Dissertations / Theses on the topic 'Nursing home patients – social conditions'

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1991.
A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.

This study confirms that depression is highly prevalent in nursing homes. In addition, this study reveals incongruency between depression rates and recognition rates of depression in the nursing home environment.

The purpose of the study was to describe the relationship between in-home health care services for elderly patients who were recently discharged from inpatient care and re-hospitalization rates. The design was descriptive and the hypothesis was that the provision of in-home health care services would mitigate a decline in the health status, of an elderly patient, following discharge from inpatient care and prevent re-hospitalization.

Nursing home residents often experience loneliness and social isolation. Research indicates that visitation via the telephone can decrease feelings of social isolation and loneliness. The purpose of this study was to introduce visual images to the telephone conversations of this population. It was hypothesized that the residents receiving this intervention would evidence decreased levels of loneliness and a greater sense of social support. This hypothesis was not supported by the data; however, emotional and social loneliness scores did show positive trends that may have been due to the intervention.

Face às transições demográfica e epidemiológica observadas no Brasil nas últimas décadas, muitos autores têm discutido as alterações nos perfis saúde-doença das populações. Assim como vêm crescendo o número de idosos, graças aos ganhos obtidos com os avanços tecnológicos na área da saúde e o controle das doenças infecto-contagiosas, verifica-se um importante aumento do número de pessoas com doenças crônico-degenerativas, que muitas vezes carreiam consigo incapacidades e dependência. Numa cidade como São Paulo também é digno de nota o expressivo incremento da violência urbana, expressão das desigualdades impostas pela vigência do sistema capitalista e das políticas de ajuste neoliberal em nosso país. Os que sobrevivem aos acidentes por armas de fogo ou de trânsito, não raro apresentam mutilações ou deficiências físicas com limitações importantes, para os quais os cuidados domiciliários podem representar uma importante estratégia para que se garanta a equidade prevista pelo Sistema Único de Saúde. Pautada pela determinação social do processo saúde-doença, buscou-se compreender as desigualdades sociais e de saúde associadas à distribuição da população em atendimento domiciliário por equipes de Saúde da Família do MSP à luz do Atlas da Exclusão Social no Brasil. Para tanto foi feito o levantamento, por meio de dados secundários, do perfil das pessoas com perdas funcionais e dependência atendidas por 111 (60%) de 185 Unidades de Saúde da Família presentes em 25 das 31 Subprefeituras do MSP em agosto de 2003, abrangendo 45 (66%) dos 96 distritos administrativos da capital, resultando numa amostra de 7.160 pessoas. Utilizando os softwares SPSS® 13.0 e EPI-INFO 2000 versão 3.3.2, os distritos administrativos pesquisados foram agrupados, por meio de uma análise de cluster, tendo por variável base o Índice de Exclusão Social. Em seguida, procedeu-se a descrição estatística das variáveis sexo, idade, grau de incapacidade, patologia, uso de oxigenoterapia, uso de sonda, presença de úlcera por pressão e uso de traqueostomia, cruzando-as entre si e comparando-as nos quatro grupos resultantes da análise de cluster. Efetuou-se o cálculo da correlação entre variáveis e o Índice de Exclusão (Iex) e os indicadores de vida digna, escolaridade e violência. Verificou-se prevalência de idosos (75%), com incapacidade leve (32%) e pouca ou nenhuma complexidade de cuidado (92%), sendo o acidente vascular cerebral (AVC) a doença precursora do atendimento (18%). Apesar de as mulheres serem maioria (60%), quanto maior a exclusão social, maior a proporção de homens com menos de 60 anos e crianças com severa incapacidade e maior complexidade de cuidado. Nos grupos com maior exclusão há proporcionalmente mais homens não idosos com severa incapacidade e maior complexidade de cuidado, sendo o AVC a doença predominante. Já nos grupos de menor exclusão há mais mulheres idosas com incapacidade leve e moderada e menor complexidade de cuidado, sendo o AVC e a hipertensão as doenças principais. Foram encontradas correlações negativas significativas entre o Iex e uso de sonda e traqueostomia, AVC não especificado, fratura de outros ossos dos membros neoplasia de laringe e outros efeitos de causas externas, e positivas entre aquele índice e linfoma não Hodgkin. Observaram-se diferenças no perfil dos distritos estudados de acordo com a exclusão social. Os achados estatísticos vasculharam diferenças nos perfis de saúde-doença de certos grupos sociais, permitindo levantar suspeitas sobre quem são as pessoas que precisam ser assistidas em suas casas. Aquelas em maior exclusão social, além de serem mais numerosas que as outras, apresentaram maior gravidade e complexidade de cuidado. O sentido desses seus achados merece ser investigado com mais substrato teórico, com amostras representativas da população, valendo-se de instrumentos que captem todas as dimensões do processo saúde doença. Faz-se necessário não só discutir a dificuldade de as pessoas acessarem os serviços, mas a potência do PSF em atingi-las, potencializando a diminuição da exclusão sócio-espacial, principalmente se, além de excluída, essa pessoas são portadora de necessidades especiais que demandam assistência no próprio domicílio
In the view of the demographic and epidemiologic transitions observed in Brazil during the last decades, many authors have been discussing the changes in the health-illness profile of the populations. As the number of elderly people has been increasing, mainly due to the technological advances in the health field and to the control of the infecto-contagious diseases, it is also possible to verify a great increase in the number of people with chronic-degenerative diseases, which most of the times bring along disabilities and dependency. In a city like São Paulo it is also important to note the expressive growing of the urban violence, which are the expression of the inequalities imposed by the capitalist system and by the neoliberal policies settings in our country. The individuals who survive the firearms or traffic accidents normally present mutilations or physical disabilities with serious limitations. For these people primary home care may represent an important strategy in order to guarantee the equality foreseen by the Sistema Único de Saúde. Grounded by the social determination of the health-illness process, we tried to understand the social and health inequalities associated to the distribution of the population being attended at home by parties of the Family Health in São Paulo through the light of the Atlas of Social Exclusion in Brazil. Therefore, using secondary data, a survey of the profile of the people who are attended and who bare functional disabilities and dependency was carried out by 111 (60%) of the 185 Units of Family Health de in the 25 of the 31 administrative subdistricts of MSP in August, 2003, embracing 45 (66%) of the 96 administrative districts of the capital, resulting in a sample consisting of 7.160 people. Using SPSS® 13.0 e EPI-INFO 2000 version 3.3.2 as the main softwares, the administrative districts researched were grouped together by means of a cluster analyses, in which the base variable was the Social Exclusion Index. After that, we wrote the statistical description of the following variables, sex, age, disability level, pathology, oxigenotherapy use, catheter use, presence of ulcer due to pressure and tracheostomy use, intercrossing and comparing the variables in the four resulting cluster analyses groups. Then, we calculated de correlation among the variables, the Social Exclusion Index (Iex) and the indicators of condign life, educational level and violence. The results verified are prevalence of elderly (75%), with low disability (32%) and few or none complexity care (92%), being the cerebral vascular accident (AVC) the precursor disease (18%). Although the women represent the majority (60%), the bigger the social exclusion, the bigger the proportion of men who are less than 60 years old and children with severe disability and greater complexity of care. In the groups with greater exclusion there is proportionally more non-elderly men with severe disability and greater complexityof care, being AVC the main disease. In the groups with less exclusion there are more elderly women with low and medium disability and less complexity of care, being AVC and high blood pressure the main diseases. We found significant negative correlation among the Iex, catheter and tracheostomy use, non-specified AVC, fracture of other bones, larynx neoplasy and other effects of external causes, and positives between that index and non Hodgkin lymphoma. We noticed differences in the profile of the studied districts according to social exclusion. The statistical data found searched for differences in the profile of health-illness of certain social groups, allowing us to suspect who are the people that need to be assisted in their homes. Those suffering the higher social exclusion, besides being in greater number than others, presented greater gravity and complexity of care. The meaning of these results deserve to be investigated with better theoretical substrate, with representative samples of the population, making use of tools capable of analyzing every dimension of the health-illness process. It is not only necessary to discuss about the difficulties people encounter when accessing the services, but also the potency of the PSF in reaching them, increasing the lesser of socio-spatial exclusion, principally if, besides being excluded, these people have special needs which demand assistance in their own homes

The aim of this research was to explore the challenges faced by women providing home-based care to those infected and affected by HIV and AIDS. The specific objectives of the study were to explore the gender-related, sociocultural and socioeconomic challenges faced by these women; and to investigate best practices in home- based care. An exploration of the challenges women experience in their communities as they provide care for the HIV and AIDS infected and affected is located within a gender and power framework. Feminist theories are also used to try and explain the reasons behind the differences and inequalities that exist in the community, particularly as regards the women who provide home-based care. A qualitative study, which used both qualitative and participatory methods of data gathering, was undertaken in 2014 in Mzimba, Malawi. Data was collected from 26 women participants by means of Critical Incident Narrative interviews (5), Individual In-Depth Interviews (5), and two Focus Group Discussions (6 and 10 participants respectively). Three Key Informant Interviews were conducted with a Ministry of Local Government official, another with a Nursing sister at the Mzimba District Hospital Tuberculosis Ward, and the Mzimba District Hospital Home-based care Coordinator. Purposive and snowballing sampling techniques were used to recruit the research participants. A topic guide was used in critical incident narrative interviews. An interview schedule consisting open-ended questions and face interviews were used for the Individual In-depth Interviews. A topic guide was used for the Focus Group Discussions. All the data collection instruments were guided by the themes of social, economic, cultural, psychological challenges; food security, and coping mechanisms. An interview schedule consisting of open-ended questions were used for the Key Informant Interviews. A Check List of WHO minimum package for home-based care programmes was used to assess the actual program best practices. The methodology of this study was guided by the WHO framework on home-based care. In this framework, the home-based care programme includes the following elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to drop of school to marry when their parents or guardians died. The other dimension to this issue was that the older women carers reported that during their young years, it was common place to find girls who did not attend school or were pressurised to get married because their parents did not believe in educating girls. The background is currently affecting the women carers as they find that they cannot get involved in profitable business or even look for employment. They lack the basic literacy levels that would allow them to be become more productive and ensure financial security. Women carers experienced a number of gender related challenges as they provided care and these included the burden of care being almost solely borne by the women. Women revealed that they have had to use various coping strategies in the face of the overwhelming challenges that they continue to experience. Elderly women have found ways to cope by selling the property such as land and household goods, conducting small scale informal business, and sending the children away to relatives to be fostered. The young women on the other hand have sometimes reverted to some dangerous strategies for coping such as getting a boyfriend to provide for their financial needs, engaged in transactional sex, and some got married very early. The other coping strategies that the young women employed were to conduct small businesses, depended on family and relatives to provide for their various needs. The women volunteers revealed that they used their group as a therapy group, they shared the work, and that they were involved in small scale businesses. The study has also revealed that there is a home-based care programme that is functioning fairly well. However, there are indications that as much as the various players are trying to assist those who are infected and affected by HIV and AIDS, there are severe gaps in the effectiveness of the programme. There is need for a review of the programme so that it answers to the needs of those who are caring for those who are on home-based care i.e. a more rigorous implementation of HBC programme is required. The overall findings of the study indicate that the poverty trap in which the women are caught impacts on every aspect of their existence, with little hope of them ever improving their conditions. There is need for the Malawi government to come up with strategic interventions that would alleviate of women in general but in particular those who are left to provide care at home. Such interventions could include poverty alleviation strategies for women who are providing care to ensure that their situation does not deteriorate once they begin to provide care. Since Malawi is a signatory to the UN Millennium Development Goals, it is important that the plight of women is revisited and find lasting solutions to the challenges that they experience. Women are still lagging behind in education for example. There is need to improve girls and women access to education. The health of women has been affected by HIV and AIDS. The Government of Malawi also needs to review the policies that are in place which address women’s health. Essentially the status of women is need of a major change in order for the country to achieve some level of development which is at par with other countries in the sub-Saharan African region.
Sociology
D. Phil. (Sociology)

MMed (Family Medicine), Faculty of Health Sciences, University of the Witwatersrand
The family care-giver has a pivotal role to play in the management of the chronically ill HIV/AIDS patient. The well being of the care giver is therefore crucial since impairment of their physical or mental health could impact negatively on the management of the HIV patients. Aim The purpose of this qualitative study was to find out the psychosocial impact of care-giving on the family care-giver of the chronically ill HIV/AIDS patient in home based care. Methodology In-depth, tape recorded, unstructured interviews were conducted on eleven care-givers recruited at an adult HIV clinic at United Bulawayo Hospitals, Bulawayo, Zimbabwe. Relevant demographic data was collected from each participant. The interviews were then transcribed before analysis of the data was done. Results The care-givers biggest challenge was meeting care costs such as food, transport and medical expenses. Certain conditions relating to the care-recipients‟ health and family issues such as abandonment of the ill patient and orphans added to the burden of care. Carers also had health and physical factors that impacted on their psychosocial well being. All these issues resulted in a spectrum of emotions such as helplessness, sadness, anxiety and anger but despite this the carers still reported on positive aspects of their care-giving role. Conclusion Care-giving impacted negatively on the care-givers‟ psychosocial well being but there were also positive aspects to the role.

Text in English
With the Acquired Immune Deficiency Syndrome (AIDS), first recognised in 1981 as a new disease that subsequently took on pandemic proportions, home-based caregivers became instrumental to ensure that, notwithstanding the encumbered health care systems, people living with HIV and AIDS (PLWHA) receive care, support and treatment within their households to live prolonged dignified lives. Despite their pivotal role in the field of HIV and AIDS care, there seems to be a dearth of literature, and research locally and internationally, from the ambit of Social Work on the topic of how HBCGs manage and cope with the work-related challenges they experience when caring for PLWHA and their need for Social Work support. Through this exploratory, descriptive, contextual and phenomenological qualitative study, I scrutinised the HBCGs’ experiences and associated challenges and the coping strategies they employ to address these challenges as well as their views on how social workers could support them in overcoming these challenges in the specific case on home-based care to PLWHA. Twenty-five HBCGs were identified and recruited through purposive and snowball sampling techniques from twelve home-based care organisations in South African provinces, namely, North West, Limpopo and Gauteng. Data was collected through individual face-to-face semi-structured interviews using an interview-guide. Data analysis was conducted through Tesch’s eight steps (in Creswell 2014:189) while Guba’s model (in Shenton, 2004) was adopted for data verification. Cast against Loretta Williams’ (2014) middle range theory of caregiving dynamics (Williams 2014), the coping theory of Lazarus and Folkman (1984) and the strength-based perspective (Saleebey, 2013) adopted as theoretical frameworks for this study, the following findings were revealed. The HBCGs were motivated by, among other factors, their mere desire to care for PLWHA; their personal experiences of caring for an ill relative; and future career aspirations to become involved in this care work. HBCGs were found to face various work-related challenges in connection with reactions from community members, the patients and their relatives; their unsafe working conditions; as well as from their colleagues, other role players and their own organisations. It was found that for most of the HBCGs their care work saddened, pained and discouraged them. In the midst of feeling sorry for their patients, they feared getting infected themselves, in addition to their work-related challenges that caused them to experience feelings of failure. The strategies adopted to cope with their work-related challenges included getting support from employers, receiving counselling and becoming involved in support groups. Finally, several suggestions were directed to the management structures of HBC organisations, the HBCGs themselves and social workers on how they could address the work-related challenges. Based on the research findings, some recommendations are forwarded concerning guidelines for Social Work support directed at work practice, policies and programmes; associated education and training endeavours; and continuous professional development initiatives, as well as avenues for further research.
Social Work
D. Phil. (Social Work)

Master's project identifies, describes, analyses and provides sugestions of solving ethical problems whom social worker is dealing with when working and looking after clients in terminal phase of their life. Master's project is divided into 4 chapters. First chapter is focusing on explanation of terms like dying, aging, nursing home and social worker. Second chapter is about explanation of chosen ethical terms with whom social worker is often dealing with. Third chapter is focusing on each of all areas where problems may occur for social worker during his work, for example moving clients to the hospital, keeping their privacy during stay in a double bed room and optimizing daily schedules of dying patient. Last area of interest is divided into providing tasks like feeding, hygiene and spiritual care. Last chapter is conclusion of those problems with ideas and examples how to solve them. Moving clients in terminal stadium of their life is within competences of a nurse, however, it would be better if nursing homes would have their own doctors, who could examine and analyse each patient individualy. Dying in a double bed room with presence of another patient is uncomfortable and displeasing moment, that could be solved with spare room, where this roommate could stay during last moments of that dying patient. Food is served in accordance with schedule, which could be good to adjust to clients individual needs. Same adjustments would be good in schedule of staff, to ensure 24 hour care. Spiritual care is insufficient, and social worker is responsible for this situation and should fix it along with coopreation of various churches.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.