovations in different settings, further innovations associated with communication methods need to target the specifics of individuals involved, healthcare settings, and available resources.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
Full Text

Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome (results). The research questions examined operational values underpinning company sanctioned work processes, how personal values underpin work processes of the direct caregivers, configuration of personal values the caregivers believe should be supported in the group home context, and how critical incidents shaped the value set of direct caregivers in regard to care processes. Using structured questionnaires and observing staff as they delivered care to their clients, data were collected from participants who were direct caregivers (n = 7), a facility administrator, and a nurse. The data were coded, categorized, and analyzed for emergent themes. The results of the analysis indicated that there was discord between staff and the organizational leadership. This discord could be improved through increased interaction between the mentioned stakeholders. The results further depicted that client-centered care may have a positive impact on the health of the MCIs that would enable the MCIs to make notable contributions to social change.

Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.

Thesis (Ph. D.) -- University of Maryland, College Park, 2007.
Thesis research directed by: Family Studies. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.

In recent years, sentimentalist care ethics has been developed and defended as a normative ethical theory alongside and in opposition to Kantian liberalism. Carol Gilligan introduced the idea of a woman’s moral perspective that emphasizes maintaining relationships and responding to need, and saw it as a different way of framing moral issues. Care ethics is no longer associated only with women, and it is presented as a theory for both men and women that has its own distinctive accounts of ethical notions like justice and autonomy. These accounts have developed from analyses of injustice towards women and uncaring attitudes that they face in patriarchal societies, but ironically, care ethics has failed to discuss women’s anger at their own mistreatment, and their inability to deal with that anger. This notable lacuna in the care ethics literature is of philosophical importance because analyzing the phenomenon of women’s anger uncovers epistemic issues that have not been addressed. I discuss these epistemic issues in order to strengthen care ethics from within and extend it into other areas of ethics. My goal is to make care ethics a real contender among normative ethical theories and a truly feminist ethic.

What is the problem? The number of people coming to the hospital eye departments is likely to increase in the future, as a result of an ageing population, increased optometric case finding and raised public awareness. This fact coupled with the increased economic pressures in health-care financing, and the relative shortage of ophthalmologists in the United Kingdom is going to put significant strain on ophthalmology provision. As a result of these issues, there has been a drive by the government to move eye care into the community and to have more primary care involvement. A variety of alternative models have been proposed for patient care in the community. An important part of assessing these models is to investigate their relative cost effectiveness as well as safety, capacity and patient acceptance. What are the current models? There have been many shared care models that have been proposed. These have included the Community and Hospital Allied Network Glaucoma Evaluation Scheme (CHANGES), the Peterborough Scheme, East Devon Scheme, Waltham Forest Scheme and the Nottingham Scheme. One of the main schemes was the Bristol Shared Care Scheme. This scheme was shown not to be cost effective. It did show that community optometrist’s measurements were of comparable accuracy to those made in the hospital. The annual cost per patient follow-up by a community optometrist was £68.98-£108.98 compared to £14.50-£59.95 in the hospital. The main reason for the cost difference was due to a variation in the patient recall interval between the community and hospital. The second reason was due to the re-referral of patients back from the community clinics to the hospital clinics. What was our contribution? We developed an Integrated Glaucoma Care Model. This involved training and accrediting community optometrists to run Moorfields glaucoma clinics in their Optometric practices whilst alternating attending glaucoma clinics in the hospital. Our results showed that it was more costly to run the community based glaucoma clinics compared to hospital based clinics. These were the same findings as in the Bristol shared care model. The main reasons for the higher costs in the community were due to the large overhead costs of running the glaucoma scheme in the community optometric practices as well as fewer patients being seen in the community compared to the hospital. The community optometrists involved in our scheme were in general found to be competent, efficient and safe. The patient perspectives of our model were overall positive with a large majority of patients happy to be seen in the community again. What were our recommendations? Our main recommendation was to evolve our model to run the shared care scheme within the hospital setting to avoid the high rental costs of the optometric practices. This model is being successfully run at Bristol Eye Hospital where there is a complete shared care department involving optometrists. This type of model could utilise hospital optometrists but could also have accredited community optometrists attending the hospital and participating in such schemes. A second possibility could be to run these shared care schemes in hospital satellite settings or mobile units. An example of this is the Newmedica model. There is a clear requirement for cost effectiveness evaluation of such schemes along with an assessment of safety, capacity and patient acceptance before any conclusions can be reached.

El presente proyecto de investigación, denominado “Plataforma web Dog Care”, busca satisfacer la problemática del deficiente número de hoteles, hospedajes y guarderías para perros que existen en Lima moderna, debido al crecimiento exponencial del número de familias que cuentan con uno o más canes en casa. El servicio conecta vía web a un dueño de perro que desea hospedaje y cuidado de su mascota con un anfitrión. Este último es una persona amante de los perros (dog lover), que cuenta con tiempo y espacio en su casa para poder realizar el cuidado y de esta manera ganar un dinero extra. El mercado meta de la plataforma web Dog Care son la persona residente en Lima moderna que cuenten con un can y salen los fines de semana o viajan por motivo de trabajo o vacaciones y desean dejar su mascota bajo un buen cuidado. La etapa inicial del proyecto se enfoca en el distrito de San Isidro. El proyecto cuenta con estimaciones financieras favorables. Se prevé que podrá materializarse con una inversión total de S/173,128. Los socios aportarán el 71% y se necesitará S/50,000 extras, que serán financiados a través de un préstamo bancario. Como proyecto, se ofrece una rápida recuperación (2.24 años) y una tasa de rentabilidad TIR de 87%.
The present research project, called "Dog Care Web Platform", seeks to satisfy the problem of the deficient number of hotels, lodgings and day care for dogs that exist in modern Lima, due to the exponential growth of the number of families that have one or more dogs at home. The service connects via web to a dog owner who wants to host and care for his pet with a host. The latter is a person who loves dogs (dog lover), who has time and space in his house to carry out the care and thus earn extra money. The target market of the Dog Care web platform is the person residing in modern Lima who have a can and leave on weekends or travel for work or vacation reasons and want to leave their pet under good care. The initial stage of the project focuses on the district of San Isidro. The project has favorable financial estimates. It is foreseen that it could materialize with a total investment of S / 173,128. The partners will contribute 71% and will require S / 50,000 extras, which will be financed through a bank loan. As a project, it offers a fast recovery (2.24 years) and a TIR rate of return of 87%.
Trabajo de investigación

Para este trabajo de investigación, el equipo parte de una necesidad recurrente en los distritos descritos posteriormente, el gran factor común en los clientes es la ausencia de tiempo para el cuidado de los hijos, esto ocasionado por el ritmo de vida de los padres. En este trabajo se realizó una investigación a profundidad, detallando también las necesidades, expectativas del cliente, gustos sobre los servicios del cuidado de un niño, así como las perspectivas esperadas para clientes que por primera vez solicitaron este tipo de servicios para sus hijos. Nuestro servicio revoluciona el concepto del cuidado tradicional del niño, esto debido a las necesidades actuales del infante, lo cual requiere nuevos aprendizajes y mayores cuidados. Proponemos un negocio con un óptimo valor agregado que sobrepasen las expectativas del cliente, priorizando la innovación, constante investigación y tecnología.
For this research work, the team starts from a recurrent need in the districts are updated, the great common factor in the clients is the absence of time for the care of the children, this caused by the rhythm of the life of the parents. In this work we carried out an in-depth investigation, the needs of the clients, the child care services, as well as the perspectives expected for the clients that the first time request this type of services for their children. Our service focuses on the concept of traditional child care. We propose a business with an optimal added value that surpasses the expectations of the client, prioritizing innovation, constant research and technology.
Trabajo de investigación

In this paper, I will describe and analyze the process of creating my thesis film, titled Care Packages. I will recount the production from start to finish, focusing on each specific phase of production – this includes any act associated with the writing, planning, shooting, and editing of the film. I will then reflect on my work in self-analysis to decide the success of my film.

Existe en nuestro país un gran número de personas entre los 25 y 45 años, trabajadores con una vida agitada, muchos de ellos son padres de familia, y otros tienen a sus padres, quienes son adultos mayores. Con el paso de los años, las responsabilidades crecen y el tiempo se vuelve enemigo, creando ocasiones en las cuales es difícil estar presentes para acompañar a sus familiares a actividades o trasladarlos de manera segura. Es por esto, que, con el presente proyecto empresarial, FAMILY CARe, queremos entregar el soporte necesario, para que lo antes mencionado deje de ser una carga y podamos brindarles la solución ideal a este problema. No sólo lo visualizamos como un tema académico, sino como un proyecto realizable, con el cual ya nos sentimos identificados en aras a que se abra la posibilidad de llevarlo a cabo. La modernidad y la tecnología nos ayudarán a llevar este servicio a nuestros clientes de manera eficiente, posicionándonos, es así que estos recursos los manejaremos con un cuidado especial para siempre estar a la altura y responder con veracidad, trasparencia y rapidez ante ellos. Sacaremos el mejor provecho a estos medios para obtener el mayor beneficio en pro de nuestros clientes. Además, con una adecuada y óptima estrategia de marketing lograremos nuestros objetivos, para hacer nuestro servicio escalable y conocido, mediante las estrategias y medios para así aumentar nuestra participación en el mercado y posicionarnos en este rubro, aún novedoso por el tipo de servicio, el cual es especializado.
There are a large number of people in our country between the ages of 25 and 45, hardworking workers, many of them are parents, and others have their parents, who are older adults. Over the years, responsibilities grow and time becomes an enemy, creating occasions in which it’s difficult to be present to accompany family members to activities or move them safely. That is why, with this business project, FAMILY CARe, we want to deliver the necessary support, so that the aforementioned doesn’t become a burden and we can provide the ideal solution to this problem. We don’t only visualize it as an academic subject, but as an achievable project, which we already feel identified in order to open the possibility of carrying it out. Modernity and technology will help us to bring this service to our customers in an efficient way, positioning ourselves, so we will handle these resources with a special care to always be up to and respond with truthfulness, transparency and speed to them. We will make the best use of these means to obtain the greatest benefit for our clients. In addition, with an adequate and optimal marketing strategy we will achieve our objectives, to make our service scalable and known, through strategies and means to increase our market share and position ourselves in this area, still novel by the type of service, that which is specialized.
Trabajo de investigación

Syftet med vår studie är att undersöka hur förskollärare ser på innebörden av begreppen undervisning och omsorg i förskolans verksamhet. Uppsatsen baseras på frågorna:-Hur beskriver pedagogerna vad undervisning är?-Hur beskriver pedagogerna vad omsorg är?-Hur förklarar pedagogerna relationen mellan undervisning och omsorg? -Hur redogör pedagogerna för fördelar respektive nackdelar med en mer skolinriktad förskola?Metoden vi använt för denna studie är intervjuer med pedagoger från olika avdelningar på en och samma förskola. Arbetets tidigare forskning och teoridel förklaras bland annat utifrån John Bowlby och Mary Ainsworths forskning kring anknytning, Lev S Vygotskijs forskning om språk och sociala samspel samt nationella forskare, som till exempel Ingrid Pramling Samuelsson, Sonja Sheridan och Sven Persson. I delen resultat och analys sammanfattar och förklarar vi vår empiri med hjälp av teori och forskning. Begreppen undervisning och omsorg förklaras var för sig för att avslutningsvis knytas samman till en helhet. Slutsatsen av vår studie visar att det spänningsfält som vi först upplevde fanns mellan undervisning och omsorg egentligen inte finns. Efter vår analys av empirin har vi insett att problematiken och spänningsfältet istället ligger mellan begreppen undervisning och lärande. Resultatet visar på att undervisning och omsorg går hand i hand i den verksamhet vi undersökt. Däremot så upplevs undervisning som ett laddat begrepp som hellre ersätts med begreppet lärande när det handlar om förskolan.

Thesis (Ph. D.)--University of Oregon, 2001.
Typescript. Includes vita and abstract. Includes bibliographical references (leaves 226-236). Also available for download via the World Wide Web; free to University of Oregon users. Address: http://wwwlib.umi.com/cr/uoregon/fullcit?p3024513.

Excerpt: It’s July 26, 2010, late. I’ve sunk onto the edge of the bed in my childhood home. The bedroom reminds me of one of those cozy, pretty Valentine’s Day shoeboxes I made back in elementary school: small, pink, white, flowery.

Prevalence of missed health care by life course stage is examined with a critique of the measure of missed care. Canadians reporting missed care has increased from 4.2% in 1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2. What are the relationships among life course stages, social support, predisposing, enabling and need factors to the reporting of missed care? 3. What is the role that life course stages play in the relationships among social support, predisposing, enabling, and need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What reasons are provide for missing care?; and 6. Who accesses primary care and what is the relationship to reporting missed care? Methods: Analysis was done using the Canadian Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore the relationships among variables of interest predicting missed care. Results: Young adults (18-30) are more likely to report missed care compared to other age groups and are least likely to have a regular doctor. Social support is most significantly protective against missed care for young adults. Weak sense of belonging to a local community and lower income are stronger predictors of missed care for young adults. Young adults differ from others in the reasons they report for missed care (i.e., more likely to report cost as a barrier). Discussion: It's not clear if the difference between young adults and other life course stages is in actual missed care or expectations of primary care. Yet, the literature on emerging adulthood invites curiosity about how delayed adulthood leaves them in less stable, financially insecure, socially and institutionally isolated situations that have subsequent consequences for primary care access. Changes in models of primary care have led to a decline in comprehensive care and more drop-in clinics; while, not having a regular doctor is associated with missed care. If patterns of inadequate primary care access established in young adulthood are perpetuated in later life, this may foretell undesirable consequences for the health of Canadians. A new model for measuring unmet health care needs is proposed.
Graduate and Postdoctoral Studies
Graduate

Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.

Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.

Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.

Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.