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Shannon, Sarah Elizabeth. "Caring for the critically-ill patient receiving life-sustaining therapy : combining descriptive and normative research in ethics /." Thesis, Connect to this title online; UW restricted, 1992. http://hdl.handle.net/1773/7329.
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Cloutier, Ardis. "The quality of life in Mark 2:1-12 and 5:25-34 and of persons on life-support systems." Theological Research Exchange Network (TREN), 1990. http://www.tren.com.
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Andrade, Joana Sofia Carvalho Casimiro de. "Suporte nutricional artificial em cuidados paliativos: questões éticas." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/7575.
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Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da NutriçãoOs Cuidados Paliativos são o cuidado ativo dos Doentes cuja doença não responde ao tratamento curativo. São cuidados que englobam uma abordagem holística e interdisciplinar, onde se tem em vista não só o Doente, mas também a sua família e a comunidade envolvida. O objetivo principal é preservar a melhor qualidade de vida e conforto até à morte. O Suporte Nutricional Artificial é um dos assuntos mais controversos nesta área do cuidar. O objetivo deste trabalho foi compreender e discutir as questões éticas relacionadas com o Suporte Nutricional Artificial em Cuidados Paliativos. Realizou-se uma revisão de literatura, sendo que os artigos analisados referem que a alimentação não tem apenas um significado fisiológico, mas apresenta também um valor simbólico, dado que afeta o estado psicológico e emocional, tendo em consideração as diferenças culturais e crenças espirituais. Quando o Suporte Nutricional Artificial é estabelecido em Cuidados Paliativos, o melhor interesse do Doente deve ser salvaguardado. Para alguns autores, o Suporte Nutricional Artificial é uma necessidade básica, e desde que o Doente deseje, este deve ser alimentado. Em contrapartida, outros autores consideram que o Suporte Nutricional Artificial corresponde a um tratamento e há determinadas circunstâncias em que é legítimo não iniciar, não manter ou parar a terapêutica. Os artigos referem também, quanto aos princípios bioéticos, que (1) a autonomia reconhece a autodeterminação de cada Doente na decisão de iniciar ou parar o Suporte Nutricional Artificial; (2) o princípio da beneficência diz respeito a que as ações sejam realizados de acordo com os melhores interesses do Doente; (3) o princípio da não-maleficência diz respeito a não fazer dano ao Doente ao iniciar o Suporte Nutricional Artificial e (4) a justiça remete para a importância de dar a cada Doente o mesmo número de possibilidades com os recursos disponíveis. Torna-se também crucial entender a diversidade cultural e religiosa de forma a integrar a Bioética na Nutrição.
Palliative Care is the active, total care of the patients whose disease is not responsive to curative treatment. PC is interdisciplinary in its approach and encompasses the patient, the family and the community in its scope. It sets out to preserve the best possible quality of life and comfort until death. Artificial Nutritional Support remains one of the most controversial issue in Palliative Care. The main purpose of this work was to understand and discuss the ethical questions related to the Artificial Nutritional Support in Palliative Care. This work was based on a literature review and the articles refer that food has not only a physiological meaning but also a symbolic value, affecting our psychological and emotional status, based on our cultural and spiritual believes. When Artificial Nutritional Support in Palliative Care is established, the best interest of the patient must be safeguarded. For some authors, Artificial Nutritional Support is a basic human care and, as long as the patient wants and can be fed, there is an obligation to provide such measure. To other authors it constitutes a medical treatment and there are circumstances in which it is legitimate for them not to start, maintain or stop. The articles also refer that: (1) the principle of autonomy recognizes patients self-determination to decide to start or stop Artificial Nutritional Support; (2) the principle of beneficence is related to the patients’ best interests; (3) the principle of non-maleficence regards doing no harm to patient by beginning Artificial Nutritional Support; and (4) regarding justice, there is the need to give every patients the same number of possibilities with the resources available. Understanding the cultural and religious diversity is necessary to integrate bioethics into nutrition.
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Hjelm, Teresia, and Wall Nils. "Att avsluta eller avstå livsuppehållande behandling : En litteraturstudie ur sjuksköterskans perspektiv." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2257.
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Bakgrund Sjukvårdspersonal får dagligen handskas med etiska överväganden och beslut. Ställningstagandet om när livsuppehållande behandling ska fortsätta eller avslutas är ett komplext beslut som kräver flera överväganden. Läkaren har det fulla ansvaret vid ställningstagandet om att avsluta livsuppehållande behandling. Sjuksköterskan besitter ofta viktig kunskap och kännedom om patientens behov, vilket kan bidra till beslutsprocessen med betydelsefull information. Syfte Syftet med litteraturstudien var att belysa sjuksköterskans upplevelse av delaktighet och kommunikation gällande det etiska ställningstagandet om att avsluta eller avstå från patientens livsuppehållande behandling. Metod Beskrivande litteraturöversikt av tio kvalitativa vetenskapliga artiklar. Resultat Analysen resulterade i två teman; delaktighet och kunskapsbrist. Resultatet visade att sjuksköterskor ansåg sitt deltagande i ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling som bristande. Sjuksköterskan upplevde att samarbetet med läkaren i beslutsprocessen inte fungerade och kände ofta en frustration över att inte bli tillräckligt lyssnad på. Ytterligare hinder för sjuksköterskans delaktighet i beslutsprocessen framkom av sjuksköterskors kunskapsbrist gällande lagar, riktlinjer och etik samt bristande arbetserfarenhet och självförtroende. Slutsats Sjuksköterskans delaktighet i vårdteamet kring ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling är bristfälligt. Ytterligare belyser studien sjuksköterskans behov av ökad kunskap inom lagar, riktlinjer och etik.Background Healthcare professionals deal with ethical considerations and standpoints on a daily basis. Decision-making about when life-sustaining treatment should be continued or terminated is a complex position that requires several considerations. The doctor has the full responsibility regarding the standpoint to discontinue life sustaining treatment. The nurse often possesses important knowledge and understandings of the patient´s needs, which can provide important information in the decision making. Aim The aim of the study was to illustrate nurse´s experience of participation and communication regarding the ethical decision-making to terminate or refrain from patients life-sustaining treatment. Method Descriptive litterature review of ten qualitative research articles. Results The study resulted in two themes; participation and lack of knowledge. The results show that nurses considered their participation in the stance of maintaining or sustaining treatment as inadequate. The nurses felt that the cooperation with the physician in the decision-making did not work and felt a frustration related to not being listened to. Additional barriers to nurse’s participation in the decision-making appeared by nurse’s lack of knowledge regarding laws, guidelines and nursing ethics, as well as lack of work experience and confidence. Conclusion The nurse’s participation in the caring team about the stance of maintaining or sustaining life support care is inadequate. The study also highlight the nurses need for increased knowledge of laws, guidelines and ethics.
Röda Korsets sjuksköterskeförening stipendium 2017
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Greer, Marjorie Bedell. "Cognition, life satisfaction, and attitudes regarding life support among the elderly /." Full-text version available from OU Domain via ProQuest Digital Dissertations, 1994.
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Leung, Edward. "An examination of biblical and Confucian teachings on end-of-life decisions." Fort Worth, TX : Southwestern Baptist Theological Seminary, 2008. http://dx.doi.org/10.2986/tren.049-0495.
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Sundin-Huard, Deborah. "Brief encounters: end of life decision-making in critical care." University of Southern Queensland, Faculty of Sciences, 2005. http://eprints.usq.edu.au/archive/00001514/.
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The health care system has, in many respects, been developed to oppose suffering. Yet health care’s almost compulsive urge to treat death as the enemy and to battle disease and injury with all available technology unavoidably results in suffering for someone. This paradox and its impact upon the decision-makers in critical care, has attracted some interest overseas, but none to date in Australia. This study sought to understand the interactions between the key stakeholders in end-of-life decision-making in critical care in the interests of developing strategies to ameliorate the avoidable suffering arising from these processes. A modification of Denzin’s Interpretive Interactionism (Denzin, 1989), was developed to apply the epistemological and ontological principles of the critical paradigm while preserving the advantages of Denzin’s design in the investigation of interactions. Semi-structured interviews with relatives, nurses and doctors from a variety of critical care units in South-East Queensland and New South Wales, provided the data that enriches this study. Using the critical lens, analysis focussed on the interactions (and gaps and silences) between the decision-makers at the key moments of decision-making: initiation, maintenance or withdrawal of life-sustaining treatments. A model of 'best practice' with respect to end-of-life decision-making was produced and concrete recommendations made. This project has found that the amelioration of avoidable suffering in the critical care environment related to end-of-life decision-making requires policy and procedural changes at the organisational level.
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Fischer, Grönlund Catarina. "Experiences of being in ethically difficult care situations and an intervention with clinical ethics support." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-126973.
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Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found. Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV). Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV). Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV). Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.
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Wilson, Monika Anne. "Accompanying them home : the ethics of hospice palliative care." Queensland University of Technology, 2009. http://eprints.qut.edu.au/20536/.
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This inquiry, which employed a narrative research approach, critically explored the ethical dimension of hospice palliative care. Hospice palliative care is the profession specifically developed to care for the dying. The development of this practice has grown significantly since the 1980s in Australia, yet ethical inquiry into this professional practice has largely focused on particular issues, problems or dilemmas, such as euthanasia. Although particular ethical issues are important considerations, a broader investigation of the ethics of hospice palliative care practice has not been given sufficient consideration in the growing accumulation of the research literature in Australia. Jennings (1997) surmises that “systematic reflection on ethics in the hospice field is curiously underdeveloped” (p. 2). This study goes someway towards filling this gap. In building upon the Pallium research by European scholars and integrating a social practice framework (Isaacs, 1998) this inquiry provides an alternative account of the ethical agenda and one which has privileged an internal exploration, rather than assume that the ethics would be the same as any other health care modality or to simply adopt a dominant, principles-based approach. These internal explorations were located in the storied accounts of thirty interdisciplinary hospice palliative care professionals.
This thesis provides a thorough, textual conversation into the realm of ethical caregiving at the end of life. Several key insights were illuminated. Firstly, total care must be central to the philosophy underpinning hospice palliative care practice, but this concept and practice of total care was being eroded and contested. Secondly, a predominantly modernist account of personhood was located in the narrative accounts. This modernist account of personhood was thought to be insufficient for the practice of total care and needed to be reconceptualised. An embedded ontological account was provided which would assist with the understanding and practice of total care. Thirdly, initially it was thought that there was no common, shared understanding of the purpose of the practice. It was suggested that the profession was “wandering in the wilderness” when it came to the aim of its practice. However, the professionals did share a common telos (aim towards a good) and it was overwhelmingly relational. This led to the proposal of a new telos for hospice palliative care practice centered on the creation and maintenance of unique relationships which would assist people in their final stage of life. Lastly, the ethical frameworks which guided practice for the professionals were presented. In these frameworks it was significant values (acceptance of human mortality, total care and honest and open communication) and relationships (how we treat each other) which played the main role in what constituted hospice palliative care ethics. An account of a hospice palliative care ethical relationship was provided which included a proximity stance of in-between. Overall, any ethic for hospice palliative care must have at the heart the relationship between professional caregiver and living-dying person. The relationships in this social practice, between each other, accompanying one another, are our ethical compass.
This thesis concluded that hospice palliative care, as a social practice, has a rich ethical dimension as understood and articulated by its professional members. These insights have resulted in the construction of a new ethical framework reflecting, formalising and adapting the ethical dimension as understood by its professional members. This ethical framework - A Relational Ethic of Accompanying - is needed to help maintain, sustain and protect the unique identity of this profession. This framework adds to the “moral vocabulary” (Jennings, 1997) and “moral specificity” (ten Have & Clark, 2002) of hospice palliative care practice. In addition, it would provide important guidance to palliateurs reflecting on how best to provide quality, compassionate and ethical care at the end of life.
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Klein, Ellen W. "Changing Landscapes: End-of-Life Care & Communication at a Zen Hospice." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5364.
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This dissertation examines end-of-life experiences at a small Zen hospice in the Pacific Northwest region of the United States. Through an exploration of how end-of-life communication, sense-making, decision-making, and care in this setting differ from that of typical clinical settings, this project highlights and interrogates the experiences of dying as spiritually, rhetorically, narratively, relationally, and communally bound events.
Keywords: Zen hospice, end of life, narrative sensemaking, medical-ethical decision making, spirituality, healing rhetoric, communities of practice
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Ma, Kristina. "Nurses' Moral Experiences of Ethically Meaningful Situations in End-of-Life Care." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38274.
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Nursing ethics in end-of-life care is often framed in reference to dramatic moral dilemmas and resulting moral distress that nurses experience in practice. While important, this framing obscures the moral significance of nurses’ everyday practice. The purpose of this study was to explore nurses’ moral experiences of palliative and end-of-life care, including situations that are enriching. The research question was: What are the moral experiences of nurses engaged in ethically meaningful situations in end-of-life care? Semi-structured interviews were conducted with five nurses from across Canada who practice in settings where palliative and/or end-of-life care are an important part of their role. Informed by interpretive description and a theoretical scaffold about nurses’ moral practice, a descriptive and thematic analysis of the data was performed. The participants described ethical challenges relating to patient autonomy, futility, prognostication, and navigating requests for medical assistance in dying. Experiences that were ethically enriching involved situations where the nurse, patient, and family worked together to create a peaceful and dignified death. Taken together, the participants’ narratives revealed them as morally engaged in their everyday practice, where such moral engagement is both reflective and relational. This study expands understanding about how nurses’ stories of end-of-life care reveal their capacity for moral sensitivity. This study also contributes to the articulation of a theoretical lens for examining the moral dimensions of nursing work. By explicating the relational dimensions of ethically meaningful experiences, including relationships with wider structures that facilitate and constrain the possibility for ethical action, this theoretical lens can support researchers to think creatively about palliative and end-of-life nursing from an explicitly ethical perspective.
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Thorén, Ann-Britt. "How can we optimize bystander basic life support in cardiac arrest /." Göteborg : Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy at Göteborgs University, Sahlgrenska University Hospital, Göteborg, 2007. http://hdl.handle.net/2077/7566.
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Robinson, Lisa. "Engaging Personhood at End of Life: A Qualitative Study of Nurses’ Practice in Acute Care." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38584.
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The acute care setting is designed to provide short-term care for people who require treatment for a severe episode of acute illness and exacerbations of chronic conditions. Yet, more than half of Canadians die in acute hospitals every year. Evidence shows that nurses in acute care units feel limited in their ability to provide quality end-of-life care due to a variety of factors. As a result, the needs of patients that are dying are often overlooked, which can cause them to experience a loss of identity and control, as well as suffering at the end-of-life; a unique time in one’s life trajectory marked by significant changes in personhood. Personhood is the philosophical underpinning of the frequently used concept ‘person-centered care’ – one of the fundamental ideologies of nursing and a central concept in palliative care. An interpretive description design was used to explore the following research question: What do nurses’ stories reveal about the ways in which they engage, or fail to engage, with personhood in end-of-life care in acute care units? To appreciate the culture in which participant stories were situated, a literature review of acute care culture, end-of-life care in acute care units, and the concept of personhood was conducted. Eight nurses from an acute medical-surgical ward of a tertiary care hospital in Eastern Ontario were interviewed for this study. Thematic analysis was used to analyze the data, which elucidated tensions between participants’ ability to enact ethical end-of- life care reflective of their values and the contextual constraints of working in a culture of biomedicine. Exploring these tensions provided insight on the nuances and complexities of navigating ethical end-of-life care in an acute care setting as well as implications for nursing practice, education, and research with particular attention to promoting moral communities in acute care that value personhood and biomedicine equally.
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Frederiksen, Matthew David. "Engaging physicians to support corporate compliance programs| A grounded theory study." Thesis, University of Phoenix, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3538847.
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The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.
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Raffel, Kathleen Keefe. "A Participatory, Mixed-Methods Assessment of Clinical Ethics Committees: How Might They Support Clinicians and Positively Impact Care?" The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1369866382.
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Dean-Haidet, Catherine Anne. "Thanatopoiesis: The Relational Matrix of Spiritual End-of-Life Care." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1342453467.
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van, Beinum Amanda. "Withdrawal of Life Support Therapy: Processes and Patterns of Death In the Intensive Care Unit." Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30720.
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Withdrawal of life support therapy involves controlled removal of life support modalities including artificial respiration and circulation with intent to provide a comfortable death. Withdrawal of life support therapy is necessary prior to procedures such as organ donation after cardio-circulatory death, but remains poorly explored in current literature. To enhance the current evidence, we conducted a thorough structured review, an observational study, and a qualitative comparison of components comprising withdrawal of life support therapy in both donor and non-donor patient groups. At all stages, we considered how results impacted donation after cardio-circulatory death. Withdrawal of life support therapy processes vary between countries, hospitals, practitioners, and patients. Variability in practice impacts care and outcomes for both donor and non-donor patients. Improved definitions and consensus about the process of withdrawal of life support therapy may improve patient care, success of organ donation after cardio-circulatory death, and uptake of donation protocols.
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Martin, Jason. "The virtuous Human Resource-practitioner : Can virtue ethics support the emerging role for the HR-profession in a changing labour market?" Thesis, Linköpings universitet, Centrum för tillämpad etik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-119075.
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The purpose of this thesis is to evaluate the possibilities of applying virtue ethics in the HR-profession by presenting the foundation for virtue ethics and addressing how it could be transformed into virtue ethical principles for HR-practitioners in Swedish work-life. I address the questions how virtue ethics could support HR-practitioners in doing ”the right thing” and how a HR-practitioner should be. I argue that the fit between virtue ethics and the HR-profession rests on principles of moral consciousness and intellectual reflection and on the principles of practice and developing excellence. I also argue that moral institutionalization through measures of professional ethical codification could form an important practical feature. Mediated by the concept of phronesis, I define four core virtues for HR-practitioners: trustworthiness, cooperation, justice and integrity. I conclude that virtue ethics could be pivotal in promoting positive culture, forming the basis of increased trust, confidence and security within organizations.
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Shaw, Kristen Marie. "Racial Differences in Time to Withdrawal of Care after Intracerebral Hemorrhage." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/317039.
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Intro/Aims: Differences in end-of-life decision-making among minorities have been well described. However, among Native Hawaiian and Other Pacific Islanders (NHOPIs), this has not been well studied. Aim 1: Determine if differences in time to withdrawal of life support (WOLS) exist between NHOPIs and non-Hispanic whites (NHWs). Aim 2: If differences in time to WOLS between races are found, examine factors that may contribute to these differences. Methods: A retrospective study was conducted on patients admitted to a primary stroke center in Honolulu with diagnosis of spontaneous intracerebral hemorrhage (ICH). Medical records were reviewed for occurrence of WOLS and time of WOLS. Unadjusted and multivariable logistic regression models were performed to determine associations between race and WOLS. Kaplan Meier analysis and Cox regression were performed to estimate survival time to WOLS and to compare these results between racial groups. Results: 396 patients with diagnosis of spontaneous ICH were studied. Mean time to WOLS after ICH was found to be similar between NHWs and NHOPIs (p = .925). Prevalence of WOLS was significantly lower in NHOPIs in univariate analysis (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15, 0.80) and Kaplan Meier analysis predicted a significant difference in WOLS between NHOPI and NHWs within 30 days of ICH (p =<. 01). However, in multivariate analysis, race was no longer significant when adjusted for age (OR 0.59, 95% CI 0.25, 1.43) and when fully adjusted (OR 0.68, 95% CI 0.20, 2.39). NHOPIs were significantly younger at the time of ICH when compared to NHWs (p =<.001) although ICH severity and presentation such as initial Glasgow Coma Scale, presence of intraventricular hemorrhage and ICH volume were similar (p = .241; p = .604; p = .901, respectively). Conclusions: No difference in mean time to WOLS was noted between NHOPIs and NHW. However, secondary analysis showed WOLS was less prevalent after ICH in the NHOPI population compared to NHWs, although the significance of this finding was attenuated by age. NHOPIs in this population likely had a lower incidence of WOLS due to the fact that they presented with ICH at a significantly younger age, although small sample size also may have resulted in difficulty detecting variances between races.
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O'Shea, Michael D. "STUDENT PERCEPTIONS OF TEACHER SUPPORT: EFFECT ON STUDENT ACHIEVEMENT." Connect to this title online, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=bgsu1143054461.
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Okamura, Naoki. "Ethical dilemmas in the care of severely impaired neonates a critical evaluation of the principle of the sanctity of human life /." Theological Research Exchange Network (TREN), 1993. http://www.tren.com.
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Karapliagou, Aliki, Allan Kellehear, and K. Wegleitner. "The public health end-of-life care movement: History, principles, and styles of practice." Oxford University Press, 2018. http://hdl.handle.net/10454/17172.
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Forrester, Margaret Vivienne. "Communities of practice for end of life care workplace settings : a case study." Thesis, University of Wolverhampton, 2017. http://hdl.handle.net/2436/620644.
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Communities of practice have been used as a way of sharing practice and developing knowledge. The End of Life Care Education Consortium was formed by three hospice education departments in the West Midlands, United Kingdom, with the support of the Strategic Health Authority, to provide education programmes for healthcare professionals in palliative care. As the Consortium worked collaboratively, I wanted to explore whether there was potential for it to evolve into a community of practice and whether there was scope for communities of practice being utilised in end of life care settings to share and develop practice. The literature review revealed there were no articles written on communities of practice in palliative care settings and demonstrated that the workplace is an important area for learning as new staff learn from more experienced members of the workforce. Communities of practice can be used for experienced staff to learn from each other and share practice with others from outside the community. Case study research was used to explore whether the Consortium had the potential to evolve into a community of practice and if its members learnt from each other. Members of the Consortium were interviewed using semi-structured interviews, documents including my research diary, reports and notes from meetings were also used as data. Although the findings showed that the Consortium was not functioning as a community of practice it did have the key characteristics of one and there is potential for hospices to form communities of practice to enable staff to share practice and support each other. The findings demonstrated that for a community of practice to be successful it requires the support of management to allow staff to take part in community activities, seen as an important part of the organisation’s culture and there needs to be leadership to enable the community to develop. Journal clubs, clinical supervision and multidisciplinary meetings are already in place and these could be ways of healthcare professionals sharing knowledge and learning together. The Nursing and Midwifery Council (2015) state that all nurses and midwives are required to revalidate every three years to enable them to practise as registered nurses; one of my recommendations is that communities of practice could be used to keep staff updated. Inviting healthcare professionals from outside the hospice to take part in community activities would enable knowledge to flow in and out therefore enhancing patient care.
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Barrett, Donna Marie. "Exploring Social Support Networks of African American Emancipated Foster Care Women." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3428.
Full textAbstract:
Many youth exit the United States foster care system each year and face challenges related to housing, employment, health care, and education. After emancipation, foster youth can experience family instability, educational disruption, incarceration, unemployment, unstable housing, and emotional problems at a much higher rate than youth in the general population. The purpose of this qualitative case study was to examine the experiences of African American foster women and the social support they received in finding housing upon exiting foster care system. Bronfenbrenner's ecological theory provided a conceptual framework of social interrelation for the study. Data were collected from a purposeful sample of 4 African American former foster care women, a foster parent, a social worker, and a director of a support service's programs through face-to-face interviews. Data were analyzed using a 5-step approach for coding and analysis. Key findings were that the mobilization of collaborative social network support from foster parents, social workers, and government officials before foster youth enters their transitional phase were keys to successful outcomes. According to the foster care women and supporting adults' reports, more collaboration among agencies may assist youth with transitioning to independent living. Additionally, one-on-one mentorship program could address housing, education, employment, and health plans prior to emancipation. This study contributes to social change by providing information to those who provide services to foster care youth and may lead to enhanced programs and services encouraging youth to pursue their goals, and promote economic self-sufficiency.
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Currier, Erika. "A Study To Investigate The Significance Of Knowing One's Prognosis In People Diagnosed With Life-Limiting Illnesses." ScholarWorks @ UVM, 2015. http://scholarworks.uvm.edu/graddis/432.
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ABSTRACT
Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment.
Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between provider and patient. The over-arching goal is to capture the personal perspectives of participants with a view to exploring their experiences around knowledge of their prognosis.
Methods: A qualitative research design using a phenomenological approach was employed to examine how people experience prognosis. An invitation to participate in the study was publically announced via local newspapers, social media venues, and word of mouth. Participants who responded to study advertisements and who met inclusion criteria were asked to participate in one interview answering open-ended questions aimed at examining their experience with and knowledge of their prognosis. In addition, questions about prognostic communication between patient and health care provider were explored. All interviews were recorded, transcribed verbatim and analyzed using phenomenological methods.
Results: Three study participants met the study criteria and were interviewed. Several themes emerged from the data including 1) patients have need for information about their illness, 2) prognostic data inform treatment choices, 3) patient experiences are unique and 4) patients feel a connection to nurses involved in their care.
Conclusions: This study illuminated the patients' desire and need for information during their illness, the desire for patient autonomy, the difficulty of starting and having prognostic conversations, the downstream impact of having prognostic information, and the important role that nurses play for patients facing serious health issues. It is hopeful that the themes identified during the course of this research ultimately contribute to the knowledge base by informing healthcare providers on the importance of conveying prognostic information in a timely, direct, and sensitive manner.
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Kryworuchko, Jennifer. "An Intervention to Involve Family in Decisions about Life Support." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/20448.
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Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU).
Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital.
Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA).
Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication.
Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process.
Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions.
Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.
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Gryglewicz, Kimberley A. "The Mediating Role of Social Support and Fulfillment of Spiritual Needs in End of Life Care." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3131.
Full textAbstract:
End of life (EOL) caregiving can be a daunting and challenging endeavor as caregivers adjust to the ever-changing care demands associated with dying. Increased personal care, assisting with symptom and medication management, and attending to the emotional and spiritual needs of the dying person require caregivers to learn new tasks and to assume new roles such as social worker, nurse, and chaplain. As families continue to play an essential role in meeting the health care needs of their dying loved ones, it is imperative for social workers to understand the complexities of the end of life caregiving experience in order to better serve this population. One way to better understand this experience is by examining it within the context of the stress process model of caregiving. This model provides a comprehensive way to examine the relationship among multiple risk and protective factors within the "caregiver-in-environment" context. Using a secondary dataset, the best fit predictive model of caregiver depression included a mix of sociodemographic characteristics, primary objective and subjective stressors, and mediating variables. Two protective factors, social support and the fulfillment of spiritual needs lessened the effects of caregiver depression among the most vulnerable caregivers. Findings from this study help to bridge the gap between theory and social work practice. The stress process model of caregiving is a well-tested theoretical model, which can be utilized to guide social workers in developing comprehensive assessment measures and interventions that target specific aspects and sources of stress within the EOL caregiving experience.
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Axelsson, Isabelle, and Annika Karlsson. "Att kunna leva fram till döden. : En systematisk litteraturstudie om varför patienter i ett palliativt skede väljer att avsäga sig livsuppehållande vårdinsatser." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-52975.
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Moscatel, Sarah J. "End-of-life transition experiences of ICU nurses : mindful realization /." Connect to full text via ProQuest. IP filtered, 2005.
Find full textAbstract:
Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2005.Typescript. Includes bibliographical references (leaves 139-146). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;
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Masko, Meganne Kathleen. "Music therapy and spiritual care in end-of-life: ethical and training issues identified by chaplains and music therapists." Diss., University of Iowa, 2013. https://ir.uiowa.edu/etd/5021.
Full textAbstract:
The overarching purpose of this study was to explore the thoughts and attitudes of hospice chaplains and music therapists (MTs) related to the questions, "Is it appropriate for music therapists to provide spiritual care as part of the hospice team," "What kind of training and preparation do music therapists and chaplains think hospice music therapists should have before engaging in spiritual care work," and "What should the content be of spiritual care training for music therapists?" The study used a sequential exploratory qualitative/quantitative mixed methods design utilizing parallel purposive subject samples to examine the research questions.
The first phase of the study included semi-structured interviews with eight music therapists and seven chaplains specializing in hospice care. These interviews were designed to collect in-depth information about the research questions. Each interview was recorded, transcribed, and analyzed using open coding within a grounded theory approach. Thematic analysis revealed the prevalence of the categories of "ethics" and "training." Participants discussed issues related to scope of practice, cultural competence, maintaining personal boundaries, educational content, and educational methods. Analysis of the data information also indicated the need to expand the research questions, which were examined with larger participant samples in the second phase of the study.
Phase II of the study included the development and implementation of a survey tool to explore the results of Phase I with a larger group of participants. The following questions were used as the basis for the survey tool: 1) How appropriate do chaplains and music therapists feel it is for music therapists to provide spiritual care as part of the hospice team? 2) What is the scope of practice for music therapists with regards to providing spiritual care as part of the hospice team? 3) How important are specific aspects of cultural competence in providing ethically sound spiritual care to hospice patients? 4) How do music therapists' music selections for addressing spiritual goals reflect culturally competent practice? 5) What are the personal boundaries that should be maintained by music therapists in order to provide ethically sound spiritual care? 6) How do music therapists feel their personal spiritual beliefs influence their interactions with patients? 7) What types of previous spiritual care training do music therapists report completing? 8) What training topics do music therapists and chaplains feel music therapists should study in order to provide competent spiritual care? 9) What types of training methods do music therapists and chaplains think are most appropriate for music therapists wanting to learn more about spiritual care? 10) What, if any, differences exist between chaplains' and music therapists' responses to these research questions?
A final sample of music therapists (n=48) and chaplains (n=44) completed the survey. Results indicated that the role of music therapists includes providing spiritual care as part of the hospice team.
The spiritual care scope of practice for music therapists identified by survey participants included assisting with spiritual practices, experiencing God or a higher power, assisting with meditative practices, and assisting with guided imagery experiences. According to participants, music therapists should not lead religious rituals or ceremonies, nor should they conduct spiritual assessments. Music therapists felt that all aspects of cultural competence mentioned in the survey were important, especially selecting interventions that are reflective of patients' cultural and spiritual backgrounds. This was also reflected in the ways music therapists wrote about selecting music for use in addressing spiritual goals.
Participants identified specific personal boundaries that should be maintained when providing spiritual care, including avoiding pushing one's personal beliefs onto a patient or family. Music therapists expressed a variety of opinions about how their personal beliefs affected their interactions with patients. These varied from "not at all" to "allows me to be open to others." Music therapists and chaplains expressed similarly varied responses to a question about the wearing of religious symbols when providing hospice services.
Questions about spiritual care training methods and content revealed that music therapists were more likely to engage in on-the-job learning, or attend continuing education and conference presentations about spiritual care. Music therapists and chaplains also wrote about learning from patients, participating in group feedback sessions, and reading materials about spiritual care as ways to learn about spiritual care provision.
Differences were seen between music therapists and chaplains on their understanding of the concept of "spirituality" and "spiritual care." There were also differences between the two groups on questions of the importance of knowing one's own background as a component of cultural competence, as well as the appropriateness of music therapists providing spiritual care/counseling.
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Yazdani, Nahal. "Parental Decision-Making for a Child with a Life-Limiting Condition." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/41039.
Full textAbstract:
Purpose: To explore the decision-making experiences of and the supports provided to the parents of children with life-limiting conditions.
Qualitative Study: A qualitative interpretive description study guided by the Ottawa Decision Support Framework was conducted. Interviews with parents and healthcare professionals revealed that parents made difficult healthcare decisions for their child and were prone to experiencing decisional conflict. Participants described a need for interprofessional support, guided decision support, and a preference for formal and informal support networks.
Scoping Review: A scoping review was conducted. The three eligible studies revealed that parents require early and timely decision support provided by an interprofessional team of healthcare professionals and aided by a structured decision support intervention.
Conclusions: Decisions made by parents of children with life-limiting conditions are complex. Healthcare professionals are required to facilitate appropriate decision support interventions for parents including a parent based support network.
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Jakobsson, Larsson Birgitta. "Quality of life, Coping and need for Support during the ALS disease trajectory." Doctoral thesis, Uppsala universitet, Institutionen för neurovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-283077.
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The overall aim of this thesis was to investigate quality of life, coping and emotional distress (i.e. anxiety and depression) among newly diagnosed ALS patients. An additional aim was also to investigate relatives’ experiences of the care for the patient and the support they received for themselves during the disease progression. The most nominated areas of importance for the patient’s overall QoL were family, friends and own physical health. Most patients rated their QoL as good, which did not change at subsequent measurement, despite their physical function having changed for the worse during disease progression. Some patients had symptoms of clinical anxiety and depression during the first year after diagnosis. The total quality of life score did not correlate with physical function but with depression early on after diagnosis. Most patients used support and independence as strategies to cope with the disease during the first six months after diagnosis. There were few changes early on after the diagnosis, and the patients used several different strategies. The results show that the use of coping strategies remained stable over time. Both physical function and emotional distress correlated significant with different coping strategies, with some variation during the disease progression. Relatives experienced the care of their loved one as positive and based on the patient’s needs and desires. The treatment, knowledge, support and help from the staff were important for the relatives’ feeling of security. Different factors influence the use of support for themselves. The relatives did not think of their own needs, but their focus was rather on the patient. The results of the thesis highlight the importance of providing support both to patients and their relatives during the disease progression. With early and regular evaluation on quality of life, coping and emotional well-being among the patients, the health professionals may be able to support the patients based on their specific needs, which probably will increase their quality of life.
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Liu, Qiaoming. "Social support for the frail elderly at two kinds of retirement communities." PDXScholar, 1990. https://pdxscholar.library.pdx.edu/open_access_etds/4098.
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As few studies focus explicitly on social support for residents by residents in retirement communities which have staff, this thesis is designed to explore the nature of informal social support among residents at planned, non-subsidized retirement care facilities: the types, the amount, the impact, the limitation and the appropriateness of such support. Our focus is to explore whether different organization of a retirement community affects social support among residents, so we compare two retirement care facilities. One provides single-level care for its residents and the other provides multiple-level care. We chose our two sites from retirement care facilities in the City of Portland, Oregon. We generated our data by interviewing residents who live independently in the two retirement communities.
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Dokos, Malinda K. "The Role of Social Support in Dementia Care Facilities: Staff Member Perspectives." DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7648.
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In this study, certified nursing assistants (CNAs) who work regularly with long-term care residents with dementia were interviewed to investigate whether they considered providing social and emotional support to people with dementia an important part of their jobs. They were given an online survey, then each participated in an in-person interview that was recorded and later transcribed and analyzed for common themes. Through data analysis, I found that the participating CNAs unanimously considered social support to be an important aspect of caring for someone with dementia, and several personal values were associated with this perspective. They also reported the trainings they had received in preparation for dementia care were largely not sufficient to prepare them for interacting effectively with the residents. Additionally, they cited various other barriers that impede their ability to provide the social support they feel is necessary to provide. Overall, this sample of CNAs did not provide great diversity, and future research should compare these results to more diverse groups.
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Klein, Robert R. "Toward a Good Life in Later Life: Perspectives, Problems, and Responses." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1364341896.
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Everett-Fry, Rachel. "It's a Good Life If You Don't Weaken: Taking Care of a Small Farm In Ontario." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42085.
Full textAbstract:
Small-scale animal agriculture is a fruitful site for examining the relationships among humans, animals, and the land. This thesis endeavours to show what practices are constitutive of these relationships and, moreover, that establishing the “right” relationships between them are ethical concerns with both analytical and ecological import. Basing myself on fieldwork consisting of participant observation, informal interviews, and filmmaking on a small farm in Ontario, I argue that: dominion is the position from which the farm is cared for; that maintaining the farm is both reproductive and generative of the ethical subject; and that the indeterminacies involved in this maintenance might be resolved or unresolved depending on one’s position in regard to the local farming tradition.
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Cronqvist, Agneta. "The moral enterprise in intensive care nursing." Doctoral thesis, Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-942-0/.
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Wright, David. "Delirium and the Good Death: An Ethnography of Hospice Care." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23606.
Full textAbstract:
Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.
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Mazanderani, Fadhila. "Information as care : reconnecting internet use, HIV and health." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:e9959b49-ca0c-48ba-9916-03a32d1455c4.
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Internet technologies are increasingly advocated as a means for transforming health care and improving people’s health. In the field of e-health questions on the health implications of internet use are typically approached through attempts at measuring the effect of internet use on health outcomes. In this, information is usually conceptualised as a form of knowledge/power and online information practices are enrolled in discourses on patient empowerment. Taking the different meanings ascribed to information in these approaches as my point of departure, in this thesis I rethink the implications of internet use on health through an empirical exploration of alternative conceptualisations of the relationship between information and health in the context of contemporary HIV treatment and care. I do this through two analytical moves. First, drawing on the concept of performativity, a concern with what effect internet use has on health is turned into one of how internet use enacts health. Second, rather than treating information as knowledge/power, through an analysis of how a specific group of women ‘living with HIV’ in the UK use the internet, I reconfigure the connections between internet use and health through a conceptualisation of information as care. Drawing on a range of empirical materials – including forty-seven in-depth interviews with patients and internet content providers, non-participant observations, document and website analysis – three areas of health-related internet use are analysed in detail: the seeking out of health-related and specifically biomedical information; the seeking out and sharing of experiential knowledge and narratives about living with HIV; meeting prospective partners and dating. However, rather than studying these areas of internet use in order to interrogate what they can tell us about the internet, I analyse them as part of the ethical regime of ‘living with HIV’, in which the virus, previously thought of as ‘terminal’, becomes, through info and bio technologies, normalised as ‘chronic’. From this perspective, enacting health not only entails working on and with one’s body, but also always invokes its distribution across bodies, to other areas and relations, including internet technologies and the networks of relations established via these technologies.
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Renblad, Karin. "Empowerment : a question about democracy and ethics in everyday life : ICT and empowering relationship as support for persons with intellectual disabilities." Doctoral thesis, Stockholm : Stockholm Institute of Education Press (HLS förl.), 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-139668.
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Jennings, Elizabeth M. "Matters of life and death : rationalizing medical decision-making in a managed care nation /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC IP addresses, 2002. http://wwwlib.umi.com/cr/ucsd/fullcit?p3049667.
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Arving, Cecilia. "Individual psychosocial support for breast cancer patients : Quality of life, psychological effects, patient satisfaction, health care utilization and costs." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7929.
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Wingate, Tiah J. "An Examination of Instrumental Support Received by Parents of Children with Special Health Care Needs Throughout the Life Course." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1500326342108006.
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Pasmeny, Gloria A., and University of Lethbridge Faculty of Education. "Social support and quality of life in adults with severe and persistent mental illness." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Education, 2008, 2008. http://hdl.handle.net/10133/780.
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The current study investigated the relationship between social support and quality of life
(QoL) as well as social support and community functioning among persons with severe
and persistent mental illness (SPMI). Empirical data from Phase II of the Continuity of
Mental Health Services (COMHS) Study of Alberta (Adair, Wild, Joyce, McDougall,
Gordon, et al., 2003) were used to comprehensively examine these variables among a
broad-based sample of 301 people with SPMI receiving a mix of inpatient, outpatient,
and community services. Multiple measures administered in Phase II of the COMHS
research program provided comprehensive data on QoL (i.e., disease-specific and generic
QoL), functioning (i.e., community ability), and objective (OSS) and subjective (SSS)
measures of social support. Higher ratings of both OSS and SSS were associated with
better QoL and functioning at outcome. Participant ratings of objective dimensions of
their own social support were shown to be most important in determining life quality and
functioning at outcome. Of the two SSS variables, the one most predictive of life quality
was the participants’ sense of the provision and receipt of social support. Clinician-rated
OSS was a significant predictor of QoL only for participants who rated social support
availability as poor. The results of this study may inform policy development, planning,
and resource allocation for community treatment programs in Alberta and elsewhere, as
there is widespread support both provincially and nationally for increasing community
support services and decreasing the number and length of inpatient admissions (Kirby &
Keon, 2006). A better understanding of the relative impact of social support variables is
essential for further development of effective psychosocial rehabilitation programming.xvii, 217 leaves ; 29 cm.
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Houghton, Lindsey C. "Dementia and End-of-Life Decision Making: A Case-Based Approach to the Clinical Application of Bioethical Principles." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/549725.
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Urban BioethicsM.A.
People with dementia account for a growing number of patients requiring end-of-life medical care each year in the United States. The clinical application of bioethical principles is rarely more important than in the context of end-of-life decision making, and determining the appropriate clinical treatment plan can be difficult and complex for clinicians, patients, and medical proxies. While the current bioethical literature offers a wealth of information on the principles underlying ethical medical practice, real-world clinical scenarios are often fraught with confusion, complexity, and conflicting understandings of best practices. There is a need for clinical decision-making tools that are both comprehensive yet simple, and broadly-applicable enough to be clinically useful. This thesis explores the cultural factors that necessitate further discussion and understanding of the issues surrounding end-of-life care for people with dementia, uses a clinical case to demonstrate a real-world approach to the ethical complexities surrounding such care, and proposes a basic ethical decision-making algorithm with the potential for broad application by students and clinicians encountering complex ethical scenarios.
Temple University--Theses
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Young, Nancy. "The transition to adulthood for children with cerebral palsy: what do we know about their health care needs?" Lippincott Williams & Wilkins, 2007. https://zone.biblio.laurentian.ca/dspace/handle/10219/101.
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There have been significant changes in the clinical management of cerebral palsy (CP) during the past 2 decades. Gastrostomy tubes and nutritional supplements have been paramount in enhancing the life expectancy of those with CP. The literature shows that as many as 90% of children with CP can now expect to live to adulthood.1-4 As a result, CP is no longer considered to be a condition limited to childhood. However, emerging populations pose new challenges to those who provide health care support. This article presents an overview of what we know about the health care needs of adults with CP.From the Laurentian University, Sudbury, Ontario; The Hospital for Sick Children, Toronto, Ontario; and The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Dr Young is supported by a Canadian Institutes of Health Research Canada Research chair.
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Jaarsma, Tiny. "Heart failure: nurses care effects of education and support by a nurse on self-care, resource utilization and quality of life of patients with heart failure /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1999. http://arno.unimaas.nl/show.cgi?fid=6874.
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Schmid, Sophia. "The Political Potential of Women’s Voluntary Activity in Refugee Support Work." Doctoral thesis, Humboldt-Universität zu Berlin, 2019. http://dx.doi.org/10.18452/20885.
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Die vorliegende Arbeit beruht auf der Beobachtung, dass in der Geflüchtetenarbeit (GA) vor allem Frauen aktiv sind und stellt die Frage, welche Rolle Geschlecht in der GA spielt und wie die weiblichen Ehrenamtlichen ihre Arbeit mit den Geflüchteten erfahren. Besonderes Augenmerk liegt auf der Wahrnehmung von Unterschiedlichkeit und Gemeinsamkeit. Ein dritter Schwerpunkt liegt auf den Strategien, die weibliche Ehrenamtliche einsetzen, um Differenz in der Arbeit mit Geflüchteten zu überwinden.
Das erste Paper analysiert zwei quantitative Studien mit deutschen Ehrenamtlichen in der Geflüchtetenhilfe. Es zeigt, dass GA als eine Form von „Care Work“ verstanden werden kann, die von Care-Ethik beeinflusst ist. An zweiter Stelle ergab die Analyse, dass vor allem weibliche Freiwillige ihr Engagement auch als gesellschaftspolitischen Einsatz gegen Fremdenfeindlichkeit und Rassismus sahen. Somit argumentiert das Paper, dass GA entgegen traditionellen Annahmen in der Forschungsliteratur eine Form von politischer Partizipation von Frauen darstellt.
Das zweite Paper konzentriert sich auf die direkte Beziehung mit Geflüchteten und basiert auf 22 qualitativen Interviews mit weiblichen Ehrenamtlichen. Sozialpsychologischen Annahmen folgend, dass eine gemeinsame Identität zur Verringerung von Vorurteilen beiträgt, zeigt es auf, wie die Studienteilnehmerinnen Verbundenheit mit Geflüchteten herstellten. Demgegenüber betonen poststrukturalistische, postkoloniale und feministische Theorieansätze die Bedeutung von Differenz, die Konstruktionen von Gemeinsamkeit immer wieder durchschneidet.
Schließlich führt das dritte Paper den politischen Care-Ansatz und die Herausforderung durch Differenz zusammen und legt dar, wie weibliche Ehrenamtliche in der GA Differenz mithilfe care-ethischer Grundsätze zu Integration aushandeln. Das Paper bezieht sich auf Care-Ethik, die auf Beziehungen und Verantwortung als zentralen ethischen Maximen beruht und entwickelt die Idee einer ‚caring integration‘.In German refugee support work (RSW), women comprise the majority of the volunteers. Therefore, this PhD project focuses on the experiences, motivations and attitudes of female volunteers in RSW from three angles. Apart from investigating the role of gender in RSW, it studies constructions of sameness and difference and how the female volunteers resolve the latter in their daily work. The first paper analyses two quantitative studies on German volunteers in RSW. It first establishes that RSW can be conceptualised as a form of care work influenced by care ethics, which potentially forms one motive for women to be drawn to volunteering. Secondly, female volunteers also interpret their voluntary care work politically and employ it as a tool to speak out against racism and right-wing mobilisation. The paper thus demonstrates that contrary to traditional assumptions in the literature, RSW constitutes a form of political participation for women and argues that care and politics are not mutually exclusive. The second paper takes a closer look at the actual experience of female volunteers in RSW based on 22 qualitative interviews. Following social-psychological ideas of a common identity facilitating prejudice reduction, the paper first illustrates how the volunteers form bonds with refugees. However, in a second step it employs poststructural, feminist and postcolonial theory to demonstrate how difference continually intersects and disrupts these constructions of sameness. Finally, the third paper argues that female volunteers in RSW negotiate difference by following a care-ethical approach to integration. Based on the feminist ethics of care which centres on relationships and responsibility, the paper develops the theme of a ‘caring integration’. In addition, it investigates to what extent this notion can be found in the actual practice of female volunteers in refugee support work relying both on the quantitative and qualitative data.
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Chavarria, Brijae Anne. "THE PERCEIVED BARRIERS TO HEALTH CARE ADVANCE DIRECTIVE POSSESSION IN THE BLACK AMERICAN COMMUNITY—SHOULD WE ADDRESS IT AS A RACIAL DISPARITY OR A CULTURAL DIFFERENCE?" Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/542364.
Full textAbstract:
Urban BioethicsM.A.
Death is an inevitable part of life, yet many Americans fail to plan for this final part of life. Only about 1/3 of our country has an advance directive (Off White Papers, 2014). This underutilization of advance directives is reflected in our health care spending. It is estimated that 30% of all Medicare spending occurs during the last six months of a patient’s life. The numbers are even lower when broken down into sub-categories. Only 24% of older Black Americans possess an advance directive versus 44% of their older White counterparts (Huang, Neuhaus, & Chiong, 2016). Some studies found that African Americans were more likely to “express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs which conflict with the goals of palliative care, and distrust the healthcare system” (Johnson, Kuchibhatla, & Tulsky, 2008). Other studies have even concluded that Black race is an independent predictor of lack of advance directive possession (Huang et al., 2016). This paper further explores the possibility that race and ethnicity may simply be proxies for cultural values that impact advance directive possession. We’ll discuss the barriers, for both Black patients and health care providers, to advance directive possession as well as investigate culturally mindful interventions to combat the barriers.
Temple University--Theses
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Pheiffer, Evette. "The perceptions of professional nurses with regard to the process of withdrawing life-support treatment in a private intensive care unit." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/3115.
Full textAbstract:
Life-support treatment is regarded as the support of vital functions of respiration and circulation such as mechanical ventilation and inotropic support, and life-sustaining therapy which incorporate therapies such as artificial hydration, nutrition and haemodialysis. Life-support treatment is rendered to critically ill patients within the intensive care units. However, when treatment options are maximised, and the patient’s condition is unchanged, a decision is often made to withdraw treatment. Professional nurses are usually involved in the process of withdrawal of life-support treatment as they care for this population of patients. The study followed a qualitative, explorative, descriptive and contextual research paradigm in order to explore and describe the perceptions of professional nurses with regard to the process of withdrawing life-support treatment in a private intensive care unit. Data was collected by means of interviews, which were transcribed according to Tesch’s method of analysis. Field notes were used to supplement the data findings. Based on the data collected, it is clear that professional nurses experience difficulties when performing withdrawal of life-support treatment. There are a number of communication concerns which need to be addressed and suggestions were also made by the interview participants regarding these concerns. The study makes recommendations to assist professional nurses with the process of withdrawing life-support treatment in a private intensive care unit. The findings of the study will be disseminated to the relevant hospital and unit managers. Ethical principles were maintained throughout the study by adhering to the principles of privacy, confidentiality, anonymity and beneficence.