Practice In Care Of People Research Articles

Common skills for the interprofessional practice in care for people in sexual violence

Resumo Introdução: A violência sexual é um grave problema na sociedade brasileira cujas repercussões no âmbito da saúde pública tornam imperativa a abordagem dessa questão no contexto da formação das suas profissões. Igualmente, a integralidade do cuidado destinado às pessoas em situação de violência sexual requer a atuação conjunta de diversas profissões, além da integração em rede e articulação de diferentes equipamentos sociais. Objetivo: Este estudo teve como objetivo reconhecer quais competências - entendidas como o conjunto de conhecimentos, habilidades e atitudes - são necessárias para o desenvolvimento do cuidado integral destinado às pessoas em situação de violência sexual, segundo os melhores padrões de qualidade e segurança para a saúde delas. Método: Realizou-se um estudo qualitativo de caráter exploratório e descritivo que envolveu a aplicação de um formulário prévio sobre os conhecimentos acerca das competências, seguido da dinâmica da construção da figura humana, que consiste na confecção de um boneco no qual os conhecimentos estariam representados pela cabeça, as habilidades pelos membros e as atitudes pelo corpo, na realização de uma oficina com 76 participantes de diferentes profissões. Adicionalmente, aplicou-se um questionário a 32 profissionais com reconhecida expertise na área de violência sexual e com experiência prática no atendimento às pessoas nessa situação. Foi empregada a análise temática categorial. Resultado: Identificaram-se desafios a serem superados nas três dimensões constituintes das competências, com nítida deficiência de conhecimentos para a atuação em rede visando à efetividade e à integralidade do cuidado. Reconheceram-se 15 competências comuns aos profissionais que lidam com a violência, e o produto final foi representado num infográfico de disposição radial com a organização dos conhecimentos, das habilidades e das atitudes identificados como necessários para o desenvolvimento de tais competências. Conclusão: Reconhecer competências comuns e identificar, separadamente, quais conhecimentos, habilidades e atitudes as constituem representa estratégias promotoras da abordagem transversal desses conteúdos na formação das profissões, sobretudo da saúde. A proposição de uma matriz de competências comuns para prática interprofissional no cuidado destinado às pessoas em situação de violência sexual pode orientar a qualificação desse cuidado e alicerçar a interprofissionalidade em cenários cruciais de atuação coletiva para o enfrentamento da flagrante injustiça social que a violência sexual significa.

Palliative care practices and policies in diverse socio-cultural contexts: aims and framework of the ERC globalizing palliative care comparative ethnographic study.

Palliative care as a specialist professional practice of care for people with advanced illness is becoming increasingly influential worldwide. This process is affected by global health inequalities as well as cultural dimensions of approaching death and practicing care in life-limiting illness. The European Research Council-funded Globalizing Palliative Care (ENDofLIFE) project aims to understand how palliative care policies, discourses and practices are translated, adapted and reconstituted in diverse socio-cultural settings and how cultural dimensions of approaching death and local practices of care shape palliative care implementation. Using a multi-scalar and multi-sited ethnographic approach, the project uses person-centered ethnography, participant observation, semi-structured interviewing, focus group discussions and policy and discourse analysis at transnational, national and local levels. Ethnographic case-studies are conducted in Brazil, India and Indonesia. The globalizing palliative care project develops a novel ethnographic methodology of studying end-of-life care trajectories through long-term participant observation with individual patients and families as they manage and practice formal and informal health care in advanced illness. By analyzing how patients and families experience and navigate care over time, complemented by stakeholder interviews, the study advances critical theoretical insight into the relation between (large-scale and dynamically traveling) palliative care models, policies and discourses on the one hand and the experience and practice of palliative care in the lives of patients and informal care givers in local health care practices on the other hand. Insights are expected to benefit culturally situated palliative care policies and practices.

Nutrition and Congruent Care Improve Wellbeing of Residents With Dementia in Slovenian Care Homes.

IntroductionCurrent nutritional strategies for people with dementia focus on nutritional diets and regimens, although in recent years congruent care for people with dementia has been increasingly recognized to improve their wellbeing. This includes consistency of care, respecting the variability of psycho-sociological factors, emphasizing the importance of participation in activities, and congruence with the individual's needs and capabilities. When applied to the nutritional aspects of care, it aims to empower people with dementia to have an active role in their care and during meals. Congruent care has previously shown promising results in improving the quality of life of residents, reducing the incidence of negative social interactions and daily intake of medicines.MethodsA mixed methods qualitative-quantitative study was carried out. Out of 102 residential care homes for the elderly in Slovenia, a non-random sample of homes was selected. Seven homes that have implemented congruent care and five who have not implemented it agreed to participate. Content analysis of the transcripts of focus group interviews was carried out, to establish how the congruent care model was included into their everyday practice of care for people with dementia. Qualitative comparative analysis was used to describe the differences in the practice of care between the two groups of homes, in the fields of nutritional and general care. Frequencies and assigned importance of statements relating to different aspects of nutritional care were statistically compared.ResultsThe introduction of congruent care improved the wellbeing of the people with dementia, as observed by caregivers. The homes that had implemented congruent care gave more attention to the food choice aspects of nutritional care (p = 0.0474, 95%CICongruent = 50.77–72.35%, 95%CINon−congruent = 27.65–49.23%), while the homes that had not were more attentive to the dietary intake aspects (p = 0.0067, 95%CICongruent = 22.79–44.74%, 95%CINon−congruent = 55.26–77.21%). In the homes for the elderly that had implemented congruent care, both caregivers and management reported that the frequency of use of pro re nata medication decreased, which is supported by the results of the linear regression ( =78.4, p = 0.005), although the data available is limited.ConclusionFirst, the people with dementia in the care homes that had implemented congruent care were observed to have improved in mood, attitudes toward eating and wellbeing, as reported by caregivers. Second, the implementation of congruent care was well received by the management and caregivers of the care homes. A model of implementation of congruent nutritional care for people with dementia is presented.

Te Kete Marie-the peaceful basket: an initiative for supporting people with dementia or delirium.

This article describes the development of a toolkit for interdisciplinary team members to use to improve care for people with dementia or delirium in a hospice inpatient unit. An occupational therapist and two nurses identified that caring for the increasing number of people with dementia and delirium in the unit was a challenge for staff. The authors took a collaborative quality improvement approach to address the problem, engaging both the hospice interdisciplinary team and external community partners. The overall aim was to establish, reinforce and maintain best practice of care for people with a cognitive impairment within the Mary Potter Hospice short stay (average admission 11 days) environment, which the authors believe is a largely unexplored venture in a hospice inpatient unit setting.

2.K. Regular workshop: Innovative care practices for people with multimorbidity in Europe

2.K. Regular workshop: Innovative care practices for people with multimorbidity in Europe

2.K. Regular workshop: Innovative care practices for people with multimorbidity in Europe

2.K. Regular workshop: Innovative care practices for people with multimorbidity in Europe

Quality of care for people with dementia in residential care settings and the “Vážka” Quality Certification System of the Czech Alzheimer Society

IntroductionPeople with dementia are one of the most vulnerable groups of residents of long-term care institutions. The Czech Alzheimer Society (CALS) aims to improve the situation of people with dementia and their families using various methods, including the improvement of quality of care. ObjectiveTo present the development of the “Vážka” Quality Certification System developed by CALS through first-hand experience. MethodsCALS organised workshops and focus groups to discuss the main issues in dementia care quality, worked to define criteria and their classification, and developed the “Vážka” Certification System. CALS also evaluated these criteria in practice through a pilot evaluation project and established standards that were achievable within the system of dementia care in the Czech Republic. The main characteristics of the process of assessment and certification are: partnership and mutual discussion, evaluation of relational care, respect for the dignity of people with dementia and those who care for them, and the level of collaboration with families. ResultsThirty-two facilities have been successfully certified. Among these feature 25 residential services, 5 day care centres, 1 weekday centre and 1 healthcare department. ConclusionThe criteria within “Vážka” are meaningful and valid. They change slightly with any increasing quality of care but they need not be radically changed or updated. After its first years of experience, it is possible to say that the system is able to confirm good practice in care for people with dementia in actual conditions and distinguish it from care which is not acceptable.

État des lieux des pratiques d’accompagnement sanitaire et médico-social des personnes avec troubles envahissants du développement (TED) dans trois régions françaises

AimThis study is a component of the “French Autism Plan 2008–2010”. Its objective is to describe intervention and care practices proposed to people with pervasive developmental disorders (PDD) in three French regions (Île-de-France, Franche-Comté, Nord-Pas-de-Calais). MethodData were collected by a questionnaire adapted mailed to special education and health care services in three regions (quantitative data) and semi-structured interviews from a sample of professionals (qualitative data). A total of 254 questionnaires (163 from services for children and adolescents, 91 from services for adults) and 48 interviews (21 for children and adolescents, 27 for adults) were analyzed. ResultsIntervention and care practices described often lack of specificity and are not enough adapted to people with PDD, particularly in adults’ services. An improvement of practices is nevertheless evidenced, with the development of interventions centered on the development of communication or daily living skills and procedures to manage challenging behaviors, yet not generalized. Important efforts are made regarding training and partnership with ordinary settings. Professionals also wish to better take into account the person's and his family's point of view in the individualized program. ConclusionThis study emphasizes lacks and improvement in intervention and care practices for people with PDD in France, and those data might be a useful basis to study the practices’ evolution in the future.

The Right to Health, International Human Rights Legislation and Mental Health Policy and Care Practices for People with Psychiatric Disability1

This article is based on research which examined the current and potential impact of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) on Australian and South Australian legislation and policy. A particular focus was on the ‘right to health’ for people with a psychiatric disability. Ten interviews were conducted with professionals from law, psychiatry, government and service user advocacy, working at state, national (Australian) and international levels. It addresses three key themes: the rights of people with psychiatric and other disabilities; perceptions of the rollout of the United Nations Convention on the Rights of Persons with Disabilities (CRPD); and the impact on current policy and practice of the ‘right to health’.

How do medical treatments and ideas affect the process of caring for people with dementia? An exploratory study on care practices for people with pre-senile dementia at a day-service center

How do medical treatments and ideas affect the process of caring for people with dementia? An exploratory study on care practices for people with pre-senile dementia at a day-service center

Citizenship and autonomy in acquired brain injury

In ethical theory, different concepts of autonomy can be distinguished. In this article we explore how these concepts of autonomy are combined in theory in the citizenship paradigm, and how this turns out in the practice of care for people with acquired brain injury. The stories of a professional caregiver and a client with acquired brain injury show that the combination of various concepts of autonomy in practice leads to tensions between caregivers and clients. These dynamics are discussed from a care ethics perspective, stressing the importance of relationships and interdependence, as well as paying attention to various, sometimes conflicting, perspectives in a deliberative dialogue.

The Question of Movement in Dwelling

The authors explore transformations in the surveillance and discipline framework proposed by Foucault (technologies that “allow to see,” the panoptic as a completely closed space) by analyzing new Global Positioning System (GPS) care technologies. The authors contrast the antinomadic characteristics of traditional care practices for people with dementia with the new “in-movement” GPS care devices. They outline three main displacements: the definition of a new space that erases the distance between separated social and sanitary spaces; the lifting of the boundary between the home and the neighborhood; and finally, we point out the importance of movement in this process. These devices show the emergency of new micropractices of power and control: a new anatomy of surveillance. Grounded on movement, they transform physical barriers into risk alarms that do not block users' way; instead, they generate information that mobilizes others. The authors refer to the notion of kinevalue to explain how these devices turn living organisms' motility properties into a value that can be managed, as well as the central feature around which new exercises of patients' security and caregiving may be deployed. Through the analysis of a pilot project on GPS telecare devices carried out by the Spanish Red Cross, the authors suggest a new diagram of the control and management of subjects based on their movement, called “kinepolitics.”

Mother and baby units for schizophrenia.

Mother and baby units (MBUs) are recommended, in the UK, as an optimal site for treating post partum psychoses. Naturalistic studies suggest poor outcomes for mothers and their children if admission is needed during the first year after birth, but the evidence for the effectiveness of MBUs in addressing the problems faced by both mothers with mental illness and their babies is unclear. To review the effects of mother and baby units for mothers with schizophrenia or psychoses needing admission during the first year after giving birth, and their children, in comparison to standard care on a ward without a mother and baby unit. We undertook electronic searches of the Cochrane Schizophrenia Group's Register (June 2006). We included all randomised clinical trials comparing placement on a mother and baby unit compared to any other standard care without attachment to such a unit. If data were available we would have independently extracted data and analysed on an intention-to treat basis; calculated the relative risk (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data using a random effects model, and where possible calculated the number needed to treat (NNT); calculated weighted mean differences (WMD) for continuous data. Unfortunately, we did not find any relevant studies to include. One non-randomised trial, published in 1961, suggested beneficial effects for those admitted to mother and baby units. For the experimental group, more women were able to care for their baby on their own and experienced fewer early relapses on their return home compared with standard care. Care practices for people with schizophrenia have changed dramatically over the past 40 years and a sensitively designed pragmatic trial is possible and justified. Mother and bay units are reportedly common in the UK but less common in other countries and rare or non-existent in the developing world. However, there does not appear to be any trial-based evidence for the effectiveness of these units. This lack of data is of concern as descriptive studies have found poor outcomes such as anxious attachment and poor development for children of mothers with schizophrenia and a greater risk of the children being placed under supervised or foster care. Effective care of both mothers and babies during this critical time may be crucial to prevent poor clinical and parenting outcomes. Good, relevant research is urgently needed.

Veterans Affairs Quality Enhancement Research Initiative in chronic heart failure.

Chronic heart failure (CHF) is a highly prevalent condition associated with serious morbidity, intense levels of health services use, and shortened survival. It is also a condition for which ameliorative therapies exist. The evidence indicates that there is substantial need to change clinical practice and health care delivery for people with CHF and thereby improve their outcomes. The goal of the Veterans Affairs (VA) Quality Enhancement Research Initiative in CHF (CHF QUERI) is to create measurable, rapid, and sustainable improvements in quality of care and health outcomes of veterans with heart failure. This article describes the current state of knowledge and practice in care for people with CHF. Using the framework of the 5 steps of the QUERI process, we point out the gaps in research and practice that must be filled if the CHF QUERI is to achieve its goal. We relate our recommendations for how the VA can put its research and administrative infrastructure to work to fill the gaps. Lessons learned about CHF in the course of the CHF QUERI will be applicable to all people with heart failure and to all health care systems--VA as well as non-VA--that care for them.