Состояние сексуального здоровья в адаптированном супружестве

Описано состояние сексуального здоровья в адаптированном супружестве и выделены его диагностические маркеры.The state of sexual health in adapted marriage is described; its diagnostic markers are emphasized

Development of an evaluation tool for geriatric rehabilitation care

Background: Geriatric rehabilitation care (GRC) is short-term and multidisciplinary rehabilitation care for older vulnerable clients. Studies were conducted about its effects. However, elements that influence the quality of GRC have not been studied previously. Methods: In this study realist evaluation is used to find out which are the mechanisms and outcomes and which (groups of) persons are the context for GRC, according to GRC professionals. The mechanisms, outcomes and context of GRC were explored in three consecutive phases of qualitative data gathering, i.e. individual interviews, expert meeting, and focus groups. Results: Eight mechanisms — client centeredness, client satisfaction during rehabilitation, therapeutic climate, information provision to client and informal care givers, consultation about the rehabilitation (process), cooperation within the MultiDisciplinary Team (MDT), professionalism of GRC professionals, and organizational aspects — were found. Four context groups—the client, his family and/or informal care giver(s), the individual GRC professional, and the MDT—were mentioned by the respondents. Last, two outcome factors were determined, i.e. client satisfaction at discharge and rehabilitation goals accomplished. Conclusions: In order to translate these insights into a practical tool that can be used by MDTs in the practice of GRC, identified mechanisms, contexts, and outcomes were visualized in a GRC evaluation tool. A graphic designer developed an interactive PDF which is the GRC evaluation tool. This tool may enable MDTs to discuss, prioritize, evaluate, and improve the quality of their GRC practice. Keywords: Geriatric rehabilitation care (GRC), Quality improvement, Evaluation, Realist evaluation, Mechanisms, Context, Outcomes, GRC evaluation too

Zorg; wie doet er wat aan : een studie naar zorgarrangementen van ouderen

As a result of fertility decline and increasing life expectancy, the age structure of the Dutch population is changing, with a larger proportion and number of elderly persons and declining proportions and numbers of younger adults. Hence, the number of people in need of care is growing. While -at the same time- the number of people that can provide care declines and numerous independently living elderly are on waiting lists for professional care. Concerns about care for the elderly in the future prompted us to do research about the topic of care for independently living elderly. Given the rural orientation of Wageningen University the research was focused on rural elderly. The age groups included were persons aged 75 years and older. The following research questions were formulated:What is the picture of instrumental and social-emotional care for rural elderly, who still live independently and are aged 75 and older? Which characteristics of the elderly and which of the informal care givers influence the care that elderly receive? Which problems in the care of the elderly can arise in the future and how could these be solved?Data collection for this research proceeded in two stages. First, qualitative research was done to gain insight into the care for the elderly. Eleven elderly people and six informal carers ( mantelzorgsters ) were interviewed. In consequence of the qualitative research, the instrumental-care situation, the instrumental-care arrangement and the social-emotional-care arrangement were defined and hypotheses for the quantitative research were specified. For the quantitative research, the second stage of data collection, a survey was done among a random sample of people aged 75 years and over, stratified according to sex and marital status, living in seven rural municipalities in the Netherlands. We were able to analyse the cases of 465 elderly (response rate of 62,6%). Besides, interviews were conducted with 235 carers who give informal care to elderly persons from the sample. Below we will report about the main findings of the research.The instrumental-care situationThe instrumental-care situation pictures the degree to which the elderly receive instrumental care from people beyond the own household. Elderly people in self-caring households care for themselves and in households consisting of more than one person for each other. Elderly people in cared-for households receive much care of people who are no household members. They themselves cannot do much. In between are elderly persons in households that just can manage ( redzaam ). These elderly care largely for themselves, but in addition receive substantial care from people beyond their own household. They receive more instrumental care than self-caring elderly and less than cared-for elderly. In the quantitative sample 27,5% of the people aged 75 years and over can be called self-caring, 50,1% managing and 22,4% cared-for.The quantitative research shows that the instrumental-care situation is significantly related to the variables of household composition, age and health indicators of the elderly. Elderly who live alone and older elderly receive more instrumental care from people who are no household member than elderly who share their household with someone else and younger elderly. At first sight the instrumental-care situation is not influenced by the sex of the elderly person. However, the female elderly in the sample are less healthy than the male elderly. Thus, for a comparison we have to control for health status. When women and men with a comparable health situation are compared, we can see that women receive less instrumental care than men. Besides, elderly who are less mobile receive more care than elderly who are more mobile.These results enable us to put the instrumental-care situation in a live course perspective. When people become older their health tends to decline. Thus, the three types of the instrumental-care situation can be seen as phases in the life course.Characteristics of informal carers are no predicting factors for the instrumental-care situation of elderly. When people give informal care it does not seem to matter whether they are woman or man and whether they are family or not. Furthermore, the quality of the relationship does not influence the amount of instrumental care elderly receive. The qualitative research has shown that children give informal care even when they experience the relationship with their parents not very positively. The obligations attached to kinship relations seem to be more important than the quality of the relationship.The instrumental-care arrangementThe instrumental-care arrangement pictures the proportion of informal carers and professional carers in the care elderly receive. We defined the instrumental-care arrangement only for the elderly that just can manage. In comparison with the sample, the degree to which these elderly receive instrumental care varies less. The qualitative research shows that elderly who receive predominantly informal care refer to this care in terms of self-care. This way they emphasise that the care they receive from their daughter or son is closely to them. Elderly who receive predominantly formal care emphasis their feeling of independence in the care relationship. From a professional care giver they receive care, pay for it and do not further have a relationship with her. Because of this elderly experience this care, in comparison with informal care, less as a threat to their independence.Managing elderly with an informal safety net receive only or predominantly instrumental care of informal carers. Managing elderly with a formal safety net receive only or predominantly formal (professional) care. In the quantitative sample 36,0% of the managing elderly can be called managing with a informal safety net (18,0% of the sample) and 64,0% managing with a formal safety net (32,1% of the sample). The care they receive is diverse. Managing elderly with a formal safety net almost all are supported with the heavy tasks in the household such as vacuum cleaning and cleaning the windows. In comparison with the care managing elderly with an informal safety net, they receive fixed care. The care for elderly people with an informal safety net is more diverse and seems to be more adjusted to their individual needs and wishes.The quantitative research shows that the instrumental-care arrangement is significantly related to the normative values and characteristics of the social network of the elderly. Elderly who believe that children (in-law) ought to give informal care and elderly who think traditionally about sex roles have more often an informal safety net than elderly who have other normative values about these topics. Furthermore, elderly who have a social network that consist for more than half of children, elderly who have more children and elderly who have more children without paid employment receive more often predominantly informal care than elderly for whom this is not true.Characteristics that can not be influenced by the elderly such as their sex, their age and their health do not influence significantly the instrumental-care arrangement. This enables us to conclude that elderly choose for either informal or formal care.Like the instrumental-care situation, the instrumental-care arrangement is not predicted by characteristics of informal carers. These results also show that when people give informal care it does not matter whether they are woman or man and whether they are family or not. Furthermore, the instrumental-care arrangement is not significantly related to reciprocity. The qualitative research has shown that material reciprocity is important to informal carers because they experience it as an expression of appreciation. Especially the meaning and intention of material reciprocity seems to be important.The social-emotional-care arrangementThe social-emotional-care arrangement pictures the degree to which the elderly receive social-emotional care and the proportion of kin and non-kin in this care process. Self-oriented elderly receive hardly any social-emotional care from people beyond the own household. Family-oriented elderly receive this type of care predominantly from family members who do not live in their household. They share the joyful and the more serious parts of social-emotional care with their children and other family members. Community-oriented elderly receive social-emotional care predominantly from non-kin. In comparison with the care for family-oriented elderly, the care for community-oriented elderly is more focused on the joyful parts. In the quantitative sample 19,6% of the elderly people can be called self-oriented, 36,3% family-oriented and 44,1% community-oriented.The quantitative research shows that the social-emotional-care arrangement is significantly related to several variables. Elderly women are more often family-oriented and elderly men are more often community-oriented. Also elderly whose social network consists for more than half of family members and elderly who have more children are more often family-oriented than elderly for whom this is not the case. Furthermore, health indicators are related to the social-emotional-care arrangement. Elderly who use more technical aids and elderly who cannot drive a car are more often family-oriented than elderly who use less technical aids and elderly who can drive a car.In contrast with instrumental care, characteristics of informal carers predict the social-emotional care elderly receive from people beyond the own household. Informal carers who say that the elderly appreciate the given care and informal carers who talk about their own problems with the elderly have more often a relationship with a community-oriented elderly than informal carers who do not experience immaterial reciprocity. Furthermore, informal carers who experience the care giving as a burden have more often a relationship with a family-oriented elderly than informal carers who do not experience it as a burden.Looking at the predicting factors for social-emotional care, we see that this care diverts from instrumental care. Social-emotional care is significantly related to the sex, the number of children and the health situation of the elderly, but also to characteristics of informal carers, such as immaterial reciprocity and the experienced burden. Furthermore, the results show that the relationships with family-oriented elderly are more experienced as relationships containing obligations than the relationships with community-oriented elderly. In comparison to community-oriented elderly, family-oriented elderly seem to have less to offer to their informal carers. They are in poorer health and give less social-emotional care to their informal carers. Because of their better health, community-oriented elderly are much more able to visit other people and seem to give more social-emotional care to others.ConclusionOur research shows that family members are an important source of care for the elderly. When they provide instrumental care, this care is more adjusted to the individual needs and wishes of the elderly people than the care provided by formal (professional) carers. When they provide social-emotional care, this care also includes the more serious aspects of this care. Furthermore, our data show that the quality of the relationship is not significantly related to the care that informal carers provide. The qualitative research has shown that children care for their parents even when they experience the relationship with them as not very positively.</p

Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2:A systematic review

Background: Integrated care interventions for chronic conditions can lead to improved outcomes, but it is not clear when and why this is the case. This study aims to answer the following two research questions: First, what are the context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Second, what are the relationships between context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Methods: A systematic literature search was conducted for the period 2003-2013 in Cochrane and PubMed. Articles were included when they focussed on integrated care and type 2 diabetes, and concerned empirical research analysing the implementation of an intervention. Data extraction was performed using a common data extraction table. The quality of the studies was assessed with the Mixed Methods Appraisal Tool. The CMO model (context + mechanism = outcome) was used to study the relationship between context factors (described by the barriers and facilitators encountered in the implementation process and categorised at the six levels of the Implementation Model), mechanisms (defined as intervention types and described by their number of Chronic Care Model (sub-) components) and outcomes (the intentional and unintentional effects triggered by mechanism and context). Results: Thirty-two studies met the inclusion criteria. Most reported barriers to the implementation process were found at the organisational context level and most facilitators at the social context level. Due to the low number of articles reporting comparable quantitative outcome measures or in-depth qualitative information, it was not possible to make statements about the relationship between context, mechanisms and outcomes. Conclusions: Efficient resource allocation should entail increased investments at the organisational context level where most barriers are expected to occur. It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level, especially by increasing staff involvement and satisfaction. If future research is to adequately inform practice and policy regarding the impact of these efforts on health outcomes, focus on the actual relationships between context, mechanisms and outcomes should be actively incorporated into study designs

Legal rights of client councils and their role in policy of long-term care organisations in the Netherlands

BACKGROUND: Legislation demands the establishment of client councils in Dutch nursing homes and residential care facilities. The members of those councils are residents or their representatives. Client councils have the right to participate in the strategic management of long-term care facilities. More specifically, they need to be consulted regarding organisational issues and a right to consent on issues regarding daily living of residents, including CQ-index research. CQ-index research concerns a method that measures, analyses and report clients' experiences about the quality of care. Research questions were: 'Do client councils exercise their rights to be consulted and to give their consent?' and 'What is the role of client councils in the process of measuring clients' experiences with the CQ-index and what is their opinion about the CQ-index?' METHODS: Postal questionnaires were sent to members of 1,540 client councils of Dutch nursing homes and residential care facilities. The questionnaire focussed on background information and client councils' involvement in decision-making and strategic management. RESULTS: The response rate was 34% (n = 524). Most councils consisted of seven members (range: 5 to 12 members). One out of four members participating in the client councils were clients themselves. Although councils have a legal right to be consulted for organisational issues like finance, vision, annual report, and accommodation, less than half the councils (31-46%) reported that they exercised this right. The legal right to consent was perceived by 18 to 36% of the councils regarding client care issues like food and drink, complaints registration, respectful treatment, and activities. For CQ-index research, only 18% of the client councils perceived a right to consent. Their rights to choose an approved contractor -who performs CQ-index research- and indicating improvement priorities, were hardly used. CONCLUSIONS: Client councils play a rather passive role in determining the policy on quality of long-term care. Therefore, specific attention and actions are needed to create a more proactive attitude in councils towards exercising their rights, which are already supported by legislation

The feasibility of the story as a qualitive instrument as a narrative quality improvement method.

Background and objectiveStories from older adults give insight into their personal lives and in the care they receive. The story as a quality instrument is a narrative quality improvement method with which care professionals can interview older adults about how care is experienced. Each performed interview will be translated into a portrait containing the core themes of the shared story. The objective of this study was to assess the feasibility of and experiences with the story as a quality instrument amongst care professionals and older adults receiving long-term care.MethodsFive care locations providing nursing home care and one providing home care participated in the current study. In total 19 trained care professionals performed interviews with 52 older adults. Both the performed interviews and written portraits were scored according to preset criteria to establish the compliance to the predetermined protocol. Next to that, experiences from care professionals as insider researchers and respondents were gathered.ResultsOverall the fidelity for performing the interview was good. In 90% of cases interviewers posed one inviting open question. Following, interviewers used proposed interviewing techniques such as asking in depth questions, asking for an example or summarizing what has been said. In 20 of the interviews, the respondents input accounted for over 80% of the total number of words, and in 27 interviews the respondents’ input accounted for 60%-80%. Fidelity with the protocol for drawing up portraits was sufficient in most cases. In 66% the portrait contained all important themes and in 32% the majority of important themes. One portrait missed a significant proportion of themes mentioned during the interview. The experiences from care professionals consist of successes, challenges, added value and prerequisites.ConclusionsCare professionals were mostly capable of following the method according to protocol after being trained. The method is believed to be a promising innovation because care professionals play a key role in gathering and using stories to improve quality of care. The outcomes can be used by care professionals to learn and improve within their care location according to the quality framework for nursing home care

Demand-based provision of housing, welfare and care services to elderly clients:From policy to daily practice through operations management

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes