Dissertations / Theses: 'Nursing home care Victoria'

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Buckley, Patricia Louise, and pbuckley@swin edu au. "'A sense of place' : the role of the building in the organisation culture of nursing homes." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20060317.114711.

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This study attempted to identifj and explore the role the building plays in the organisation culture of nursing homes. To do this a research plan was formulated in which the central plank was a case-study of a seventy-five bed high care nursing home. As part of the case-study, interviews were conducted at the nursing home with ten members of staff, two residents and a daughter of a resident. The study was also informed by interviews with two architects, who specialise in the design of nursing homes and aged care facilities. A theoretical model entitled the 'Conceptual Framework' was developed prior to the case-study. It was tested by applying it to findings related to the physical context and the organisation culture of the case-study venue. The hypothesis that the building does influence the culture of the nursing home environment was explored by studying the manner in which the building influenced the lives of those who work in the nursing home and those who live there. This challenge was met with the use of theoretical contributions from organisation theory and psychodynamics, which together provided a vehicle for analysis of the culture and the building's role in it.

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Saxer, Susanne. "Urinary incontinence in nursing home care." [Maastricht] : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=13767.

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Nelson, Ian M. "Predictors of Nursing Home Placement for Home Care Consumers." Miami University / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=miami1073924945.

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Baker, Kay Stouffer. "Home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276586.

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This descriptive correlational study describes the relationships among 30 home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care. The self-report data were collected using a Nursing Invasiveness Scale (NIS), Index of Patient Territorial Control Perceptions (IPTCP), and Patient Satisfaction Instrument (PSI). The subjects were males and females, aged 23 to 93 years, who were receiving home care nursing. Analysis of the data suggests that the subjects perceived a low level of invasiveness by home care nurses, "much control" within their homes (their primary territories), and were highly satisfied with their nursing care. There was a significant negative correlation (r = -0.79) between perceptions of nursing invasiveness and satisfaction with nursing care. The relationships between perceptions of nursing invasiveness and territorial control (r = -0.02) and between perceived territorial control and satisfaction with nursing care (r = 0.14) were not significant.

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Bostick, Jane E. "The relationship of nursing personnel and nursing home care quality." MU has:, 2002. http://wwwlib.umi.com/cr/mo/fullcit?3052150.

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Harker, Jeanne M. "Planning for the future in home care nursing." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ59501.pdf.

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Yates-Bolton, N. J. "Meaning and purpose in care home (nursing) life." Thesis, University of Salford, 2017. http://usir.salford.ac.uk/42545/.

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Meaning and purpose in life are important aspects of the life experience of individuals. These aspects of life have often been studied using psychological and quantitative approaches addressing meaning and purpose across the life span. However, there is a dearth of studies of meaning and purpose in care home (nursing) life. This care sector has an important contribution to make nationally and internationally to the lives of older people who require long-term care. This study addresses the gap in the body of knowledge by exploring how to enhance meaning and purpose in the lives of care home (nursing) residents. This study of meaning and purpose in the lives of care home (nursing) residents was undertaken using an appreciative inquiry methodology. Two U.K. care homes (nursing) were the settings for the study; 20 residents and 25 members of staff were included in the sample of the study. The residents who participated in the study had moved into the care homes because of their physical disabilities. None of the residents who participated in the study had appreciable cognitive incapacity. Data were collected using life story interviews, structured interviews and focus groups. Data were constructed during the four stages of appreciative inquiry: Discovery, Dream, Design and Destiny. The data were analysed using the Framework Analysis approach. The findings of the study provide clear definitions of meaning and purpose in care home (nursing) life. The knowledge generated addresses the required focus on the creation of opportunities for residents to flourish and optimise their potential in order to enhance meaning and purpose in their lives. The ways in which care home staff can support residents enhance meaning and purpose in their care home experience through the physical setting, valuing of residents’ identities, the dynamics of relationships, the focus of activities and the component of care are articulated. This study presents the benefits of appreciative inquiry dialogue as a way of enhancing meaning and purpose in the lives of care home residents.

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Lee, Hyang Yuol. "Quality of care: Impact of nursing home characteristics." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3352465.

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Thesis (Ph.D.)--University of California, San Francisco, 2009.
Source: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2206. Advisers: Mary A. Blegen; Charlene A. Harrington. Includes supplementary digital materials.

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Kihlgren, Annica. "Older patients in transition : from home care towards emergency care /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-271-3/.

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Kaye, Debra Anne. "Women's perceptions of telephone nursing care within an antenatal home care program." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/26308.

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Purpose/problem. Telephone nursing care (TNC) has replaced some home visits to increase efficiency of The Ottawa Hospital Antenatal Home Care Program (AHCP). There is limited published research addressing TNC in similar settings to guide program development. Therefore, chose an evaluation strategy to explore the clients' the researchers and organization perceptions of TNC. Objectives. (1) Perform a systematic literature review of TNC in the high risk antenatal population. (2) Profile high risk antenatal population receiving telephone nursing care. (3) Describe clients' perceptions of telephone nursing care. (4) Explore the feasibility of this methodology for continuous program evaluation and informing development and improvement. Method. A mixed methods approach was used. Two surveys and a semi-structured interview were completed by 13 participants. Data were analyzed using descriptive statistics and constant comparative analysis. Results. Sample was similar to the population in diagnosis, maternal and fetal outcomes. Anxiety scores were high and women identified the highest needs related to high risk pregnancy, psychological and information domains. Four main themes emerged: the experience of being at home, perceptions of the telephone care, perceived benefits, and perceived health systems issues.

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Peltz, Claudia. "Facility design & planning to improve nurses' effectiveness in administering care to fulltime residents of nursing homes." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/436.

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Cook, Glenda. "Life as a care home resident in later years : "living with care" or "existing in care"." Thesis, Northumbria University, 2007. http://nrl.northumbria.ac.uk/533/.

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Despite a widely accepted view of the importance of understanding experience from the point of view of the individual using services in modern western society, there are relatively few studies that have explored day-to-day living in a care home from the older person's perspective. This study aimed to present the voice of the untold stories of care home residents through an interpretative study that was informed by a biographical approach and narrative method. Eight older people who lived in four different care homes in England participated in a sequence of up to eight narrative interviews over a six month period. Through the process of listening to, retelling and interpreting the residents' stories the resident world was explored. There were three stages to the interpretative process that focused on:- developing a naïve or surface understanding to acquire a sense of the whole sequence of a participant's interviews; a structural analysis that examined the interviews to investigate what the text said and how it was said; and a critical in-depth examination of the interpretation within the wider social context. The interpretation revealed the unique way that each participant lived in a care home. These older people worked hard to reconstruct their life following the move to a care home and as they lived there. Though the residents were limited by physical, functional and cognitive problems, they developed strategies with the aim of influencing the life that they lived within a care home. Where they were able to implement those strategies they reconstructed their life in ways whereby they 'lived with care.' In this sense they were active biographical agents shaping this phase of their life. This is an alternative biography, to that of older people 'existing in care' as an outcome of care received. This thesis provides new insights into the residents' world. The overriding conclusion that can be drawn from these stories is that these older people were trying to live as active biographical agents who were instrumental in shaping their own life. They were able to do this to a greater or lesser extent and the conceptual model of biographical living that has been developed from the resident stories provides a framework to depict the complex interactions that shape an individual's experience in this environment. An inherent feature of this model is recognition that residents can be active agents throughout their lives in care homes. In summary, residents' desire to 'live with care' and this is not only possible, it is achievable.

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Damberg, Jonas. "Availability of primary care physicians in nursing homes and home care nursing services and associations with emergency care consumption." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-61585.

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Free, Corinne. "Direct Assessment of Quality of Care in a Memory-Care Residential Setting: A Systematic Replication." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1404514/.

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The quality of care of residents in nursing homes receive is an important issue facing our society, and reliable methods to assess and measure important indicators of quality of care are necessary to ensure that nursing homes are providing adequate services. Previous researchers have developed methodologies to evaluate indicators of quality of care, including environmental conditions, resident conditions, resident activities, and staff activities using momentary-time sampling procedures across a variety of settings and populations. The purpose of the present study was to replicate and extend the time-sampling methodology used in previous research in two units in a nursing home.

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Nakrem, Sigrid. "Measuring quality of care in nursing home - what matters?" Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for samfunnsmedisin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-14729.

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Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live safely and comfortably at home. The demographic change with increasing number of persons over 65 years in the next 20 years also means that the percentage of those who will require care in a nursing home some time before the end of their lives will increase. Therefore, anticipating this pressure to expand nursing home availability, it is critical that these services are developed from a profound understanding of what creates the best value. Nursing homes in developed countries have evolved over the past half-century from being places of mainly custodial care to facilities responsible for the management of an ever increasing range of complex nursing and medical conditions. Nursing home residents are frail older adults with complex needs, dependent on advanced nursing care. Determining what aspect of nursing homes should and can be measured is the current work of many national health care systems. However, uncovering what the nursing home residents perceive as the most important aspects of quality and how they experience living in a nursing home is necessary to develop effective person-centred care. The overall aim of the present thesis was to contribute to a deeper understanding of quality of care in nursing homes, integrating the professionals’, residents’ and family’s perspectives. The research design is a qualitative approach to explore the concept quality of care and its domains. The thesis comprises a review of internationally used nursing sensitive quality indicators for nursing homes. The indicators are evaluated for their validity as described in the literature. The thesis further describes the residents’ experiences with the interpersonal factors of nursing care quality, as well as the residents’ experiences of living in a nursing home. The thesis also explores the understanding and belief about nursing home quality held by family members of residents. The thesis is based on in-depth interviews of residents in four different nursing homes, and focus group interviews of family members of residents in two different nursing homes. The findings are that quality of care in long-term care in nursing homes encompasses at least four domains: quality of the living conditions, quality of the nursing staff, quality of direct nursing care, and quality of the social environment. Moreover, care quality is influenced by a range of external factors such as the national policy, laws and regulations, management of the organization and the physical building. The local community provides a context in which the nursing home is more or less integrated into. The review of internationally used quality indicators indicate that some factors of care processes and health outcomes for nursing home residents could be measured and give valid and reliable evaluation of the nursing home care quality. In the explorative qualitative study, residents and family placed more emphasis on physical and psychological well-being, interpersonal relationships and the social environment if quality of care is to result. Objective indicators of essential areas of resident-experienced quality need to be developed. This should be done in collaboration with the residents and their next-of-kin, in addition to professional expertise. Methodological and practical implications of the results are discussed.
Sykehjem er en helsetjeneste som vil være nødvendig for eldre som ikke føler seg trygge eller kan få tilstrekkelig behandling, pleie og omsorg i eget hjem. Antall eldre over 65 år er økende i Norge, noe som innebærer et økt press på sykehjem i framtiden. Det er derfor av stor betydning at sykehjemstjenesten utvikles med tanke på å skape best mulig nytteverdi ut fra behov. Sykehjemmene har utviklet seg de siste 50 årene fra hovedsakelig et botilbud til helseinstitusjoner som gir avansert helsehjelp. Sykehjemsbeboere er skrøpelige eldre med komplekse problemstillinger, avhengig av avansert sykepleie. Kvalitetsindikatorer er kvantitative mål som reflekterer en profesjonell standard for pleie og omsorg, og slike mål benyttes i økende grad for å vurdere kvalitet i sykehjem. Imidlertid er det nødvendig å inkludere det som har størst betydning for sykehjemsbeboere i slike mål for å kunne gi god pasientsentrert sykepleie. Hovedmålsettingen med studien var å bidra til en dypere forståelse av sykehjemskvalitet, ut fra helsepersonellets, beboernes og pårørendes ståsted. Avhandlingen omfatter en oversikt over kvalitetsindikatorer som er i bruk internasjonalt. Videre beskriver avhandlingen beboernes erfaringer med mellommenneskelige faktorer ved sykehjemskvalitet, samt hvordan de erfarer å bo i et sykehjem og opplever kvaliteten på “hjemmet” sitt. I avhandlingen blir også pårørendes forståelse av og meninger om sykehjemskvalitet utforsket. Avhandlingen er basert på dybdeintervju av beboere ved fire ulike sykehjem, og fokusgruppeintervjuer med pårørende ved to av sykehjemmene. Funnene viser at kvalitet på pleie og omsorg i sykehjem omfatter minst fire hovedområder: Bokvalitet, personellkvalitet, helsetjenestekvalitet og sosial kvalitet. Videre er pleie- og omsorgskvaliteten påvirket av en rekke eksterne faktorer som nasjonale føringer, lovverk, ledelsesstruktur, bygningskonstruksjon og lokale forhold. Den internasjonale oversikten over kvalitetsindikatorer gir indikasjoner på at noen av dem kan brukes som pålitelige og gyldige evalueringer av kvaliteten på pleie og omsorg, samt helserelaterte resultater for beboerne. I den kvalitative intervjuundersøkelsen med beboere og pårørende, ble fysisk og psykisk velvære, mellommenneskelige forhold og det sosiale miljøet tillagt større betydning for kvaliteten. Objektive indikatorer for disse beboererfarte områdene for kvalitet må utvikles. For å sikre at disse er pasientsentrerte, bør utviklingen av kvalitetsindikatorer gjøres i tett samarbeid med sykehjemsbeboerne og pårørende, i tillegg til helsepersonell.

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Chien, Hui-Wen. "Understanding the Nursing Home Care Processor: An Ethnographic Study." University of Sydney, 2009. http://hdl.handle.net/2123/6389.

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Doctor of Philosophy
Aim and significance: The aim of this research was to explore the phenomenon of Australian nursing home care from the perspective of those who provide and receive it. Its focus is on the processes of ‘quality care’ provision and the meanings and evaluations that care providers attach to their work. In other words, its purpose was to shed light on the practices based on a conceptualisation of care that is entwined with the mechanisms of ‘care’ production and identity creation, or what actually happens in the daily life of the complex social phenomenon that is a nursing home. A related aim was to add to understandings of clinical nursing competence and develop tools that will assist nurses to conceptualise and implement positive change in this setting. Background: The provision of care to our elderly has become a major concern with the ageing of the world population. This is occurring in the context of decline in the capacity of families to take on the responsibility of elder care, and of increasing commercialisation of medical care. Governments have responded by shifting their responsibilities from direct care provision to become auditors of the business of care provision that is supported by public funding. However poor care delivery has largely been hidden from the public gaze. Governments present themselves as having systems in place, creating the illusion of rational control; in reality, like the market economy, there is a ‘black box’ of unknown factors driven by human impulse. The aim of this study was to open up the black box of ‘quality care’ to direct observation, drawing insights from the literature on organisational culture and with a focus on the frontline worker and the construct of quality assurance. Specific research objectives were to: • Document the beliefs and attitudes of care providers towards elderly people in general and the needs of nursing home residents in particular • Elicit the range of meanings and evaluations that care providers attach to their work • Describe their constructions of ‘care’ and ‘quality of care’ and the organisational factors they believe to impact (positively and negatively) on their ability to provide it. • Through in-depth understanding of a particular setting, generate grounded theoretical insights into the phenomenon of quality of residential care that are more widely applicable Method: The study adopted a paradigmatic bricoleur approach, seeking to develop connections between a diverse range of methodologies. These included combinative ethnography, phenomenology, hermeneutics and traditional grounded theory. Conceptual insights were drawn from organisational studies, psychosocial nursing and coping theory. The research site was an Australian for-profit suburban nursing home. The student investigator conducted more than 500 hours of participant observation, recording extensive field notes which were analysed through the perspective of a hermeneutic middle way horizon that directed an augmented constant comparison traditional grounded theory approach. Additional data were collected through formal indepth interviews with six key stakeholders. Interviews were tape recorded, transcribed in full and analysed to reveal themes that were brought within a hermeneutic circle that spiralled recursively from the whole to the part and back to the whole. Findings: Eight key interrelated factors in the production of care within the nursing home were identified: internal and external accountability (the accreditation system); economic considerations; management and training; advocacy; characteristic of residents; care providers’ working conditions and environmental stressors; organisational culture; and the work/care styles of individual care providers. I have categorised the latter into two main types: ‘tortoises’ and ‘hares’. This typology is then used to generate a process-driven schematic diagram that tracks a hypothetical novice care provider through the process of learning how to produce ‘care’. Specifically, I found that nursing home ‘care’ is the outcome of a complex social process involving the interplay between resident, relative, care provider, proprietor, quality assessors and government within the phenomenon of the nursing home. Such care, indeed the phenomenon of the nursing home itself, is not a stable, controllable entity but is in a constant state of flux – what I refer to as a moral ecology. In their everyday practice, care providers devise a construction of ‘quality care’ that is more clearly grounded in their own worldviews and the development of the own identity than in the formal quality assurance system of standards, guidelines and evaluations. Conclusion: Understanding the ‘black box’ of processes that produce care is the key to identifying courses of action that will improve care outcomes. The study findings also question the validity, assumptions and significance of the accreditation system, which only identifies some of the component variables, disregarding both the complexity within the ‘black box’ and failing to acknowledge that the quality of care outcomes is overwhelmingly dependent on individual care providers.

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Huizing, Anna Rensche. "Towards restraint-free care for psychogeriatric nursing home residents." Maastricht : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=10682.

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Bell, Mary Ann 1953. "Perceptions of quality of care in the nursing home." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/291785.

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The purpose of this study was to determine the perceptions of residents, family members, and nursing staff regarding quality of care and the physical environment in the nursing home. Relationships among quality of care, the physical environment, and selected organizational characteristics were then described. The Quality of Care Scale (QoCS) and the Environment Description Scale (EDS) were given to a convenience sample of 100 subjects. A significant difference in perceptions of quality of care was found between the nurse assistants and residents. Significant relationships were obtained between perceptions of quality of care and the physical environment for Registered Nurses, Licensed Practical Nurses, and families. Defining quality of care and determining the significance of the physical environment from the consumer perspective may contribute to both quality of life and quality of care in the nursing home.

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Riggs, Jennifer Sue. "The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522.

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Dillman, Jennifer L. "Geographic Distance, Contact, and Family Perceptions of Quality Nursing Home Care." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc28412/.

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The effect of frequency of nursing home contact on family perceptions of quality care is the focus of this research. A family member characteristic, such as geographic distance from the nursing home, affects his or her frequency of contact with the nursing home. Frequency of contact, in turn, affects family perceptions of the care his or her loved one receives in the nursing home. The theoretical framework for this study is based on Allport's intergroup contact theory, which posits that when four contact conditions - institutional support, equal status, common goals, and intergroup cooperation - are present in an intergroup situation, a reduction in anxiety between groups is likely to occur. Regression analysis tested the stated hypotheses using survey data collected from 275 family members of residents in 10 Dallas-Ft. Worth area nursing homes. This study is among the first to quantify family geographic distance, finding that family geographic distance is a significant negative predictor of nursing home contact. Additionally, results build on Allport's theory by extending its' usefulness to nursing home organizations in two distinct ways. First, findings support Allport's premise that contact alone between groups - i.e., family members and nursing home staff - is insufficient for increasing or decreasing family perceptions of nursing home care. Second, three of the four contact conditions included in Allport's theory were statistically supported by the data. In sum, findings of this research provide nursing homes with an empirically tested model for improving family perceptions of quality nursing home care.

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Mathew, Rachael. "Adelaide dentists' involvement in dental care for nursing home residents /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09SDN/09sdnm4821.pdf.

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WANG, CHENG-CHING. "PSYCHOMETRIC PROPERTIES OF THE PERCEIVED NURSING HOME CARE NEEDS INSTRUMENT." University of Cincinnati / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1155200851.

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Traskos, Andrea M. "Death in the Nursing Home: Impact on Direct Care Staff." Bowling Green State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1435671865.

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Ogawa, Keiko. "Workload of Home Health Care Nurses in Japan." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1207180785.

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Lee-Treweek, Geraldine Anne. "Discourse, care and control : an ethnography of residential and nursing home elder care work." Thesis, University of Plymouth, 1994. http://hdl.handle.net/10026.1/362.

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This thesis presents the notion that paid elder care work is often more involved with ordering individuals, than caring for them. It discusses this issue via ethnographic data about care assistant and nursing auxiliary work, which was collected in two elder care homes: Hazelford Lodge residential home and Bracken Court nursing home. The thesis uses care, control, and knowledge as the main themes for the discussion of work in both homes. The first chapter sites the thesis within the context of the academic literature on the discourses of the body, the nature of care work and residential care. It focuses especially upon care work as body labour. Chapter two presents the ethnographic methodological approach of the thesis, in two sections. Firstly, the use of the Foucauldian notion of discourse is explained, and secondly, the research process and research relationships are explored through a reflexive account. Chapters two and three present social, structural and spatial aspects of the two settings. They discuss the different ways in which the homes were organised, and that spaces were utilised and had different meanings, within the homes. Chapters four and five are based upon data from Hazelford Lodge residential home, and illustrate the care assistants' work as centred upon created order in the home, based upon the typification of residents and others. Chapters six and seven explore the auxiliaries' work in Bracken Court and present three control issues as central to their jobs. Firstly the overt ordering of patients around spaces in the home. Secondly, the normalisation of individuals into patient, and objects, of body work. Thirdly, the auxiliaries' resistance to heir role and status. Chapter eight compares the work of the assistants and auxiliaries in terms of resident and patient construction, the nature of the two forms of work, their knowledge, and lastly, their constructions of place and status. The thesis argues that both groups of workers are involved in ordering bodies that they perceive to be problematic and degenerating. In Hazelford Lodge order and discipline is practised as care and in Bracken Court the auxiliaries use more overt forms of control, but both 'caring' and controlling are effective methods of creating order. By introducing notions of body labour and ordering, the thesis presents a unique critique of paid care.

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Öresland, Stina. "Nurses go visiting : ethics and gender in home-based nursing care." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-43796.

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The overall aim of this thesis is to explore how nursing is constructed in home-based nursing care from the viewpoint of patients and nurses who are receiving or giving care. Since nursing both constructs and is in turn constructed by the context in which it serves, language plays a central part in those constructions and in this thesis. The thesis has been guided by social constructionism, meaning that the positions the patients and the nurses inhabits have been considered as social phenomenon constructed in discursive processes. There are two ideas that guided this thesis. One idea was that home-based nursing care promotes the association of caring abilities in relation to nursing, women and the private sphere. Another idea was that the place where the care was carried out has ethical implications. Data was collected from interviews with 10 home-based nurses (study I) working in community in the western part of Sweden and 10 patients cared for in their home by these nurses (study II). Nurses and patients were interviewed about their experiences of giving respectively receiving home-based nursing care. The interviews were transcribed verbatim and analyzed with a discourse analytic method in study I and II. The findings in study I show that the nurses described their subject positions as "guests" and "professionals" and that they have to make a choice between these positions, as it is impossible to perform both positions at the same time. Dependent on the situation, both an ethics of care and an ethics of justice were applied by the nurses, that is, to perform according to the subject positions of "guest" or "professional." In study II, the patients describe their own subject position as "safeguard" and the nurses‟ positions as "substitutes". These subject positions provided the opportunities, and the obstacles, for the patients‟ possibilities to receive care in their home which included which kind of strategies, habits and activities the patients described and what tasks and how they considered or expected the nurses to perform. These findings are discussed within a theoretical framework, i.e. a gendered dichotomy of the private spheres versus the public spheres. Inherent in this framework is a discussion of the findings related to the habits that are essential in the nurses‟ and the patients‟ constructions of subject positions. In study III, metaphors used by home-based nurses‟ were explored as a means to discover values and norms held by nurses working in home-based nursing care. Ten interviews with nurses working in home-based nursing care (the same interviews as in study I) were analyzed and interpreted with a metaphor analytic method. In the analysis metaphoric linguistic expressions (MLE) were explored and patterns of MLEs formed two entailments. After exploring MLEs and entailments on an explicit surface level the analysis went to a broader underlying dimension of conceptual metaphors identifying the overall metaphor: "Home-based nursing care is an endless journey". The metaphor "Home-based nursing care is an endless journey" exposed home-based nursing care in constant motion, thereby requiring nurses to adjust to circumstances. This adjustment required ethical maturity based on experience, knowledge, and creativity. The study III focuses on the importance of further developing reflections over experiences related to everyday ethical issues. In study IV, the findings from study I were the starting point for a philosophical exploration of the concept "guest" and its relation to other adjacent concepts such as hosts and hospitality. The question to be answered was as follows: In what ways can home-based nurses‟ description of being "guests" in patients‟ home be understood? The exploration was based on Derrida‟s philosophy of unconditional and conditional hospitality, Levinas‟ philosophy of "face" and "the Other" and Arendt‟s philosophy of "go visiting". The findings indicated that the concept "guest" was not appropriate for the nurses to use when describing their position in home-based nursing care, since the concept was problematic for the content and the complexity of home-based nursing care. The findings also showed that exposing concepts as binaries is fruitful since they show relationship between concepts. Just illuminating the concept "guest" did not reveal the power relationship between the "guest" and the "host" and their relationship to hospitality. The distinction between diverse ethical perspectives could be seen as problematic or as an opportunity. According to this study, the nurses used a plurality of different ethical ideas, such as an ethics of care, an ethics of justice, an ethics of virtue and an "everyday ethics." A possible interpretation could be that this was a sign of a difficulty to maintain distinction between ethical theories in clinical practice. Ethical issues in the private sphere are less commonly explored compared to ethical issues in the public sphere, for example in hospital care. As showed in this thesis, the distinction between the private and the public spheres was problematic. It does not describe two spatially separate spheres, but rather it describes functionally dependent activities, interests and relations, such as diverse areas of ethical ideas and "feminine" and "masculine" positions. Home-based nursing care is a complex area and discourse analysis of the relation between home-based nursing care, subject positions, ethics and gender is more or less lacking. Exploring home-based nursing care outgoing from discourse analytic perspectives and methods is rewarding for nurses‟ practice, education and research as it opens up new perspectives of home-based nursing care.

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Wright, Pamela Leshel. "Development of a Home Health Transitional Care Program for Elderly Heart Failure." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/613.

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Ineffective transitional care programs for ensuring the continuation of care from the hospital setting to the home setting often result in rehospitalization for elderly heart failure patients age 65 and older. The purpose of this project was to develop a home health transitional care program for elderly patients transitioning from inpatient settings to home settings using care bundles consisting of evidence-based practices to reduce preventable rehospitalizations within 30 days of discharge. The home-based chronic care model, which provides a foundation for home health's integral role in chronic disease management by ensuring patient-centered evidence-based care, guided the development of this program. The developmental process elicited feedback from a team of home health advisory members, 3 home health experts, and 2 health care consumers who may use this program in the future. The readability of the program was at a 5th grade level for easy comprehension. A 3-item survey was given to 2 members from the target population, and a 5-item survey was given to 3 content experts to evaluate the transitional program. The advisory members were asked to read and provide feedback on the transitional care program. Data were analyzed using descriptive statistics to obtain a content validity ratio score of 1.00. Findings suggested universal agreement on the content of the transitional care program, which was developed as a resource tool to provide evidence-based care bundle interventions from scholarly literature. Implications for social change include improving the outcomes of elderly heart failure patient by providing home health care agencies with a comprehensive transitional care program to prevent avoidable rehospitalizations and help patients effectively manage the disease.

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Hays, Bevely J. "Relationships among nursing care requirements, selected patient factors, selected nurse factors, and nursing resource consumption in home health care." Case Western Reserve University School of Graduate Studies / OhioLINK, 1990. http://rave.ohiolink.edu/etdc/view?acc_num=case1054924269.

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Davy, Julia. "PATIENT'S EDUCATION IN A HOME CARE: STRATEGIES FOR SUCCESS." Thesis, Ternopil, 2021. https://repository.tdmu.edu.ua//handle/123456789/17192.

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This study describes principles for patient education, beginning with assessment of learning needs through evaluation. Strategies for effective teaching in the homecare setting are presented including use of educational material and resources.

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Kim, So-Yun. "The effect of long-term care insurance on the first nursing home entry and home care use using duration analysis /." Columbus, Ohio : Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1242907491.

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Bonifas, Robin P. "Multi-level factors related to deficiencies in psychological care in Washington State skilled nursing facilities /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/8139.

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Thomas, Cynthia M. "Issues of concern for directors of nursing in long term care." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1154778.

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Health care delivery has changed and the long term care facility has residents with more complex medical problems. The director of nursing (DON) faces many problems and stressors, is often dissatisfied and leaves the position within the first two years. This turnover is associated with increased cost to the facility, decrease in the quality of care provided to residents and an increase in the turnover rate of the nursing staff. While the turnover problem is significant to the agency and the industry, little has been accomplished to correct the situation.The purpose of this descriptive study was to examine the stressors and emotions that are associated with the tenure and job satisfaction of directors of nursing in long term care. The theoretical framework for this study was the revised causal model of job satisfaction developed by Agho, Mueller and Price (1993).Participants were obtained from a current list from the National Association of Director's of Nursing Administration/Long Term Care (NADONA/LTC). The population was 400 directors of nursing currently employed in long term care. The sample of 134 (34%) was obtained from the completed questionnaires. Participants completed two questionnaires about the stressors of the director's position and demographics. The procedures for the protection of human subjects were followed.Findings supported Agho, Mueller and Price's (1993) revised causal model of job satisfaction. In this study (39.6%) of the DONs reported they would not leave the position even if there were other opportunities elsewhere. This was in spite of 67 (50%) who stated the area they worked in had other nursing opportunities. DONs (77.7%) had a great deal of freedom to make decisions in the job, supporting Agho et al., (1993) findings that autonomy was important to job satisfaction as an abstract concept. Role overload was also cited by Agho et al., (1993) to effectjob satisfaction. The majority of respondents ( n = 123; 92.5%) believed the job to be stressful yet 78 (58.6%) did not leave work with feelings of failing, as well as 119 (88.8%) saw their work as having a greater purpose. This finding did not support Agho et al. (1993) model.In spite of being stressed and dealing with a high degree of repetition 83 (62.4%) of the DONs had a high degree of job satisfaction with the current position and 94 (70.2%) felt fulfilled. Believing DONs could make a positive change in the career was expressed by 115 (85.9%) which supports Agho et al. (1993) work motivation or the belief in the centrality of the work role in one's life. Findings did not support the current trend for advanced education as preparation for the position. The DONs (61.6%) in this study believed that an associate degree or diploma was adequate preparation for the position.In conclusion the DONs participating in the study were able to identify areas of stress and issues of concern which impact job satisfaction and tenure. Findings suggested that to retain a DON in long term care the administrator and staff must be supportive of decisions made while managing the department. DONs indicated jobs were stressful, required long hours, and involved dealing with staff conflict which created stressors. However, individuals loved the work, because individual believed some good was being accomplished and making a difference in people's lives which made the stress tolerable. Findings suggest the majority of the DONs remain in the position for personal satisfaction.Implications from this study suggested that the tenure and job satisfaction of the DON in long term care can be lengthened and strengthened to improve and stabilize long term care facilities and the industry as a whole. Quality of care, staffing turnover and negative/positive cost to the facility hinges on the tenure of the DON. Long term care directors may need advanced education to manage stress and handle complex daily decisions. Directors need a sense of support from the administrator and the staff to develop autonomy. Directors need to be involved in nursing organizations and hold certifications that support and provide some stature to the position. Directors may need to unite and lobby to create change in the long term care industry.
School of Nursing

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Obioma, Chidiadi. "Improving the Quality of Nursing Documentation in Home Health Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3500.

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Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes (80 pre- and 80 post) was selected from active patient records in the agency (n = 160). Descriptive and inferential statistics from the project showed that there was improved quality for the 15 criteria representing quality nursing documentation. After the educational intervention, documentation of patient's status if changed or unchanged improved to 80%, and patient's response to treatment improved (57% to 85%), entries were written as incidents occurred improved (53% to 64%). The nurse refers to the patient by name improved (0% to 66%). These findings were an indication of practice change, validating the need for periodic audits of nurses' notes in the agency in order to demonstrate compliance with quality standards. Based on the project findings, a retraining program is recommended to improve structured nursing documentation in a home health agency. This project is likely to contribute to social change as it enhanced the information communicated to other health care providers, coordination of care, and patient outcomes.

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Hopson, Christopher Paul. "Alternative Models of Nursing Home Care: A Study of the Impact of the Teaching Nursing Home Model on Staff Quality and the Quality of Resident Care." Diss., Temple University Libraries, 2009. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/47128.

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Business Administration
Ph.D.
As the percentage of elderly adults within the U.S. continues to grow, long-term care options will increase. Facing increased competition from other forms of long-term care, many nursing homes are seeking innovative models to enhance management and clinical care practices. The Teaching Nursing Home model, first established in the 1970s, is one in which academic institutions partner with nursing homes to create information exchanges between the nursing home and the school. Currently, nursing schools throughout the country work with nursing homes to create clinical training sites for nursing students. The partnership is also used to encourage research among school faculty and to assist nursing homes in their management of best practices. This study examined the impact of these relationships on nursing home quality. Twenty teaching nursing homes were matched with twenty nursing homes that are not engaged in this practice. Using nursing home quality scores published by the Centers for Medicare and Medicaid Services, mean outcomes for the matched pairs were compared using T-tests. Regression analyses were also performed to test whether quality improves over time within a teaching nursing home. The results from the T-tests performed did not show overall quality differences between the matched pairs. However, when analyzed regionally, some significance was observed for teaching nursing homes in the Upstate NY region (p<0.1). The study discusses some of the differences in design of the teaching nursing homes within that region and the impact that may have on results. Time as a teaching nursing home did not appear to affect quality for nursing homes in this study. Possible explanations for these insignificant results are discussed in the Summary, Discussion and Limitations section of the study. Overall, the findings from this study suggest that the Teaching Nursing Home model can add value to nursing homes by offering them research and professional training opportunities with academic institutions. Within the study, recommendations are made to further explore the impact of these partnerships on nursing home quality and to encourage the development and use of the model through policy changes.
Temple University--Theses

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Storm, Palle. "Care work in a Swedish nursing home : gendered norms and expectations." Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-87327.

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The picture of a traditional care worker is changing.Nowadays more men and immigrants of differentbackgrounds are working in nursing homes. This chapterdescribes and analyses how gender, interacting withethnicity and sexuality, is expressed by male and femalecare workers in a Swedish nursing home. What kinds offeminine and masculine stereotypes occur and how is careconstructed by different care workers? It seems that theintersection between various identity categories, suchas gender, ethnicity and sexuality will create differentopportunities and limitations for the care workers in theincreasingly diverse nursing homes of the future.

The book as a whole is attached in fulltext

Omsorg i omvandling

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Liu, Lifan. "Nursing home care in Taiwan : some factors influencing demand and supply." Thesis, King's College London (University of London), 2000. https://kclpure.kcl.ac.uk/portal/en/theses/nursing-home-care-in-taiwan--some-factors-influencing-demand-and-supply(57ee0bc3-4c7b-4295-90c6-a990c5ef8d2c).html.

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Baah, Juliana. "Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4589.

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Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain the etiology and progression of PI while Lewin's Change Theory was used to promote behavioral change in the nursing team. The practice-focused questions for closing the gap between nursing knowledge and practice were what percentage of nurses complied with standard PI prevention guidelines and what was the level of nursing staff teamwork in the agency per the Nursing Teamwork Survey [NTS]. This PI prevention initiative used a cross-sectional design. Data collection involved review of nursing documentation and electronic surveying of all nursing staff using the MISSCARE survey, the NTS, and the AHRQ assessment checklists, which were completed via SurveyMonkey, an online survey software. The impact of the PI prevention initiative was assessed by comparing the results of the documentation review and surveys pretest to the posttest results. There was significant improvement in nursing compliance with PI prevention and treatment. Pressure injury incidence rate fell from 13.6% to 5.1%. The positive social impact includes improving patient care and safety, minimizing PI incidence and producing an efficient team.

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Henderson, Jo-Anne. "A grounded theory study, nursing aides learning to care for nursing home residents with dementia." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0024/MQ62129.pdf.

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Myers, Carissa, Lisa Ousley, and Florence M. Weierbach. "Identifying Caregivers in Primary Care to Influence Keeping Elderly Patients in the Home." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7160.

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There are many barriers present to keeping elderly in the home . One of these barriers is lack of identifying and supporting caregivers of these patients . Informal caregivers provide the majority of care for elderly patients residing in the community . Being able to identify and support these caregivers in the primary care setting may prevent caregiver burden, with a primary goal of keeping the care recipient in the home . This interactive presentation objectives include; exploring the influences of the caregiver role and the elderly’s ability to stay in the home, critiquing the existing evidence for identifying caregivers of elderly patients and introducing and describing ongoing research within a Tennessee Primary Care Practice .

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Lindabury, Jennifer Kate. "Nursing Home Use Expectations: The Influence of Family Structure." Oxford, Ohio : Miami University, 2010. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1272642887.

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Macleod-Downes, Leslie. "Gender-related vulnerability to sexually transmitted HIV infection in women home care workers." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/2957.

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Includes bibliographical references.
The purpose of this study was firstly to analyse the factors determining the vulnerability of women for sexually transmitted HIV. Secondly, to investigate if the measurement of the empowerment level of the participants could lead to programme adaptations to improve the efficacy of a training intervention. The intervention was an HIV training programme making use of enhancements. Effectiveness was measured in terms of raising the empowerment status while lowering the HIV risk.

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Lansmon-Winter, Erin Cready Cynthia M. "Family perception of quality in nursing home care impact of gender, level of involvement, and utilization of empowered CNA teams /." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9069.

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Milberg, Anna. "Family members' experience of palliative home care /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med821s.pdf.

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Mendes, Michele A. "Parents' descriptions of ideal home nursing care for their technology dependent child, themselves, and their families /." View online ; access limited to URI, 2004. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3135909.

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White, Mary Kathryn. "Certified nursing assistants' feelings of preparedness in caring for nursing home residents at the end of life." Laramie, Wyo. : University of Wyoming, 2007. http://proquest.umi.com/pqdweb?did=1445048331&sid=8&Fmt=2&clientId=18949&RQT=309&VName=PQD.

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46

Wälivaara, Britt-Marie. "Mobile distance-spanning technology in home care : views and reasoning among persons in need of health care and general practitioners." Licentiate thesis, Luleå tekniska universitet, Omvårdnad, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-26437.

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The overall aim of this licentiate thesis was to describe views and reasoning about the use of mobile distance-spanning technology (MDST) in health care at home, from the perspectives of persons in need of health care and general practitioners (GP). A descriptive qualitative approach was chosen to achieve the overall aim. Individual qualitative research interviews and qualitative group research interviews were used for data collection. Qualitative content analysis and qualitative thematic content analysis were used for data analysis.The findings show that persons in need of health care at home recognized MDST as being similar to the technology used at hospital. They described the MDST at home as acceptable but still in its infancy. The limited experiences in using MDST led to some persons doubting the reliability of the examinations routinely carried out at home instead of at hospital. When using the MDST, more examinations can be performed at home but there was some overconfidence concerning the possibility of what MDST can achieve. They saw the staff as users of the MDST, and the MDST should not be used by the persons or their family members. The MDST was seen as possible for distance communication but personal meetings with a GP or a nurse also have to be possible. The GPs must know the person concerned before making decisions at a distance. The persons felt that as long as it is easy to go to the healthcare centre or to the hospital the examinations should be done there, but if they are in a bad condition and there are long distances, then examinations at home become relevant. In an emergency situation, going to hospital rather than staying at home was inevitable and obvious. The MDST at home was described as a part of a chain which can be efficient only when other parts of the chain are taken good care of. When the MDST was assumed to be safe and secure then it could be used on a permanent basis at home, but this decision had to be made by DNs and GPs. The GPs reasoned that the MDST should be used with caution. There is a professional caution, which is based on the GPs' professional experiences, responsibilities and skills. Human meetings were seen as important for performing secure judgments and as the basis for health care, but some meetings can be replaced by virtual meetings. A virtual meeting could be useful for the patients and their families but it depends on their expectations. It could benefit them but there is also an overconfidence concerning what MDST can do. The GPs reasoned about the MDST in general and the usability of different diagnostic tools. The MDST was described as being not yet fully developed. Sometimes the MDST could support the GPs' decisions, but when handling very complicated cases, meeting the patient and understanding his or her context was seen as highly important. Expanded access to patient records facilitates the GPs work but the patient's integrity has to be ensured. It is easy for nurses to do more during home visits, but there must be an agreement between the nurse and the GP regarding how to handle the responsibility.The results in this thesis indicate that the participants attach both positive values about MDST as well as believing that some tools have no value at all. This is important when attempting to understand what is important for persons in need of health care and for GPs benefit when planning health care at home for the future.
Godkänd; 2009; 20091021 (brival); LICENTIATSEMINARIUM Ämnesområde: Omvårdnad Examinator: Professor Siv Söderberg Extern opponent: Professor Kenneth Asplund, Mittuniversitetet, Sundsvall Tid: Fredag den 20 november 2009, klockan 13.00 Plats: Sal E246, Luleå tekniska universitet

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Al, Chami Mohamad Hamze. "Economization of Home Care in Ontario: A Critical Ethnography of Nursing Actions." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42670.

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Many nursing theorists consider caring the essence of nursing practice. Yet, the meaning of caring is still elusive in nursing theories. This confusion in conceptualizing caring is exacerbated by the neoliberal socio-political and economic transformations of our societies that infuse nursing practice with economic efficiency values ‒ a condition that threatens the ethical dimensions of nursing. This critical study analyzes nursing actions in home care in Ontario and empirically reconstructs the normative dimensions of care based on nurses’ own perceptions of good care. The findings are used to critique current healthcare transformations through a critical theory of nursing actions. This study is situated in the tradition of the Frankfurt critical school and pursues an emancipatory interest. Axel Honneth’s theory of recognition is the principal theoretical foundation complemented by Jürgen Habermas’ theory of communicative action and the interests of knowledge, in addition to the concepts of phenomenology and corporality. It uses critical ethnography as a methodological approach. Data collection included audiotaped semi-structured open-ended interviews with 18 nurses working for two different home care providers in Ottawa. Analysis demonstrates that the patient must be recognized on three dimensions: love, legal rights, and solidarity. Care is a specific form of communicative action in which patients should participate equally in decision making. Nursing actions comprise a hermeneutic-phenomenological dimension of “deep knowing” that respect the corporal and personal needs of the patient. Healthcare transformations and economic efficiency measures reinforce technical and standardized forms of care, which lead to pathologic practices that neglect patients’ corporal needs, thereby reifying patients. Nursing actions combine both technical and corporal aspects that characterize their “double logic.” This study provides elements for a critical theory of nursing actions. Findings highlight that nurses have a vision of how nursing care should look like, but the reality of home care makes it rather impossible to realize this vision. Economization leads to a systematic violation of multiple dimensions of recognition and to reification. Nurses must resist these social pathologies and this study provides some theoretical tools to engage in this struggle.

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MaGee-Rodgers, Tamiko R. "Character Strengths of Nursing Home Administrators Who Lead Exemplary Long-Term Care." Thesis, Indiana Wesleyan University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930255.

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The growth in the older adult population will result in an increasing number of individuals with functional and cognitive limitations. The demand for nursing home administrators will grow proportionately with the aging population and the need for effective leadership within nursing homes is and will continue to be imperative as the population ages. Identifying top-rated nursing homes that provide quality care is essential to understanding the operations of successful long-term care facilities. Nursing home administrators (NHAs) are tasked with leading and directing provision of skilled, intermediate and rehabilitation care on a 24-hour basis while ensuring high quality operations. Identifying the character strengths of nursing home administrators who lead exemplary nursing homes may benefit other nursing home leaders who lead lower rated or underperforming facilities. In this qualitative study, 19 nursing home administrators who lead exemplary facilities across Indiana completed the Value in Action Inventory Strengths (VIA-IS) questionnaire and engaged in face-to-face interviews. Analysis of the interview data via NVivo indicated how the use of character strengths is crucial to effective leadership within long-term care. Creativity, fairness, bravery, perspective, and judgment were identified by a majority of study participants as essential to decisionmaking and problem solving, especially in a heavily regulated environment. Humor, hope, courage, and spirituality were acknowledged as contributing to a positive and optimistic environment. Humor, hope, courage, and spirituality were also noted as coping mechanisms when faced with stress and adversity. Honesty, kindness, love, teamwork, and gratitude were emphasized by the study participants as essential to relationship development and formation of trust with staff, residents, and families. This study allowed participants the opportunity to reflect on their own character strengths and leadership both personally and professionally. This reflection resulted in increased self-awareness and appreciation of their staff, residents, and roles as nursing home administrators.

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Ai-Cheng, Li, and 李愛誠. "Quality of Care in Home Care and Nursing Home." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/12111248590566418717.

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碩士
亞洲大學
健康產業管理學系長期照護組
99
Objective: The problem of long-term healthcare for a disabled and aging population has gradually become a point of concern in many countries. Improvement of the quality of long-term healthcare is a topic that requires urgent focus. Thus, this study used the National Health Insurance (NHI) Claim Database to investigate differences in quality of care with regard to home care and nursing home services. Methods: This study obtained data on 2006 inpatient and outpatient medical claims from the data of one million people in 2005 Health Insurance Database. A sample of 1,564 users of home care and nursing home services was taken. This study then investigated the difference in quality indicators of healthcare, drug use, and healthcare utilization among these users within a two-year period. Results: Observation of users of home care services showed the following statistics: 4.5 % sought medical care due to depressive illnesses in the first year; 49.8 % sought medical care due to urinary tract infection (UTI) in the second year; 4.6 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 34.Observation of users of nursing home services showed the following statistics: 9.6 % sought medical care due to depressive illnesses in the first year; 62.1 % sought medical care due to urinary tract infection (UTI) in the second year; 4.2 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 49. The differences among users of home care services and users of nursing home services reached statistical significance. After other variables had been controlled, logistic regression analysis showed that the probability of depression (first year) and UTI (second year) among users of nursing home services was 2.62 and 1.54 times that of users of home care services, respectively. Conclusion: Although NHI in Taiwan affords a similar degree of disability benefits to users of home care services and nursing home services, the quality of the two service models differs. Related medical referral units and service providers should plan health education and guidance, and improve index management and care processes as soon as possible, to enhance the quality of healthcare services.

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Toles, Mark Pettiss. "Transitional Care in a Nursing Home." Diss., 2011. http://hdl.handle.net/10161/3827.

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Background: Each year, 2 million older Americans complete three to four week courses of post-acute care in nursing homes and return home; however, scant research describes services to protect older adults during their transitions from nursing homes to home. In hospital-based studies, transitional care interventions were associated with improved health outcomes for older adults, but these interventions added new staff positions, which are likely cost-prohibitive in nursing homes. Further, no prior study explored transitional care provided for vulnerable, post-acute care patients in nursing homes. Thus, this dissertation was designed to develop new understandings about transitional care provided by existing staff members in nursing homes. The study has two specific aims: (a) describe transitional care and outcomes for older adults who obtain post-acute care in nursing homes from the day of admission through discharge; (b) explore the influence of interactions, among selected older adult patients and their group of nursing home caregivers, on their ability to accomplish transitional care processes.

Method: Using data from a literature review and theoretical models, including Donabedian's Model of Healthcare Quality and Anderson's Local Interaction Model, a conceptual model of transitional care for post-acute care patients in nursing homes was constructed. The conceptual model was then used to guide exploration of the research aims with a longitudinal, multiple case study of transitional care in a nursing home. The unit of analysis was the patient care-team, defined as individual post-acute care patients, family caregivers, and 6 to 8 professional staff in each team (e.g., rehabilitation therapists, physicians, nurses and social workers). Three patient care-team members were purposively sampled for study. Moreover, longitudinal data were collected using repeated interviews and observations with patients, family caregivers, and staff; document and daily chart reviews; and surveys of patient preparedness for discharge. Manifest content analysis and thematic analysis (qualitative methods) were used to conduct within- and across-case analyses of trajectories of transitional care and to identify strengths, gaps and inconsistencies in care.

Results: Findings related to the first research aim include a description of transitional care in the study nursing home. Serious gaps and inconsistencies in transitional care exposed older, post-acute care patients to risks for complications in their transitions from the study nursing home to home: (a) systemic supports were not available to support nursing home staff who provided transitional care; further, nursing home staff and leadership were unaware that they provided transitional care; (b) care processes were not in place to prepare older adults and their caregivers to continue care at home; (c) care-team interactions often excluded family members; and (d) post-acute care patients left the nursing home without resources needed to support safe transitions in care, including transitional care plans, education to appropriately respond to acute changes in health, written materials to guide care at home, referrals for medical follow-up after discharge, and transfers of clinical information to primary care physicians.

Findings related to the second research aim include a description of local interaction strategies and the effectiveness of transitional care processes. When professional staff more consistently used local interaction strategies, specified in the model, care-team members exhibited greater capacity for connections, information exchange, and cognitive diversity. Further, when care-team interactions were of high quality and sufficient frequency, there were multiple indications of more effective transitional care, such as patient engagement in care, inclusion of patient priorities in care plans, and problem solving which included family members and diverse members of the patient care-team. Thus, local interaction strategies were essential staff behaviors needed to adapt care processes to the specific transitional care needs of individual patients.

Because transitional care is a grossly under-developed care process in nursing homes, these findings will likely have immediate implications for practice and research. Findings will provide nursing home administrators and staff with resources to develop and evaluate care in nursing homes; further, the findings will help to create targets for protocol and care process development to strengthen existing practice and address deficiencies. Findings will provide researchers with resources for studying transitional care in diverse samples of nursing homes, which should facilitate development of testable hypotheses for needed intervention studies. In addition, the local interaction strategies findings in the study may generalize to other settings of care, where interdependent staff work is required to establish connections, information networks, and to coordinate care among multiple staff members.

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