Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

A fuzzy rule-based decision support system for Duodopa treatment in Parkinson

A decision support system (DSS) was implemented based on a fuzzy logic inference system (FIS) to provide assistance in dose alteration of Duodopa infusion in patients with advanced Parkinson’s disease, using data from motor state assessments and dosage. Three-tier architecture with an object oriented approach was used. The DSS has a web enabled graphical user interface that presents alerts indicating non optimal dosage and states, new recommendations, namely typical advice with typical dose and statistical measurements. One data set was used for design and tuning of the FIS and another data set was used for evaluating performance compared with actual given dose. Overall goodness-of-fit for the new patients (design data) was 0.65 and for the ongoing patients (evaluation data) 0.98. User evaluation is now ongoing. The system could work as an assistant to clinical staff for Duodopa treatment in advanced Parkinson’s disease.

Formal caregivers' perceptions of quality of care for older people : associating factors

Background: Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results: In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conculsions: The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.

Åldersblandning i skolan : elevers erfarenheter

Mixing ages in school classes became more and more common during the last dec-ades of the 20th century. From being a way to organise classes out of necessity they have now come to be something which is implemented on the basis of pedagogical arguments. The aim of this research has been to improve our knowledge of classes where pupils are not of the same age. A study of the pupils’ perspectives has been my main interest. (Age) homogeneous class can been looked upon as a result of the authorities’ deci-sion to have a fixed age for children to start school and their decision that certain courses should be completed within a defined period of time. Terms and the data concerning heterogeneous age groupings are ambiguous and cannot be fully understood without knowledge of national and sometimes even local contexts. Practices within age heterogeneous classes may differ greatly. A great deal of individual work takes place in age heterogeneous classes. Whether the class is non-mixed or mixed-aged does not seem to have a major im-pact on cognitive or non-cognitive abilities among the pupils, but there are suggestions that age heterogeneous classes might be disadvantageous to pupils in problematic situations. I am able to show that more than 30% of pupils in grades 1-3, close to 25% in grades 4-5, about 15% in grade 6 and a couple of percent of Swedish pupils in the later school years are taught in mixed-age groups. My own empirical research focuses on pupils’ experiences. My investigation has a ‘life-world’ oriented approach inspired by phenomenology. Pupils in grades 5 and 6 from three schools in three different socio-economic settings were interviewed. These pupils had experienced both mixed-age and single-age classes. The life-world of pupils seems to be something different from that encompassed by the philosophy about the advantages of mixing the ages in classes. Pupils find it diffi-cult to maintain or create relationships when only a few pupils of the same sex, who have started school at the same time, can be together in a class for a long time. Be-cause of the importance of social relationships almost every pupil in this investigation wished to be in a single-age class during the following year. It is the importance of common experiences rather than age that is central. Pupils stated that having things in common to study in their everyday schoolwork makes it easier to communicate and contributes to stable friendships. In my conclusion I focus on what it means to have relationships and how these are important for human identity. I also try to show how relationships are important in learning situations at school and for pupils’ opportunities to expand their knowledge.