6,639 research outputs found

    East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

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    Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

    A Qualitative Study Investigating Stroke Survivors’ Perceptions of their Psychosocial Needs Being Met During Rehabilitation

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    Background: Depression and anxiety can negatively impact one’s recovery, outcomes, and quality of life. Even though therapists consider the mental health needs of their clients to be a priority, they are dissatisfied with their ability to completely address these needs. The purpose of this study was to examine the client’s perspective regarding the extent to which health care professionals addressed their psychosocial needs after a stroke. Method: A phenomenological research design was used to collect data from six participants. Interviews and focus group were audiotaped, transcribed verbatim, and thematically analyzed. Member checks, peer-review, multiple coders, triangulation, and expert examination were used to increase trustworthiness of findings. Results: Five themes emerged. People with strokes: (a) experience an array of emotions, (b) are not likely to initiate disclosure of their state of mental health, (c) feel their psychosocial needs are not being addressed by health care professionals, (d) grieve the loss of prior roles post stroke and work hard to establish a new normal routine and purpose in life, and (e) have suggestions for improved care. Conclusion: These findings reinforce the importance of addressing the mental health needs of individuals post stroke and the importance of identifying methods to enhance the ability to effectively address the psychosocial needs of clients post stroke

    Home & place making after stroke:Exploring the gap between rehabilitation and living environment

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    This thesis addresses the question why many stroke survivors, even when they have received optimal treatment in the rehabilitation center, fall into a black hole when they are at home. The goal is twofold: 1) to gain a better understanding of the experienced gap between the rehabilitation and living environment of stroke survivors, and 2) to help improve the transfer from the rehabilitation to the living environment with help of scientific knowledge. This thesis shows that to improve rehabilitation care till into the own living environment, available evidence-based knowledge should be enriched with practical knowledge of rehabilitation professionals and experience-based knowledge from stroke survivors and caregivers. Interviews with stroke survivors reveal that ‘being at home’ does not equal ‘feeling at home’. Resuming life at home after a stroke is very different from recovering in the rehabilitation environment. In order to better understand the problems, other theory is needed than only theory from rehabilitation medicine. This thesis provides a new theoretical perspective for rehabilitation medicine. We have viewed stroke survivors’ and their caregivers’ experiences through a socio-spatial lens. This results in a shift in focus from functional recovery to identity confusion and feeling at home at important places after stroke. It is recommended to have one professional in outpatient and home rehabilitation, who acts as a coach, and assists stroke survivors and caregivers in rebuilding meaningful and interconnected relationships with their lives, place by place

    The experiences of employed caregivers, working in private South Africa homes, with patients who have suffered from a stroke

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    University of the Witwatersrand Faculty of Humanities A dissertation submitted in fulfilment of the requirements for the degree of Master of Arts in Speech Pathology. July, 2015Background: Many people who have suffered from a neurological condition, including stroke, have an employed caregiver who cares for them within their home environment. Previous studies have investigated caregiving within the family unit, when a family member takes the role of the primary caregiver. These family caregivers often experience many physical, emotional, and psychological burdens such as anxiety, depression, and stress. However, there seems to be a lack of investigation into the experiences and needs of employed caregivers, working as the primary caregiver within a patient’s private home in South Africa. Aims: This research aimed to explore the experiences and perceived needs of employed caregivers working for patients who have suffered from a stroke within home settings in South Africa. It further aimed to explore the unique challenges to caregiving that may be present within the South African context. Methods: A sample of fifteen participants with experience in working as an employed caregiver for patients who have suffered from a stroke, within a home setting in South Africa, were included in the study. The qualitative research design took place in two phases. Phase one consisted of semi-structured interviews between each participant and the researcher. The open-ended questions focused on the caregivers’ backgrounds, training, experiences, and possible needs while working within South African homes. Phase two involved two focus groups consisting of five participants per group. Within each focus group, open-ended questions and discussions allowed for exploration into the caregivers’ experiences and needs while working in South African homes. Thematic analysis of the collected data from both phases was triangulated and analysed. Results: The findings of the study revealed that the relationships that employed caregivers develop with patients, patients’ families, and with other workers within the home setting, influence levels of happiness and burden in the caregiving role. Employed caregivers feel unheard and voiceless within South African society, as evident by their perceived lack of support, resources, and rights. The caregiver burden experienced by these caregivers seems to be influenced by contextual factors within South Africa. These factors include gender stereotypes and being task shifted between household roles, not receiving reciprocal care from employers, experiencing financial stressors, and receiving limited benefits and support both within the home and within South African society. Conclusion: The findings of this study provide insight into the experiences and needs of employed caregivers in South Africa, allowing for a recognized voice to be established for this caregiving population. The findings of this study contribute to current caregiving literature specifically with reference to employed caregivers, caring for patients who have suffered from a stroke, and caring within the South African context. The experiences and needs of employed caregivers explored in this study may lead to the development of various support structures for employed caregivers in South Africa

    Using experience-based co-design with older patients, their families and staff to improve palliative care experiences in the emergency department: a reflective critique on the process and outcomes

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    Background: Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of − and preferences for − palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. Objectives: To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. Setting: an Emergency Department in a large teaching hospital in the United Kingdom. Methods: Experience-based Co-design incorporating: 150 hours of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. Findings: the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the ‘voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. Conclusion: Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the ‘accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase

    Experiences of hospitalized patients with dementia

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    People with dementia are hospitalized for a variety of reasons. The combination of dementia with additional health conditions creates a unique challenge to caregivers in acute care settings. There is a dearth of information available to provide guidance to the nursing staff caring for these patients. This integrated review of the literature examined the experiences of hospitalization from the perspective of the older adult with dementia, the family caregiver, and the patient care staff. Results showed a limited body of literature that addressed hospital experiences of people with dementia and those of family and professional caregivers. Additionally, few studies addressing this topic have been conducted in the United States. The primary finding from this study is that better communication is needed between nursing staff, patients, and their family caregivers. Nurses should carry out detailed assessments of cognition and pain in all elderly patients, and strive to provide appropriate palliative and end-of-life care. Dementia- specific training for all staff members may help to promote a better understanding of patients with dementia. Lastly, further research into the experiences of hospitalized dementia patients is needed, with a focus on acute care settings within the United States

    The Experiences of Taiwanese Women Caregiving for Parents-in-Law

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    Using grounded theory, a semi-structured in-depth interview was conducted to explore the experiences of Taiwanese women who were caregivers for their parents-in-law. Thirty-one Taiwanese women aged 23 to 58 participated in this study. Just Doing was identified as the core category to indicate the caregivers\u27 striving process once they committed to their in-laws\u27 care. Recognizing Duty, Experiencing Trials, and Responding to Caregiving were subcategories and reflected how a caregiver perceived her role, how she was affected by caregiving tasks, and what responses she had to the caregiving situation. The findings also suggested that caregiving behaviors were influenced by cultural expectations when the parent-in-law was ill. Being Called, a condition in this study, indicated that caregiving tasks were started when the caregiver recognized providing care was her duty. Caring For reflected the context for providing daily comfort, keeping watch, as well as seeking assistance if needed. The category of Holding Up involved the ability to persevere in providing care and was influenced by the depth of family relationships, their appreciation and degree of reinforcement. The extent of the difficulties and the resources for care also affected the ability to continue caring. Additionally, the strategy of Keeping Harmony, was adopted by caregivers to comfort themselves and cope with their caregiving difficulties. This category reflected Taiwanese women\u27s fatalism and optimism in meeting the daily care needs of a parent-in-law. Maintaining Filial Pity was identified as a consequence of a caregiver\u27s experience in fulfilling her duty. As a daughter-in-law, she was able to establish an inner peace or serenity. If this was not possible, she continued to have inner conflict and perceived her life as one of sacrifice. This story of Taiwanese women caregivers\u27 experiences may be beneficial in facilitating the development of a comprehensive policy for long-term care. These women\u27s voices will be helpful in forming the basis for nursing intervention strategies for individual and family care. Recommendations for future research focus on cultural determinants of caregiving roles and coping strategies

    Investigating the Comprehensive Inventory of Thriving (CIT) as a rehabilitation outcome measure

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    Reliable and valid outcome measures are needed in community rehabilitation settings following acquired neurological injury. The Comprehensive Inventory of Thriving (CIT) (Su, Tay and Diener, 2013) was investigated for this purpose. The CIT is a 54 item self-report measure that provides 18 subscales and seven main scales of thriving: Relationships, Engagement, Mastery, Autonomy, Meaning, Optimism and Subjective Well-being. Participants (n=76) were administered the CIT on admission to a community rehabilitation service. The mean age of participants was 54.8 (SD = 17.7), with 43% being male. The main diagnostic groups were cerebrovascular disease (28%), traumatic brain injury (17%) and Parkinson's disease (12%). Internal consistency was moderate to high (α =.6 to .9) for all subscales with the exception of Support (Relationships) and Skills (Mastery); and high (α=.79-.93) for all indexes with the exception of Subjective Wellbeing. Correlational analyses supported the scale groupings. However, the subscales of Support (Relationships) and Skills (Mastery) did not correlate significantly with any subscales. Additionally the Subjective Well-being scale should not be calculated, but instead its three subscales (Negative Feelings, Life Satisfaction, Positive Feelings) used individually. In terms of demographic variables, there were no significant gender differences on CIT scales. Age had low correlations with two Relationships subscales only (Trust r=.23, p=.04; Loneliness r=-.25, p=.03). Diagnostic group minimally influenced CIT scores. Significant between-group differences were only found for Accomplishment (Mastery), with post-hoc analyses indicating higher levels for the cerebrovascular group. The CIT shows considerable promise in rehabilitation outcomes as a reliable and valid multi-component measure of wellbeing
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