Discharge planning is an integral part of patient care, which involves the transfer of patients from the hospital to the community, taking into account the patient’s unique and complex needs. However, this process is often fraught with complexities. This study was designed to explore challenges of current practices in discharge planning and to establish factors and effective strategies for future management. A qualitative and descriptive study was undertaken to understand the views of health care professionals on discharge planning within a tertiary hospital setting in KwaZulu-Natal. A comprehensive, rather than a disease-specific approach was used. Systems theory and the bio-psycho-social model formed the appropriate theoretical framework for the current study, which considered a holistic approach, taking into account systemic factors, relationships, physical, psychological and social aspects of patient care. Purposive sampling was used to identify 26 members of the multidisciplinary team with the relevant knowledge and experience. Semi-structured interviews, that were audio-recorded, were undertaken as the primary method of data collection, from which transcripts were thematically analysed. The study identified the key themes in terms of major challenges that included inter-hospital transport and referrals, resource constraints, patient compliance, and caregiver preparedness. The poor socio-economic circumstances of patients and their families formed a grim background. A documentation analysis of discharge summaries, utilized as a secondary method for the purposes of triangulation, revealed inconsistencies in the discharge summary system that varied between incomplete or well written reports. Based on the study findings, recommendations are made in respect of practice, policy and further research in the designated area of study. Some of the strategies recommended include collaboration with the multidisciplinary team, improving patient and caregiver education and establishing a formalized system of discharge planning, policies and discharge summaries. / M.A. University of KwaZulu-Natal, Durban, 2014.

[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.

Förmaksflimmer är den vanligaste arytmin. Symtomen och diagnosen i sig har visats kunna orsaka upplevelser av oro, rädsla, osäkerhet och nedsatt livskvalité. Även om upplevelserna har visats kunna lindras med information, är det inte klargjort vilka behov personerna har av hjälp och stöd från vården. Syftet med arbetet var därför att undersöka det upplevda behovet av eftervård hos personer med förmaksflimmer. Metoden som har använts är av deskriptiv design med nio stycken kvalitativa semistrukturerade intervjuer efterföljt av manifest innehållsanalys. I resultatet presenteras tre kategorier besvarande av syftet. I kategorin Kunskapsbehov beskrivs informanternas upplevelse av behov att få ställa frågor och att få svar, bland annat på vilken behandling som var aktuell. Kategorin beskriver även behovet av information, som varierade, samt hur information bäst inhämtas. I kategorin Ansvar för uppföljning och eftervård framkom det olika upplevelser om var ansvaret för eftervård ligger. Vissa personer ansåg att det var deras ansvar att kontakta vården, medan andra personer ansåg att ansvaret låg hos vården. Kontinuerlig uppföljning är ett behov som många upplever, men som kan styras av det aktuella måendet och medicineringen. Den tredje kategorin är Vård och egenvård, behov av stöd. Den kännetecknas av behovet av en hantering av förmaksflimmer, som delvis kunde upplevas vara botemedel för sjukdomen. Behovet av vägledning från vården, i form av fysioterapeut, kurator och praktiska hjälpmedel påtalades. Kategorin beskriver även behovet av stöd från vården och samtalsgrupp var ett förslag som framkom för att tillgodose behovet av stöd. Slutsatsen är att det upplevda behovet av eftervård vid förmaksflimmer varierar. Behovet av uppföljning utmärker sig, även om alla inte upplever det behovet. För att tillgodose personernas individuella behov ställs det krav på sjuksköterskan och dennes roll i informatik, hälso-informatik samt personcentrerad vård. Eftervården måste anpassas efter den individuella personens behov. / Atrial fibrillation is the most common arrhythmia. The symptoms and diagnosis has shown to cause experiences of worry, fear, uncertainty and reduced quality of life. Even though these experiences can be relieved by information, it is not clear what need of help and support from healthcare the persons has. That is why the aim of this study was too investigate the perceived need for aftercare in persons with atrial fibrillation. The method that have been used is a descriptive design with nine qualitative semi-structured interviews, follow by a manifest content analysis. In the result three categories that described the aim is presented. The category The need for knowledge showed that the persons experience a need to ask questions and get them answered, among other things answers about current treatment. The category also describes the need for information, which varied, as well as how information is best collected. In the category Responsibility for follow-up and aftercare different experiences of where the responsibility for aftercare lays arose. Some persons felt that it was their responsibility to contact the healthcare, while other persons felt that the responsibilities laid with the healthcare. Continuous follow-up is a need that many people experience, but the need can be controlled by the current mood and medication. The third category is Care and self-care, the need for support. It was characterized by the need for management of atrial fibrillation, which in part could be perceived as a cure for the disease. The need for guidance from the healthcare, in form of a physical therapist, curators and practical aids was pointed out. The category also describes the need for support from healthcare and conversation therapy group was a proposal that came up to meet the need for support. The conclusion is that the perceived need for aftercare with atrial fibrillation varies. The need for follow-up stands out, even though not all experience that need. In order to accommodate the persons individual needs the nurse play a pivotal role in informatics, health informatics and person-centered care. The aftercare must accommodate the individual persons need.

This thesis presents postpenitentiary care / after care and its basic definition. It also discusses the use of coaching approaches in the after-care. The main objective of this thesis is to design and test the suitability and efficiency of leadership coaching approaches in after-care interviews. In the introduction of coaching approaches, I present the results from tests done with a research group made of former prisoners from facilities based in Prague, who left in the period between 17th 2010 and 24 5th The 2011th. A key finding is that researchers proved the suitability of the use of variable roles. In the following thesis, I define the three main borders and two roles that can be used for client access. The basic forms of access to clients can be identified as the approach of coach, child behavioral / ethopedy and social worker. Boundary roles can be described as a role transition between the essential roles. Through roles based on current client's needs, it can help to develop various personalised ways towards the independence. This thesis can serve as input into the area of after-care treatment. It also introduces a possibility to access after-care providers by enriching other possible approaches to clients.

L’hospitalisation représente une étape de vie à laquelle doit faire face une grande majorité des personnes âgées. Cette expérience trop souvent accompagnée d’un déclin physique et psychologique marque pour beaucoup le début de la fin. Basé sur les fondements théoriques de la théorie de l’autodétermination (TAD), ce travail doctoral a deux objectifs. (1) Définir qualitativement le soutien à l’autodétermination dans les services de soins de suite et réadaptation (SSR). (2) Connaître l’impact des orientations de causalité́ des patients sur la perception de soutien ou de contrôle à l’autodétermination et les conséquences motivationnelles et émotionnelles associées. L’étude 1 a montré que les professionnels de santé mettaient en avant une image idéalisée de leur environnement de soins. Les patients (étude 2) ont indiqué de nombreuses contraintes qui atténuent l’effet de cette vision positive. L’étude 3 a démontré que les orientations de causalité du patient étaient une variable qui en interaction avec la perception de l’environnement, n’aboutissait pas aux mêmes conséquences motivationnelles et émotionnelles. De par le rôle déterminant octroyé par la TAD à la motivation, les professionnels de santé se doivent d’être capables de nourrir, entretenir et soutenir la motivation des patients. Une réflexion sur les recommandations pratiques et des axes de recherches futurs seront proposés. / Hospitalization is a life stage that faces a large majority of older people. This experience is often accompanied by both physical and psychological declines and means, for most of older people the beginning of the end. Based on the self-determination theory (SDT), this doctoral dissertation has two objectives. (1) To qualitatively define an autonomy supportive environment in after-care and rehabilitation services (ACRS). (2) To know the impact of causality orientations on patients' perceptions of an autonomy supportive or controlled environment and the associated motivational and emotional consequences. Study 1 showed that healthcare professionals conveyed an idealized image of their work environment and the care they provide. Patients (study 2) indicated many constraints that mitigated the effect of this positive view of an autonomy supportive environment and reduced their ability to experience it. Study 3 demonstrated that patient's causality orientations were a variable which interacted with the perception of ACRS environment, did not induce the same motivational and emotional consequences. Thus, these studies contribute to the self-determination theory in the health setting by showing the determining role of patients’ motivation. It is therefore necessary for healthcare professionals to be able to feed, maintain and support patients’ motivation. In the light of the contribution of the self-determination theory, a reflection about practical recommendations and future lines of research will be proposed.

The aim of this study was to investigate the leaving care services provided to youth leaving residential care in Sweden. Through the use of qualitative research interviews residential care workers perception of what practical and emotional needs youth leaving care have, and whether current aftercare services meet these needs, were examined. The study further sought to compare the swedish and english leaving care services. The main findings of the study were that the residential care workers interviewed expressed that they had a good working relationship with the local social services and that they through the residential care services were able to provide some degree of aftercare. They further identified loneliness as the most prominent emotional need of youth had after leaving care. The most pressing practical need youth leaving care were described as help concerning apartment and job searching, how and when to pay bills as well as managing a budget. The residential care staff further conveyed a wish for a higher degree of regulation surrounding aftercare services. Their main reasoning was to assure that youth leaving care received aftercare regardless of the economic situation of the local municipalities.

The Best PhD Thesis in the Faculties of Architecture, Arts, Business & Economics, Education, Law and Social Sciences (University of Hong Kong), Li Ka Shing Prize, 2003-2005. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Syftet med denna studie är att utifrån elevers perspektiv undersöka vad eleverna själva uppfattar att de lär sig och vad som är meningsfullt lärande för dem. Följande frågeställningar har legat till grund för denna undersökning. Vad uppfattar eleverna att de lär sig i fritidshemmet? Vad uppfattar eleverna som meningsfullt lärande i fritidshemmet? Studien är kvalitativ och utgår från en fenomenografisk ansats där samtalspromenader har legat till grund för insamling av data. Tio semistrukturerade intervjuer har gjorts med elever i årskurs tre som är inskrivna i fritidshemmet. Analys av transkriberingarna har givit studien ett resultat som visar på att eleverna kunde beskriva och sätta ord på sitt lärande. Följande beskrivningskategorier har hittats som besvarar studiens frågeställningar: Rörelse, Kognitiv förmåga, Skapande och Bra kompis. Samlärande, Sortera och klassificera samt Vardagsnytta.

No description available.

Hjärtstopp har ett lågt antal överlevare men under de senaste trettio åren har statistiken påvisat signifikant ökning av överlevare. Bakomliggande orsaker innefattar omfattande spektrum av tillstånd och sjukdomar, där kardiologiska och respiratoriska tillstånd påvisats i större utsträckning. Behandling och rehabilitering kan variera utifrån bakomliggande tillstånd och situation. Hjärtstoppsöverlevare har många olika besvär som framkommer i efterförloppet som leder till att patientens upplevelse av livsvärld kan komma att se sig påverkad i relation till en förändrad vardag. Genom att sjuksköterskan har förståelse för patientens upplevelse ökar möjligheten att utgå från en personcentrerad omvårdnad för att öka förutsättningarna för patienten. Syftet med studien var att belysa patienters upplevelse av att ha överlevt hjärtstopp. Metoden som användes innefattar en allmän litteraturöversikt som skapade ökad kunskap om patienternas upplevelse av att överleva hjärtstopp. Datainsamlingen genomfördes via databaser PubMed och CINAHL där det framkom totalt femton artiklar som valdes utifrån inklusions- och exklusionskriterier som besvarar valt syfte och problemformulering. Artiklarna analyserades vidare med hjälp av integrerad analys för att fastställa likheter och skillnader genom att redovisa huvudkategorier med respektive underkategorier. I resultatet redovisas varierande beskrivningar av patienters upplevelse av att överleva hjärtstopp. Resultatet har framställts i tre primära huvudkategorier; Upplevelsen av emotionella och fysiska hinder, Upplevelsen av utomståendes delaktighet samt En ny vardag och svårigheterna att hitta tillbaka. Avslutningsvis kan det konstateras att patienternas upplevelse av att överleva hjärtstopp påverkas utifrån alla aspekter i livet. Stöd från anhöriga och hälso- och sjukvården har visat sig generera en positiv uppfattning under återhämtningsfasen. Patienter är i behov av utökad information om de kommande symtom och besvär, sjuksköterskan bör erbjuda stöd, utbildning och verktyg för att kunna öka välbefinnande i deras nya verklighet. / Cardiac arrest has shown to have a low outcome of survivors but for the past thirty years the statistic of survivors has increased significantly. Underlying causes include a wide range of conditions and diseases where cardiological and respiratory conditions are the most common findings. Treatment and rehabilitation can vary based on the underlying condition and situation. Cardiac arrest can affect patients experience of life world due to the high problems and changes that emerges after surviving. These changes can cause problems in the way that the individual accept the new situation. Through an understanding of the patient's experience, the opportunity to offer a more person-centered nursing increase. The purpose of the study was to elucidate patients' experience of having survived cardiac arrest. The method used includes a general literature review to create knowledge about the patient's experience surviving a cardiac arrest. The data collection was carried out in PubMed and CINAHL where fifteen articles emerged based on the inclusion- and exclusion criteria that answered the purpose and problem formulation. Selected articles were analyzed using integrated analysis to determine similarities and differences by presenting main categories with respective subcategories. During the results, it emerged that patients who experience cardiac arrest have a broad idea of what it is like to survive cardiac arrest. Description of the patient's experience has produced three primary areas: The experience of emotional and physical obstacles, The experience of outsiders' participation and A new everyday life and the difficulties of finding their way back. It can be stated that the experience of surviving is affected by different aspects. Support from relatives and the healthcare system generate positive perception during recovery. Patients are in need of information about the upcoming symptoms and ailments, the nurse should offer support, training and tools to increase well-being in their new reality.