3 results
4 - Reablement as an evolution in home care: a comparison of implementation across five countries
- Edited by Tine Rostgaard, Roskilde Universitet, Denmark and Stockholms Universitet, John Parsons, University of Auckland, Hanne Tuntland, Oslo Metropolitan University
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- Book:
- Reablement in Long-term Care for Older People
- Published by:
- Bristol University Press
- Published online:
- 18 January 2024
- Print publication:
- 26 January 2023, pp 68-90
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Summary
Introduction
Chapter 2 presents the policy context for reablement across seven countries and highlights the similarity in institutional characteristics across these countries. However, despite this commonality in characteristics and the development of an agreed conceptual understanding of reablement (Metzelthin et al, 2020), there is considerable variation in how reablement is actually implemented across countries. This chapter illustrates the influence of various factors on the implementation of reablement in five countries/regions across the world, namely Denmark, the Netherlands, New Zealand, Norway, and Western Australia (WA) (see more on how ideas of reablement have travelled across the world in Chapter 3 by Feiring et al). The choice of countries is driven by the ability to explore the implementation of reablement up to 2020, with some countries having reablement models that have been in place for over a decade and others being in the situation that reablement was at the stage of small pilots at the time of writing the chapter. The chapter illustrates that the actual implementation of reablement into practice is dependent on contextual factors within the country, and there is a need to consider these factors when introducing and scaling up a multifaceted intervention such as reablement.
A study of implementation offers a systematic approach to explore how to get ‘what works’ to people who need it with greater speed, fidelity, efficiency, and coverage (Bonell et al, 2012). This chapter utilises constructs and principles from i-PAHRIS (Kitson et al, 2008; Harvey and Kitson, 2015), an established implementation framework, to explore implementation of reablement across the five countries. i-PARIHS is a well validated method of exploring the implementation of initiatives into clinical practice and has four key constructs:
• The innovation construct: relates to the new approach that is being introduced (here, how is reablement defined and delivered as an innovative approach within each country). It also includes the underlying assumption of how the new approach works and what its fit is within the existing systems.
• The recipient construct: considers the impact individuals and teams have in supporting or resisting an innovation (this includes both the perceptions and experience of team members involved in the design and delivery of reablement).
9 - Better care, better work? Reablement in Danish home care and the implications for care workers
- Edited by Tine Rostgaard, Roskilde Universitet, Denmark and Stockholms Universitet, John Parsons, University of Auckland, Hanne Tuntland, Oslo Metropolitan University
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- Book:
- Reablement in Long-term Care for Older People
- Published by:
- Bristol University Press
- Published online:
- 18 January 2024
- Print publication:
- 26 January 2023, pp 189-216
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- Chapter
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Summary
Introduction
As covered elsewhere in the book, reablement has been introduced with the aim of improving functioning in daily activities for older people, and has implications for clients and their informal caregivers. However, it also has implications for formal care workers with respect to changing the aims and nature of their work, as well as introducing collaboration across different disciplines. The introduction of reablement could therefore potentially affect how attractive it is to work in the sector. This is highly relevant in an ageing world, where demographic changes are increasing the need for staff in the long-term care (LTC) sector as populations and the care workforce are ageing. There is currently a ratio of five LTC workers for every 100 people aged 65+ in the OECD countries, which extrapolates to an additional 13.5 million workers by 2040 (OECD, 2020). However, LTC work is generally characterised by insufficient staffing, poor working conditions, and low status and pay. The sector suffers from recruitment problems, high turnover, and subsequent staffing shortages, which will likely worsen soon. Attracting and retaining workers in the LTC sector is therefore a common concern in OECD countries (OECD, 2020), and reablement may be one solution to this.
This chapter primarily focuses on what the implications of the introduction of reablement are for home care workers, in the setting of Denmark where reablement has been implemented in home care since 2007. The chapter first investigates how reablement may affect care workers’ approach to their work and what they consider to be good care, and the chapter thereafter considers the implications for how attractive they find the sector. Interview data from two municipalities and data from a national survey among care workers are applied. The results reveal how a common understanding has been established within the home care organisations: that furthering client self-reliance makes for more cost-effective interventions while also increasing their quality of life. Reablement appears to provide care workers with more professional autonomy and flexibility in the planning of their work while they also receive more support and attention from managers. The applied tasks and methods focus particularly on motivating the clients towards achieving such independence, and the reablement care workers find this both meaningful and professionally rewarding to the degree that they seem to be less likely to want to quit their job.
Colloidal Agglomerates in Tank Sludge and Their Impact on Waste Processing
- J. M. Tingey, B. C. Bunker, G. L. Graff, K. D. Keeper, A. S. Lea, D. R. Rector
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- Journal:
- MRS Online Proceedings Library Archive / Volume 556 / 1999
- Published online by Cambridge University Press:
- 10 February 2011, 1315
- Print publication:
- 1999
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Disposal of millions of gallons of existing radioactive wastes in underground storage tanks is a major remediation activity for the United States Department of Energy. These wastes include a substantial volume of insoluble sludges consisting of submicron colloidal particles. Processing these sludges under the proposed processing conditions presents unique challenges in retrieval transport, separation, and solidification of these waste streams. Depending on processing conditions, these colloidal particles can form agglomerated networks having high viscosities that could clog transfer lines or produce high volumes of low-density sediments that interfere with solid-liquid separations. Under different conditions, these particles can be dispersed to form very fine suspended particles that do not settle. Given the wide range of waste chemistries present at Department of Energy sites, it is impractical to measure the properties of all treatment procedures. Under the current research activities, the underlying principles of colloid chemistry and physics are being studied to predict and eventually control the physical properties of sludge suspensions and sediment layers in tank wastes and other waste processing streams. Proposed tank processing strategies include retrieval transport, and solid-liquid separations in basic (pH 10 to 14), high ionic strength (0.1 to 1.0 M) salt solutions. The effect of salt concentration, ionic strength, and salt composition on the physical properties such as viscosity, agglomerate size, and sedimentation of model suspensions containing mixtures of one or two of the major components found in actual wastes have been measured to understand how agglomeration influences processing. Property models developed from theory and experiment on these simple suspensions are then applied to explain the results obtained on actual wastes.