Dissertations / Theses on the topic 'Home care services Victoria Evaluation'

The outcomes of a child protection/family support programme, the Cottage Community Care Pilot Project, were evaluated in this study. The evaluation employed a non-equivalent comparison group design of 'at risk' consenting first-time mothers in the perinatal period with babies up to 6 weeks of age. Ninety-three families were recruited and 58 of these were matched with a trained volunteer home visitor. Analysis of assessment items and questionnaires, reviews of hospital records and the Department of Community Services Child abuse and neglect notification register and focus groups with mothers and volunteers provided the information used in this study. The CCCP had an impact on particular aspects of family function, certain infant and maternal health indices and the families' use of community services, but its contribution to reducing the incidence of child abuse and neglect is less clear. Client and volunteer feedback indicated support for the programme. While home visitation by trained volunteers is not proposed as the total answer for effective child protection or family support, the findings of this evaluation suggest that there is a place for similar programmes.
Master of Science (Hons)

Thesis (M.Sc.) (Honours) -- University of Western Sydney, Macarthur, 1999.
A thesis presented to the University of Western Sydney, Macarthur, in partial fulfillment of the requirements for the degree of Master of Science (Honours), March, 1999. Bibliography : leaves 117-125.

Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)

O acelerado processo de envelhecimento populacional é desafiador para a elaboração de estratégias de atenção à saúde nos diferentes níveis de complexidade. Em concordância com a integralidade do cuidado em assistência domiciliar, o interRAI-Home Care é um exemplo de avaliação multidimensional utilizado em vários países na gerência de casos, gestão em saúde pública e cooperação internacional na busca de melhores soluções para gestão de saúde. As características culturais e do funcionamento dos serviços de assistência domiciliar podem influenciar o processo de adaptação transcultural e uso desses instrumentos. Os objetivos desse estudo foram realizar a adaptação transcultural do interRAI-Home Care para a população brasileira e verificar a validade de conteúdo e face da versão em português brasileiro em um serviço de assistência domiciliar. Foram seguidas as etapas do processo de adaptação transcultural com tradução do instrumento, retro tradução para a língua de origem, avaliação de equivalência das versões do instrumento por uma comissão de especialistas e pré-teste com aplicação da versão pré-final em uma amostra selecionada por conveniência de 30 indivíduos (n=30), matriculados e atendidos no Núcleo de Assistência Domiciliar Interdisciplinar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados mostram que os procedimentos para a adaptação transcultural foram realizados com ajustes necessários para garantir a equivalência de conteúdo das versões original, traduzida e retro traduzida após revisão e consenso da comissão de especialistas. Na fase pré-teste, verificou-se compreensão de todos os itens da versão pré-final por parte dos entrevistados e concordância entre os avaliadores >= 85% para cada item do instrumento, obtendo-se a versão final do interRAI-Home Care, traduzido e adaptado para o português, interRAI-Assistência Domiciliar. Conclui-se que a adaptação transcultural de um instrumento de avaliação multidimensional em assistência domiciliar foi realizada com verificação da validade de conteúdo e face dos itens do instrumento e elaboração da versão brasileira do interRAI-Home Care, em português brasileiro, interRAI-Assistência Domiciliar. Em etapas futuras, sugere-se a avaliação das propriedades psicométricas do interRAI-Assistência Domiciliar para viabilizar o seu uso e aplicabilidade prática em nosso meio
The accelerated population aging process is challenging for health care strategies development at different levels of complexity. In agreement with the integrality of care in home care, the interRAI-Home Care is an example of multidimensional assessment used in different countries in case and public health management and international cooperation for better solutions to health management. The culture and functioning of home care services can influence the process of cross-cultural adaptation and use of these instruments. This study aims to perform the cross-cultural adaptation of interRAI-Home Care for the Brazilian population and verify the content and face validity of the Brazilian Portuguese version in a home care service. Cross-cultural adaptation process stages were followed with translation, back translation, assessment of equivalence by an expert committee and pretesting with the pre-final version in a sample selected by convenience of 30 subjects (n = 30) registered and attended by the Núcleo de Assistência Domiciliar Interdisciplinar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The results shows that the procedures for cross-cultural adaptation were carried out with adjustments to ensure the equivalence of content of the original, translated and back translated versions after the committee experts review and consensus. Pretesting resulted in understanding of all items in the pre-final version by the interviewees and agreement between observers >= 85% for each item of the instrument thus obtaining the final version of interRAI-Home Care, translated and adapted to Brazilian Portuguese, interRAI-Assistência Domiciliar. In conclusion, the cross-cultural adaptation of a home care multidimensional assessment instrument was performed with statement of content and face validity of the instrument items and development of brazilian interRAI-Home Care version, in Brazilian Portuguese, interRAI-Assistência Domiciliar. In future steps, we suggest the evaluation of the psychometric properties of the interRAI-Assistência Domiciliar to enable its use and practical applicability in home care in Brazil

This thesis evaluated the effectiveness and cost-saving potential of a health service delivery model in Queensland Australia, the Hospital in the Nursing Home program. The research adopted a before-after controlled study design, comparing the outcomes between an intervention hospital and a control hospital during the pre- and post-intervention periods. Findings from the research supported that the intervention was preferred over the current practice, which reduced the attendances to emergency departments (EDs) and inpatient hospitals from patients in residential aged care facilities, shortened their length of ED stay, and saved the overall costs.

There is a large number of biosignals that can be obtained from the human body. Repositories of biosignals are used for researchers in many studies as datasets. Datasets with clinical and personal information have many regulations and they are not accessible to everyone. Platforms with acquisition, recording and visualization of data are currently used in homecare systems for monitoring patients in an effcient way. Distant monitoring allows a good and prompt communication between patients and physicians. This work describes the design and development of a platform at hardware and software level for recording, storage, visualization and analysis of biosignals on the cloud. For the platform, IoT and Cloud Computing resources were used. Open-source and free software are considered for an easy and flexible enlargement of the system.

Trata-se de um estudo exploratório-descritivo, de abordagem quantitativa, cujo objetivo foi avaliar a prática assistencial da intubação gástrica para nutrição enteral dos usuários em Programa de Assistência Domiciliar (PAD), no Hospital Universitário da Universidade de São Paulo. A população foi composta por 37 sujeitos admitidos no PAD, portadores de intubação gástrica para nutrição enteral. A coleta de dados ocorreu no período 15 de abril a 15 de agosto de 2010 por meio de dois formulários. Os dados foram analisados em função da estatística descritiva e inferencial e aplicados testes estatísticos com significância de 5%. Na caracterização dos usuários, constatou- se que 51,4% pertenciam ao sexo feminino e 67,6% apresentavam idade a 60 anos. Em relação ao diagnóstico principal, houve o predomínio de 67,6% dos portadores de doenças neurológicas e a média de permanência no PAD foi de 10,3 meses (dp+12,2). Quanto aos cuidadores, a maioria (89,2%) pertencia ao sexo feminino, e a média de idade foi de 50,6 anos (dp+13,4), 97,3% mantinham vínculo familiar com o usuário e 35,1% não completaram o ensino fundamental. No que diz respeito à via de intubação gástrica, 51,4% utilizaram a gastrostomia, o tipo de dieta predominante 51,4% foi a semi-artesanal. A sonda gástrica foi substituída 29 vezes e o tempo médio de permanência foi de 3,8 meses. Na classificação das extubações, considerando 100 dias, obteve- se a taxa de incidência geral de 1,08, sendo 0,26 de extubações planejadas e 0,82 de não planejadas. As principais circunstâncias envolvidas nas extubações foram: na planejada, a substituição eletiva da sonda; na não planejada, o rompimento do balão da sonda de gastrostomia, com diferença estatística significante (p=0,009). Na comparabilidade entre os grupos de usuários pediátrico e adulto/idoso, houve diferença estatística para o tempo de permanência no PAD e média de idade do cuidador (p=0,00). A taxa incidência de extubação não planejada, no grupo pediátrico, foi de 1,05 e no adulto/idoso de 0,73, não havendo diferença estatística significante (p=0,28). Conclusão: o perfil de usuários do PAD foi constituído, na sua maioria, por usuários idosos, do sexo feminino, tendo como diagnóstico de admissão as doenças neurológicas e com intubação gástrica via gastrostomia; o cuidador era do tipo informal, membro da família, representado pela figura feminina. No que tange às extubações gástricas mensuradas por meio dos indicadores de resultado e pela identificação das circunstâncias envolvidas, verificou-se que os achados permitiram conhecer a realidade dos portadores de intubação gástrica para aporte nutricional no programa, fornecendo subsídios para o estabelecimento de metas assistenciais e gerenciais para a melhoria contínua da qualidade e as reformulações necessárias dos processos de trabalho no âmbito da assistência domiciliar.
This is an exploratory-descriptive study, with a quantitative approach, aiming to evaluate health care practice of gastrointestinal intubation for enteral feeding for users of the Home Care Program (HCP), at the University Hospital of the University of São Paulo. The population consisted of 37 subjects enrolled in the HCP, with gastrointestinal intubation for enteral feeding. Data collection was performed by means of two forms and collected between April 15 to August 15, 2010. Data were analyzed according to descriptive and inferential statistics and statistical tests with significance of 5% were applied. In the characterization of users, 51.4% were female and 67.6% were aged 60 years. In relation to primary diagnosis, there was predominance of 67.6% of patients with neurological diseases and the mean stay in the HCP was 10.3 months (sd +12.2). Regarding caregivers, the majority (89.2%) was female, mean age of 50.6 years (sd +13.4), 97.3% had family ties with the user and 35.1% did not finish elementary school. Regarding the route of gastrointestinal intubation, 51.4% used the gastrostomy, the predominant type of diet was 51.4% semiartisan. The gastrostomy feeding tube was replaced 29 times and the mean time of stay was 3.8 months. In the classification of extubations, considering 100 days, we obtained the overall incidence rate of 1.08, of which 0.26 of planned extubations and 0.82 of unplanned. The main circumstances involved in extubations were : in the planned, elective replacement of the tube; in the unplanned, balloon rupture of the gastrostomy tube, with a statistically significant difference (p = 0.009). When comparing the pediatric with the adult / elderly group, no statistical difference regarding stay in HCP and mean age of the caregiver (p = 0.00) were observed. The incidence rate of unplanned extubation in the pediatric group was 1.05 and in the adult / elderly group was 0.73, with no statistically significant difference (p = 0.28). Conclusion: The user´s profile of HCP consisted mostly of elderly female patients, with an admission diagnosis of neurological diseases and gastrointestinal intubation via gastrostomy; the caregiver was a casual and family member represented by the female figure. Regarding gastrointestinal extubations measured through result indicators and by identifying the involved circumstances found that the findings helped to understand the reality of patients with gastrointestinal intubation for nutritional support in the program, providing subsidies to establish the assistance and managerial goals for the continuous improvement of quality and for the necessary changes in work processes in the home care area.

The purpose of this study is to explore how emancipated youth, who are clients of the aftercare ILP (Independent Living Program) and transitional housing program with Cameron Hill, evaluate those services.

This study proposed to explore several factors that promote foster parent satisfaction in order to preserve quality foster homes to serve the 532,000 displaced children currently in the child welfare system. A sample of 52 foster parents were surveyed to determine overall satisfaction with their foster care experience at Children's Way Foster Family Agency in San Bernardino, California. It was hypothesized that the higher the level of foster parent satisfaction, the higher rates of retention. A modified version of an existing instrument titled "Foster Parent Satisfaction Survey" was utilized in this study.

Abstract The purpose of this study was to evaluate characteristics, the cost of the intervention and effects of participation on the first year preterm cost of care. Home-based intervention is a new preventive nursing intervention, which focuses mainly on early interaction between an infant and its mother. Many long-term advantages have been found in developmental issues of preterm infants, on mothers caring skills and the mother-child relationship. Even though those positive effects are well known, there still remains a gap of information concerning effective characteristics of the intervention as well as costs of such an intervention. The study focused on two main questions: 1) What are the characteristics of the intervention perceived by the mothers with preterm infants? 2) What are the costs of the intervention and what kind of effects did the intervention have on the first year cost of care of preterm infants? This was a retrospective evaluation study. The population consisted of preterm infants (≤ 32 gw), who were treated in eastern an northern Finland during 1996?1998. All infants received usual preterm care. In addition to this, the intervention group participated in the intervention. Data was gathered during 1998?1999. Two groups of mothers were interviewed. The first were mothers (N = 17), who described the care for a preterm infant at home. The other group of mothers (N = 7) evaluated the intervention. Content analysis was performed inductively and deductively. The last one was based on concept and characteristics of social support. Cost of the intervention was evaluated as salary, time and travelling cost for the nurse. Costs of preterm care were computed as direct and indirect social and family costs and compared the first year cost of intervention (N = 18) and control (N = 118) group of preterm infants. Data was gathered by a questionnaire and from hospital statistics and patient files. Descriptive statistical methods as well comparing the means were used. The results indicated an exceptional motherhood of the mothers with preterm infants. The exceptionality consisted of challenges of care for the infant, needs for information related to prematurity and care for the infant. Many fears, worries and feelings of guilt burden the mothers. The home-based intervention supported the mothers of the intervention group by equipping them with situation suitable information concerning prematurity and giving them emotional, integrative and active support. The mean cost of the intervention was 970 euroa per an infant to the hospital. Costs of new episodes of care and primary health care were smaller among the intervention group than among the control group. Cost-analysis indicated that the initial phase of care formed the main proportion of infants' first year cost of care. The results suggest that the home-based intervention may have potential to support mothers with preterm infant without significantly increasing the cost of care
Tiivistelmä Tämän tutkimuksen tarkoituksena oli kuvailla vauvaperhetyön sisältöä, arvioida vauvaperhetyön tuottamisesta aiheutuvia kustannuksia sairaalalle sekä vertailla siihen osallistumisen vaikutuksia keskosten ensimmäisen elinvuoden hoitokustannuksiin. Vauvaperhetyöllä on havaittu olevan vuosia kestäviä suotuisia vaikutuksia keskosten kehitykseen, äidin hoivataitoihin ja vuorovaikutukseen. Kuitenkaan ei ole tietoa siitä, millaisena tuen vastaanottajat sen näkevät. Samoin on niukasti tietoa siitä, paljonko vauvaperhetyön tuottaminen maksaa. Tutkimustehtävinä olivat: Millaisena tukena vauvaperhetyö ilmeni keskosten äideille? Millaiset olivat vauvaperhetyön kustannukset sairaalalle ja miten siihen osallistuminen vaikutti keskosten ensimmäisen elinvuoden hoitokustannuksiin? Tutkimus toteutettiin retrospektiivisena arviointitutkimuksena. Tutkimusjoukko koostui vuosina 1996?1998 Itä- ja Pohjois-Suomen alueilla hoidetuista keskosista (≤ 32 vk). Kaikille keskosille annettiin tavanomainen hoito, jonka lisäksi interventioryhmän keskoset osallistuivat vauvaperhetyöhön. Aineistot koottiin vuosina 1998?1999. Vauvaperhetyön sisällöllisistä piirteistä koottiin tietoa kahden äitiryhmän teemahaastattelulla. Ensimmäisen aineiston äidit (N = 17) kuvailivat keskosten hoitoa kotona. Toisen aineiston äidit (N = 7) kuvailivat vauvaperhetyön sisältöä. Haastatteluaineistot analysoitiin aineisto- ja teorialähtöisellä sisällönanalyysilla. Jälkimmäisen luokittelurunko rakentui sosiaalisen tuen ominaispiirteiden mukaan. Vauvaperhetyön kustannusten arviointi perustui perhetyöntekijän palkkaan sekä kotikäyntien matka- ja aikakustannuksiin. Interventioon osallistumisen vaikutuksia hoitokustannuksiin arvioitiin vertailemalla interventio- (N = 18) ja verrokkiryhmän (N = 118) keskosten hoitokustannuksia. Tietoa koottiin vanhemmille suunnatulla kyselylomakkeella, sairaalan tiedostoista, potilasasiakirjoista ja perhetyöntekijän tiedostoista. Kustannukset laskettiin suorina ja epäsuorina yhteiskunnalle ja perheille aiheutuneina kustannuksina. Tulokset analysoitiin taulukkolaskennalla käyttäen kuvailevan tilastotieteen menetelmiä ja keskiarvotestejä. Aineistolähtöisen sisällönanalyysin mukaan keskosen äitiys oli erilaista äitiyttä, jota määritti keskosten hoidon asettamat vaatimukset ja äitien emootiot. Hoidon vaatimuksissa korostuivat päivittäisen hoidon, tiedon tarpeen ja erilaisen arjen asettamat tiedolliset ja taidolliset haasteet. äitien emootiot sisälsivät keskosten terveydentilaan ja kehitykseen sekä äitiin itseensä liittyviä pelkoja, huolia ja syyllisyyden tunteita. Teorialähtöisen analyysin perusteella vauvaperhetyön keskeinen sisältö muodostui tilannekohtaisen, keskosten hoitoon sovelletun erityistiedon antamisesta sekä perhetyöntekijän saavutettavuudesta. Muita vauvaperhetyön antaman tuen muotoja olivat emotionaalinen, integroiva ja aktiivinen tuki. Vauvaperhetyön tuottaminen maksoi sairaalle keskimäärin 970 euroa lasta kohden. Vauvaperhetyöhön osallistuneiden interventioryhmän keskosten uusien hoitojaksojen ja perusterveydenhuollon kustannukset olivat verrokkien kustannuksia matalammat. Tulokset viittaavat siihen, että vauvaperhetyöllä voidaan vastata keskosten äitien tuen tarpeisiin lisäämättä merkittävästi hoitokustannuksia

碩士
雲林科技大學
全球運籌管理研究所碩士班
96
The purpose of this study is to find out the factors influencing the elder’s satisfaction through questionnaire. Moreover, this study was to explore the factors of influencing outcomes and quality by in-depth interviewing. Study subjects were drawn from some association in the central area of Taiwan. This study investigated 83 elders, and 81 questionnaires were completed. The mean score of the situation of service attendants were 4.07 and the mean score of the attitude of service attendants were 4.05. Overall, participants felt satisfied with both home help services and the subsidy program provided by the government for long-term care. The mean score were 3.53. The main findings of the qualitative study were summarized as follows: The offering of the service is full of considerate and supportive for elders. The satisfaction of elders were affected by solved method and reaction time. While the resource is limited, the government should subsidize for needful and poor elders. The results of the study may provide some information for improvement.

碩士
南華大學
非營利事業管理研究所
91
Improved medical treatment and nutrition have resulted in the fast increase of the aged population in Taiwan. The proportion of senior citizens has been up from 7% in 1993 to over 8.6% in 2002. The Ministry of the Interior’s projection also indicates that the aged population is projected to be 9.19% by the year 2006. This trend indicates that various problems associated with the aged will be everyone’s concern in the future. It also means that not only　physical but also mental and financial strategies have to be planned. In order to assist the aged in keeping a normal life, home services have become one of the the main strategies in the long-term care spectrum. 　　 　　Nevertheless, the clients of home services are various; senior citizens are still the main subjects of the population. For Chia-Yi County, the highest aged population county in Taiwan, how the resources to be effective in used is an important issue, especially in the time that government budget are squeezed and downsized. This study would like to（1）evaluate the home services of Chia-Yi County are reached to the target,（2）observe the process to understand the items and the quality of services, and their suitability,（3）through the outcome evaluation, to learn if the services got the expected effect for the clients and their families,（4）collect information from different situations to provide home services of Chia-Yi County a multi-evaluation. 　　 　　The evaluation of home services is base on the perspectives of input、process and output. The human resource、professional knowledge、service cost、service model and requirement of assessment are considered as input and process factors. And the output；according to the record in 1992 the number of the clients is 295. However, compare this data with the statistics number from Department of health, there are still a lot of home care requirement are not reached. The records show that the popular items of services are medical and concerning care, and the investigation of this study get the same outcome; the most of clients thought the concerning care、emotion supporting are necessary. Therefore, we believe that the current services are indeed meets the client’s requirement. And the greater parts of clients are satisfied with the home services they are treated.

碩士
國立暨南國際大學
社會政策與社會工作學系
89
Program Evaluation of Home Care Services for Elderly ─An Example of Red Heart Association This study aimed at evaluating the process and effectiveness of home care services for elderly. Study subjects were drawn from the Red Heart Association in Taipei. Data were gathered through both quantitative and qualitative research approaches, including structured questionnaires and in-depth interview. Case records and agency documents were also used as supplementary data. The purposes of this study were to examine the outcome and impact of home care services program might have upon the elderly and their caregivers. The results of this study revealed the following: First, the service delivery process of the program was examined from two levels, the supervisor system and homemaker system. Supervisors’ working model varied in accord with clients’ stability and the nature of clients’ problems. Homemakers could be divided into two types, the rational type and the affective type. Their characteristics differed in their service attitudes and principles, which affected the outcomes of the program. Second, through the service provision the program was able to maintain ADL and cognitive function of the elderly, and to provide emotional support for the elderly. On the other hand, the effect of service provision on the rest of the outcome measures depends upon the health status and informal support resources of elderly. Besides, the program was helpful in sharing caregivers’ work and mitigating their pressure, providing respite care, releasing the tension between caregiver and elderly, and maintaining the willingness to care. Third, the effectiveness of the program was affected by three groups of factors: (1) the factors related to the providers, included administration and management system, design of supervision, characteristics of homemaker; (2) the factors related to the characteristics of elderly, such as welfare eligibility, marital status, with or without a caregiver, level of informal support resources, health status; and (3) the factors related to program output, such as service time arrangement, service frequencies and content. Finally, this study categorized the service impact on the elderly and their caregivers into three distinct types: the compensatory effect, the supplemental effect, and the respite effect.

碩士
國立中正大學
政治學研究所
102
Li Yun Datong chapter, references to "enemy not only pro-his parents, are not only son of his son, the old have eventually, have to use strong, young director, widows or disabled by key has been raised," this standard, thousands years has been for the government (more accurate to say that politicians - for eternal well-being of children and grandchildren of those in power) goal. Datong article points out the basic spirit of the whole social welfare system --- ie "Social Security." When people fully understand him (her) the fruits of labor are not in vain, to protect life somewhat older, prime time need not fear the future comes, will naturally ease willing to work wholeheartedly to maintain social stability, freedom from fear freedom, peace of mind and no worries.

碩士
國立暨南國際大學
社會政策與社會工作學系
100
The aim of the study was to investigate the related factors of the quality of care in home services from client-centered perspectives, and to understand the impacts of the users, caregivers, providers, and care workforces on the quality of care in home care services. This study used quantitative method by using face-to-face surveys to collect data to understand the perceptions of the quality of care in home services from users and caregivers of nine agencies in Nantou County. A total of 302 users’ samples used home services completed questionnaires, and from the users’ samples to match that 167 care workforces samples are completed the questionnaires. The researcher also combined qualitative method by using in-depth interview, including 4 users, 4 care workforces, and 4 supervisors of those agencies. The main findings of this research are as following: 1. The quality of care in home services was affected by users, caregivers, care workforces, and agencies. From the Quality of Care Scale, the factors of the relationships between home care clients and their workers had the highest score. In the second place was the factor of the skillfulness of home care, and in the third place was the factor of the homecare in being responsive to client expectations. The result indicates the relationships between home care clients and their workers are the most important factor of quality of care in home services. 2. From the quantitative data, by the hierarchical regression analysis, the significant variables of quality of care in home services are the characteristics of users, caregivers, and agencies, including total income, previous types of jobs, users’ subjective perception of the workforces, relationship, and organization established period. These variables are significant predictive factors of quality of care in home services. In depth analysis, all of the variables accounted for 29.3% of variances. The first sub-scale had the lowest explained variances of 25.0%.The second sub-scale had the highest explained variances of 35.3%, and the third sub-scale accounted for 31.7% variances. 3. In qualitative interviews, from the client perspectives, good care relationships appear to be important determinants of Quality of Care, including communication, appropriateness, and trust. "On time" and "Do not be late" are the most important facors that users are concerned for. The skillfulness of home care is the basic equipment, because the factor shows the professional attitudes of care workforces. However, if the care relationship is positive, the techniques which are poor may be acceptable. From the perspectives of the system, whether the needs assessment actually rendered service users also affect the demands for quality of care, and to respond to the needs of the expectations of the users. Therefore, even care relationship is great, when the needs are unmet or the assessment is incorrect, negative feelings still emerged. Finally, according to the finding and conclusions, this study has suggestions for further research on practice, academic, and policy.

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team.
Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323

碩士
逢甲大學
公共政策研究所
104
The purpose of this research is to evaluate the stay-home policy of family-factor alternative military service conscripts, and the results of their taking care of family. The research is conducted on 431 family-factor alternative military service conscripts who are in the service as of March 2016 at governmental institutes in Taichung City. A total of 431 questionnaires were distributed, with 391 of them retrieved and 328 of which effective. Surveys, descriptive and inferential statistical analysis (Independent Sample T Test, One-way Analysis of Variance, Pearson Product-Moment Correlation Analysis) are adopted to evaluate policy based on the cognition, fairness, efficacy, response to the stay home policy, and to evaluate the effectiveness of taking care of family based on family functions, daily care, communication, understanding, role playing, and consideration for one anothers feelings. The result shows that not only does the effectiveness of taking care of family differ depending on the background of the conscripts, the opinions on the stay-home policy are also different. The effectiveness of home care is related to the stay home policy, with the effectiveness as well as the results of the policy both being positive. According to the research results, suggestions to increase conscripts understanding and care for their family, to broaden the conscripts functions of taking care of family, to provide multiple choices of accommodation during military service, to implement home care, to promote the campaign of the policy, and to reinforce policy implementation are proposed for reference by the government to better and promote the policy of home-factor alternative military service.

碩士
國立中正大學
企業管理學系碩士在職專班
105
Abstract A nursing home provides people who suffer chronic diseases or physical and mental retardation, and are unable to take care of themselves for quite some time, with a variety of satisfying medical and non-medical services. Therefore, a scientific measure should be made periodically to assess the service quality of a nursing home. This research was based on PZB’s service quality as a theoretical fundation, and divided the service quality into three sectors – structure, process and outcome so as to assess a nursing home on its services and staff members’ service quality. This research recorded how a resident or his/her family members satisfied and placed a high value on the service quality. Besides, this research also probed the correlation between service satisfaction and loyalty to a resident. This research analyzed the differences of a resident’s attention degree, satisfying degree and loyalty degree based on his/her personal nature, and “physical and mental” status. The outcomes of the analysis showed that the residents of different economic backgrounds had significant different attentions on institution’s service quality. The residents who paid the bill by their own savings or by their relatives or friends, placed a higher value on service quality. Different MMSE residents had significant difference on the satisfaction degree of institution’s service quality. The residents who had serious cognitive dysfunction were much dissatisfied with institution’s service quality. There was a slight positive correlation between satisfaction degree and loyalty degree. The research method adopted here provides other nursing homes with reference material if they want improve their services in the future. Keywords: long-term care institution, nursing home, service quality, loyalty degree

Aujourd’hui, la satisfaction des utilisateurs des services de santé est reconnue comme une mesure de la qualité des soins. Au Québec, le congé précoce en obstétrique constitue la norme pour les mères ayant donné naissance à un bébé en santé. Selon la littérature, cette pratique n’entraîne pas de répercussions négatives pour la santé des mères et de leur nouveau-né à condition qu’un suivi adéquat soit assuré. D’autre part, bien qu’il semble que la diminution de la durée du séjour hospitalier soit appréciée par les mères, peu de données sont disponibles relativement aux caractéristiques menant à l’appréciation du suivi postnatal. Objectifs : Cette étude s’intéresse principalement à la première visite à domicile effectuée par une infirmière suite au congé précoce en obstétrique. Dans un premier temps, elle vise à tracer un portrait des mères en fonction du délai de la première visite à domicile et, dans un second temps, à connaître les facteurs associés à l’appréciation, par les mères, du délai de cette visite. Méthode : Les données de cette étude ont été recueillies au Québec, entre janvier 2002 et janvier 2003, lors d’une enquête téléphonique effectuée auprès de mères de bébés nés en santé, un mois suivant leur accouchement vaginal sans complication (n=1548). Pour nos analyses, nous avons retranché les mères ayant eu une durée de séjour de plus de 60 heures, une grossesse de moins de 37semaines et un bébé pesant moins de 2500 g à la naissance. Notre échantillon se compose donc de 1351 mères. Résultats : 86,2 % des mères ont reçu une offre de visite à domicile. La majorité (80.2 %) des mères ont reçu la visite dans les trois premiers jours suivant leur retour à la maison, dont près du tiers (28,1 %), dans les 24 premières heures. Comparativement aux mères visitées au deuxième ou troisième jour suivant le congé, celles visitées dans les 24 premières heures ont jugé la durée de séjour hospitalier trop courte (p=0,018) et reçu un appel de l’infirmière qui a duré plus longtemps (p=0, 009). De plus, au moment du congé, elles perçoivent leur bébé en moins bonne santé (p=0,029). Elles ont aussi accouché d’un bébé plus petit (p=0,052) qui a tendance à avoir présenté des signes d’ictères pendant le séjour hospitalier (p=0,100). D’autre part, la majorité des mères (86,4 %) disent que le délai de la première visite à domicile est adéquat alors que 11,6 % le jugent trop court et 2,3 % trop long. Pour les mères visitées au premier jour, l’analyse multivariée révèle que certaines caractéristiques et certains besoins sont associés à la perception que le délai de la visite est trop court : une seule visite postnatale, un revenu familial de plus de 40 000 $, la perception que la durée de séjour est trop longue et le fait de ne pas allaiter. Pour les mères qui reçoivent la visite au deuxième et troisième jour, ce sont, seulement, le fait d’avoir été au rendez-vous médical et le fait d’avoir reçu une seule visite qui sont associés à la perception que le délai de la visite est trop court. Pour conclure, au Québec, le programme de suivi postnatal universel semble en mesure d’offrir une visite à domicile dans les délais prescrits à une majorité de mères. Les résultats de cette étude suggèrent que le délai de la première visite à domicile n’est pas optimal pour toutes les mères et permettent d’envisager que certaines mères auraient souhaité recevoir une seconde visite plus tardivement au cours de la période postnatale. D’autres recherches devront être effectuées afin de parfaire nos connaissances relativement au moment idéal pour réaliser les interventions postnatales.Mots clefs : Satisfaction, appréciation des utilisateurs, qualité des soins, programme universel, suivi postnatal, congé précoce en obstétrique, visite à domicile, délai de la visite, provision des services.
Patient satisfaction is now recognized as part of a measure of quality of care. In Québec, early discharge following normal delivery is common practice. Early discharge was proven to have no impact on the mother’s and baby’s health status when adequate follow-up is ensure. Women’s seems to appreciate early discharge but few studies have explored the factors contributing to the expression of satisfaction regarding home visits in the context of postnatal early discharge. Objectives: This study as two main objectives. First, we want to identify which characteristics are associated with the delay of the first postnatal visit. Second, we want to determine which factors are contributing to the appreciation of the visit’s delay. Methods : Data were obtained through a telephone survey conducted in the province of Quebec between January 2002 and January 2003. Mothers that had a normal vaginal delivery and a healthy baby were reached one month after giving birth (n=1548). For analysis purposes, mothers with length of stay above 60 hours, less than 37 week of pregnancy and a newborn weighing less than 2500 g at birth were cut off leaving a sample of 1351 mothers. Results: 86.2% of the mothers have been offered a postnatal visit. Most women (80.2%) received a home visit within three days and almost a third (28.1%) within the first 24 hours after hospital discharge. When compared to the mothers who received the visit within 2 or 3 days, mothers that received a visit within the first 24 hours found the hospital stay too short (p=0.018) but received a longer telephone call by the nurse (p=0.009). These mothers gave birth to smaller babies (p=0.052) whom also presented jaundiced while being in the hospital (p=0.100). Finally, at discharge, these mothers perceive their baby to be less healthy (p=0.029). On the other end, 86.4 % of all mothers are satisfied with the delay of the first postnatal visit, while 11.6% of them found it too short and 2.3% too long. For the mothers visited the first day, logistic regression analysis reveals that some characteristics as: having only one postnatal visit, a family income of more than 40 000$, perceived hospital stay as too long and not breastfeeding, are significantly associated with the perception of having a visit too soon after hospital discharge. For mothers visited on the second or third day after discharge, the perception that the delay was too short is only significantly associated with having a baby’s medical appointment within the first two weeks and one postnatal visit. Conclusion: Quebec’s postnatal visit program seems to offer a visit within an adequate length of time for the majority of mothers. Results of this study suggest that the time after the hospital discharge for the first visit might not be optimal for all mothers. This allows us to consider that some mothers would have appreciated a second postnatal visit. Further studies are needed to pursue analysis of the delays between discharge and the first visit in order to better meet the needs of mothers. Keywords :Satisfaction, user evaluation, quality of care, universal program, postnatal care, postpartum early discharge, home visit, timing, service provision