Desafios para o cuidado digno em instituições de longa permanência / Challenges for dignified care in homes for the aged / Desafíos para una atención digna en instituciones de larga permanencia

Este artigo tem como objetivo apresentar estudo de natureza descritiva e abordagem qualitativa para analisar como vêm sendo implantados os cuidados no fim de vida em instituições de longa permanência para idosos (Ilpi) na região metropolitana de Porto Alegre. Foram entrevistados 19 sujeitos do corpo técnico e 13 responsáveis pelos idosos institucionalizados. Nesse sentido, buscou-se investigar se as Ilpi estão estruturadas para reconhecer a necessidade de cuidados que garantam conforto e dignidade no processo de morrer de seus pacientes. A partir da análise do conteúdo das entrevistas e das observações, pode-se dizer que há precariedade nessas estruturas. Também se identificou uma relação entre cuidado de boa qualidade e disponibilidade de recursos financeiros, demonstrando indicativos para a reificação do cuidado, ou seja, o cuidado enquanto mercadoria. Como ferramenta para superação do desafio do cuidado digno está a bioética de proteção.

This article aims to present a descriptive and qualitative study to understand how care is implemented at the end of life in homes for the aged in the metropolitan region of Porto Alegre, Brazil. We interviewed 19 members from the technical team and 13 staff responsible for taking care of the institutionalized elderly. In this sense, we sought to investigate whether institutions are structured to recognize the need for care to ensure comfort and dignity in the dying process of their patients. From the analysis of the content from interviews and observations, it can be said that some of these structures are precarious. A relationship between care quality and availability of financial resources was also identified, demonstrating reification of care, that is, care is regarded as a commodity. In this way, bioethics of protection would be a tool to overcome the challenge for dignified care.

Este artículo tiene como objetivo presentar un estudio de naturaleza descriptiva, con un abordaje cualitativo, para analizar de qué modo se están implementando los cuidados en el fin de la vida en las instituciones de larga permanencia para ancianos (Ilpi), en la región metropolitana de Porto Alegre. Fueron entrevistados 19 sujetos del cuerpo técnico y 13 empleados responsables por los ancianos institucionalizados. En este sentido, se procuró investigar si las instituciones están estructuradas para reconocer las necesidades de cuidado que garanticen la comodidad y la dignidad en el proceso de muerte de sus pacientes. A partir del análisis de contenido de las entrevistas y observaciones, se puede decir que existe una precariedad en estas estructuras. También se identificó una relación entre la calidad de la atención y la disponibilidad de recursos financieros, evidenciando una serie de indicadores tendientes a la reificación del cuidado, es decir, el cuidado visto como una mercadería. Una herramienta para la superación del desafío del cuidado digno es la bioética de protección.

Respite Care for Family Caregivers of Elders with Dementia: Concept Clarification / 기본간호학회지

PURPOSE: Respite care is not a discrete intervention, but encompasses a range of services. This research was conducted to clarify the phenomenon of respite care for family caregivers of elders with dementia from a nursing perspective. METHODS: The Hybrid Model of concept development was applied to clarify the concept of respite care for family caregivers of elders with dementia. The study was conducted in the following three steps, theoretical phase, fieldwork phase, and final analytic phase. RESULTS: The definition of respite care for family caregivers of elders with dementia was delineated through integration of data analyses in theoretical and fieldwork phase, and has three dimensions; tailored supports for caregivers, tailored supports based on physical and cognitive function of elders with dementia and community interventions related to family care function. CONCLUSION: Through this study, the concept of respite care for family caregivers of elders with dementia is clarified and reformulated as nursing practice phenomena in the Korean context, which indicates ways to develop caring practice forms for a family living with an elder with dementia in a community setting.

Development and Evaluation of Community-based Respite Program for Family Caregivers of Elders with Dementia / 기본간호학회지

PURPOSE: Purposes of this study were to develop a community-based respite program for family caregivers and to test the effects of the program. METHODS: Focus group interviews were performed to extract meaning of respite care for family caregivers (13 participants) and a survey was done to identify respite needs of family caregivers (157 participants). The community-based respite program for family caregivers was developed based on results of the focus group interview and survey. The program was used with 41 participants (19 experimental and 22 control). Independent t-test and Mann-Whitney U-test were used to test differences between control and experimental groups for respite needs, burden of caregivers, subjective wellbeing, social support, fatigue and functional status of elders with dementia. RESULTS: There were statistical differences in caregiver burden, subjective wellbeing, and social support after the program, but, none for respite needs, fatigue and functional status of elders with dementia. CONCLUSION: The results indicate that a respite program can be useful to decrease burden of caregivers and increase subjective wellbeing and perceived social support of family caregivers in community settings. Further intervention research is needed to increase the functional status of elders with dementia and decrease fatigue in caregivers.

The Effects of the Day Care Service Program for the Elderly and Family with the Stroke: Compared with the Elderly and Family in Home / 간호학회지

PURPOSE: The purpose of this study was to identify the effects of the day care service for the elderly and family with the stroke. METHOD: Data were collected from September 2002 to March 2003 by self report questionnaires and interview. 50 elderlies and families(Gr I) who used day care center were compared with 51 elderlies and families (Gr II) who didn't used. The data were analyzed using independent sample t test and chi square test. RESULT: The general characteristics, stressors, and situational variables related to outcome variables were homogeneous between two groups. The caregiver burden(t=-2.287, p=.024) score in the Gr I was significantly lower than in the Gr II. However there was no evidence of an effect day care center attendance on the depression of the elderly, the relationship between elderly and caregiver, and the family functioning. CONCLUSION: Findings indicate that day care service was effective in reducing the caregiver burden of the elderly, however more day care service programs(elderly health management, rehabilitation...)will be added.

A Review of the Effects of Respite Care for Patients with Dementia and Caregivers / 간호학회지

PURPOSE: The purpose of this study was to analyze the effects of respite care. The analysis was conducted by reviewing published intervention studies on the effects of formal respite care for caregivers of dementia patients, patients with dementia, and the prevented or delayed rate of institutionalization of the patients. METHOD: Two computerized databases (MEDLINE, CINAHL) were searched to find respite care-related articles published from the year of 1981 to 2000. A total of 49 published articles were identified. Of them, nine studies, which met for the inclusion criteria of this study, were included. RESULTS: Results revealed that there was little evidence of the effect of respite care on, not only caregivers' burden, stress, depression and well-being, but also the rate of institutionalization of the patients. It was noteworthy that dementia patients reported fewer problems in behavior, although cognitive functioning and activity of daily living abilities continued to decline. However, these findings should be carefully interpreted because of methodological problems, such as non-random sampling, non random group assignment, a small sample size, uncontrolled confounding variables, limited period of services, and no specific types of services. CONCLUSION: It is recommended to conduct intervention studies of respite care being conducted in Korea with the corrections of methodological problems suggested from this study.