Dissertations / Theses on the topic 'Transition between hospital and home'

Medication discrepancies occurring at the interfaces of care between hospital and home may cause patient harm. Medication reconciliation (also known as medicines reconciliation) has been suggested as an intervention that may reduce discrepancies. National guidance has made it mandatory for hospitals in the UK to have Medication Reconciliation policies in place for adult patients admitted to hospital. This policy excluded children aged less than 16 years. This thesis aimed to investigate the incidence and potential clinical outcome of medication discrepancies occurring across the interface of care for hospitalized children from admission, discharge and post-discharge. At hospital admission across four UK paediatric settings it was observed that 32% (95% CI = 26.1 – 37.8%) of 244 paediatric patients had at least one potentially clinically significant unintended discrepancy between their pre-admission medication and initial admission medication order in the absence of pharmacist-led medication reconciliation. At discharge, approximately one third of 142 discharge letters reviewed for accuracy over 5 weeks had at least one discrepancy which were detected and corrected by a pharmacist. Post-discharge follow up of patients revealed that 7.7% (95% CI 1.1 – 16%) of patients experienced at least one discrepancy between what was prescribed by the hospital at discharge in comparison to what was prescribed by the GP. Qualitative observations revealed that more than one source of information were required to reconcile medication at admission and GP records did not provide a complete medication history. Post discharge observations highlighted that hospital discharge letters were not always clear resulting in discrepancies between the intended discharge medication list and GP record. This work provides evidence that children aged less than 18 years of age require medication reconciliation when transferring between primary and secondary care. Preventable interventions are required across the care settings to ensure patient safety and to reduce chances of preventable adverse events.

Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: “the daily stuff is difficult”; “engineering care at home is difficult”; “life is stressful” and “difficulty managing complex health problems”. Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project. Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274, df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p < .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early post-discharge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p <.001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the post-discharge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.<br>Ph.D.<br>Doctorate<br>Nursing<br>Nursing<br>Nursing

Thesis advisor: Ellen K. Mahoney<br>Purpose: The purpose of this qualitative descriptive study was to investigate the experiences of post stroke survivors (PSSs) during transition from hospital discharge home during the first four weeks. Background: PSSs describe the transition from hospital to home as an important time in recovery and stress various physical and cognitive concerns early within the recovery period. Research to date fails to adequately reflect PSSs' experiences early after discharge home. This gap in research limits the ability to create interventions for PSSs during this critical time period. Methods/analysis: Semi-structured telephone interviews were conducted with 31 participants, recruited from a large metropolitan hospital in the northeastern United States. The use of in-vivo codes lead to the development of themes that described PSSs' experiences during the four week transitional period. Credibility and transferability of findings were strengthened through memoing, field notes, reflexivity of analysis, member checking, and peer review throughout the analysis process by qualitative experts. Results: The five major themes were: (a) the shock of a stroke interrupting a normal day, (b) transition to an unfamiliar home, (c) experiencing a life riddled with uncertainty, (d) a journey to a new sense of self, and (e) adjusting to a new sense of self. Throughout their journey all PSSs had to cope with uncertainty and adjust to a new sense of self. PSSs that experienced less uncertainty were able to return to their prior daily routine, knew how to prevent another stroke, had a helpful support system, and had frequent follow-up and communication with health care professionals. Conclusion: All PSSs are at risk for complications regardless of stroke severity. To address PSSs complex needs, nurses can provide care beyond symptom management by fostering a dynamic intentional relationship to support recovery. The framework resulting from this study can provide the platform for advanced neuroscience nurses to engage with PSSs to improve their recovery and adjustment to a new sense of self as they transition from hospital to home<br>Thesis (PhD) — Boston College, 2014<br>Submitted to: Boston College. Graduate School of Arts and Sciences<br>Discipline: Philosophy

Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams. Study Purpose & Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes. Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56). Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively). Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.

<p>Major changes have occurred in South Africa over the past twelve years. The delivery of health care changed significantly. Community Health Centres (CHCs) became the main service delivery sites within districts. Due to socio-economic changes in the country, the care of dependants, particularly children and the aged, became problematic to families where most of the adult members have to work to secure an income. A focused literature search indicates that informal carers are ill prepared for their task, that there is a need to include these carers in the discharge planning of the dependants and that the carers need to be supported within their families and communities. The aim of this study was to explore the experiences of informal carers during the transition of their elderly dependants from hospital to home, within the home and across different social groupings in the metropolitan area of Cape Town, South Africa. In addition, the involvement of informal carers in the rehabilitation of the elderly was explored.</p>

This randomized controlled trial determined whether the delivery of a telehealth program after discharge from hospital for coronary artery bypass graft (CABG) surgery made a difference in the post-surgical adjustment and health service use of patients and caregivers. Patients and caregivers (n=182) consented to be randomly assigned to receive one week of daily home audio-video visits from a nurse or routine cardiac instruction only in-hospital. Participants completed individual telephone interviews the day before surgery and 5 days and 3 weeks after discharge..<br>The primary outcomes were changes in anxiety between entry into the program and 3 weeks after discharge for patients and caregivers. Exploratory outcomes included changes in participants' depression symptoms, perceived uncertainty, illness control, support, and conflict with the caregiver, as well as use of health services over the same time period. The potential moderating effects of sex and coping style were also explored..<br>Data were analyzed using 2x2 analyses of covariance assessing the main effects of telehealth and patient sex and their interaction on changes in the dependent variables, including baseline scores as covariates. Results showed no difference between changes in anxiety for patients in telehealth versus usual care. However, patients in telehealth showed greater decreases in perceived uncertainty (p=.03) and increases in perceptions of treatment control (p=.09) than the comparison group. Also, fewer telehealth patients contacted their physicians (p=.04). For caregivers of male patients in telehealth there was a greater change in anxiety than for caregivers of male patients in usual care (p=.0003). While greater decreases in uncertainty (p=.002) and increases in perceived personal control (p=.10) were also realized for caregivers of male patients, greater reductions in depression symptoms (p=.03) and perceptions of conflict (p=.04) were experienced by caregivers in telehealth compared to usual care, regardless of the sex of the caregiver. The coping styles of neither patients nor caregivers influenced their responses to telehealth. Finally, changes in caregivers of male patients' uncertainty were associated with reductions in anxiety, and accounted for more than one third of the observed changes in anxiety. These results can help guide the recruitment of patients into telehealth with knowledge that male and female CABG surgery patients and caregivers can benefit from the service, though in different ways. Future research that examines caregiver and patient outcomes needs to include enough participants of both sexes in order to achieve adequate power to detect clinically meaningful results for women and men.<br>Cet essai clinique randomisé (ECR) servait à déterminer si la prestation d'un programme de Télésanté après un congé de l'hôpital à la suite d'une intervention de pontage aortocoronarien a eu un impact positif sur l'adaptation postopératoire et l'utilisation de services de santé chez les patients et les aidants naturels. Les patients et les aidants naturels (n=182) ont consenti à être répartis de façon aléatoire en deux groupes : l'un recevant des visites audio vidéo quotidiennes à la maison et l'autre, des instructions de routine suivant une intervention cardiaque seulement à l'hôpital. Les participants ont pris part à des entrevues téléphoniques individuelles la journée précédant l'intervention, puis 5 jours et trois semaines après le congé de l'hôpital.<br>Les mesures de résultats primaires incluaient les changements au niveau de l'anxiété chez les patients et les aidants naturels entre la date d'entrée dans le programme et trois semaines après le congé de l'hôpital. Les mesures de résultats exploratoires, incluaient les changements au niveau des symptômes de dépression des participants, de l'incertitude perçue, du contrôle de la maladie, du soutien/des conflits avec l'aidant naturel et de l'utilisation des services de santé au cours de la même période. Les effets modérateurs potentiels du sexe et du style d'adaptation ont également été explorés.<br>Les données ont été examinées selon des analyses de covariance 2x2 évaluant les effets principaux du programme de Télésanté et du sexe des patients, et de leur interaction sur les changements dans les variables dépendantes, incluant les pointages de bases comme covariables. Les résultats n'ont révélé aucune différence entre les changements au niveau de l'anxiété chez les patients qui ont bénéficié du programme de Télésanté versus ceux qui ont disposé des soins habituels. Toutefois, les patients qui ont bénéficié du programme de Télésanté ont présenté des baisses plus importantes au niveau de l'incertitude perçue (p=.03) et des hausses au niveau des perceptions quant au contrôle du traitement. De plus, on a constaté que moins de patients qui ont bénéficié du programme de Télésanté ont contacté leurs médecins (p=.04). Les aidants naturels des patients de sexe masculins ont connu de plus importants changements au niveau de l'anxiété que les aidants naturels des patients de sexe masculins qui ont bénéficié de soins habituels (p=.0003). Tandis qu'il y a eu d'importantes baisses au niveau de l'incertitude (p=.002) et des hausses au niveau de la perception du contrôle personnel (p=.10) auprès des aidants naturels des patients de sexe masculins, tous les aidants naturels du programme de Télésanté ont connu de plus importantes baisses au niveau des symptômes de la dépression (p=.03) et des perceptions au niveau des conflits (p=.04) que les aidants naturels de soins de santé habituels et ce, indépendamment du sexe des patients . Ni le style d'adaptation des patients ou des aidants naturels n'ont eu d'influence sur leurs réponses au programme de Télésanté. Enfin, les changements au niveau de l'incertitude chez les aidants naturels des patients de sexe masculins ont été associés à la baisse de l'anxiété, et représentaient plus du tiers des changements observés au niveau de l'anxiété. Ces résultats pe

Thesis advisor: Judith A. Vessey<br>Background: Parents of children with epilepsy and other neurological conditions live with a feeling of constant uncertainty. The uncertainty associated with caring for a child with epilepsy and other neurological conditions produces stress, which leads to decreased parental belief in caregiving skills, anxiety, and depression, ultimately altering parental functioning resulting in an increase in child behavioral problems. The stress associated with caring for a child with epilepsy and other neurological conditions is unlike caring for children with other chronic conditions. Epilepsy and other neurological conditions are unpredictable and there are often no warning signs prior to an acute event. This unpredictability accompanied with stigma results in social isolation and impacts family functioning. In addition, children with epilepsy have a higher rate of psychological co-morbidities and behavior problems when compared to children with other chronic conditions. This produces an additional burden on the parents and family. Study Design: This randomized controlled trial tested the efficacy of the COPE intervention for parents of children with epilepsy and other neurological conditions. This intervention was administered at three intervals: 1) during hospital admission in writing and by audiotape, MP3 download, or Podcast; 2) three days following hospital discharge by telephone; and 3) four to six weeks after hospital discharge in writing and by audiotape, MP3 download, or Podcast. Results: Forty-six parents of children admitted to the inpatient neuroscience unit at Boston Children's Hospital participated in the study. Several study limitations resulted in an inadequate sample size to obtain the power necessary to reach statistically significant results for a majority of the research questions. A one-between, one-within multivariate analysis of variance (MANOVA) revealed that the main effect of time was significant for differences in state anxiety for both the Usual Care Group and the Intervention Group, F, (1, 20) = 9.86, p = .005, indicating that state anxiety for both groups combined was more pronounced during the hospitalization. A one-between, one-within MANOVA demonstrated that the effect of the interaction between time and group was significant for internalized behavior assessment system score only (p=.037) as the Usual Care Group reported a significant decrease in internalizing behavior scores in their children over time. Conclusions: Findings from this study have significant implications for clinical practice and future research. Parents of children with neurological conditions often struggle to manage a constant feeling of uncertainty in their daily lives. Nurses possess the knowledge and expertise necessary to identify the psychosocial needs of these parents and provide education and support as needed. Future research should focus on designing interventions to meet the needs of these families and develop strategies to help improve the quality of life for both the parent and child living with a neurological condition<br>Thesis (PhD) — Boston College, 2013<br>Submitted to: Boston College. Connell School of Nursing<br>Discipline: Nursing

My essay is about the transition between home and preschool and takes its starting point in two stories. The first describes an induction conversation and how I as an educator react and act on the basis of the reactions of the two caregivers. The second story also depicts two different reactions from caregivers just before they go home after the first day of preschool training.         My purpose with the essay is to find out whether these reactions from caregivers are based on the same problem, institutionalization of childhood. From society's demands on society's members, preschool politics and society's views, it has developed a institutionalization. Through a historical perspective, I want to try to shed light on how it can affect the reactions and actions of legal representatives in the transition between home and preschool.         Shared responsibility, how does it look between home and preschool when society has created an institutionalization of childhood? In my essay I would like to shed light on how the pre-school's policy documents over time influenced and changed the perception of responsibility. From being nurtured in the home and educated in preschool as an institution to give the preschool the responsibility to develop a collaboration between home and preschool in a close and trusting way.         As a ready preschool teacher June 2019 I start working in the business of preschool with a mission that is guided by a new curriculum, “Lpfö 18”. I wondered then, how these changes affect my job as a preschool teacher? In my essay, I want to try to give my views on the changes and how I now think that I can approach the concept of teaching that is part of education.         I will use a scientific essay as a method, where I reflect on my dilemmas and with the help of a historical perspective on preschool politics. By trying to shed light on positions and assignment formulations that have been given may have gained importance in the perception of the shared assignment between home and preschool. Also highlight and reflect on what the new curriculum, “Lpfö 18”, and its reformulations can be of importance in terms of the view of a preschool teacher's mission in the future.

碩士<br>輔仁大學<br>護理學系碩士班<br>93<br>Abstract The purpose of this qualitative study is to explore the adaptation experiences of post-stroke patients during their first week after hospital discharge. Samples were recruited from a community hospital in northern Taiwan. Data were collected via home-visiting interviews based on the unstructured interview guidelines. Six cases were each interviewed twice. All interviews were tape-recorded and then literalized for further data analysis. During the interview, observation notes were also taken to assist on grasping the meaning derived from non-verbal language and posture expressions. The major contribution of this study revealed the six categories of care needs: daily life assistance, original home environment readjustment, resumption of health maintenance, emotional adaptation, inner emotion expressions, and resources utilization. In terms of the adaptation experience includes: challenge of simultaneous multi-factorial adaptation, the first priority of intervening physiological demand, and reflexive adaptation experiences. During this transition period, the post-stroke patient and the caregiver encounter all the problems together. The primary family caregivers are dominant in rearranging family life-style, while the post-stroke patients are much more just reflexing to the arrangement. This period can be defined as “new lifestyle exploring period”. During this period, the patient and family experience a diverse and sequential adaptation process. This is a model of unstable process of adaptation. The patient and primary family caregiver interact through the process of role-making and time schedule arrangement. The results derived from this study will be useful for nurses to understand the adaptation experience of post- stroke patients during the transition period. The nurses can provide their stroke patients proper nursing intervention and resources accordingly, so as to meet the standard of discharge planning model. Meanwhile, the result may be useful for developing a scaling system for the transitional care of stroke patients.

碩士<br>南臺科技大學<br>企業管理系<br>106<br>The number and proportion of older persons is increasing in recent years so the demand of long-term care has become important issue. Also, community-based health service and the concept of aging in place have come to be emerging trend. Home healthcare care is health care service that can be chosen by patients and families and be given at home. The service provider may periodically view the needs of patients; besides, they also provide appropriate care guide to patients and families. Home healthcare service is not only regarded as the optimal model of care for people with disabilities, physical and mental limitation, including elder individuals but also one of key themes of long-term care; therefore, the demand for home healthcare and nursing workforce continues to expand. Nurses are at high risk for many diseases and illnesses due to high pressure and heavy workloads. Home healthcare nurses with complicated and complex work must face aging, disability and unstable patients so it’s more important to explore their occupational hazards. In this retrospective cohort study, the clams data of 4108 nurses was used to define study population with Charlson Comorbidity Index (CCI), using a national sample cohort from the National Health Insurance Service in Taiwan between 2000 and 2013. The collected data was processed by descriptive statics, T -test, and Pearson correlation coefficient to investigate occupational hazards and illnesses of case group (home healthcare nurses) and control group (hospital nurses). The major findings were summarized as follows: 1.Home healthcare nurses are at higher risks for specific occupation injury and illness than hospital nurses. Home healthcare nurses have increased incidence for chronic lung disease, peptic ulcer disease, mild liver disease, severe kidney disease, severe liver disease, lumbar disc disease, flank pain, back pain, menstrual disorders, migraine, tuberculosis, and sleep disorder compared to hospital nurses, with statistical significance (p<0.05). 2.Home healthcare nurses aged 31-40years have higher incidence than hospital nurses, followed by 51 years above, 41-50 years, 21-30years. 3.Home healthcare nurses experience the highest incidence rates of occupation injury and illness, followed by nurses at district hospital, nurses at regional hospital, and nurses at medical center. This study is helpful to realize home healthcare nurses have higher risks for specific diseases and illness; therefore, the results can provided administrator with insight to develop health promotion program for home healthcare nurses to protect nurses’ health, optimize working environment and enhance quality of care.

The trend toward early postpartum discharge programs means that much more of the postpartum teaching traditionally carried out in hospital will need to be conducted at home with visiting nurses. However, before any postpartum education changes could be recommended, it was necessary to investigate the perceptions of the two groups of people involved in early postpartum education; postpartum mothers and maternal/newborn nurses. The purpose of this study was to identify the postpartum learning needs that early discharge mothers and hospital based maternal/newborn nurses regarded as either more suitably addressed in hospital or more suitably addressed at home and to compare the perceptions of both groups. Therefore, a factor-searching and relation-searching approach was used to study convenience samples of 89 low risk, primiparous mothers eligible for early discharge and 50 nurses. Each participant completed a questionnaire which was developed for the study. Concerns and interests identified in the literature as important to mothers during the postpartum period were included. Topics were assigned to three categories; self, infant, and family. Each category contained an "other" option so that both groups would feel free to identify topics that were not present in the questionnaire. Results of the study suggested that postpartum mothers want learning needs related to their infants addressed first, followed by those related to self, and those related to family last. While mothers' and nurses' perceptions of topics suitable for hospital were similar, their perceptions of topics suitable for home differed. Mothers perceived most of the infant topics as more appropriate to discussion in hospital and most of the family topics as more appropriate to discussion in the home. Most of the nurses perceived only physical care/skill kinds of infant topics as appropriate to hospital and informational topics related to the infant as more appropriate to home. The study also indicated that both groups expected a large portion of postpartum learning to occur within a 48 hour hospital stay postpartum. The results have implications for nursing practice, education, administration, and research. Strategies aimed at meeting the learning needs of early discharge postpartum mothers more effectively are identified and described.

碩士<br>國立臺北大學<br>社會工作學系<br>103<br>The subjects of this study are Taiwanese male adolescents who lost their fathers and have been raised by their mothers. The research goals include examining the relationship change due to the youth’s leaving home for college, exploring the negotiation process between the two, and evaluating the impact of leaving home for college on mother-son relationship and associated adjustment process. This study adopted a qualitative research method and used purposive sampling to select the research participants. A total of five adolescents whose fathers died in their elementary school years were interviewed. In-depth interviews were conducted to collect data, and the results were presented after the data was analyzed and summarized. The findings of this study include: (1) Openness and trust created a harmonious mother-son relationship. (2) Mother’s rigid discipline resulted in the son’s escape from the relationship. (3) Son’s fierce opposition led to mother's feeling of powerlessness and compromise. (4) After leaving home for college, the adolescents’ emotional bond with their mothers gradually increased, and there was more space for the development of autonomy. (5) Father's death became the family's unspeakable secret, and children were parentified. (6) Men had a communication style that seldom revealed their concerns in mind. (7) The adolescents eased tension with their mothers through the peer support system. Based on the findings of this study, a number of practical suggestions were discussed. It is hoped that the helping professionals can provide effective interventions when they deal with the mother-son relationship for the adolescents who lost their father.

A prematuridade é um problema que constitui cada vez mais uma questão de saúde pública quer a nível internacional como nacional, que necessita de medidas continuadas. Embora a literatura seja profícua em investigações ligadas a toda esta problemática, as necessidades de pais de bebés prematuros no período de transição Hospital-Casa estão ainda muito pouco cobertas em termos de programas de intervenção que apoiem a família num momento crítico de transição Hospital-domicílio. Esta investigação teve como objetivo o desenho e aplicação piloto de um programa de educação parental – Programa Papillon – que visava atenuar/eliminar as lacunas/dificuldades sentidas pelos pais no referido período. Inclui três estudos de famílias residentes na zona de Lisboa, com bebés prematuros no período de transição para casa, tendo sido realizadas duas avaliações antes e após a implementação do programa, com o intuito de verificar possíveis alterações nas dimensões: stresse parental, competência parental e conhecimento do desenvolvimento infantil, bem como satisfação com a implementação do programa. Os resultados são bastante díspares entre os diversos estudos de caso, mas a competência parental parece ser o aspeto que melhores resultados apresenta, bem como a satisfação dos participantes com a participação no programa, apoiando o interesse e importância deste tipo de programas.<br>Prematurity is becoming a public health problem in a national and international level, which needs a continued measure. Although the literature on research related to this topic are profitable, the needs of premature babies’ parents in the transition to home period still have few responses from intervention programs to support the family in this critical moment. This investigation aims to design and apply a pilot parental education program – Program Papillon - in order to decrease/eliminate the gaps/difficulties in this period. This investigation includes case studies of three families who lived in Lisbon area, with preterm babies in the transition to home period. It was carried out two assessments, before and after the implementation of the program, to verify possible changes in parental stress and parental competence dimension, knowledge of the child development and the satisfaction with the program implementation. The results are heterogenic between the three case studies, but the parental competence seems to presents the best results, as well the participants’ satisfaction with the implementation of the program, which support the interest and importance of such studies.

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team.<br>Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323