Дисертації з теми "Nursing home care Victoria"
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Buckley, Patricia Louise, and pbuckley@swin edu au. "'A sense of place' : the role of the building in the organisation culture of nursing homes." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20060317.114711.
Повний текст джерелаSaxer, Susanne. "Urinary incontinence in nursing home care." [Maastricht] : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=13767.
Повний текст джерелаNelson, Ian M. "Predictors of Nursing Home Placement for Home Care Consumers." Miami University / OhioLINK, 2004. http://rave.ohiolink.edu/etdc/view?acc_num=miami1073924945.
Повний текст джерелаBaker, Kay Stouffer. "Home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276586.
Повний текст джерелаBostick, Jane E. "The relationship of nursing personnel and nursing home care quality." MU has:, 2002. http://wwwlib.umi.com/cr/mo/fullcit?3052150.
Повний текст джерелаHarker, Jeanne M. "Planning for the future in home care nursing." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ59501.pdf.
Повний текст джерелаYates-Bolton, N. J. "Meaning and purpose in care home (nursing) life." Thesis, University of Salford, 2017. http://usir.salford.ac.uk/42545/.
Повний текст джерелаLee, Hyang Yuol. "Quality of care: Impact of nursing home characteristics." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3352465.
Повний текст джерелаSource: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2206. Advisers: Mary A. Blegen; Charlene A. Harrington. Includes supplementary digital materials.
Kihlgren, Annica. "Older patients in transition : from home care towards emergency care /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-271-3/.
Повний текст джерелаKaye, Debra Anne. "Women's perceptions of telephone nursing care within an antenatal home care program." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/26308.
Повний текст джерелаPeltz, Claudia. "Facility design & planning to improve nurses' effectiveness in administering care to fulltime residents of nursing homes." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/436.
Повний текст джерелаCook, Glenda. "Life as a care home resident in later years : "living with care" or "existing in care"." Thesis, Northumbria University, 2007. http://nrl.northumbria.ac.uk/533/.
Повний текст джерелаDamberg, Jonas. "Availability of primary care physicians in nursing homes and home care nursing services and associations with emergency care consumption." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-61585.
Повний текст джерелаFree, Corinne. "Direct Assessment of Quality of Care in a Memory-Care Residential Setting: A Systematic Replication." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1404514/.
Повний текст джерелаNakrem, Sigrid. "Measuring quality of care in nursing home - what matters?" Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for samfunnsmedisin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-14729.
Повний текст джерелаSykehjem er en helsetjeneste som vil være nødvendig for eldre som ikke føler seg trygge eller kan få tilstrekkelig behandling, pleie og omsorg i eget hjem. Antall eldre over 65 år er økende i Norge, noe som innebærer et økt press på sykehjem i framtiden. Det er derfor av stor betydning at sykehjemstjenesten utvikles med tanke på å skape best mulig nytteverdi ut fra behov. Sykehjemmene har utviklet seg de siste 50 årene fra hovedsakelig et botilbud til helseinstitusjoner som gir avansert helsehjelp. Sykehjemsbeboere er skrøpelige eldre med komplekse problemstillinger, avhengig av avansert sykepleie. Kvalitetsindikatorer er kvantitative mål som reflekterer en profesjonell standard for pleie og omsorg, og slike mål benyttes i økende grad for å vurdere kvalitet i sykehjem. Imidlertid er det nødvendig å inkludere det som har størst betydning for sykehjemsbeboere i slike mål for å kunne gi god pasientsentrert sykepleie. Hovedmålsettingen med studien var å bidra til en dypere forståelse av sykehjemskvalitet, ut fra helsepersonellets, beboernes og pårørendes ståsted. Avhandlingen omfatter en oversikt over kvalitetsindikatorer som er i bruk internasjonalt. Videre beskriver avhandlingen beboernes erfaringer med mellommenneskelige faktorer ved sykehjemskvalitet, samt hvordan de erfarer å bo i et sykehjem og opplever kvaliteten på “hjemmet” sitt. I avhandlingen blir også pårørendes forståelse av og meninger om sykehjemskvalitet utforsket. Avhandlingen er basert på dybdeintervju av beboere ved fire ulike sykehjem, og fokusgruppeintervjuer med pårørende ved to av sykehjemmene. Funnene viser at kvalitet på pleie og omsorg i sykehjem omfatter minst fire hovedområder: Bokvalitet, personellkvalitet, helsetjenestekvalitet og sosial kvalitet. Videre er pleie- og omsorgskvaliteten påvirket av en rekke eksterne faktorer som nasjonale føringer, lovverk, ledelsesstruktur, bygningskonstruksjon og lokale forhold. Den internasjonale oversikten over kvalitetsindikatorer gir indikasjoner på at noen av dem kan brukes som pålitelige og gyldige evalueringer av kvaliteten på pleie og omsorg, samt helserelaterte resultater for beboerne. I den kvalitative intervjuundersøkelsen med beboere og pårørende, ble fysisk og psykisk velvære, mellommenneskelige forhold og det sosiale miljøet tillagt større betydning for kvaliteten. Objektive indikatorer for disse beboererfarte områdene for kvalitet må utvikles. For å sikre at disse er pasientsentrerte, bør utviklingen av kvalitetsindikatorer gjøres i tett samarbeid med sykehjemsbeboerne og pårørende, i tillegg til helsepersonell.
Chien, Hui-Wen. "Understanding the Nursing Home Care Processor: An Ethnographic Study." University of Sydney, 2009. http://hdl.handle.net/2123/6389.
Повний текст джерелаAim and significance: The aim of this research was to explore the phenomenon of Australian nursing home care from the perspective of those who provide and receive it. Its focus is on the processes of ‘quality care’ provision and the meanings and evaluations that care providers attach to their work. In other words, its purpose was to shed light on the practices based on a conceptualisation of care that is entwined with the mechanisms of ‘care’ production and identity creation, or what actually happens in the daily life of the complex social phenomenon that is a nursing home. A related aim was to add to understandings of clinical nursing competence and develop tools that will assist nurses to conceptualise and implement positive change in this setting. Background: The provision of care to our elderly has become a major concern with the ageing of the world population. This is occurring in the context of decline in the capacity of families to take on the responsibility of elder care, and of increasing commercialisation of medical care. Governments have responded by shifting their responsibilities from direct care provision to become auditors of the business of care provision that is supported by public funding. However poor care delivery has largely been hidden from the public gaze. Governments present themselves as having systems in place, creating the illusion of rational control; in reality, like the market economy, there is a ‘black box’ of unknown factors driven by human impulse. The aim of this study was to open up the black box of ‘quality care’ to direct observation, drawing insights from the literature on organisational culture and with a focus on the frontline worker and the construct of quality assurance. Specific research objectives were to: • Document the beliefs and attitudes of care providers towards elderly people in general and the needs of nursing home residents in particular • Elicit the range of meanings and evaluations that care providers attach to their work • Describe their constructions of ‘care’ and ‘quality of care’ and the organisational factors they believe to impact (positively and negatively) on their ability to provide it. • Through in-depth understanding of a particular setting, generate grounded theoretical insights into the phenomenon of quality of residential care that are more widely applicable Method: The study adopted a paradigmatic bricoleur approach, seeking to develop connections between a diverse range of methodologies. These included combinative ethnography, phenomenology, hermeneutics and traditional grounded theory. Conceptual insights were drawn from organisational studies, psychosocial nursing and coping theory. The research site was an Australian for-profit suburban nursing home. The student investigator conducted more than 500 hours of participant observation, recording extensive field notes which were analysed through the perspective of a hermeneutic middle way horizon that directed an augmented constant comparison traditional grounded theory approach. Additional data were collected through formal indepth interviews with six key stakeholders. Interviews were tape recorded, transcribed in full and analysed to reveal themes that were brought within a hermeneutic circle that spiralled recursively from the whole to the part and back to the whole. Findings: Eight key interrelated factors in the production of care within the nursing home were identified: internal and external accountability (the accreditation system); economic considerations; management and training; advocacy; characteristic of residents; care providers’ working conditions and environmental stressors; organisational culture; and the work/care styles of individual care providers. I have categorised the latter into two main types: ‘tortoises’ and ‘hares’. This typology is then used to generate a process-driven schematic diagram that tracks a hypothetical novice care provider through the process of learning how to produce ‘care’. Specifically, I found that nursing home ‘care’ is the outcome of a complex social process involving the interplay between resident, relative, care provider, proprietor, quality assessors and government within the phenomenon of the nursing home. Such care, indeed the phenomenon of the nursing home itself, is not a stable, controllable entity but is in a constant state of flux – what I refer to as a moral ecology. In their everyday practice, care providers devise a construction of ‘quality care’ that is more clearly grounded in their own worldviews and the development of the own identity than in the formal quality assurance system of standards, guidelines and evaluations. Conclusion: Understanding the ‘black box’ of processes that produce care is the key to identifying courses of action that will improve care outcomes. The study findings also question the validity, assumptions and significance of the accreditation system, which only identifies some of the component variables, disregarding both the complexity within the ‘black box’ and failing to acknowledge that the quality of care outcomes is overwhelmingly dependent on individual care providers.
Huizing, Anna Rensche. "Towards restraint-free care for psychogeriatric nursing home residents." Maastricht : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=10682.
Повний текст джерелаBell, Mary Ann 1953. "Perceptions of quality of care in the nursing home." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/291785.
Повний текст джерелаRiggs, Jennifer Sue. "The Influence of Home Care Nursing Visit Pattern on Heart Failure Patient Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244663522.
Повний текст джерелаDillman, Jennifer L. "Geographic Distance, Contact, and Family Perceptions of Quality Nursing Home Care." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc28412/.
Повний текст джерелаMathew, Rachael. "Adelaide dentists' involvement in dental care for nursing home residents /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09SDN/09sdnm4821.pdf.
Повний текст джерелаWANG, CHENG-CHING. "PSYCHOMETRIC PROPERTIES OF THE PERCEIVED NURSING HOME CARE NEEDS INSTRUMENT." University of Cincinnati / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1155200851.
Повний текст джерелаTraskos, Andrea M. "Death in the Nursing Home: Impact on Direct Care Staff." Bowling Green State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1435671865.
Повний текст джерелаOgawa, Keiko. "Workload of Home Health Care Nurses in Japan." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1207180785.
Повний текст джерелаLee-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.
Повний текст джерелаÖresland, Stina. "Nurses go visiting : ethics and gender in home-based nursing care." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-43796.
Повний текст джерелаWright, Pamela Leshel. "Development of a Home Health Transitional Care Program for Elderly Heart Failure." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/613.
Повний текст джерелаHays, Bevely J. "Relationships among nursing care requirements, selected patient factors, selected nurse factors, and nursing resource consumption in home health care." Case Western Reserve University School of Graduate Studies / OhioLINK, 1990. http://rave.ohiolink.edu/etdc/view?acc_num=case1054924269.
Повний текст джерелаDavy, Julia. "PATIENT'S EDUCATION IN A HOME CARE: STRATEGIES FOR SUCCESS." Thesis, Ternopil, 2021. https://repository.tdmu.edu.ua//handle/123456789/17192.
Повний текст джерелаKim, So-Yun. "The effect of long-term care insurance on the first nursing home entry and home care use using duration analysis /." Columbus, Ohio : Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1242907491.
Повний текст джерелаBonifas, Robin P. "Multi-level factors related to deficiencies in psychological care in Washington State skilled nursing facilities /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/8139.
Повний текст джерелаThomas, Cynthia M. "Issues of concern for directors of nursing in long term care." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1154778.
Повний текст джерелаSchool of Nursing
Obioma, Chidiadi. "Improving the Quality of Nursing Documentation in Home Health Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3500.
Повний текст джерелаHopson, Christopher Paul. "Alternative Models of Nursing Home Care: A Study of the Impact of the Teaching Nursing Home Model on Staff Quality and the Quality of Resident Care." Diss., Temple University Libraries, 2009. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/47128.
Повний текст джерелаPh.D.
As the percentage of elderly adults within the U.S. continues to grow, long-term care options will increase. Facing increased competition from other forms of long-term care, many nursing homes are seeking innovative models to enhance management and clinical care practices. The Teaching Nursing Home model, first established in the 1970s, is one in which academic institutions partner with nursing homes to create information exchanges between the nursing home and the school. Currently, nursing schools throughout the country work with nursing homes to create clinical training sites for nursing students. The partnership is also used to encourage research among school faculty and to assist nursing homes in their management of best practices. This study examined the impact of these relationships on nursing home quality. Twenty teaching nursing homes were matched with twenty nursing homes that are not engaged in this practice. Using nursing home quality scores published by the Centers for Medicare and Medicaid Services, mean outcomes for the matched pairs were compared using T-tests. Regression analyses were also performed to test whether quality improves over time within a teaching nursing home. The results from the T-tests performed did not show overall quality differences between the matched pairs. However, when analyzed regionally, some significance was observed for teaching nursing homes in the Upstate NY region (p<0.1). The study discusses some of the differences in design of the teaching nursing homes within that region and the impact that may have on results. Time as a teaching nursing home did not appear to affect quality for nursing homes in this study. Possible explanations for these insignificant results are discussed in the Summary, Discussion and Limitations section of the study. Overall, the findings from this study suggest that the Teaching Nursing Home model can add value to nursing homes by offering them research and professional training opportunities with academic institutions. Within the study, recommendations are made to further explore the impact of these partnerships on nursing home quality and to encourage the development and use of the model through policy changes.
Temple University--Theses
Storm, Palle. "Care work in a Swedish nursing home : gendered norms and expectations." Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-87327.
Повний текст джерелаThe book as a whole is attached in fulltext
Omsorg i omvandling
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.
Повний текст джерелаBaah, Juliana. "Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4589.
Повний текст джерелаHenderson, Jo-Anne. "A grounded theory study, nursing aides learning to care for nursing home residents with dementia." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0024/MQ62129.pdf.
Повний текст джерелаMyers, 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.
Повний текст джерелаLindabury, Jennifer Kate. "Nursing Home Use Expectations: The Influence of Family Structure." Oxford, Ohio : Miami University, 2010. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1272642887.
Повний текст джерелаMacleod-Downes, Leslie. "Gender-related vulnerability to sexually transmitted HIV infection in women home care workers." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/2957.
Повний текст джерелаThe purpose of this study was firstly to analyse the factors determining the vulnerability of women for sexually transmitted HIV. Secondly, to investigate if the measurement of the empowerment level of the participants could lead to programme adaptations to improve the efficacy of a training intervention. The intervention was an HIV training programme making use of enhancements. Effectiveness was measured in terms of raising the empowerment status while lowering the HIV risk.
Lansmon-Winter, Erin Cready Cynthia M. "Family perception of quality in nursing home care impact of gender, level of involvement, and utilization of empowered CNA teams /." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9069.
Повний текст джерелаMilberg, Anna. "Family members' experience of palliative home care /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med821s.pdf.
Повний текст джерелаMendes, Michele A. "Parents' descriptions of ideal home nursing care for their technology dependent child, themselves, and their families /." View online ; access limited to URI, 2004. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3135909.
Повний текст джерелаWhite, Mary Kathryn. "Certified nursing assistants' feelings of preparedness in caring for nursing home residents at the end of life." Laramie, Wyo. : University of Wyoming, 2007. http://proquest.umi.com/pqdweb?did=1445048331&sid=8&Fmt=2&clientId=18949&RQT=309&VName=PQD.
Повний текст джерелаWälivaara, Britt-Marie. "Mobile distance-spanning technology in home care : views and reasoning among persons in need of health care and general practitioners." Licentiate thesis, Luleå tekniska universitet, Omvårdnad, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-26437.
Повний текст джерелаGodkänd; 2009; 20091021 (brival); LICENTIATSEMINARIUM Ämnesområde: Omvårdnad Examinator: Professor Siv Söderberg Extern opponent: Professor Kenneth Asplund, Mittuniversitetet, Sundsvall Tid: Fredag den 20 november 2009, klockan 13.00 Plats: Sal E246, Luleå tekniska universitet
Al, Chami Mohamad Hamze. "Economization of Home Care in Ontario: A Critical Ethnography of Nursing Actions." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42670.
Повний текст джерелаMaGee-Rodgers, Tamiko R. "Character Strengths of Nursing Home Administrators Who Lead Exemplary Long-Term Care." Thesis, Indiana Wesleyan University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930255.
Повний текст джерелаThe growth in the older adult population will result in an increasing number of individuals with functional and cognitive limitations. The demand for nursing home administrators will grow proportionately with the aging population and the need for effective leadership within nursing homes is and will continue to be imperative as the population ages. Identifying top-rated nursing homes that provide quality care is essential to understanding the operations of successful long-term care facilities. Nursing home administrators (NHAs) are tasked with leading and directing provision of skilled, intermediate and rehabilitation care on a 24-hour basis while ensuring high quality operations. Identifying the character strengths of nursing home administrators who lead exemplary nursing homes may benefit other nursing home leaders who lead lower rated or underperforming facilities. In this qualitative study, 19 nursing home administrators who lead exemplary facilities across Indiana completed the Value in Action Inventory Strengths (VIA-IS) questionnaire and engaged in face-to-face interviews. Analysis of the interview data via NVivo indicated how the use of character strengths is crucial to effective leadership within long-term care. Creativity, fairness, bravery, perspective, and judgment were identified by a majority of study participants as essential to decisionmaking and problem solving, especially in a heavily regulated environment. Humor, hope, courage, and spirituality were acknowledged as contributing to a positive and optimistic environment. Humor, hope, courage, and spirituality were also noted as coping mechanisms when faced with stress and adversity. Honesty, kindness, love, teamwork, and gratitude were emphasized by the study participants as essential to relationship development and formation of trust with staff, residents, and families. This study allowed participants the opportunity to reflect on their own character strengths and leadership both personally and professionally. This reflection resulted in increased self-awareness and appreciation of their staff, residents, and roles as nursing home administrators.
Ai-Cheng, Li, and 李愛誠. "Quality of Care in Home Care and Nursing Home." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/12111248590566418717.
Повний текст джерела亞洲大學
健康產業管理學系長期照護組
99
Objective: The problem of long-term healthcare for a disabled and aging population has gradually become a point of concern in many countries. Improvement of the quality of long-term healthcare is a topic that requires urgent focus. Thus, this study used the National Health Insurance (NHI) Claim Database to investigate differences in quality of care with regard to home care and nursing home services. Methods: This study obtained data on 2006 inpatient and outpatient medical claims from the data of one million people in 2005 Health Insurance Database. A sample of 1,564 users of home care and nursing home services was taken. This study then investigated the difference in quality indicators of healthcare, drug use, and healthcare utilization among these users within a two-year period. Results: Observation of users of home care services showed the following statistics: 4.5 % sought medical care due to depressive illnesses in the first year; 49.8 % sought medical care due to urinary tract infection (UTI) in the second year; 4.6 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 34.Observation of users of nursing home services showed the following statistics: 9.6 % sought medical care due to depressive illnesses in the first year; 62.1 % sought medical care due to urinary tract infection (UTI) in the second year; 4.2 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 49. The differences among users of home care services and users of nursing home services reached statistical significance. After other variables had been controlled, logistic regression analysis showed that the probability of depression (first year) and UTI (second year) among users of nursing home services was 2.62 and 1.54 times that of users of home care services, respectively. Conclusion: Although NHI in Taiwan affords a similar degree of disability benefits to users of home care services and nursing home services, the quality of the two service models differs. Related medical referral units and service providers should plan health education and guidance, and improve index management and care processes as soon as possible, to enhance the quality of healthcare services.
Toles, Mark Pettiss. "Transitional Care in a Nursing Home." Diss., 2011. http://hdl.handle.net/10161/3827.
Повний текст джерелаBackground: Each year, 2 million older Americans complete three to four week courses of post-acute care in nursing homes and return home; however, scant research describes services to protect older adults during their transitions from nursing homes to home. In hospital-based studies, transitional care interventions were associated with improved health outcomes for older adults, but these interventions added new staff positions, which are likely cost-prohibitive in nursing homes. Further, no prior study explored transitional care provided for vulnerable, post-acute care patients in nursing homes. Thus, this dissertation was designed to develop new understandings about transitional care provided by existing staff members in nursing homes. The study has two specific aims: (a) describe transitional care and outcomes for older adults who obtain post-acute care in nursing homes from the day of admission through discharge; (b) explore the influence of interactions, among selected older adult patients and their group of nursing home caregivers, on their ability to accomplish transitional care processes.
Method: Using data from a literature review and theoretical models, including Donabedian's Model of Healthcare Quality and Anderson's Local Interaction Model, a conceptual model of transitional care for post-acute care patients in nursing homes was constructed. The conceptual model was then used to guide exploration of the research aims with a longitudinal, multiple case study of transitional care in a nursing home. The unit of analysis was the patient care-team, defined as individual post-acute care patients, family caregivers, and 6 to 8 professional staff in each team (e.g., rehabilitation therapists, physicians, nurses and social workers). Three patient care-team members were purposively sampled for study. Moreover, longitudinal data were collected using repeated interviews and observations with patients, family caregivers, and staff; document and daily chart reviews; and surveys of patient preparedness for discharge. Manifest content analysis and thematic analysis (qualitative methods) were used to conduct within- and across-case analyses of trajectories of transitional care and to identify strengths, gaps and inconsistencies in care.
Results: Findings related to the first research aim include a description of transitional care in the study nursing home. Serious gaps and inconsistencies in transitional care exposed older, post-acute care patients to risks for complications in their transitions from the study nursing home to home: (a) systemic supports were not available to support nursing home staff who provided transitional care; further, nursing home staff and leadership were unaware that they provided transitional care; (b) care processes were not in place to prepare older adults and their caregivers to continue care at home; (c) care-team interactions often excluded family members; and (d) post-acute care patients left the nursing home without resources needed to support safe transitions in care, including transitional care plans, education to appropriately respond to acute changes in health, written materials to guide care at home, referrals for medical follow-up after discharge, and transfers of clinical information to primary care physicians.
Findings related to the second research aim include a description of local interaction strategies and the effectiveness of transitional care processes. When professional staff more consistently used local interaction strategies, specified in the model, care-team members exhibited greater capacity for connections, information exchange, and cognitive diversity. Further, when care-team interactions were of high quality and sufficient frequency, there were multiple indications of more effective transitional care, such as patient engagement in care, inclusion of patient priorities in care plans, and problem solving which included family members and diverse members of the patient care-team. Thus, local interaction strategies were essential staff behaviors needed to adapt care processes to the specific transitional care needs of individual patients.
Because transitional care is a grossly under-developed care process in nursing homes, these findings will likely have immediate implications for practice and research. Findings will provide nursing home administrators and staff with resources to develop and evaluate care in nursing homes; further, the findings will help to create targets for protocol and care process development to strengthen existing practice and address deficiencies. Findings will provide researchers with resources for studying transitional care in diverse samples of nursing homes, which should facilitate development of testable hypotheses for needed intervention studies. In addition, the local interaction strategies findings in the study may generalize to other settings of care, where interdependent staff work is required to establish connections, information networks, and to coordinate care among multiple staff members.
Dissertation