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Dissertations / Theses on the topic 'Nursing the elderly'
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1
Avin, Nadege. "Improving Diabetes Management in Elderly Haitians." Thesis, Grand Canyon University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=10842164.
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Abstract For decades, type 2 diabetes mellitus (T2DM) has been prevalent in various vulnerable communities in America. American Haitians are disproportionately affected by T2DM. Diabetes is the primary cause of death among elderly Haitians, most of whom have no knowledge of diabetes management. The purpose of the project is to determine if an educational intervention would increase compliance with diet and exercise, decrease blood glucose, and promote successful management of T2DM among elderly diabetic patients living in District 16. A trans-theoretical model (TTM) that emphasizes intentional behavior change guided the project. A convenience sample of five females and five males ( n = 10) between 65 to 82 years of age who had been diagnosed with uncontrolled T2DM participated in the project. Interviews were conducted via focus groups and were audiotaped and analyzed using the Krueger and Casey method to extract themes. The emergent themes of the project were the standard of care for diabetes, diabetes care support, access to services and resources, diabetes knowledge and self-management, the educational intervention of diabetes, and cultural beliefs. There were marked differences in pre-mean finger sticks values of the participants when compared to post-intervention finger stick values; mean finger stick values began at 244.55 and decreased to 129.85. The efficacy of the exercises and diet were based on the difference in Finger stick values. A paired t-test showed a significant decrease in finger stick values, indicating finger stick improvement, and a reduction in baseline finger stick values after diabetes education intervention (t = 14.76; p < 0.05). Thus, diet and exercises decreased finger stick levels in Haitian patients with uncontrolled T2DM. There is limited transferability of the project due to small sample size.
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Zabalegui, Adelaida. "Health perception and participation in cancer screening in the elderly /." Staten Island, N.Y. : [s.n.], 1991. http://library.wagner.edu/theses/nursing/1991/thesis_nur_1991_zabal_healt.pdf.
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Nakagawa, Sage. "Payer source for single, elderly women in nursing homes." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1524144.
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This study seeks to determine the payer source for single, elderly women in nursing homes. By determining the payer source for single, elderly women, the next generation of women can prepare for high nursing home costs by saving earlier or investing in long-term care insurance. Studies have shown the primary payer sources for nursing home costs are Medicare and Medicaid. This study hypothesized single women, when compared to married women, would utilize Medicaid and welfare to pay for nursing home costs. Secondary data from the 2004 National Nursing Home Survey was extracted and analyzed for the aforementioned hypotheses. The analysis determined the primary payer sources for elderly women in nursing homes were self-pay and Medicaid. Marital status did not have an impact on the payer sources for single, elderly women in nursing homes when compared to married women.
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Buiyan, Salmah, and Nongfei Sheng. "Experience of Oral Care among Elderly in Nursing Homes." Thesis, Umeå universitet, Tandläkarutbildning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-97910.
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Life expectancy among the elderly has been improving for decades and edentulousness is constantly decreasing among the senior citizens. The steady decrease of tooth loss among the elderly is a challenge to the dental profession due to the increased demand of oral care. This study aims to explore the perspectives regarding oral health and oral care among the elderly living in nursing homes. Ten subjects from two nursing homes in Umeå were interviewed based on a defined interview guide. The interview guide contained open-ended questions regarding oral health and oral care. The subjects were interviewed, all the interviews were recorded and transcribed verbatim. Categories, subcategories and codes were created using qualitative content analysis. Two categories and six subcategories were established based on qualitative content analysis. The two categories revealed opposing attitudes, the first promoted oral care and the second disfavored oral health. The oral care promoted factors included general satisfaction with the elderly’s’ present oral status, positive experiences associated with oral care and strong desire to maintain their own oral hygiene. The most notable negative factors for good oral health was the lack of thorough oral examinations and individually adapted assistance with daily oral hygiene. The informants took oral hygiene as a part of their integrity and expressed wishes to be independent. In general, the informants held positive attitudes toward their current oral status and understood that proper oral care is a prerequisite to good oral health. However, it should be noted that assistance with oral hygiene is not practiced in either of the two nursing homes on a regular basis. This may be attributed to staff shortages and the residents desire to maintain their independence.
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Johansson-Pajala, Rose-Marie. "Pharmacovigilance in municipal elderly care : From a nursing perspective." Doctoral thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-34750.
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Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems. The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions. RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV). This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.
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Anderson, Loretta 1941. "The effects of relocation on elderly nursing home residents." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/277279.
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A descriptive study, using a retrospective chart review, investigated the mortality rates for 77 elderly nursing home residents who at the time of the study had been relocated between 10.5 and 13.5 months. Variables identified were age, sex, diagnosis, frequency of acute hospital admissions, nursing home placement, time interval between relocation and date of death, and number of years spent in a nursing home. Findings showed that 31 (40%) of the relocated subjects died within the 13.5 month post-relocation period. Sixteen (52%) of those deaths occurred within six weeks of relocation. Data revealed that mortality increased with age, from 14% for 60 years olds to 73% for those in their nineties. Age was the only variable found to be statistically significant between those who lived or died. The study's findings demonstrated the need for nursing assessment and surveillance of relocated nursing home residents.
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West, Betty Johansen 1931. "Falls in elderly veterans in a nursing home setting." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/291778.
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The purpose of this study was to describe the characteristics of falls and risk factors for falls in elderly male veterans residing in a Veterans Affairs nursing home care unit. Risk factors included cognitive status, mobility status, and restraint use. Relationships between risk factors and falls were investigated using a two-phase descriptive correlational design. Nursing and medical records of residents who fell were reviewed retrospectively, and assessment of cognitive status was done using the Mini-mental Status Exam. The convenience sample included 20 male veterans, age 65 and older, who had at least one documented fall from the year of January 1991 through December, 1991. Results were not statistically significant; however, trends in the data were identified. Findings were clinically significant and validated literature on risk factors for falling.
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Hong, Soon-Duk. "Effectiveness of client education in promoting compliance among Korean elderly hypertensive clients /." Staten Island, N.Y. : [s.n.], 1990. http://library.wagner.edu/theses/nursing/1990/thesis_nur_1990_jenki_hong_effec.pdf.
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Cabrera, Amparita L. "The role of group activity participation in depression among institutionalized elderly." FIU Digital Commons, 1996. http://digitalcommons.fiu.edu/etd/1954.
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The role of group activity participation in depression among a group of residents (N=65), age 80 and older, in a nursing home was examined using the framework of Roy's Adaptation Theory and Nolen-Hoeksema's Response Style Theory of Depression. Roy views depression as a maladaptation. Nolen-Hoeksema views group activity participation as a therapeutic distraction to break depressed moods and thus allow for positive adaptation.
This study utilized data from medical records, group activity attendance, and self-report questionnaires. Demographic distributions were computed and correlational statistics were performed between subjects' participation and their degree of depression, pain experience, functional status, presence of social support, and perception of benefits. Results show a negative correlation between frequency of participation and Geriatric Depression Scale score (GDS). The wide range of measured frequencies among low GDS-scored subjects suggests that less depressed individuals exercise more freedom of choice to participate than those who are more depressed. Significant finding show a positive correlation of group activity participation with functional status in terms of ambulation. Data shows that the experience of pain was not a significant deterrent to participation. The presence of social support from the staff and family did not increase participation. However there is a lesser GDS score among subjects who had recent family/friends visit suggesting a positive role of family in decreasing depression.
These results are significant not only for optimizing group therapeutic effects but also for understanding basic human and environmental correlates of depression. Study limitations are pointed out and recommendations are presented.
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Ho, Man-kei Joanne. "Perspectives of Chinese elderly women towards nursing in Hong Kong." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31972913.
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Ho, Man-kei Joanne, and 何敏琪. "Perspectives of Chinese elderly women towards nursing in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31972913.
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Fan, Man-shan Susan, and 范文姗. "Nursing homes for the elderly: an alternativemode of welfare provision." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1988. http://hub.hku.hk/bib/B31248111.
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Chidester, June C. "Adequacy of fluid intake of an elderly nursing home population." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/845937.
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The actual fluid intake of forty (40) residents of a nursing home was determined by an analysis of detailed three-day food and fluid intake records obtained by direct observation. Intake was compared to an established standard to determine the adequacy of fluid intake for this population. Subjects were grouped in two groups according to age (<85 years and >85 years) to determine whether age influenced fluid intake. In addition, data such as number and frequency of medications and dependency factors, such as ability to feed self, ability to communicate, ability to move and ability to make decisions, were collected and correlated.There was no significant difference between actual fluid intake and required fluid intake for the population a whole and for the two age groups. However, there were individuals who had very low fluid intakes suggesting other factors which influence fluid intake. There were positive correlations between fluid obtained from non meal feedings and frequency of medication delivery and number of medications delivered during a 24 hour period. In addition, there were positive correlations among the dependency factors. There was no correlation among any of the dependency factors and fluid intake for the group as a whole or for the two age groups.It was concluded from this study that this population of elderly nursing home residents obtained adequate fluid. Medication frequency and number appeared to influence the amount of fluid that a resident might obtain during non meal feedings. However, as a subject became more dependent, this factor did not affect the fluid intake of this population.Department of Home Economics
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Bjorn, Agnes Marie. "Community health assessment and nursing care needs of the elderly." Thesis, University of Manchester, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.237239.
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Hussain, Manir. "Therapeutic management of the elderly in nursing and residential homes." Thesis, Cardiff University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297902.
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Ehrmann-Vanderbilt, Irine 1932. "Survival status of elderly nursing home residents following involuntary relocation." Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/278389.
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Survival status of 45 elderly skilled nursing care residents was examined over a 42 month period following involuntary interinstitutional relocation. Medical and relocation planning records provided data to examine survival status of residents in relation to focal and contextual stimuli. Results were compared to a relocation study previously conducted in the same community. Significant relationships existed between survival status and family support and participation in relocation planning event. A higher percentage of subjects survived who did not have family support and did not participate in planning events. A significant relationship was found between time intervals in which deaths of male and female subjects occurred. In the first nine months, 13 of 14 males died; six of the 14 females died. No significant relationships were found between survival status and age, gender, mobility, or dementia. Findings suggest the need for continued study of variables affecting survival status of relocated elders.
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Habjanic, A. (Ana). "Quality of institutional elderly care in Slovenia." Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514291869.
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Elderly people, because of the frail health condition and consequent problems, have in most cases substantial difficulties living at home. Despite the need for widened nursing home custody, the field of quality institutional elderly care in Slovenia in the past did not undergo comprehensive research.
The purpose of this two-part study was to investigate the quality of institutional elderly care and elderly care offered in Slovenian nursing homes. Additional purpose was to evaluate nursing staff members about their willingness, knowledge, skills and importance to meet residents’ physical and psychosocial nursing care needs. Also, a part of this research was bound for recognition of maltreatment and nursing staff members’ well-being.
The qualitative and quantitative research methods were used. The quality of institutional elderly care and elderly care offered were researched by interviewing the parties involved in elderly care, residents, relatives and nursing staff members (N=48). The data for quantitative research was collected by surveying nursing staff by using a structured questionnaire (N=148). All data have been collected in three public and one private nursing home located in two major cities of Ljubljana and Maribor. Collected data was examined by content analysis method and statistical analysis, to corroborate findings across data sets, reducing the impact of potential biases that can exist in a single study. Triangulation was used to approach to data analysis to synthesize data from multiple sources.
Main categories of quality institutional elderly were formulated as attentive care, optimal custody and holistic approach. The most important issue of quality institutional elderly care was formulated as meeting needs on time. Nursing staff members were found to be better skilled in meeting physical than psychosocial needs of residents. Maltreatment was recognised as neglect of care due to postponed duties or hastiness in nursing interventions resulting in discomfort of residents. Factors in connection to quality of institutional elderly care were expressed as quality of nursing care, friendly relationship, meaningful activities, pleasant dwelling environment and versatile assistance.
The obtained findings were presented in form of proposals to improve quality of institutional elderly care in Slovenian nursing homes, and could be used to develop institutional elderly care and improve dwelling. In addition many specific terms have been extracted during the analysis process that may contribute to development of gerontological nursing care rationale in Slovenia.
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Bianchi, Lisa A. "An investigation of the relationships among social behavior, pet therapy, and gender in the elderly. /." Staten Island, N.Y. : [s.n.], 1997. http://library.wagner.edu/theses/nursing/1997/thesis_nur_1997_bianc_inves.pdf.
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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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Litell, Munjanja Yvonne. "Medication Reconciliation in the Elderly." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6236.
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Medication therapy is the most prevalent and critical intervention of health delivery and the source of most errors in healthcare. Medication errors and associated adverse drug events (ADE) have serious health and economic ramifications, and in elderly patients ADE are the leading cause of morbidity and mortality. Medication reconciliation is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing ADEs. This education project answered the question whether education provided to long term care staff would improve knowledge of medication reconciliation and be retained over time. The education program was developed through results of a literature search to identify evidence-based standards for medication reconciliation. The guiding theory for program was Kurt Lewin's theory of planned change. The test was developed on the medication reconciliation content and arrangements made for each of the 30 participants who were RNs, LPNs, and CMAs to take the test before and after the education program and again at 30 and 45 days. Results showed statistically significant improvement (p < 0.05) with knowledge of medication reconciliation retained at 30- and 45-days post intervention. Positive social change is possible as nurses and CMAs in the long-term care facility use the knowledge of medication reconciliation to improve patient medication safety for the long-term care residences in the facility. Through appropriate reconciliation, medication errors and ADEs can be reduced or prevented and patient outcomes improved.
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Wood, Beverley. "Attitudes toward the elderly : a case study of nursing students' attitudes." Monash University, Faculty of Education, 2001. http://arrow.monash.edu.au/hdl/1959.1/8808.
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Gudorf, Gerald E. "The effects of life review therapy with elderly nursing home patients." Click here for text online. The Institute of Clinical Social Work Dissertations website, 1991. http://www.icsw.edu/_dissertations/gudorf_1991.pdf.
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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.
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Stephens, Patrick H. "The effects of reality orientation on confused elderly nursing home resident." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1993. http://digitalcommons.auctr.edu/dissertations/1755.
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The purpose of this study was to examine the effects of individualized reality orientation therapy on paranoid behavior in a nursing home resident diagnosed with dementia. There were two hypotheses, the first one hypothesized that reality orientation therapy would increase the resident's awareness of environment. The second hypothesized that reality orientation therapy would produce a decrease in verbal statements of paranoid delusions by the resident. This study was conducted over a nine week period. The design of the study was a single A-B case study. The results showed a decrease in statements by the resident of verbal abuse, physical abuse, and neglect. Findings indicated that the resident experienced improvement from the intervention.
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Barnes, Kathryn Elizabeth. "The interaction of nutrition and nursing care in elderly longstay patients." Thesis, University College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307204.
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Salvio, Marie-Anne. "Sleep disturbance and sedative/hypnotic use by elderly in nursing homes." Diss., The University of Arizona, 1992. http://hdl.handle.net/10150/186094.
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The overuse of medications has been referred to as the most common "error of commission" in nursing homes and evidence suggests that pscychotropic medications are overused and inappropriately prescribed for nursing home patients. The purpose of the present studies was to document the actual prescription and administration practices of sedative/hypnotics for the elderly residing in nursing homes and also to assess the difference in self-reported sleep complaints as well as behavioral and cognitive impairment between those residents receiving sedative/hypnotics and those not receiving sedative/hypnotics. Doctors' and nurses' progress notes were reviewed for two weeks prior to the initial administration of a sedative/hypnotic. Results showed that there was only one resident for whom a formal diagnosis of sleep disorder was documented. In addition, there were 81 charted references to sleep on 42 of the 56 residents during the two weeks prior to initial prescription of a sedative/hypnotic. In the four weeks following initial administration of a sedative/hypnotic, there were 167 references to sleep on 40 residents. These findings suggest minimal documented evidence to support the prescription of sedative/hypnotic medications. Prescription use was also examined in light of the initiation of new guidelines regarding psychotropic medications instituted by the Health Care Financing Administration (HCFA) on October 1, 1990. The number of residents receiving prescriptions of these medications decreased in the 6 months following October 1 but those who received medication were given it with increased frequency. In a second study, residents on sedative/hypnotic were compared to those not on sedative/hypnotics with reference to sleep complaints as well as behavioral and cognitive impairment. Findings showed that there were no differences between groups. Sleep disorders may not be the primary justification for the prescription of sedative/hypnotic medications. These findings are consistent with previous assertions that sedative/hypnotic medications are used as "chemical restraints" in this fragile population. This may be a particular danger if the nursing home staff is not knowledgeable regarding the diagnosis and treatment of sleep disorders.
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Fraire, Mari L. "Reducing Delirium in the Hospitalized Elderly With a Nursing Prevention Protocol." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3942.
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The aim of this project was to implement and evaluate the effectiveness of the Clear Minds protocol for early detection and prevention of delirium in hospitalized, elderly patients. The protocol was used to monitor for delirium and improve sleep quality by reducing sleep disturbances caused by environmental factors in hospital settings. Due to the risk of delirium for patients in late adulthood, implementation of a delirium-prevention protocol was needed. Upon admission, patients 60 years and older or patients that screened positive for the Brief Confusion Assessment Method (bCAM) were placed on the Clear Minds protocol. The protocol consisted of establishing healthy habits including structured eating, toileting, and sleeping times. Patients were oriented, exposed to light during the day, and had orders to not disturb during the night unless medically necessary. A convenience sample of 100 patients were reassessed using the bCAM every shift. Sleep patterns, morbidity, mortality, and length of hospital stay of patients were examined pre- and post- implementation of the protocol through surveys and aggregate data pulled from the electronic medical record. Results from a 2-sample t-test indicated no difference between the pre- and post- implementation groups, although there was a positive relationship between the use of the protocol by clinical staff nurses and the length and quality of sleep for patients, suggesting that nurses can have a positive impact on sleep patterns of hospitalized patients. The potential for a positive social change will result from nurses using a standardized approach with a validated tool in clinical practice to assess for delirium; intervene with patients predisposed to sleep disturbances; and thereby decrease morbidity, mortality, length of stay, and readmissions.
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Peterson, Kathy. "A study on the relationship between nurses' attitudes toward the elderly and the quality of care provided /." Staten Island, N.Y. : [s.n.], 1988. http://library.wagner.edu/theses/nursing/1988/thesis_nur_1988_peter_study.pdf.
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Latimer, Joanna. "Writing patients, writing nursing : the social construction of nursing assessment of elderly patients in an acute medical unit." Thesis, University of Edinburgh, 1993. http://hdl.handle.net/1842/9998.
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The study examines nursing assessment in the context of questioning how nurses' encounters with patients become occasions for nursing. The focus of the study is on those occasions which constitute nursing assessment, in recognition that these occasions cannot be detached from other aspects of nurses' conduct. To undertake this examination of nursing assessment, I have drawn on the work of Michel Foucault, with an approach to field research and the analysis of discourse which has developed from contemporary writings on communication, anthropology, ethnomethodology and ethnography. With its focus on examining how power effects are constituted within an acute medical ward, the position developed in the thesis seeks to integrate critical thinking in ethnography with a post-structuralist problematising of 'detachment' as an everyday feature of social conduct. There are three parts to the study. The first part entails a textual analysis of how nursing assessment has been written in the literature. Nursing assessment has been conceptualised as a component of the nursing process; as a technical and cognitive activity. Representing nursing assessment in this way raises issues of knowledge and power. Writing nursing in terms of information processing, problem-solving 'models' is however less a representation of nursing reality and more a discursive practice, one with its own domain and locus of action. The nursing process detaches nursing assessment as a technology, separable from the organisation of patient care and autonomous from the social, but one designed to reconstitute the social through making nursing thinkable in a particular epistemic space. The second part of the study, a detailed examination of the care of old people in an acute medical ward, suggests the particular development of nursing assessment as a cognitive and technical activity overlooks the heterogenous conditions in which nursing is practised, in which it is being written and in which the conditions of detachment that the nursing process, once in process, helps produce and reproduce. These include involving an instrumentalrationalist approach to research on health services, a managerialist climate which seeks to make nursing 'visible' in relation to cost and time; the professionalisation of nursing, which impacts on nurses as a call for nurses to make nursing 'professional', rational and distinct from other practices; and, instituted through fashionable talk of customer care and the care of the subject, a heightening of persons as individuated, accountable, knowing subjects. The analysis shows how the disposal of elderly persons is effected by nurses through a 'constituting of classes' and explicates the motility of these classes in response to the aforementioned pressures. The final part of the thesis develops these themes. The nursing process appears to give the burden of knowing to the nurse as expert, always saving itself from appearing to be a congenitally failing technology through appeals for more and better training. Far from this being so, I illustrate how the burden of knowing falls upon the person; how as patient, persons must detach themselves from their everyday experience and seek modes of conduct appropriate to their disposal. By writing nurses as rational, scientific and professional practitioners, I suggest how the nursing process has been developed as a control technology which both disciplines patients to help accomplish their disposal and manage nurses through the institution of new forms of accountability and self-discipline.
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Ndlovu, Keeleditse. "Perceptions of cataracts and cataract services of elderly persons in Mathangwane, Botswana." Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/26621.
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Background: Cataract is the leading cause of blindness globally. In Botswana about 60% of blindness is due to cataract. Health services in Botswana are free, as are cataract services. Despite the free health services offered, the Batswana do not fully utilize the available eye care services especially the cataract services. Many Batswana access health care in public hospitals, where patients may have to wait for long periods for clinic appointments and surgery. Research question: What are the perceptions that elderly persons in Mathangwane village in Botswana, have of cataracts and cataracts services? Aim: To explore and describe the perceptions of elderly persons in Mathangwane about cataracts and cataract services. Objectives: 1. Explore and describe elderly persons' perceptions of cataracts; 2. Explore and describe elderly persons' perceptions of cataract services; 3. Explore reasons for use and non-use of current cataract services. Methods: Qualitative exploratory descriptive methods were used. A qualitative study design with purposeful sampling was used to identify participants for interviews and focus group discussion. Semi-structured interviews with seven participants aged sixty-five years and older with diagnosed cataract as well as a focus group with six of the seven participants were conducted. Data was analysed using a content analysis approach. Results: Five themes emerged from the interviews and a focus group discussion: i. Cataract as the 'spider web'; ii. Curing cataract with traditional herbs; iii. Cataract a problem of the elderly caused by modem food; iv. The burden of cataract blindness: 'mealie on the fire'; v. The ambivalent voice of elderly persons about cataract services. Conclusion: Findings from this study show that the participants had a general understanding of what cataract is and they had a particular description for this. Both positive and negative feelings were expressed in relation to the services available. Although cataract surgery was perceived to restore vision a major concern of the elderly persons was in relation to delays they experienced while waiting for the cataract to fully mature. Despite the free services offered at community level there is a great need for affordable and accessible transportation services for elderly persons utilising the cataract services.
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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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Macmillan, Maureen S. "Autonomy shown in life histories of elderly people and a nursing response." Thesis, University of Edinburgh, 1986. http://hdl.handle.net/1842/19086.
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Tolson, Deborah. "An investigation of the nursing care of hearing-impaired elderly hospital residents." Thesis, Glasgow Caledonian University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261522.
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Niyungeko, Paul. "Reducing Fall Recurrence in Institutionalized Elderly Residents on Narcotics." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7415.
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Falls constitute a health care safety concern, specifically among the geriatric population institutionalized in health care facilities. From the pattern of observed falls at the project site, a discrepancy between fall prevention measures and expected outcomes was noted. Knowledge deficiency, inadequate practice skills, and insufficient organizational support were found to be the major obstacles to improving fall prevention. The purpose of this systematic literature review project was to identify evidence-based actions to reduce falls. The project was guided by Taylor's personality theory and Watson's theory of care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used to evaluate and analyze 4 of the 47 screened publications. The evidence supported 5 interventions: furthering implementation facilitators, removing barriers, improving strategies, integrating personality, and using a fall risk assessment tool. The systematic review addressed practice gaps, organizational support, and barriers to curb recurrent falls. By contributing to the improvement of individual and population health, the project might lead to a positive socioeconomic change by reducing falls and their complications.
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Mackel, Cindy Lee 1954. "Alcohol assessment in the elderly: Evaluation of an instrument." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/291449.
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Currently 12% of the U.S. population is over the age of 65, and by the year 2030 this number is projected to be 25% (U.S. Senate Special Committee on Aging (SSCA), 1990). It is estimated that 37% of people over age 55 have an alcohol or substance abuse problem (Subcommittee on Health and Long-Term Care (SHLTC), 1992). Failure to recognize the elderly alcoholic results in delayed treatment and as a result, the older drinker suffers adverse effects related to the disease (Metzger & O'Brien, 1990). Extant tools for detecting alcoholism have been developed and used in younger populations, however there is a lack of information about the use of these tools in older populations (Graham, 1986). This study examined differences between two different age groups of known alcoholics using an established instrument, the Alcohol Use Inventory (Horn, Wanberg, & Foster, 1986).
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Shukri, Ali Hassan, and Angela Phung. "NURSES' EXPERIENCES OF GIVING PALLIATIVE CARE TO ELDERLY PEOPLE IN NURSING HOMES." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25886.
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SJUKSKÖTERSKORS ERFARENHETER AV ATT GE PALLIATIV VÅRD TILL ÄLDRE PERSONER PÅ ÄLDREBOENDE EN LITTERATURSTUDIEALI HASSAN SHUKRI PHUNG ANGELAAli Hassan, S & Phung, A. Sjuksköterskors erfarenheter av att ge palliativ vård till äldre personer på äldreboende. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2019.ABSTRAKTBakgrund: Antalet äldre individer över 65 år som tillbringar livets sista tid på äldreboende ökar och därmed ökar behovet av palliativ vård, och det ställs höga krav på att sjuksköterskor har god kunskap och kompetens att tillhandahålla en palliativ vård av hög kvalitet. Det finns många faktorer som kan påverka sjuksköterskors arbete med äldre palliativa patienter och det är av vikt att belysa dessa utifrån sjuksköterskors erfarenheter för att få ökad kunskap om vilka de är. Syfte: Syftet med litteraturstudien var att undersöka sjuksköterskors upplevelser av att ge palliativ vård till äldre individer som bor på äldreboende.Metod: En litteraturstudie med tio vetenskapliga studier med kvalitativ studiedesign har använts för att sammanställa studiens resultat. Databaserna CINAHL, PubMed och PsycINFO användes för datainsamling. De utvalda studierna kvalitetsgranskades med hjälp av SBU:s granskningsmall för kvalitativa studier. Analysen gjordes utifrån kvalitativ innehållsanalys enligt Graneheim & Lundmans metod. Resultat: Resultatet presenterades utifrån fyra teman; Patienten i fokus, Sjuksköterskans roll, Organisatoriska barriärer och Känslomässiga upplevelser. Dessa teman i sin tur skapade fram sju underteman; Symtomlindring, Anhöriga, Undervisning, Samordning, Resurser, Samverkan i team och Kunskapsbehov. Konklusion: Sjuksköterskorna upplevde att det var en stor utmaning att ge palliativ vård till äldre personer på äldreboende på grund av många olika barriärer såsom emotionella situationer, anhörigas involvering, och verksamhetens resurser. Dessa barriärer försvårade sjuksköterskornas möjligheter att tillhandahålla en högkvalitativ palliativ vård till de äldre.Nyckelord: Boendeformer för äldre, Erfarenheter, Kommunal vård, Livets slutskede, Palliativ vård, Sjuksköterskor, Äldreboende.NURSES’ EXPERIENCES OF GIVING PALLIATIVE CARE TO ELDERLY PEOPLE IN NURSING HOMESA LITERATURE REVIEWALI HASSAN SHUKRI PHUNG ANGELAAli Hassan, S & Phung, A. Nurses’ experiences of giving palliative care to older people in nursing homes. A literature review. Degree Project in nursing 15 credits. Malmö University: Faculty of Health and Society, Department of Care Science, 2019.Background: The number of elderly persons who are over 65 years old that spend their last time in nursing homes is increasing, which means the need of palliative care is also increasing. High demands are placed on the nurse having good knowledge and skills to provide high quality palliative care. There are many factors that can affect the nurses’ work with older palliative patients. Caring for dying patients can evoke strong feelings for nursing staffs. Therefore, it is important to examine these experiences from nurse’s perspective so that newly gradated nurses can get more understanding for palliative care. Aim: The aim of this literature review was to examine nurses’ experiences of giving palliative care for elderly people in nursing homes. Method: A literature review with ten empiric studies with qualitative approach was used to compile the study’s results. Databases such as CINAHL, PubMed and PsycINFO was used for collection of data. The quality of selected studies were examined by using SBU:s review template for qualitative studies. The content of these studies were analysed by qualitative content analysis according to Graneheim & Lundman’s method. Results: The results were presented from four themes; Patient in focus, The nurse’s role, Organisational barriers and Emotional experiences. These themes in turn created seven sub-themes; Symptom relief, Relatives, Teaching, Coordination, Recourses, Team collaboration and Knowledge needs. Conclusion: The nurses felt that palliative care for elderly persons was a challenge because many different barriers such as emotional situations, family involvement and recourses were involved, and that hindered their ability to provide high quality palliative care to elderly people.Keywords: End-of-life care, Experiences, Housing for the elderly, Municipal Care, Nurses, Nursing home, Palliative care.
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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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Larsson, Mauleon Annika. "Care for the elderly : a challenge in the anaesthesia context /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-209-8/.
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Fagerberg, Ingegerd. "Nursing students' narrated, lived experiences of caring, education and the transition into nursing, focusing on care of the elderly /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-2894-0/.
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Wallhagen, Margaret I. "Perceived control and adaptation in elderly caregivers /." Thesis, Connect to this title online; UW restricted, 1988. http://hdl.handle.net/1773/7194.
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Grujic, Danko, and Alan Silva. "Omvårdnadsproblem relaterade till polyfarmaci hos äldre." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2202.
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Bakgrund: Utvecklingen av olika läkemedel och behandlingar har tillfört bättre behandlingsmöjligheter för äldre som har lett till ett längre liv. Eftersom äldre lider ofta av olika sjukdomar konsumerar de flera läkemedel än andra åldersgrupper. Samtidigt, kan förekomst av olika läkemedelsbehandlingar, som definieras som polyfarmaci, medföra en ökad risk för negativa effekter som kan påverka patientens välbefinnande och livskvalitet. Det är därför viktigt att belysa vilka omvårdnadsproblem som kan uppstå i samband med polyfarmaci. Genom identifiering av omvårdnadsproblem kan sjuksköterskan sedan prioritera och leda omvårdnadsåtgärder som gynnar den äldres trygghet och välbefinnande. Syfte: Att belysa omvårdnadsproblem relaterade till polyfarmaci hos äldre. Metod: Arbetet har utförts som en litteraturöversikt. Innehållet anskaffades genom sammanställning av tillgängliga studier inom det valda problemområdet. Valt material omfattar artiklar skrivna på engelska och inkluderar personer i åldersgruppen 65 år eller äldre som behandlas med polyfarmaci. Resultat: Resultatet baseras på 12 granskade artiklar som belyser omvårdnadsproblem i samband med polyfarmaci. Framträdande omvårdnadsproblem i denna litteraturöversikt inbegriper risk för fall, malnutrition, funktionsnedsättning, förvirring och bristande följsamhet. Diskussion: Sambandet mellan polyfarmaci och omvårdnadsproblem kan vara komplicerat att fastställa. Svårigheten beror på att polyfarmaci saknar en entydig definition. Dessutom ses polyfarmaci i många fall endast som en riskfaktor i mängden, snarare än unik orsak till olika problem.Background: The development of various medicines and treatments has resulted in better treatment for the elderly that has led to a longer life. Because the elderly often suffer from various diseases, they consume more drugs than other age groups. At the same time, the presence of different drug therapies, defined as polypharmacy, increases the risk of adverse effects that can affect the patient's well-being and quality of life. It is therefore important to illuminate the nursing problems that may arise associated with polypharmacy. Through the identification of these problems, the nurse can be able to prioritize and manage nursing actions that benefit the elderly security and wellbeing. Aim: Illuminate nursing problems related to polypharmacy in the elderly. Methods: This paper has been carried out as a literature review. The content acquired through the compilation of available studies in the chosen problem area. The choice of material included articles written in english and included people aged 65 years and older treated with polypharmacy. Results: The result is based on 12 reviewed articles that illustrate associations between polypharmacy and nursing problems. Nursing problems that have emerged in this study include risk of falls, malnutrition, function disability, confusion and lack of adherence. Discussion: The relationship between polypharmacy and nursing problems can be complicated to determine. The difficulty is due to the fact that polypharmacy lacks a clear definition. In addition, polypharmacy is seen in many cases only as a risk factor in the crowd, rather than a unique cause of various problems.
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Rose, Susan S. "Catastrophic injury and illness in the elderly." Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/289909.
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This study examined characteristics of elderly veterans who had suffered disability subsequent to catastrophic injury or illness, identified variables common to those who maintained rehabilitative gains, and developed a theoretical model that may be useful for description and explanation of the experience. The results of six preliminary studies laid the foundation for the theoretical model contained in the study. The Geriatric Rehabilitation Intervention Program (GRIP) was developed from themes gathered from a grounded theory study of elders who had recently suffered catastrophic disability. Targeted toward assisting elders with the transition to the community after discharge from geriatric rehabilitation, GRIP includes components of Adjusting to Disability, Coping with Loss, Life after Rehabilitation, and Maintaining Motivation. Those patients that participated in GRIP had significantly greater improvement in functional status, health-related quality of life (HRQOL), and self-efficacy. Qualitative and quantitative data were triangulated to form latent variables to reflect the nature of the experience from the perspective of the patient. The latent variable model demonstrated appropriate fit with this data set; however a confirmatory study is needed. Predictors of rehabilitative gain are desired by stakeholders in an effort to maximize rehabilitative programs and control health care costs. The confidence with which patients were able to manage the symptoms secondary to their catastrophic injury or illness was identified as a predictor of functional gain. This area provides a target for which to aim nursing interventions. In addition, the ability to plan for survival and information gained from the GRIP program were identified as predictors of increased general health one month after discharge to the community. This study explored client, intervention, and context characteristics of catastrophic disability in the elderly. Personal and social factors not yet identified in the literature were examined for their influence on rehabilitative outcomes and a theoretical model was developed. Further research is needed to refine and test the model.
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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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Nelson, Mira Kirk. "Relationship of home health nurses' attitudes toward the elderly and nursing care effectiveness /." Access abstract and link to full text, 1985. http://0-wwwlib.umi.com.library.utulsa.edu/dissertations/fullcit/8510837.
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Li, Chi-ho, and 李志浩. "Determinants of quality of life: the perception of the elderly in nursing homes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31250889.
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Burfield, Allison. "Cohort Study of Pain Behaviors in the Elderly Residing in Skilled Nursing Care." Doctoral diss., University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2716.
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An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact versus cognitively-impaired residents; 2) Can a theoretically derived model of pain aid in detecting pain across all cognitive levels; and 3) Do pain and cognitive status concomitantly correlate? The goal was to examine the covariance model of concomitance of pain and cognition to more accurately construct theoretical models of pain to then include additional resident care factors in future research. Traditional self-reports of pain are often under-assessed and under-treated in the cognitively-impaired (CI) elderly resident. Having additional measures to detect pain beyond self-reports of pain intensity and frequency increases the likelihood of detecting pain in populations with complex symptom presentation. Data collected from skilled nursing facilities offer exceptional opportunities to study resident demographics, characteristics, symptoms, medication use, quality indicators, and care outcomes. The Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0, a nationally required resident assessment tool, must be completed on every resident in a Medicare LTC facility within 14 days of admission, quarterly, annually and with significant changes in resident status. Because the MDS is widely used and recognized in LTC settings, core items from MDS [i.e., pain frequency (J2a) and pain intensity (J2b)] along with additional MDS items hypothesized to signify pain were analyzed in the pilot measurement model. Ten core items from MDS were used: 1) Inappropriate behavior frequency (E4da); 2) Repetitive physical movements; 3) Repetitive verbalizations (E1c); 4) Sad facial expressions (E1l); 5) Crying (E1m); 6) Change in mood (E3); 7) Negative statements (E1a); 8) Pain frequency (J2a); 9) Pain intensity (J2b); and 10) Cumulative pain sites scores. All indicators of pain were significant at the p<.01 level. A longitudinal cohort design was used to answer if a concomitance exists between pain and cognition. Data were collected from MDS annual assessments from 2001, 2002 and 2003 for residents across the United States. The sample consisted of 56,494 residents age 65 years and older with an average age of 83 [plus or minus] 8.2 years. Descriptive statistics, ANOVA and a covariance model were used to evaluate cognition and pain at the three time intervals. ANOVA indicated a significant effect (p<.01) for pain and cognition with protected t-tests indicating scores decreased significantly over time with resident measures of pain and cognition. Results from this study suggest that: 1) Using only pain intensity and frequency, pain prevalence was found in 30% of the pilot population, while 47.7% of cognitively intact residents had documented pain and only 18.2% of the severely CI had documented pain, supporting previous research that pain is potentially under-reported in the CI; 2) Parsimonious measurements models of pain should include dimensions beyond self-reports of pain (i.e., cognitive, affective, behavioral and inferred pain indicators); 3) Model fit was improved by using specific MDS items in the pain construct; 4) Longitudinal analysis revealed relative stability for pain and cognition measures over time (e.g., larger stability or consistency was found in cognitive measures than the measures of pain over the three-year period); 5) Crossed-legged effects between pain and cognition were not consistent; 6) A concomitant relationship was not found between pain and cognition. The relationship was significant (p<.01), but associations were weak (r=0.03 to 0. 08). Pain or cognition should not be used as a predictor of the other in theoretical models for similar populations. The MDS is a reliable instrument to follow resident attributes, quality of care, and patient outcomes over time. The development of more accurate assessments of pain may improve resident care outcomes. Ineffectively intervening on the pain cycle is posited to cause secondary unmet needs that affect the resident's quality of life. Findings support the importance of improving clinical outcomes in the management of pain in the elderly residing in long-term care. Deficits in the treatment of pain highlight the impetus to support health policy change that includes pain treatment as a top health priority and a quality indicator for federally funded programs supporting eldercare.Ph.D.
School of Nursing
Other
Nursing PhD
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Wu, Shu-Chen. "Nursing home care for elderly people in Taiwan : a process of forced choice." Thesis, Leeds Beckett University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423858.
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Kennedy, A. P. "Problems in the nursing management of elderly patients with long-term indwelling catheters." Thesis, University of Manchester, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.370950.
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Anderson, Margaret Joan. "Case studies in the nursing management of urinary incontinence in confused, elderly patients." Thesis, University of Edinburgh, 1991. http://hdl.handle.net/1842/19693.
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The nursing care of the confused, elderly patient suffering from urinary incontinence (UI) is poorly understood. The objectives of a study to examine the complex relationships between patient characteristics, the social and physical environment and the organisation of nursing care were to: (i) explore the ways in which nursing staff approached the problem of UI in the confused, elderly patient; (ii) examine the effect of the organisation of care on the management of UI; and (iii) examine the application of principles derived from behavioural psychology to nursing practice. As the issues are complex, an extensive review of literature in four fields was undertaken. Biomedical explanations of UI and the nature of the dementing illnesses were examined and it was concluded that evidence of an environmental component in UI was probable. Models derived from behavioural psychology were found to be inadequate to understand behavioural problems associated with a dementing illness. A contextual-dialectic framework was proposed which provided also the rationale for the study design and research methods. A combination of action-science research using case studies and single case experimental studies provided the best means of exploring the issues and was consistent with evolving thinking in nursing in which the role of the nurse is to facilitate the interaction between person and environment. Two main propositions stated that (i) under the conditions of a routine geriatric model of nursing care, the level of UI in a ward would be high and (ii) under the conditions of an intervention model in which the nurse sought to manage the interaction between person and environment, levels of UI would be reduced. Comparisons from preliminary studies in two psychogeriatric wards and one residential home provided insights that were applied in two main studies. By using the concept of accident to categorise UI as fundamental, predisposing and precipitating factors, two frames of reference, the biological and the social, were linked. Staff were encouraged to reframe the problem of UI through this perspective and to assist in the development and testing of nursing interventions. In a residential home, the legibility of the environment was improved by the use of signposts as recommended by the Department of Health, on the assumption that this would reduce episodes of UI by making toilets easier to locate. Rapid and marked improvement was shown in one of four cases over a period of four weeks following a programme of guided orientation. In a psychogeriatric ward, systematic and sustained interactions between nurse and patient was improved when the organisation of nursing was altered to limit the number of nurses caring for a small group of elderly, incontinent men. Systematic and sustained interaction was improved by alterations in the arrangement of furniture and facilitated prompted voiding. The findings showed a reduction in UI of one third of the baseline figure and an increased appropriate use of the toilet. It was concluded that, to be effective, an intervention like prompted voiding requires a shift from a routine, geriatric model of care to an interventionist model inherent in a process of systematic nursing organised in an integrated code of primary nursing practice. Although nurses are exhorted to adopt a patient-centred and individualised approach to patient care, in practice a powerful conflict exists in caring for an individual in a collective and congregate setting that can be countered only by overt strategies. It was concluded that, while alterations in the environment were necessary, these were insufficient alone to affect UI in the confused, elderly patient and that the active presence of a nurse was required. Recommendations for nursing management, education, practice and research are made.
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Li, Chi-ho. "Determinants of quality of life : the perception of the elderly in nursing homes /." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22331554.
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King, Peter Lloyd. "A Dental Health Education Program For Caregivers Of Elderly People In Nursing Homes." Thesis, The University of Sydney, 1992. http://hdl.handle.net/2123/4745.
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