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1
Courtney, Karen Lynne. "Privacy and senior adoption of assistive technology in residential care." Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4399.
Full textAbstract:
Thesis (Ph. D.)--University of Missouri-Columbia, 2006.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2006" Includes bibliographical references.
2
Preece, Michael. "Knowledge management : a residential aged care perspective." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/561.
Full textAbstract:
This research explores perceptions of knowledge management processes held by managers and employees in a service industry. To date, empirical research on knowledge management in the service industry is sparse. This research seeks to examine absorptive capacity its four absorptive capacity capabilities of acquisition, assimilation, transformation and exploitation and their impact on effective knowledge management. All of these capabilities are strategies that enable external knowledge to be recognised, imported and integrated into, and further developed within the organisation effectively.The research tests the relationships between absorptive capacity and effective knowledge management through analysis of quantitative data (n=549) drawn from managers and employees in 35 Residential Aged Care organisations in Western Australia. Responses were analysed using Partial Least Square-based Structural Equation Modelling. Additional analysis was conducted to assess if the job role (of manager or employee) and three industry context variables of profit motive, size of business and length of time the organisation has been in business, impacted on the hypothesised relationships.Structural model analysis examined the relationships between variables as hypothesised in the research framework. Analysis found that absorptive capacity and the four capabilities correlated significantly with effective knowledge management, with absorptive capacity explaining 56% of the total variability for effective xiv knowledge management. Findings from this research also show that absorptive capacity and the four capabilities provide a useful framework for examining knowledge management in the service industry. Additionally, there were no significant differences in the perceptions held between managers and employees, nor between respondents in for-profit and not-for-profit organisations. Furthermore, the size of the organisation and length of time the organisation has been in business did not impact on absorptive capacity, the four capabilities and effective knowledge management.The research considers implications for business in light of these findings. The role of managers in providing leadership across the knowledge management process was confirmed, as well as the importance of guiding routines and knowledge sharing throughout the organisation. Further, the results indicate that within the participating organisations there are discernable differences in the way that some organisations manage their knowledge, compared to others. To achieve effective knowledge management, managers need to provide a supportive workplace culture, facilitate strong employee relationships, encourage employees to seek out new knowledge, continually engage in two-way communication with employees and provide up to date policies and procedures that guide employees in doing their work. The implementation of knowledge management strategies have also been shown in this research to enhance the delivery and quality of residential aged care.
3
Grenade, Linda Elise. "Accreditation of residential aged care facilities: experiences of service providers." Thesis, Curtin University, 2003. http://hdl.handle.net/20.500.11937/1306.
Full textAbstract:
The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study.Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.
4
Grenade, Linda Elise. "Accreditation of residential aged care facilities : experiences of service providers /." Curtin University of Technology, School of Public Health, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15068.
Full textAbstract:
The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study.Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.
5
Sinasac, Patricia A. "Residential aged care health workers' knowledge, attitudes and confidence in providing care to a person with a stoma : a needs analysis for education." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/104436/1/Patricia_Sinasac_Thesis.pdf.
Full textAbstract:
This study of residential aged care health workers’ knowledge, attitudes and confidence in providing care to an older person with a stoma was conducted to identify characteristics of the learners and educational needs to effectively provide stoma care. The findings will be valuable to inform development of an educational program aimed at aged care health workers’ to give appropriate and confident stoma care to residents.
6
Ip, Siu-ming, and 葉小明. "Searching for an appropriate mode of service delivery: the contracting out of residential aged care in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31966196.
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Ip, Siu-ming. "Searching for an appropriate mode of service delivery : the contracting out of residential aged care in Hong Kong /." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22053323.
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8
Ibrahim, Rahimah. "Technicalities of ageing in place : a case study of the integration of residential care services through the use of information technology (IT) in the changing context of care." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16484/.
Full textAbstract:
Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.
9
Ibrahim, Rahimah. "Technicalities of ageing in place : a case study of the integration of residential care services through the use of information technology (IT) in the changing context of care." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16484/1/Rahimah_Ibrahim_Thesis.pdf.
Full textAbstract:
Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context.
Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology.
The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions.
The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment.
The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system.
In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.
10
Mok, Lai-shim Billian, and 莫麗嬋. "To assess the effectiveness of the services of private residential care homes for the elderly in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/207656.
Full textAbstract:
Hong Kong cannot single out herself from the global problem of increasing elderly population. The increase of elderly population like in other countries is the by-product of dwindling of birth rate and the longevity of life caused by the advanced medical care, enhancement of nutrition and low mortality rate which prolong people's life expectancy. Provision of housing as the integral part of care to the elders at their retirement age becomes a hot topic of the government to deal with. Comprehensive housing services help to develop the concept of ageing in place, care in the community and continuum services for achievement of the healthy ageing and successful ageing of the elders Moreover, government cannot cater for the needs of all elders who require residential care services when all elders becoming old and frail. Private residential care home services fills in the gap to provide such services in the elderly market. This research studies the causes of the requirement of the private residential care homes which under-went the change of family structure, change of status of elders in the traditional families due to low fertility rate, change of economic and social aspects due to urbanization and industrialization. Development of private elderly housing services provided by government and private sector from past to present and future are overviewed. Statistics on provision of private elderly care homes places in the current market are mentioned. The studies focus on the quality of services provided by the private residential care homes for the elderly. Methodology for the research is based on a mix of qualitative and quantitative method. Measurements on the level of satisfaction of the elderly respondents are identified and itemized basing on their required physical daily personal services. Face-to-face personal contact and ' in-person' dialogues with the elderly respondents and the frontline workers and operators were conducted for questionnaires and interview results. The elderly respondents were categorized into 3 ranges, namely, the young-old, old-old and the oldest-old for analysis of their level of satisfaction of services. Different age range respondents expressed different level of satisfaction with same items of services due to different requirements at various age strata. Comparisons on the services provided by sole privately operated residential care homes, NGO and Government Purchasing Scheme are examined. Results of the research are analyzed and finalized for conclusions and recommendations. The elders' willingness of ageing in place is definite yet with expectations of improvement for upgrading life quality.published_or_final_version
Housing Management
Master
Master of Housing Management
11
Fan, Lijun. "Effectiveness and cost analysis of a hospital in the nursing home program in Queensland, Australia." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101165/1/Lijun_Fan_Thesis.pdf.
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This thesis evaluated the effectiveness and cost-saving potential of a health service delivery model in Queensland Australia, the Hospital in the Nursing Home program. The research adopted a before-after controlled study design, comparing the outcomes between an intervention hospital and a control hospital during the pre- and post-intervention periods. Findings from the research supported that the intervention was preferred over the current practice, which reduced the attendances to emergency departments (EDs) and inpatient hospitals from patients in residential aged care facilities, shortened their length of ED stay, and saved the overall costs.
12
Shohel, Mohammad. "Antibiotic Stewardship in Residential Aged Care Facilities." Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/86378.
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Aged care residents are at increased risk of infections due to their frailty and comorbidities. This study aimed to identify and reduce the risk of antibiotic-related misadventure in this population. Particular medicines were associated with use of antibiotics, suggesting compromised immunity via numerous mechanisms. Potential interactions between antibiotics and residents’ other medicines were also identified, and may increase morbidity in this vulnerable group. Expanded scope of antimicrobial stewardship in aged care facilities is recommended.
13
Kaine, Sarah Jane. "Managing labour in the residential aged care sector." University of Sydney, 2010. http://hdl.handle.net/2123/6300.
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Doctor of Philosophy (PhD)Aged care is a critical public policy issue in Australia. The growing significance of the sector raises important and pressing questions about many aspects of care itself, the size of the labour force and employment relations. Answering these questions is vital, with demand for labour in the sector already outstripping supply and with demand certain to grow substantially. The implications of this labour shortfall for the sector have already been the subject of a number of key government reports. Although these reports have begun to construct a more detailed picture of the issues facing aged care workers and employers, significant gaps remain, most notably any explicit examination of approaches to the management of labour or the importance of labour law in determining these approaches. Despite the obvious importance and critical social and economic significance of the ageing population, we do not sufficiently understand many of the critical labour market features, workplace characteristics or management strategies which are evident in the aged care sector. This study seeks to build knowledge of employment and labour management in this growing and crucial sector at a decisive moment in history. It deepens our understanding of these issues and processes through a study of three residential aged care providers in New South Wales during the period from 2005 to 2009. The thesis specifically examines employer strategy in relation to the management of labour in the three cases. Further, it investigates the impact of the regulatory environment on these approaches. In doing so, the case studies reveal the intricate web of internal and external, direct and indirect, formal and informal regulation which shapes the management of labour within the sector. The complexity of the regulatory web in aged care demands the use of an explanatory framework which recognises that labour-management approaches are influenced by constraints not traditionally associated with the direct, legal regulation of employment relations. Consequently, regulation theory is applied here as an organising framework and as an interpretive prism for the research. This allows for an explicit acknowledgment of the importance of non-legal, informal and indirect regulation ‘at work’ in this sector. The study finds that in the period under review labour law was not the primary determinant of labour-management approaches in aged care. The case studies presented here show that it was, in fact, a second order consideration for aged care providers struggling with what they saw as insufficient funding, onerous ‘paperwork’ and staff recruitment and retention difficulties – in short a range of other regulatory influences. This study also shows that, despite the constraints imposed by these other regulatory modes, employers remained free to exercise their prerogative within the workplace; this, in turn, is revealed as a form of internal regulation in aged care.
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Bitner, Grace Anne. "The 'home'/'homelessness' continuum in residential aged care." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/128714/2/Grace_Bitner_Thesis.pdf.
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This project drew on the experiences of residents and staff in two different residential aged care facilities in South East Queensland, in order to better understand the factors that affect residents' ability to feel 'at home'. The resulting theoretical model reveals how the factors interconnect over time to contribute in a unique way to the meaning of home for individual residents. Ultimately, the model invites, and supports, a more sensitised and integrated approach to the design and management of Residential Aged Care Facilities.
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Pappne, Demecs Ilona. "Woven narratives: Creative participatory art in residential aged care." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/133260/2/Ilona_Pappne%2520Demecs_Thesis%5B1%5D.pdf.
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This thesis presents a participatory art project which involved relocating my tapestry weaving studio into an aged care home for six months and working with residents to co-design and co-create a woven tapestry. The project's concept, materials and processes were designed as an interpretation of two theoretical models: the motivation to meaning and transcendence in ageing focusing on subjective experiences. This thesis contributed to the arts and health literature by presenting craft as a practice and method that connects materials, ideas and people through engagement and facilitates wellbeing. It also highlighted the complexity and the advantages of the research context.
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DeBeyer, Carrie Jeanette. "Diabetes care : the status of diabetes care in Queensland residential aged facilities." Thesis, Curtin University, 2010. http://hdl.handle.net/20.500.11937/2627.
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Diabetes care of the elderly in residential aged care facilities has often been unstructured and non-standardised, with disparities in both the practice and knowledge of health care workers caring for this vulnerable group. Poorly controlled diabetes can contribute to a range of adverse events, including impaired wound health and cardiovascular events. The purpose of this study was to establish if current Australian diabetes management guidelines for the elderly are being met in residential aged care facilities in Queensland and identify areas for clinical practice improvement.A cross-sectional, descriptive design was employed to measure demographic data, perceived and actual diabetes-related knowledge, availability of diabetes management and care guidelines, and facilitators and barriers to meeting diabetes related care. A sample of 109 health care workers from residential aged care facilities completed a postal survey.Diabetes guidelines shown to be available in residential aged care facilities were aimed at care planning, with guidelines for both screening and monitoring of diabetes and diabetes care specific skills more available in private aged care and high care classified facilities. Limited monitoring of outcomes of diabetes care were evident. Overall, participants perceived their diabetes knowledge as “good”, however deficits were found in the level of actual knowledge on diabetes complications and medication management. Ratings for perceived and actual diabetes knowledge was higher with older aged health care workers by those employed in their current position the longest.Furthermore, a positive relationship was shown between perceived and actual diabetes knowledge with years of experience in aged care, employment status (RNs/ENs, AINs and other health care workers) and education status (grade 12 schooling, Technology and Further Education and university award). Diabetes – related knowledge was shown to be the most significant facilitator as well as barrier to diabetes care provision. Factors affecting perceived level of confidence in providing diabetes self-management education included experience in aged care, employment position and level of education.The contribution of this research to the area of study was to provide important data on the availability of diabetes guidelines and protocols and diabetes knowledge base. Data has also been provided for the availability of diabetes guidelines and protocols in different facility types and with different classifications of care as well as data for the perceived level of confidence in providing diabetes care in residential aged care facilities. Study findings indicate a need for an increased focus on diabetes care in residential aged care to improve health outcomes.
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Plant, Jon. "Being in care : deconstructing childhood in residential care." Thesis, University of Hull, 2002. http://hydra.hull.ac.uk/resources/hull:3548.
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Horner, Barbara Joan. "The impact and influence of change on a residential aged care community: an action research study." Thesis, Curtin University, 2005. http://hdl.handle.net/20.500.11937/1924.
Full textAbstract:
This study was an investigation of the complexities and challenges of change in a community-based aged care facility in Western Australia, to reveal the impact and influence of change on the community. It explored the impact of change on both the residents and the senior management team, as leaders of the organisation, and explored how change influenced the redevelopment process and future of the organisation. There is considerable literature on organisational change including the impact of change on the structure, function, process, workforce and leaders of the organisation. There is, however, little literature on organisational change within aged care communities, particularly with an emphasis on the complexities and challenges associated with change within an organisation that is both a business and a home for its residents. The study took the form of a participative action research study, occurring predominantly over two years (2002-2003) with some continuation into a third year (2004). The study had three phases and included two action research cycles and a critical reference group (CRG), comprising the senior management team (SMT) and researcher. It adopted a broadly qualitative methodology, using data from participatory observation and semi-structured interview; however, it did include quantitative and qualitative data from two 'quality of service' surveys for independent living residents and a staff satisfaction survey. The finding of this study are presented as a narrative account of the experiences of the participants. The study reveals that change associated with the redevelopment impacted on residents' wellbeing, described by them as quality of life.The redevelopment process and associated change also emphasised the importance of communication and explanation with residents to understand elements of quality of life and to monitor and manage the impact of change. The findings of the study highlight the challenge faced by community-based aged care communities classified by government, the industry and the wider community as primarily not-for-profit, to balance financial accountability and social conscience. The perception of benevolence influenced the attitudes of residents and staff and made business accountability more difficult to explain and realise. The study reveals that change also impacted on the structure and function of the organisation as it built its capacity for change. It reshaped the relationship between the Board and senior management team (SMT), which was reported as an improvement in communication, work relations and leadership effectiveness. The development of the leadership team, being the senior management team, was influenced by change and the change process enabled this team to become a competent, confident, cohesive senior team, with a preferred leadership style. A further finding was the realisation of the value and appropriateness of the action research process. It provided tools and processes that were used to plan, act, analyse and reflect on the many aspects of organisational change and enabled the organisation, principally the SMT, to reflect on the impact and influence of change. The research process supported their development as leaders as well as the development of the team. The process of planning, collecting data, analysing data, reflection and action provided a structure and process that they continued to use in their management practices, as new situations continued to arise with the redevelopment process.
19
Bhandari, Kunwar Sushma. "End-of-life care in residential aged care: The perceptions of bereaved family members." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2590.
Full textAbstract:
Background
In recent years, life expectancy has increased causing a higher global percentage of older people living with multiple chronic health problems including dementia. This increase in the aged population with complicated health issues has required governments and health care systems internationally to provide suitable accommodation and health care support such as residential aged care facilities. In residential aged care facilities comprehensive and holistic health care and assessment should ensure good quality of life and a supported death. The Australian Royal Commission into Aged Care Quality and Safety (2021) recognised a need for improvement in the residential aged care sector highlighting end of life care as a core business in aged care. Little research has been completed to explore the family perspective of end of life care provided in the residential aged care setting.
Methods
This study used an inductive interpretive research method to explore participants’ experiences of their relatives’ end of life care within two residential aged care facilities in Western Australia. Two facilities assisted with the recruitment of participants (n=5) and provided letters of support, and one participant (n=1) was recruited via an advertisement and did not disclose the facility. Fifty one potential participants from two residential aged care facilities were invited to participate in the study, with (n=5) family members agreeing. Qualitative data collection was undertaken using semi-structured face to face individual interviews with six participants utilising predesigned interview questions. The interviews were conducted in the aged care facilities’ meeting rooms (n=5), and Edith Cowan University’s meeting room (n =1) with each interview lasted for approximately 60 to 90 minutes. The eight Principles for Palliative and End of Life Care in Residential Aged Care from Palliative Care Australia were applied as the conceptual framework for the study.
Results
Through the analysis of data collected from participants, two themes and subthemes were identified about their experiences during the end of life care period of their family member. Family reflecting on care described their experiences of personal care, emotional and spiritual care, symptom management, grief and bereavement, and concerns about care. Providing a supportive environment was related to the palliative care plan, involving families in care, care delivery, staff communication with family, and the physical environment. Families generally observed and expressed satisfaction to the emotional and spiritual care, and to some degree to personal care and pain management. Additionally, most of the families stated that the physical environment of the facility was appropriate, however, key aspects of care highlighted for improvement included bereavement support, and the need for improved communication with families, and in providing timely information. Participants further observed that care staff were attentive, however, two participants mentioned that their expectations of professional behaviour was not met by all staff as they experienced poor communication from a few staff and one participant perceived a personality clash with care staff member.
Conclusion
This thesis explored the end of life care in Australian residential aged care facilities from the perspective of bereaved family members using a qualitative interpretative methodology. Findings from this study suggest that bereaved families perceived personal, emotional and spiritual care of the residents as satisfactory. Similarly, medication and pain symptoms management were observed to have met most of the families’ expectation. Additionally, emotional, psychological and religious supports was offered to the residents and their family, and they were involved in care discussions and decisions. Issues in communication and post death support and a lack of awareness to the cultural sensitivity were the key aspects identified for improvement.
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McKenzie-Green, Barbara. "Living life in residential aged care: A process of continuous adjustment." Thesis, Australian Catholic University, 2010. https://acuresearchbank.acu.edu.au/download/320774175c89792c3179b6b3583c698b49a8502b130a6659b78c752f33a2bc23/2084272/Barbara_McKenzie_Green_2010_Living_life_in_residential__aged_care.pdf.
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The aim of this study was to examine whether, and how, residents living in residential aged care homes become involved in their care, and what areas of their care and life they work to influence or negotiate.
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De, Bellis Anita Marie, and anita debellis@flinders edu au. "Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility." Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.
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This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care.
Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care.
Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'.
The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision.
The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice.
There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation.
If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.
22
Horner, Barbara Joan. "The impact and influence of change on a residential aged care community: an action research study." Curtin University of Technology, Centre for Research into Aged Care Services, 2005. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=16051.
Full textAbstract:
This study was an investigation of the complexities and challenges of change in a community-based aged care facility in Western Australia, to reveal the impact and influence of change on the community. It explored the impact of change on both the residents and the senior management team, as leaders of the organisation, and explored how change influenced the redevelopment process and future of the organisation. There is considerable literature on organisational change including the impact of change on the structure, function, process, workforce and leaders of the organisation. There is, however, little literature on organisational change within aged care communities, particularly with an emphasis on the complexities and challenges associated with change within an organisation that is both a business and a home for its residents. The study took the form of a participative action research study, occurring predominantly over two years (2002-2003) with some continuation into a third year (2004). The study had three phases and included two action research cycles and a critical reference group (CRG), comprising the senior management team (SMT) and researcher. It adopted a broadly qualitative methodology, using data from participatory observation and semi-structured interview; however, it did include quantitative and qualitative data from two 'quality of service' surveys for independent living residents and a staff satisfaction survey. The finding of this study are presented as a narrative account of the experiences of the participants. The study reveals that change associated with the redevelopment impacted on residents' wellbeing, described by them as quality of life.The redevelopment process and associated change also emphasised the importance of communication and explanation with residents to understand elements of quality of life and to monitor and manage the impact of change. The findings of the study highlight the challenge faced by community-based aged care communities classified by government, the industry and the wider community as primarily not-for-profit, to balance financial accountability and social conscience. The perception of benevolence influenced the attitudes of residents and staff and made business accountability more difficult to explain and realise. The study reveals that change also impacted on the structure and function of the organisation as it built its capacity for change. It reshaped the relationship between the Board and senior management team (SMT), which was reported as an improvement in communication, work relations and leadership effectiveness. The development of the leadership team, being the senior management team, was influenced by change and the change process enabled this team to become a competent, confident, cohesive senior team, with a preferred leadership style. A further finding was the realisation of the value and appropriateness of the action research process. It provided tools and processes that were used to plan, act, analyse and reflect on the many aspects of organisational change and enabled the organisation, principally the SMT, to reflect on the impact and influence of change. The research process supported their development as leaders as well as the development of the team. The process of planning, collecting data, analysing data, reflection and action provided a structure and process that they continued to use in their management practices, as new situations continued to arise with the redevelopment process.
23
Simms, Mary. "The aged 'in limbo' : accounts of 'community care' in the 1980s." Thesis, Queen Mary, University of London, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295723.
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Alizadeh-Khoei, Mahtab. "Assessing factors in utilisation of health services and community aged care services by the Iranian elderly living in the Sydney metropolitan area acculturation aged care /." Connect to full text, 2008. http://hdl.handle.net/2123/3986.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed Jan. 19, 2009) Includes tables and questionnaires in English and Farsi. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliography. Also available in print form.
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Venturato, Lorraine V. "A practice divided: Registered nurses' experience of policy and reform in residential aged care." Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/36785/1/36785_Digitised%20Thesis.pdf.
Full textAbstract:
With the increase in the percentage of the population aged over 65 years, there is increased pressure on the health care system and the nursing profession to provide quality, cost effective care to meet this growing demand for aged care services. As a result, residential aged care services in Australia have undergone a period of extensive reform, including policy and funding changes, impacting on all areas of practice. This demand for high quality, cost effective aged care requires both the involvement of committed professionals and the development and implementation of appropriate plans and policy.
This study explores the experiences of registered nurses in residential aged care facilities and how these experiences are shaped by government aged care policy and reform. By posing the research questions: How do registered nurses experience everyday practice in residential aged care? and What influence have policy and reform processes had on registered nurses' experience of their everyday practice? this study aims to further develop understanding of aged care practice and the contextual factors that define it. Thus, the purpose of this study is to challenge registered nurses to reflect on their role in residential aged care (what they do), and through examination of policy and reform (why they do it), explore nursing practices and options for service delivery aimed at creating a care environment of excellence for older Australians.
The qualitative research methodology designed for this study is based on a critical hermeneutics approach informed by the works of Gadamer and Habermas. Such an approach recognises the historical, contextual and linguistic basis for interpretation and critique. While Gadamer provides direction for the study to reveal an understanding of registered nurses' experiences, Habermas provides insight into the role of critique in understanding the contextual conditions of such experience. Ultimately, this study seeks to make explicit the cultural and political meanings that operate to establish meaning and context in residential aged care in Australia.
Fourteen (14) registered nurses practising in both public and charitable residential aged care facilities were interviewed as part of this study. Registered nurses from high, low and mixed care facilities were interviewed in-depth. Journal notes provided insight into assumptions and prejudices involved in interpretation and facilitated the critical examination of practice experiences within the residential aged care context.
Findings suggest that residential aged care is a complex and challenging environment, full of tensions, contradictions and frustrations for registered nurses employed within the system. Three aspects of the experiences of aged care practice are revealed in this study: Searching for Value; Dealing with Change; and Dividing Practice. The search for value reveals the tensions registered nurses experience in seeking to reconcile those aspects of practice that construct meaning and value in their everyday practice with dominant social and professional values that fail to acknowledge the value of ageing and aged care. Dealing with change is an everyday aspect of practice for registered nurses as they struggle to redefine their roles and responsibilities within a changing environment. This struggle highlights the tensions that exist between traditional nursing roles and their expanding managerial responsibilities. Registered nurses also identified conflicts in caring as a result of their changing roles, which have resulted in a division of practice. These conflicts in caring contribute to the tensions experienced between registered nurses and other stakeholders in residential aged care in relation to everyday practice and quality of care.
Findings indicate that aged care policy and reform have a significant impact on the experiences of registered nurses in residential aged care and contribute to the tensions, challenges and frustrations facing nurses in their everyday practice. These findings indicate that aged care policy and reform processes are integral in the restructuring of practice in residential aged care. This analysis illuminates the ways in which aged care policy constructs the tensions and evident contradictions within registered nurses' roles. Based on these findings, recommendations for practice and further research encourage cooperation between government, service providers and the nursing profession to assist registered nurses to reconcile past, present and future practices in order to redefine practice and meaning in residential aged care.
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Sukkar, Khalil Hassan, and mudeer@optusnet com au. "The prospects of Adopting Alternative Staffing Methods in Residential Aged Care in Australia." RMIT University. Graduate School of Business, 2009. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20091005.115238.
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The Residential Aged Care (RAC) industry is the fastest growing sector of the health care industry in Australia, particularly with the needs of people aging eighty five years and over consuming most health care services (Productivity Commission, 2006). This thesis examines the staffing efficiency challenge that is facing the RAC industry in Australia, from the facility managers' perspectives. Staffing efficiency is a crucial component in the success of this industry that is labour intensive, delivering complex services twenty-four hours per day and seven days per week. By achieving staffing efficiencies, facility managers would minimise labour cost expenditures; thus, ensuring sustainability and growth of their organisation in the long run. The literature reviewed revealed limited number of scholarly reviews about staffing efficiencies conducted in Australia. Nevertheless, it highlighted a number of available staffing approaches available overseas which could be of promising results if they were adopted to suit the Australian industry and its operational systems. This thesis explores the prospects of RAC facility managers adopting 'alternative' or 'new' staffing methods in their facilities as one solution for this staffing challenge. In this study, the researcher refers to alternative or new staffing methods as staffing methods that are not currently utilised in the staffing of RAC facilities in Australia. Using an Interpretivist research paradigm, 18 semi-structured interviews were conducted with the participating RAC managers in their work environment. During the interviews, a sample alternative staffing tool, developed prior to the study, was displayed. The data generated were analysed in the context of the RAC industry's environment, operational challenges, and through the theoretical implication of neo-liberalism. This theory provided a vehicle for the analysis of the data generated on staffing within the context of Australia's current economic policies. The generated data revealed little chance of such adoption reflected in a number of findings including: 1) Participants' lack of interest in adopting alternative staffing methods despite their comments on the unsuitability of current tools. 2) Overdependence of the industry on cost cutting measures and monetary performance indicators. 3) Lack of incentives for the adoption of change and 4) Lack of preparedness of RAC facility managers for such change. Thorough analysis of the findings revealed misinterpretation of free-market principles in the currently utilised staffing tools, which links demand of service to the number of individuals requiring care on one hand, and the supply of services available to the number of staff rostered to provide the care, on the other hand. The application of such a principle on the RAC industry is questionable, particularly with the inconsistency in the elderly residents' care needs and the staffing skill mix. A new staffing approach that uses the care required by the elderly individuals and the staffing skills available in the facilities as the basis for the demand and supply principles will provide a plausible solution for facing the staffing challenge. A joint venture between the Australian government and the RAC industry to encourage the adoption of such alternative staffing approach is the recommended way forward for improving staffing efficiencies.
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Phillips, Jane Louise. "Navigating a palliative approach in residential aged care using a population based focus." View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/33324.
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Thesis (Ph.D.)--University of Western Sydney, 2008.A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy to the College of Health and Science, School of Nursing, University of Western Sydney. Includes bibliography.
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Watkins, Ross. "Eating well : understanding and shaping the mealtime experience of older adults in residential care." Thesis, University of Exeter, 2018. http://hdl.handle.net/10871/33806.
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Background: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. Aim: The aim of this project was to gain an insight into residents’ experiences of mealtimes in order to inform the development of a mealtime intervention. By addressing the issues that impact on residents’ enjoyment of meals, interventions may target improvements in the health and wellbeing of residents more effectively. Methods: This thesis is comprised of three pieces of empirical work conducted using multiple methods. In a systematic review of stakeholder perceptions of mealtimes, five databases were searched from inception to November 2015, followed by thematic analysis of extracted data. In a second study, semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. These studies informed the development of a staff-focussed training programme (study three) using the process of Intervention Mapping (IM) as a guide. The feasibility of this intervention was assessed using qualitative surveys and analysed using multiple methods. Fourteen staff from two care homes participated in the feasibility study, which investigated the deliverability of the training programme and the acceptability of its content. Findings: The systematic review and resident interview study revealed that the dining experience was a focal point for residents’ broader experiences of residing in a care home. Whilst meal quality and enjoyment impacted on the dining experience, the provision of care was pivotal in determining mealtime culture and resident agency within the home. This had implications for self-efficacy and social relationships, particularly in the context of transitioning from independent living to a care home community. These findings informed the development of a mealtime intervention, which was found to be deliverable and acceptable to staff. Conclusion: Mealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. Evidence from the empirical work supports the development of interventions aimed at mealtime staff to improve resident self-efficacy. This thesis has established the necessary groundwork for a pilot trial and future definitive trial to assess resident (and staff) outcome measures including social (e.g., collective engagement) and psychological outcomes (e.g., wellbeing), as well as health outcomes (e.g., nutritional status).
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Johnson, Lula Juanita. "The effects of home based primary care with chronically ill older adults on visits to the emergency department, hospitalization, and bed days of care." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1422981.
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Baumbusch, Jennifer Lyn. "Decommissioning citizenship : the organization of long-term residential care." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/1714.
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Long-term residential care (LTRC) is a complex sociopolitical milieu where people from diverse backgrounds come to live and work together. In recent years health care restructuring has resulted in the closure of facilities; health care policy has narrowed the population that accesses LTRC so that only those who are the most medically and socially complex are admitted; and there has been a transformation of the work force, a workforce that is mainly comprised of Women of Colour and is among the lowest paid in health care. The purpose of this study was to critically examine the organization of care in LTRC within this context.
The theoretical perspective guiding the study was informed by postcolonialism, postcolonial feminism, intersectionalities, and Foucaudian epistemology. The method of inquiry for the study was critical ethnography, which allowed for critical analysis of `taken for granted' assumptions in the organization of care.
Over a period of ten months, I was immersed in two LTRC facilities in the Lower Mainland of British Columbia. Field work consisted of approximately 218 hours of participant observation. I conducted 51 interviews with administrators, family members, residents, and staff. I reviewed relevant provincial policies and facility-based policies and procedures. I also collected quantitative data related to resident transitions in the health care system (for example, admissions, discharges, and hospital admissions), and staffing levels.
Findings from this study were discussed in three key themes. First, a systematic decommissioning of citizenship occurred for residents and staff in this setting. Second, the impact of health care restructuring over the past decade had important consequences for relationships between residents, family, and staff. Third, relational care took place in `stolen' moments that occurred despite heavy workloads. All of these themes were underscored by intra-gender oppression, relations of power, and influenced by discourses of ageism and corporatism, which ultimately played out in day to day interactions between those who live and work there. Recommendations from this study included: addressing the entrenched hierarchies in nursing, further examination of the public-private funding model in LTRC, and the introduction of an independent ombudsperson to ensure consistent, high quality care across the LTRC sector.
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Walker, Helen M. "The experience of care assistants who care for residents in the final stage of life in residential aged care facilities." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/278.
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This thesis presents the results of a study that explores the experience of care assistants who care for residents in the final stages of life in residential aged care facilities in metropolitan Perth. Care assistants, with little formal training and no regulation, play a pivotal role in the direct care of dying residents in these facilities. Yet little was known about the palliative care role and the impact that caring for residents in the final stage of life has on this health care group. The literature relating to end of life care in residential aged care facilities revealed limited research in this area. In particular, there is a lack of studies that relate specifically to the care assistants' role and their experiences of end of life care. Research to date has focused on the context of palliative care in residential aged care facilities, the workplace environment, how to provide a dignified death, relationships and the central role of the care assistant. This study used a qualitative narrative inquiry research design.
32
Stokes, Julie Anne. "Introducing clinical pharmacy as a quality use of medicines intervention in residential aged care /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16923.pdf.
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McCarty, Lisa. "Evaluating the quality of care within residential services for older people." Thesis, University of Hull, 2001. http://hydra.hull.ac.uk/resources/hull:8429.
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The quality of care within residential services for older people has been a source of concern within health and social care for some time. Several attempts have been made to develop a means of assessing the quality of care; however, the nature and quality of these varies enormously. The Quest process of evaluation, which was designed as a means of assessing service quality according to the structure and process of care, is presented as a possible means of improving upon current practice. The Quest system incorporates four measures: the Service Profile, the Support Questionnaire, the Observation Profile and the Occupational Stress Indicator. The Service Profile is essentially descriptive in nature, and the Occupational Stress Indicator is a published, standardised measure. The remaining Quest measures, however, were only recently developed and therefore lack evidence in support of their psychometric properties. The present study was designed to assess the validity and reliability of the Quest system within residential services for older people. The exploration of validity and reliability took several forms, incorporating both qualitative and quantitative methodologies. The overall findings of the discussion group and assessment of face validity advocated the credibility of the dimensions of support that underpin the Quest system. With regards to reliability, the findings supported the reliability of the Observation Profile but identified that further work was needed to ascertain the reliability of the Support Questionnaire. Issues relevant to the interpretation of the results were discussed along with the reasons why a number of formal assessments of validity could not be made. Further work to explore the psychometric properties of the Quest system was recommended before it can be confidently applied to residential services for older people.
34
Piercy, Kathleen Walsh. "Family ties and care for aged parents at home." Diss., This resource online, 1996. http://scholar.lib.vt.edu/theses/available/etd-06062008-154400/.
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Curry, Robert John. "Residential homes and development of non-residential community care services : the role of the private sector." Thesis, Keele University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263201.
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Stanley, David. "The anatomy of group care : explorations in the personal social services." Thesis, University of Newcastle Upon Tyne, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.235692.
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Noden, Philip. "Perspectives on respite care services for adults affected by mental health problems." Thesis, London South Bank University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362569.
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Lau, Wai-kwan Dianna. "The utilisation of home care and residential care services by seniors in Canada: critical appraisal." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4693862X.
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Stone, Timothy T. "Cultures of consumption within residential care homes : understanding elderly bricoleurs' cultural maps of meaning." Thesis, University of Stirling, 2006. http://hdl.handle.net/1893/107.
Full textAbstract:
Set within the context that the world’s population is ageing at an unprecedented rate, it is argued that care of the elderly, and their everyday lived experiences are poised to become prominent concerns. In the shadow of this, the ageing population poses a myriad of challenges not only for the elderly but also for policy makers who put in place systems for the provision of services within residential care homes. By virtue, given that communities of elderly consumers voices are often muted within many academic analyses of social policy and service provision this study illuminates and distils communities of elderly consumers understandings of residential care homes. Given the absence of suitable literature within the fields of marketing and interpretive consumer research, this study turns to the sociological and anthropological literature of Hall and Jefferson (1976) and Levi-Strauss (1966). In doing so, communities of elderly consumers within residential care homes can be theorised as a cultural community of ‘bricoleurs’ within a ‘cultural map of meaning’. Furthermore, viewed through this lens, such bricoleurs can be seen to understand their meaningful everyday lived experiences within, and through, the use of ‘bricolage’. Emanating from eight existential-phenomenological interviews, a rich picture emerges wherein bricoleurs understandings of residential care homes can be seen to be embedded not only within, but also through, such things as the body, leisure trips, noise disturbances, death, large items of furniture, small hand-sized objects, mobility aids, quality of care and social interaction. Moreover, in the light of the resultant interpretations common themes can be seen to emerge within communities of bricoleurs social and material understandings of residential care homes, namely the notion of cultures of dependency, trauma and comfort. This research contributes to marketing knowledge in that it argues that communities of ‘elderly bricoleurs’ within residential care homes can be seen to be held together by unique understandings of cultures of dependency, trauma and comfort. Furthermore, it is also argued that elderly bricoleurs address themselves to a relatively limited amount of bricolage that enables them to keep alive actual, desired, imagined and fictional community ties. Furthermore, the reality and efficacy of cultural communities of elderly bricoleurs seems to depend on their ability to address ‘whatever is to hand’ (Levi-Strauss, 1966) in order to construct and understand their cultural maps of meaning within residential care homes.
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Shapera, Leah Elizabeth. "Meeting the nursing care needs of the elderly in the community : clients' perspectives on adult day care." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28797.
Full textAbstract:
A trend toward non-institutionalization of the elderly, in conjunction with the increasing size of the elderly population has resulted in the development of a variety of community programs and services to help meet their complex and diverse health care needs in the community setting. Although there is substantial documentation pertaining to the needs of the elderly in the community and the available services (Lifton, 1989; Padula, 1983; Starrett, 1986; Wallace, 1987), this documentation has been generated primarily by health care professionals and agencies, rather than from the perspectives of the elderly themselves.
Adult Day Care [ADC] programs were established in the late 1960s as one means of attempting to meet the needs of the frail elderly in the community (Padula, 1983). On the surface, these programs appear to be effective in meeting the needs of clients through the provision of nursing services and a wide variety of therapeutic programs and social activities.
This exploratory descriptive study was based on the premise that there exists a need to gain insight into the clients' perspectives regarding the ways in which ADC services are instrumental in meeting their perceived needs.
Data were collected and analyzed to identify the self-perceived needs of ADC clients and their perceptions of how the
ADC nursing services were instrumental in assisting them to meet these needs. Two interviews were conducted with each of the 11 ADC participants comprising the sample, using a semi-structured interview guide developed by the researcher.
The two needs most commonly identified by participants included the need to cope with a range of concurrent and/or successive losses, and the need to establish new support systems.
Participants identified the most significant components of the nursing role as those of the provision of emotional support through counselling, and the provision of health monitoring services. Participants viewed the overall ADC program as important in assisting them to meet their needs by providing access to social outings, individualized care, emotional support, and the opportunity to enhance their self-esteem, confidence, and feelings of belongingness.Applied Science, Faculty of
Nursing, School of
Graduate
41
Banks, Merrilyn Dell. "Economic analysis of malnutrition and pressure ulcers in Queensland hospitals and residential aged care facilities." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/16966/1/Merrilyn_D_Banks_Thesis.pdf.
Full textAbstract:
Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies
indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and increased length of stay. Pressure ulcers
are considered largely preventable, and the demand for the establishment of appropriate policy, standards and guidelines regarding pressure ulcers has
recently become important because the incidence and prevalence of pressure ulcers is increasingly being considered a parameter of quality of care. The aims of this study program were to firstly determine the prevalence of malnutrition and its association with pressure ulcers in Queensland Health hospitals and residential aged care facilities; and secondly to estimate the potential economic consequences of malnutrition by determining the costs
arising from pressure ulcer attributable to malnutrition; and the economic
outcomes of an intervention to address malnutrition in the prevention of pressure ulcers. The study program was conducted in two phases: an epidemiological study phase and an economic modelling study phase. In phase one, a multi centre, cross sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in
Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression. The effect of nutritional status on the presence of pressure ulcer was also determined via logistic regression. Logistic regression analyses were carried out using an analysis of correlated data approach with SUDAAN statistical package (Research Triangle Institute, USA) to account for the potential clustering effect of different facilities in the model. In phase two, an exploratory economic modelling framework was used to estimate the number of cases of pressure ulcer, total bed days lost to pressure ulcer and the economic cost of these lost bed days which could be attributed to malnutrition in Queensland public hospitals in 2002/2003. Data was obtained on the number of relevant separations, the incidence rate of pressure ulcer, the independent effect of pressure ulcers on length of stay, the cost of a bed day, and the attributable fraction of malnutrition in the development of pressure ulcers determined using the prevalence of malnutrition, the incidence rate of developing a pressure ulcer and the odds risk of developing a pressure ulcer when malnourished (as determined previously). A probabilistic sensitivity analysis approach was undertaken whereby probability distributions to the specified ranges for the key input parameters were assigned and 1000 Monte Carlo samples made from the input parameters. In an extension of the above model, an economic modelling framework was
also used to predict the number of cases of pressure ulcer avoided, number of bed days not lost to pressure ulcer and economic costs if an intensive nutrition support intervention was provided to all nutritionally at risk patients in Queensland public hospitals in 2002/2003 compared to standard care. In
addition to the above input parameters, data was obtained on the change in risk in developing a pressure ulcer associated with an intensive nutrition support intervention compared to standard care. The annual monetary cost of the provision of an intensive nutrition support intervention to at risk patients was
modelled at a cost of AU$ 3.8-$5.4 million for additional food and nutritional supplements and staffing resources to assist patients with nutritional intake. A probabilistic sensitivity analysis approach was again taken.
A mean of 34.7 + 4.0% and 31.4 + 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, metropolitan location of facility and medical specialty, in particular oncology and critical care. Malnutrition was found to be significantly associated with an increased odds
risk of having a pressure ulcer, with the odds risk increasing with severity of malnutrition. In acute facilities moderate malnutrition had an odds risk of 2.2 (95% CI 1.6-3.0, p<0.001) and severe malnutrition had an odds risk of 4.8 (95% CI 3.2-7.2, p<0.001) of having a pressure ulcer. The overall adjusted odds risk
of having a pressure ulcer when malnourished (total malnutrition) in an acute facility was 2.6 (95% CI 1.8-3.5, p<0.001). In residential facilities, where the audit results were presented separately, the same pattern applied with moderate malnutrition having an odds risk of 1.7 (95% CI 1.2-2.2, p<0.001) and 2.0 (95% CI 1.5-2.8, p<0.001); and severe malnutrition having an odds risk of 2.8 (95% CI1.2-6.6, p=0.02) and 2.2 (95% CI 1.5-3.1, p<0.001), for Audits 1 and 2 respectively. There was no statistical difference between these odds risk
ratios between the audits. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in a residential aged care facility was 1.9 (95% CI 1.3-2.7, p<0.001) and 2.0 (95% CI 1.5-2.7, p<0.001) for Audits
1 and 2 respectively. Being malnourished was also found to be significantly associated with an increased odds risk of having a higher stage and higher number of pressure ulcers, with the odds risk increasing with severity of malnutrition.
The economic model predicted a mean of 3666 (Standard deviation 555) cases
of pressure ulcer attributable to malnutrition out of a total mean of 11162 (Standard deviation 1210), or approximately 33%, in Queensland public acute hospitals in 2002/2003. The mean number of bed days lost to pressure ulcer that were attributable to malnutrition was predicted to be 16050, which represents approximately 0.67% of total patient bed days in Queensland public
hospitals in 2002/2003. The corresponding mean economic costs of pressure ulcer attributable to malnutrition in Queensland public acute hospitals in 2002/2003 were estimated to be almost AU$13 million, out of a total mean estimated cost of pressure ulcer of AU$ 38 526 601. In the extension of the economic model, the mean economic cost of the implementation of an intensive nutrition support intervention was predicted to be a negative value ( -AU$ 5.4 million) with a standard deviation of $AU3.9 million, and interquartile range of –AU$ 7.7 million to –AU$ 2.5 million. Overall there were 951 of the 1000 re-samples where the economic cost is a negative value. This means there was a 95% chance that implementing an intensive nutrition support intervention was overall cost saving, due to reducing the cases
of pressure ulcer and hospital bed days lost to pressure ulcer. This research program has demonstrated an independent association between malnutrition and pressure ulcers, on a background of a high prevalence of malnutrition, providing evidence to justify the elevation of malnutrition to a safety and quality issue for Australian healthcare organisations, similarly to pressure ulcers. In addition this research provides preliminary economic
evidence to justify the requirement for consideration of healthcare policy, standards and guidelines regarding systems to identify, prevent and treat malnutrition, at least in the case of pressure ulcers in Australia.
42
Banks, Merrilyn Dell. "Economic analysis of malnutrition and pressure ulcers in Queensland hospitals and residential aged care facilities." Queensland University of Technology, 2008. http://eprints.qut.edu.au/16966/.
Full textAbstract:
Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies
indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and increased length of stay. Pressure ulcers
are considered largely preventable, and the demand for the establishment of appropriate policy, standards and guidelines regarding pressure ulcers has
recently become important because the incidence and prevalence of pressure ulcers is increasingly being considered a parameter of quality of care. The aims of this study program were to firstly determine the prevalence of malnutrition and its association with pressure ulcers in Queensland Health hospitals and residential aged care facilities; and secondly to estimate the potential economic consequences of malnutrition by determining the costs
arising from pressure ulcer attributable to malnutrition; and the economic
outcomes of an intervention to address malnutrition in the prevention of pressure ulcers. The study program was conducted in two phases: an epidemiological study phase and an economic modelling study phase. In phase one, a multi centre, cross sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in
Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression. The effect of nutritional status on the presence of pressure ulcer was also determined via logistic regression. Logistic regression analyses were carried out using an analysis of correlated data approach with SUDAAN statistical package (Research Triangle Institute, USA) to account for the potential clustering effect of different facilities in the model. In phase two, an exploratory economic modelling framework was used to estimate the number of cases of pressure ulcer, total bed days lost to pressure ulcer and the economic cost of these lost bed days which could be attributed to malnutrition in Queensland public hospitals in 2002/2003. Data was obtained on the number of relevant separations, the incidence rate of pressure ulcer, the independent effect of pressure ulcers on length of stay, the cost of a bed day, and the attributable fraction of malnutrition in the development of pressure ulcers determined using the prevalence of malnutrition, the incidence rate of developing a pressure ulcer and the odds risk of developing a pressure ulcer when malnourished (as determined previously). A probabilistic sensitivity analysis approach was undertaken whereby probability distributions to the specified ranges for the key input parameters were assigned and 1000 Monte Carlo samples made from the input parameters. In an extension of the above model, an economic modelling framework was
also used to predict the number of cases of pressure ulcer avoided, number of bed days not lost to pressure ulcer and economic costs if an intensive nutrition support intervention was provided to all nutritionally at risk patients in Queensland public hospitals in 2002/2003 compared to standard care. In
addition to the above input parameters, data was obtained on the change in risk in developing a pressure ulcer associated with an intensive nutrition support intervention compared to standard care. The annual monetary cost of the provision of an intensive nutrition support intervention to at risk patients was
modelled at a cost of AU$ 3.8-$5.4 million for additional food and nutritional supplements and staffing resources to assist patients with nutritional intake. A probabilistic sensitivity analysis approach was again taken.
A mean of 34.7 + 4.0% and 31.4 + 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, metropolitan location of facility and medical specialty, in particular oncology and critical care. Malnutrition was found to be significantly associated with an increased odds
risk of having a pressure ulcer, with the odds risk increasing with severity of malnutrition. In acute facilities moderate malnutrition had an odds risk of 2.2 (95% CI 1.6-3.0, p<0.001) and severe malnutrition had an odds risk of 4.8 (95% CI 3.2-7.2, p<0.001) of having a pressure ulcer. The overall adjusted odds risk
of having a pressure ulcer when malnourished (total malnutrition) in an acute facility was 2.6 (95% CI 1.8-3.5, p<0.001). In residential facilities, where the audit results were presented separately, the same pattern applied with moderate malnutrition having an odds risk of 1.7 (95% CI 1.2-2.2, p<0.001) and 2.0 (95% CI 1.5-2.8, p<0.001); and severe malnutrition having an odds risk of 2.8 (95% CI1.2-6.6, p=0.02) and 2.2 (95% CI 1.5-3.1, p<0.001), for Audits 1 and 2 respectively. There was no statistical difference between these odds risk
ratios between the audits. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in a residential aged care facility was 1.9 (95% CI 1.3-2.7, p<0.001) and 2.0 (95% CI 1.5-2.7, p<0.001) for Audits
1 and 2 respectively. Being malnourished was also found to be significantly associated with an increased odds risk of having a higher stage and higher number of pressure ulcers, with the odds risk increasing with severity of malnutrition.
The economic model predicted a mean of 3666 (Standard deviation 555) cases
of pressure ulcer attributable to malnutrition out of a total mean of 11162 (Standard deviation 1210), or approximately 33%, in Queensland public acute hospitals in 2002/2003. The mean number of bed days lost to pressure ulcer that were attributable to malnutrition was predicted to be 16050, which represents approximately 0.67% of total patient bed days in Queensland public
hospitals in 2002/2003. The corresponding mean economic costs of pressure ulcer attributable to malnutrition in Queensland public acute hospitals in 2002/2003 were estimated to be almost AU$13 million, out of a total mean estimated cost of pressure ulcer of AU$ 38 526 601. In the extension of the economic model, the mean economic cost of the implementation of an intensive nutrition support intervention was predicted to be a negative value ( -AU$ 5.4 million) with a standard deviation of $AU3.9 million, and interquartile range of –AU$ 7.7 million to –AU$ 2.5 million. Overall there were 951 of the 1000 re-samples where the economic cost is a negative value. This means there was a 95% chance that implementing an intensive nutrition support intervention was overall cost saving, due to reducing the cases
of pressure ulcer and hospital bed days lost to pressure ulcer. This research program has demonstrated an independent association between malnutrition and pressure ulcers, on a background of a high prevalence of malnutrition, providing evidence to justify the elevation of malnutrition to a safety and quality issue for Australian healthcare organisations, similarly to pressure ulcers. In addition this research provides preliminary economic
evidence to justify the requirement for consideration of healthcare policy, standards and guidelines regarding systems to identify, prevent and treat malnutrition, at least in the case of pressure ulcers in Australia.
43
Chawewan, Sriburapapirom Veena Sirisook. "Self care practice of the elderly in Bangkok /." Abstract, 2000. http://mulinet3.li.mahidol.ac.th/thesis/2543/43E-Chawewan-S.pdf.
Full text
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O'Reilly, Maria Therese. "Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/40314/1/Maria_O%27Reilly_Thesis.pdf.
Full textAbstract:
Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.
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Liao, Karen Lih-Mei. "Preparation for menopause : development and evaluation of a health education intervention for mid-aged women." Thesis, King's College London (University of London), 1995. https://kclpure.kcl.ac.uk/portal/en/theses/preparation-for-menopause--development-and-evaluation-of-a-health-education-intervention-for-midaged-women(bd25d302-3953-4bcc-87ac-ab3ef2930152).html.
Full textAbstract:
This thesis examines the multi-disciplinary literature on menopause, develops and evaluates an intervention to prepare mid-aged women for the menopause transition. The literature review suggests that the intervention should aim to increase knowledge of menopause, counter overly negative attitudes, and promote health-enhancing behaviours, framed in a biopsychosocial perspective. Forty-five-year-old women registered at five general practices were targeted for the research. One hundred and seventy-eight women were sent baseline questionnaires assessing knowledge and beliefs about the menopause, and a number of healthrelated beliefs and behaviours. Sixty per cent (N=106) of the women responded. Overall, health-related behaviours were not inter-correlated, nor were health beliefs strong predictors of health behaviours. A number of relationships were found which have implications for health services for mid-aged women. The women appeared to have a low level of awareness of empirically derived information about menopause. Beliefs about menopause were complex and multi-faceted, and not necessarily congruent. Intention to use hormone replacement therapy was related to a disease model of menopause, depressed mood and a poorer sense of personal control over the experience of menopause. An as-sociation between smoking and earlier menopausal changes was found. A complex relationship between lack of exercise, greater body mass index, low self-esteem and perceived barriers to regular exercise was also evident. Fifty women subsequently participated in a health education intervention in the form of two small group sessions. Fiftyone women acted as control. The post-intervention assessment was carried out three months later, and the follow-up assessment a year later. A third group of women (N=44) was contacted for the first time at follow-up, to control for the effects of completing questionnaires by the first control group. Knowledge improved and fewer negative beliefs were expressed after the intervention. The proportion of smokers in the intervention group decreased, as did the proportion of women intending to use hormone replacement therapy, though these changes did not reach statistical significance due to the sample size. These changes were maintained at the 1-year follow-up. These outcome measures were unchanged for the control group. The results are discussed with reference to previous findings for mid-aged samples. The implications for further research are drawn. A range of suggestions for further development of health promotion services for mid-aged women are made.
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Horner, Barbara. "The impact and influence of change on a residential aged care community : an action research study /." Full text available, 2005. http://adt.curtin.edu.au/theses/available/adt-WCU20050826.094641.
Full text
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Shanley, Chris. "Navigating the change process : the experience of, and ways forward for, facility managers in the residential aged care industry /." Electronic version, 2005. http://adt.lib.uts.edu.au/public/adt-NTSM20060427.184742/index.html.
Full text
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Leung, Man-fuk Edward. "An analysis of policy on residential nursing care for the elderly in Hong Kong." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13236222.
Full text
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Tierney, Laura T. "Enhancing quality of life for aged care facility residents with dementia: The role of 'meaningful activities'." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/200216/1/Laura_Tierney_Thesis.pdf.
Full textAbstract:
This study explored quality of life and 'meaningful activity' for people living with dementia in residential aged care facilities, drawing on the experiences and perspectives of residents, their family members and care staff. The findings identified groups of residents who have fewer activity opportunities and less frequent participation in activities. A deeper understanding was developed of 'meaningful activity', the benefits of participating in these types of activities and the supports needed for residents to participate. The knowledge gained from this study will inform care practices and improve the daily lives of people living with dementia in residential aged care facilities.
50
MacAndrew, Margaret T. "A descriptive study of wandering-related boundary transgression in persons with severe dementia in residential aged care." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/78569/1/Margaret_MacAndrew_Thesis.pdf.
Full textAbstract:
This thesis described the characteristics of wandering-related boundary transgression in people with severe dementia in residential aged care. To explore all aspects of this common dementia-related behaviour that takes the person who wanders into out of bounds and hazardous areas, a two phase study with an interpretive and an observational phase was conducted. Study findings have provided evidence that will be used to develop strategies to help dementia carers to more effectively manage this behaviour in the future while maintaining the mobility and dignity of the person with dementia.