Bakgrund: Sjuksköterskans arbete inriktas idag på att bidra med god och säker vård till alla patienter. Sjuksköterskan har det högsta omvårdnadsansvaret och ska skydda patienterna från onödigt lidande. Att arbeta evidensbaserat och personcentrerat i samråd med patienten bidrar till god och säker vård. Utöver detta omfattar omvårdnadsansvaret att leda arbetsgruppen och ”vara spindeln i nätet” som uppmärksammar och förmedlar viktig information vidare till andra yrkesprofessioner samt anhöriga. Syfte: Att belysa orsaker till arbetsrelaterad stress hos sjuksköterskor inom slutenvården och hur det i sin tur påverkar patientsäkerheten. Metod: En litteraturöversikt som grundas på 15 vetenskapliga artiklar. Artiklarna bygger på studier vars design varierade mellan kvantitativ, kvalitativ samt mixed-method. De databaser som användes var Pubmed och Cinahl. Alla artiklar granskades med hjälp av kvalitetsmallar. Studierna analyserades med hjälp av Fribergs (2017) tre steg. Resultat: Resultatet belyser fyra stressfaktorer som var orsaker till arbetsrelaterad stress hos sjuksköterskan. Stressfaktorerna var; bristande teamarbete mellan professionerna, bristande bemanning, övertid och skiftarbete samt tidsbrist. Dessa stressfaktorer som ledde till arbetsrelaterad stress, visade sig i sin tur ha ett betydande samband med bristande patientsäkerhet genom att det uppstår vårdrelaterade infektioner, fallolyckor, felaktig journalföring, felaktig läkemedelshantering, oplanerad avlägsnande av endotrakealrör och bristande kontroll av medicinsk utrustning. Slutsats: Resultatet visar att sjuksköterskor som arbetar inom slutenvården upplever en rad olika stressfaktorer som leder till arbetsrelaterad stress. Denna typ av stress har i sin tur visat ett starkt samband med försämrad patientsäkerhet då risken för vårdskador ökar. Genom att använda sig av resultat som framkommit i litteraturöversikten kan ett förbättringsarbete ske genom att kartlägga grundorsakerna till arbetsrelaterad stress och därmed förhindra kommande brister i patientsäkerheten. / Background: Today, the nurse's work focusing on contribute to a good and safe care for every patient. The highest responsibility for every nurse is to protect the patients from unnecessary suffering. By working person-centered and in consultation with the patient as well as evidencebased, this should contribute to a good and safe care. Beyond this, there is a responsibility for the nurse´s that includes leading the working group, be the spider in the web who draws attention to and mediates important information to the other professions and the family of the patients. Aim: To illuminate reasons to work-related stress among nurses in hospital ward and how it’s impact on the patient safety. Method: A literature review based on 15 scientific studies. The studies design varied between quantitative, qualitative and mixed method design. The databases that was used were Pubmed and Cinahl. All studies quality was reviewed by review templates. The studies were also analyzed according to Fribergs (2017) three steps. Result: The result has shown four stressors that have been identified as the reasons of work related stress in nurses. The four stressors were; lack of teamwork between professions, staff shortage, working overtime and shift and lack of time. These stressors that contributed to work-related stress, in turn, did show a significant relationship with lack in the patient safety care that were adverse events, fall accidents, incorrect documentation, incorrect drug management, unplanned removal of endotracheal tubes and lack of control of medical equipment. Conclusion: In the literature review it was found that nurses are experiencing a couple of stressors within the hospitals environment that lead to work-related stress. The work-related stress, in turn, is strongly linked to impaired patient safety as the risk of adverse events and other patient safety incidents increase. By using results that have emerged from the literature review, improvement work can be done by mapping the basic problems and thus preventing future lack in the patient safety.

Bakgrund: Den psykiatriska slutenvården ska hjälpa patienten att lindra lidande. Det är av betydelse hur personalen bemöter patienten samt hur patienten vill bli bemött för att de ska kunna bygga upp en relation till varandra. Mötet med patienten är en viktig del i vårdandet och hur vården upplevs. All psykiatriska slutenvård bör sträva efter att vara personcentrerad och individuellt anpassad. Syfte: Syftet var att undersöka patienters upplevelse av mötet med vårdpersonalen i den psykiatriska slutenvården. Metod: En systematisk litteraturöversikt med tolv kvalitativa artiklar. Resultat: Patienterna vill bli sedda, de vill att personalen ska vara tillgänglig och engagerad. Patienten önskar att personalen ska värna om patienternas integritet och autonomi. Patienterna vill att personalen tar kontakt med dem och försöker skapa en relation. Om patienterna har en god relation till personalen, har patienterna en större benägenhet att prata om deras psykiska hälsa. Patienterna kunde känna att personalen “gömde” sig när de hade andra arbetsuppgifter som inte var patientnära. Detta kunde leda till att vissa patienter blev agiterade och irriterade över att personalen var osynlig på avdelningen.  Det framkom att vissa patienter upplevde att personalen använde sig av maktmissbruk över dem, till exempel när någon undersökning skulle se eller bara ett samtal. Detta upplevde patienterna som att det hela tiden var vårdpersonalen som bestämde, vad som skulle hända och när. Slutsats: Vi som är ansvariga för omvårdnaden av patienterna som lider av psykisk ohälsa har ett stort ansvar, och det är att se till att alla patienter blir sedda, och får den uppmärksamhet var och en behöver. Vi måste prioritera våra patienter före exempelvis kontorsarbete eller att vara i köket. Vi måste bemöta patienterna med respekt och inte se dem som en sjukdom utom att de faktiskt är människor / Background: Psychiatric outpatient care should help the patient to relieve suffering. It is important how the staff responds to the patient and how the patient wants to be treated so that they can build up and relationship with each other. Meeting with the patient is an important part of caring and how they experience spring. All psychiatric inpatient care should strive to be person-centered and individually adapted. Purpose: The purpose was to explore the patients´ experience of the meeting with the healthcare staff in the psychiatric inpatient care. Method:A systematic literature review with twelve qualitative articles. Results: Patients want to be seen, they want staff to be available and engaged. The patient wants the staff to protect the patients' integrity and autonomy. Patients want the staff to contact them and assure to create a relationship. If patients have a god-relationship with staff, patients have a greater tendency to talk about their mental health. Patients could feel that the staff "hid" when they had other tasks that were not patient-friendly. This could cause some patients to become agitated and annoyed that staff were invisible in the ward. It turned out that some patients felt that the staff used abuse of power over them, for example when an investigation would see or just one call. The patients felt that it was always our staff who decided what would happen and when. Conclusion: We who are responsible for the care of patients suffering from mental illness have a great responsibility, and that is to make sure that all patients are looked after, and receive the attention everyone needs.We must prioritize our patients before, for example, office work or being in the kitchen. We have to treat patients with respect and not see them as a disease except that they are actually people.

Dissertation Thesis: Essays on Health Economics and Health Policy Author: PhDr. Jana Votápková Advisor: doc. PhDr. Martin Gregor, Ph.D. Academic year: 2019/2020 This dissertation thesis is a collection of three applied economics essays and a comprehensive discussion essay which includes policy recommendations resulting from the empirical essays included in this dissertation thesis, and other early work of the author. The topics analyzed were motivated by recent Czech healthcare reforms that address the recommendations raised by the OECD. Firstly, efficiency of Czech general hospitals is analyzed stressing the need for a well-functioning DRG system. Secondly, inpatient user charges which were introduced in 2008 and abolished shortly after, are analyzed as a tool which increases private participation in healthcare expenses and thus may boost healthcare efficiency both through additional resources and reduction of excess demand for healthcare services. Thirdly, personal savings, pre-retirement savings in particular, are viewed as another private source which could ease the tight public healthcare and pension budgets. It is shown that health status is a positive determinant for pre-retirement liquid savings, thus preventive health programs should be given a priority within the Czech healthcare system.

Syftet med litteraturöversikten var att beskriva förutsättningar för omvårdnad av personer med kognitiv sjukdom i en slutenvårdskontext. Metoden var en icke-systematisk litteraturöversikt med kvalitativ design. 14 stycken artiklar analyserades i en induktiv innehållsanalys enligt Granheim och Lundman för att få fram kategorier som därefter delades upp i subkategorier. I analysen framkom tre kategorier: organisatoriska förutsättningar, kunskapsmässiga förutsättningar samt relationsskapande förutsättningar. Resultatet visar, att de förutsättningar som behövs för att ge omvårdnad till personer med kognitiv sjukdom i en somatisk slutenvårdskontext handlar om en organisation som ger förutsättningar avseende tid, adekvat bemanning, en anpassad vårdmiljö och ett starkt teamarbete. Vårdpersonalen efterfrågar mer teoretisk kunskap och fortbildning för att kunna ge en personcentrerad omvårdnad. Närståendes delaktighet och de enskilda vårdarbetarnas engagemang och vilja att anpassa kommunikationen till dessa patienter, är andra förutsättningar utifrån syftet som framkommer i resultatet.  Slutsatsen i litteraturöversikten är att vården av personer med kognitiv sjukdom behöver utvecklas inom slutenvården. Förutsättningar för att ge omvårdnad till denna patientgrupp bygger på att det finns tillräcklig kunskap, kompetens och engagemang hos de enskilda medarbetarna men även en organisation som inser behovet av anpassning och vårdutveckling / The aim of this study was to describe conditions regarding nursing care for persons with dementia in somatic inpatient care. The method was a literature review with a non-systematic design in which two databases, Cinahl and Pubmed, were used to find appropriate scientific articles. 14 scientific articles were analyzed through an inductive content analysis according to Granheim and Lundman. Three categories emerged from the analysis: organizational conditions, educational conditions, and conditions according to relationships. The result shows that conditions required in nursing care for persons with dementia in somatic inpatient care constituted an organization that gives time, appropriate staffing, adjusted care environment and a strong teamwork. Nursing staff requested theoretical knowledge and ongoing education to deliver person centered nursing care. Family involvement, staff commitment and willingness to adjust communication were other conditions required. The conclusion is that the care for persons with dementia needs to develop in somatic inpatient care. Conditions to give nursing care to persons with dementia are based on adequate knowledge, competence, and commitment of the individual coworker, but it is also based on an organization that realizes the need of adjustment and care development.

Sammanfattning Bakgrund: Patienter som är i behov av psykiatrisk slutenvård ska kunna förvänta sig ett gott bemötande från sjuksköterskan då bemötandet är avgörande för vilken relation patienten får till sjuksköterskan samt hur patienten upplever sin vårdtid. Psykiatrisk slutenvård bör fokusera på att ge patienten en känsla av sammanhang och värdighet under vårdtiden då det kan påverka patientens upplevda hälsa positivt. Syfte: Att undersöka patientens upplevelse av sjuksköterskans bemötande inom psykiatrisk slutenvård och hur det påverkar patienten. Metod: En beskrivande litteraturstudie med tio kvalitativa artiklar. Resultat: Resultatet visar att patienter känt sig väl bemötta av sjuksköterskorna då de har tagit sig tiden att prata med patienterna och hjälp dem med deras individuella behov. Andra patienter har upplevt sjuksköterskornas bemötande som negativt då de uppvisat olika former av maktmissbruk samt haft en bristande närvaro. Då sjuksköterskans bemötande har haft en negativ inverkan på relationen till patienten så har patienten valt att inte öppna sig om sina problem. Sjuksköterskans bemötande har varit avgörande för relationen till patienten och hens upplevda känsla av psykisk hälsa. Slutsats: Sjuksköterskan bör bemöta varje enskild patient med respekt, omtanke och engagemang. Patienternas upplevelser av sjuksköterskans bemötande har påverkat patienternas psykiska mående och därmed även deras upplevda hälsa och välbefinnande. Sjuksköterskans bemötande gentemot patienterna speglar sig även i patienternas upplevelse av vården och dess kvalitet. / Abstract Background: Patients in need of psychiatric inpatient care should be able to expect a good treatment from the nurse as the treatment is decisive for the relationship the patient gets to the nurse and how the patient experiences his care. Psychiatric inpatient care should focus on giving the patient a sense of context and dignity during the care period because it can positively affect the patient's perceived health. Aim: To examine the patient's experience of the nurse's treatment in psychiatric inpatient care and how it affects the patient. Method: A descriptive literature review with 10 qualitative articles. Results: The results showed that patients felt well treated by the nurses as they took the time to talk to the patients and helped them with their individual needs. Other patients have experienced the nurses' treatment as negative as they have shown abuse of power in different ways and had a lack of presence. When the nurse's treatment has had a negative impact on the relationship with the patient, the patient has chosen not to open up about her problems. The nurse's treatment has been decisive for the relationship with the patient and her perceived feeling of mental health. Conclusion: The nurse should treat each individual patient with respect, care and commitment. The patients 'experiences of the nurse's treatment have affected the patients' mental state and thus also their perceived health and well-being. The nurse's treatment of patients is also reflected in the patients' experience of the care and its quality.

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is to analyze early gait during inpatient rehabilitation to quantify both the improvements made and deficits that remain in important gait variables. This study identifies predictor variables that contribute to the variance in discharge ambulation device use and IRF length of stay. Subjects: A convenience sample of 230 patients discharged to an IRF following a TKA (160 following a single TKA and 70 following a bilateral procedure) was used for this analysis. Method: Paired t-tests were used to compare temporal and spatial gait variables from the initial gait assessment compared to the discharge gait assessment in patients following single TKA to determine remaining deficits. Right vs left comparisons were made for patients following a bilateral procedure. A binary logistic regression was used to identify predictors associated with the need for a two-handed ambulation device at discharge. A multiple linear regression developed a model to assess predictors of the inpatient rehabilitation length of stay. Finally, a self-assessment to evaluate patient confidence with walking (mGES scale) was correlated to actual gait speed performed on the gait analysis in a sample of patients from our study population. Findings: Deficits in step length, step time and percent of single limb support remained in the involved limb compared to uninvolved limb at discharge from inpatient rehabilitation following single TKA; no limb differences between the right and left side were noted in patients after bilateral TKA. The discharge gait speed of 54.6 cm/sec for single TKA patients and discharge speed of 61.5 cm/sec for bilateral TKA patients is within the classification of limited community ambulators and making them appropriate for a home discharge. But despite improvement from admission to discharge, the gait speed for both groups in our study remain below the gait speed identified by prior studies 3-months following TKA surgery where speed reached 135 cm/sec. The need for a two-handed ambulation device, such as bilateral canes or a walker, was associated with slow walking speed and prior use of a device before surgery. A longer rehabilitation length of stay was associated with slower initial gait speed, lower motor FIM scores and reduced knee extension at admission. The mGES patient self-report conducted at the time of the discharge gait assessment showed a moderate correlation to the discharge gait speed; however, the pairing of the admission mGES with the admission gait speed was not significantly correlated.

No description available.

Bakgrund: Tidigare forskning beskriver att sjuksköterskor i stor utsträckning erfar vården av personer med självskadebeteende utmanande samtidigt som forskning kring personernas erfarenheter visar att de ofta upplever vården negativt. Vården har ofta ett fokus på olika säkerhetsaspekter och negativa attityder bland vårdpersonal kan leda till ett sämre bemötande. Sjuksköterskornas erfarenheter visar på ett behov av ökad kunskap kring självskadebeteende. Syfte: Sjuksköterskors erfarenheter av att vårda personer med självskadebeteende inom psykiatrisk slutenvård. Metod: Studien har en kvalitativ design med induktiv ansats. Data samlades in via semistrukturerade intervjuer och sex sjuksköterskor verksamma i psykiatrisk slutenvård deltog. Resultatet analyserades via en kvalitativ innehållansalys. Resultat: Resultatet visar att sjuksköterskornas erfarenheter handlar om att vårda i det känslomässigt komplexa, viktiga aspekter kring att vårda tillsammans med andra samt betydelsen av att mötas i det svåra. Slutsats: Vårdandet innebär att sjuksköterskor påverkas känslomässigt och de upplever ofta att de inte vet hur de ska hjälpa personerna. Den vårdande relationen ses som viktigast för främjandet av en god vård. Reflektion och stöd av teamet är betydelsefullt, dels genom att arbetssituationen upplevs lättare, dels genom ett genererande av gemensamma kunskaper kring vårdandet. / Background: Previous research describes that nurses to a large extent find the care of people with self-harming behavior challenging and difficult, while research on the persons experiences shows that they often experience the care in a negative manner. Negative attitudes exist among healthcare staff, which can lead to poorer treatment. The nurses’ experiences show a need for increased knowledge about self-harming behaviour. Aim: Nurses experiences of caring for people with self-harming behaviour in psychiatric inpatient care. Method: The study has a qualitative design with an inductive approach. Data were collected via semi-structured interviews and six nurses working in psychiatric inpatient care participated. The result was analyzed by a qualitative content analysis. Result: The results show that the nurses experiences are about caring in an emotional complexity, important aspects of caring among others and the importance to be able to meet the person in emotionally demanding situations. Conclusion: Caring leads to evoking of complex emotions and the nurses often feel that they do not know how to help the person. The caring relationship is seen as the most important aspect of good care. Reflection and support by the team is experienced important because it leads to a better work situation as well as it generates knowledge of self-harming behaviour.

Bakgrund: Covid-19 upptäcktes i Kina i slutet av året 2019 och spreds snabbt över hela världen. Covid-19 orsakade flera dödsfall och klassas som ett internationellt hot mot människors hälsa. Omkring 21 620 människor i Sverige avled i sviterna av Covid-19. Utvecklingen av Covid-19 har lett till omfattande förändringar och omprioriteringar inom vården. Inom hälso- och sjukvården fick sjuksköterskor under pandemin möta allvarliga utmaningar som inkluderade okunskap om viruset och brist på resursers som skyddsutrustning. Syfte: Syftet var att beskriva sjuksköterskors erfarenhet av att vårda patienter med Covid-19 inom slutenvård. Metod: En beskrivande litteraturstudie baserad på 14 granskade artiklar tillgängliga i databasen PubMed. Resultat: 4 teman identifierades; Rädsla för att bli smittade och smitta andra med Covid-19 som berör sjuksköterskornas rädsla, oro och ångest, Sjuksköterskornas erfarenhet av att arbeta med skyddsutrustning som berör påverkning av omvårdnadsarbete och kommunikationssvårigheter, Erfarenhet gällande bristande kunskap och information om Covid-19 som berör osäkerhet om vilken behandling som är lämplig för Covid-19 patienter, bristande beredskap och dess påverkan hos sjuksköterskor, Sjuksköterskans positiva och negativa erfarenhet av att vårda patienter med Covid-19 som berör sjuksköterskans känsla av stolthet, ökad självförtroende och stöd från samhället. Faktorer som berör negativ erfarenhet hos sjuksköterskor är tung arbetsbelastning och rädsla. Slutsats: Sjuksköterskorna beskrev att de behövde kunskap och information om Covid-19 viruset för att ge en god och säker vård. Sjuksköterskorna beskrev även deras svårigheter av att arbeta med skyddsutrustning i vårdandet av patienter med Covid-19. Stöd från samhället och kollegor var viktigt för sjuksköterskor under pandemiutbrottet. / Background: Covid-19 was discovered in China at the end of the year 2019 and spread rapidly throughout the world. Covid-19 caused several deaths and is classified as an international threat to human health. Around 21,620 people in Sweden died in the aftermath of Covid-19. The development of Covid-19 has led to extensive changes and re-prioritization in healthcare. In health care, nurses during the pandemic had to face serious challenges that included ignorance about the virus and a lack of resources such as protective equipment. Aim: Describe the nurse's experience of caring for patients with Covid-19 in hospital. Method: A descriptive literature study based on 14 reviewed articles available in the database PubMed. Findings: 4 themes were identified; Fear of being infected and infecting others with Covid-19 that concerns the nurses' fear, worry and anxiety of being infected and infecting others, family members and patients, The nurses' experience of working with protective equipment that concerns the impact on nursing work and communication difficulties, Experience regarding lack knowledge and information about Covid-19 that concerns uncertainty about which treatment is suitable for Covid-19 patients, lack of preparedness and its impact on nurses, The nurse's positive and negative experience of caring for patients with Covid-19 which affects the nurse's sense of pride, increased self-confidence and support from society. Factors that affect the nurses' negative experience are heavy workload and fear. Conclusion: The nurses described that they needed knowledge and information about the Covid-19 virus to provide good and safe care. The nurses also described their difficulties in working with protective equipment in caring for patients with Covid-19. Support from society and colleagues was important for the nurses during the Covid-19 pandemic.